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      Let's Give Healthcare Consumers a Clean Slate!

      Healthcare Rethink - Episode 73

      This episode of Healthcare Rethink, a FinThrive Podcast hosted by Brian Urban, welcomes Samantha Jacobson, the Founder of Clean SlateZ, to thoroughly examine the initiatives aimed at giving healthcare consumers a “clean slate.” The conversation revolves around the innovative approaches to eliminating medical debt, the personal motivations behind Jacobson’s commitment to this cause, and the broader implications for the healthcare system.



       

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      Healthcare Rethink: Hear From Leading Changemakers

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      Brian Urban:
      Yes, this is the Healthcare Rethink podcast. I'm your host, Brian Urban. Today we're talking about giving Clean Slates to households and individuals to alleviate medical debt and help them start a new life with without a burden on their shoulders. To help us have this conversation, who else would we invite on the show other than