Special Episode Celebrating Relocalizing Health - The Book: The Textile Plant That Cracked Healthcare Before Anyone Was Watching - Phifer Inc., Alabama

[00:00:00] Before we start, I want to invite you to Rosetta Fest 2026 in Nashville. This is where employers, unions, and clinicians who are cutting healthcare costs 20-50% while improving care and outcomes share exactly how they did it. Operators learning from operators with patients at the table. Learn more and register at rosettafest.org. Now let's get into today's conversation.

[00:00:25] Hey there. Welcome to a special series within the Relocalizing Health podcast as we count down to Rosetta Fest in Nashville July 29-31. Each one of these episodes is a quick look inside the book and the communities that inspired it. Real places, real numbers, real people who decided to stop waiting for somebody else to fix healthcare and just built something better themselves.

[00:00:53] If you don't have your ticket to Nashville yet, go grab it at rosettafest.org. This is where people in these stories will actually be in the room with you, very open to sharing their methods and excited to have you copy it and run with it in your community. So let's get into it.

[00:01:11] I want you to picture a family-owned manufacturing company in Tuscaloosa, Alabama. They were founded in the 50s. They've got about 1,200 employees in Alabama and California. And they make aluminum, fiberglass, and polyester screening. This is a sun shading fabric that you might see in some lawn furniture. And it's a precision engineered product.

[00:01:49] You know, if you've gotten window screens in your house, there's a decent chance you're looking at their work and you've probably never even heard their name. But here's the detail that I love. Pfeiffer, Inc. is the last remaining made-in-the-U.S. manufacturer in their category. Last one. Everyone else chased cheap labor overseas. But this mid-size organization in Alabama figured out something the most Fortune 500 companies still haven't figured out about health care.

[00:02:17] You know, back a couple decades ago, Warren Buffett described General Motors as a health and benefits company with an auto company attached. For the automakers, you know, health care was running between $1,300 and $2,000 per vehicle, more than steel. And rather than solve the root cause issues, many of them just punted the job overseas.

[00:02:42] So you saw millions of manufacturing jobs move out of the U.S. in the first couple decades of this century. And health care costs was the primary reason on a lot of those spreadsheets. So the stakes here aren't just, hey, these are great benefits. For a manufacturer, getting health care right is a difference between keeping jobs in America or not.

[00:03:07] And the man at the center of this story is Russell DeBose. He's the VP of HR at FifeRank. And what he did was just refuse to let treat, you know, treat health care like it was some force of nature he couldn't touch. Russell will tell you, you know, through the 90s and the 2000s, wage and benefit costs were relatively stable. They could manage it.

[00:03:30] But then after 2010, the line really bent. And by the time he took over the role in the mid-2010s, he looked at the glide path they were on and saw a future where benefits became unaffordable to the plan and the people on it. Those were his words.

[00:03:50] Now, here's the move that makes this story different. Russell didn't see benefits as the problem. And in isolation, he saw it as a supply chain problem. This is something any manufacturer is very familiar with. A plant like theirs lives and breathes Lean Six Sigma, continuous improvement.

[00:04:10] So he asked, why are we not applying that same rigor that we have on the factory floor to the single biggest line item after, you know, wages? And his takeaway was the components were there. They were just kind of jumbled and opaque. And he could see the spend, but he really just couldn't see the system.

[00:04:32] And then the turning point came in 2017. He was given a copy of the CEO's Guide to Restoring the American Dream. And the Rosen Hotel story really hit him. That was a key part of that book. And by the way, that's an episode in the series as well. And he said, quote, I realized that I had discovered our blueprint. This is a hotel company in Orlando that gave a manufacturer in Alabama the template.

[00:05:01] The next steps were to run a Kaizen event. That's a manufacturing or it's a continuous improvement process that often is applied in manufacturing, but really could be applied anywhere. And he put the company leaders, the broker, the different suppliers, even a college professor in the room and map the costs the way you'd map a production deficit. And, you know, Russell's a manufacturing guy.

[00:05:28] So his instinct was, you know, you can't improve what you can't measure. And his line on this was one of my favorites. He said, it's absurd that there's no quality scores or ratings or reviews for health plans. So we rate everything else we buy, you know, and yet the thing that's eating our payroll, we're not measuring. So when Health Rosetta came out with the plan grader, he graded his plan. And I want to really underline so that everybody's listening.

[00:05:58] You know, this is an open tool to anybody who works with a Health Rosetta advisor. And many of the components I'm talking about are now open source through the Nautilus Health Institute. Back to the plan grader, you can grade your own plan. You know, as long as you have 45 minutes to answer some questions, you can do it. You don't need permission from anybody. The first score that they got on their plan grade was a 37 out of 100.

[00:06:25] Now, you know, that sounds low until you hear that most employers land between a 5 and a 17 when they start this process. So they were already well above average, you know, and they were paying attention to it, but still had a long, long ways to go. And the breakdown told them exactly where to aim. Things like transparent open networks scored a zero. Major specialty and outlier patients scored a 12. Pharmacy was a 43.

[00:06:54] And he said, like many others said, just reading these plan grader questions revealed areas to think about and improve. And then the assessment, it's about a 30-page report, was the roadmap. And that's really the philosophy in a nutshell. Basically, objective measure. I think of it as like a diagnostic score when you're, you know, in the health care system and they need a care plan or prescription to know where to go.

[00:07:21] And that basically, that prescription, if you want to call it that, essentially became a punch list for them of what to tackle. And the first thing he did was talk with his benefits consultant, Ann Blair Gribben at Cobbs Allen. And he kindly but directly let Ann Blair know that she needed to join the Health Rosetta program and learn this stuff so she could help him or he'd need to find another consultant.

[00:07:47] And she saw that opportunity not only serve her client but also differentiate herself and position herself as a leader within her firm and within her community and state. And together, you know, they've run these Kaizen events with critical intent. You know, how do we build equity and value by knocking down the barriers to affordable, quality, high-quality health care? Out of that came a seven-year roadmap.

[00:08:17] Things like advanced primary care, transparent data, transparent pharmacy, direct contracts with the best providers, nurse navigation, on-site pharmacy, you know, essentially the works. And starting in 2019, they opened the Fifer Cares Clinic where there was zero cost share for advanced primary care for every member of their plan. This is both the employees and their dependents.

[00:08:44] Within months, the clinic was running at 88% of daily capacity and 58% of the eligible members were actively using it. So people really voted with their feet. And like a lot of places around the country, it's been hard to access primary care. And it's debatable whether you could even call it primary care when it can take you weeks to get in. Then COVID hit. And this is where the model really proved itself out in the early days.

[00:09:12] Fifer was an essential business, so they never closed a single day. And the clinic became their front line, you know, testing protocols, keeping people safe and working. And after the pandemic, they really hit the gas. You know, direct contracts, a nurse to steer people to the best providers, on-site physical therapy, a transfer pharmacy benefit manager. And, you know, here's the part that really excites me and gives me chills.

[00:09:42] Russell became very focused on generating dividends from their health plan, not just trying to make, you know, the increases just a little less bad. And these became savings that just don't sit on the company balance sheet. They reinvest them in their people and into intention and purpose every year. So, you know, it started in 2019 with scholarships for employees' kids.

[00:10:09] These are hundreds of thousands of dollars, and more than 100 students went off to college with that support. In 2020, they had a summer enrichment program for a couple hundred kids so they don't lose ground over the summer. And then they went on to eliminate pharmacy co-pays at the on-site pharmacy. More than 1,700 patients have gotten that benefit.

[00:10:35] Continued bonus funding for child care and after care for more than 250 working families. And a business result all came underneath it, five straight years of essentially flat health care spending. And that's after absorbing inflation and high-cost cancer claims, you know, because they certainly have to contend with what everybody else does. Retirement readiness climbed by more than 20 points. This means more money in the employees' pockets.

[00:11:04] And the plan grader over this time steadily improved from 37 to 74. And they're definitely not done. And then, you know, last couple years, Russell has gotten national attention. He was asked to testify before the House Energy and Commerce Committee on ERISA and on behalf of the National Alliance of Healthcare Purchaser Coalition. He's the chair of the Alabama Employer Healthcare Consortium.

[00:11:33] So this is helping spread it to other employers in their region and their state. And, you know, this is where, you know, benefits decision at a, you know, screen manufacturing plant in Tuscaloosa, Alabama turns into a really key voice in D.C. and really nationwide. So here's where I want to land it.

[00:11:54] So if a 1,200-person manufacturer in Alabama can do this, then the we're-not-big-enough excuse stops being a reason to do this. It's just a story we tell ourselves. Russell treated the health plan like a line of business he was actually willing to manage. That's it. That's the secret. And he'll share that and other secrets as he's a co-leader of the employer track at Rosetta Fest.

[00:12:22] So I hope you all get a chance to meet him. He's very inspiring. Well, that's the story for today. If it resonated, the new Relocalizing Health book is going deeper into that. And Nashville goes deeper still. So Relocalizing Health comes out July 29th right at Rosetta Fest. Every attendee will get it. You can pre-order a copy now on Amazon.

[00:12:48] And if you want him in the room, when that happens, get your ticket at rosettafest.org. See you in Nashville.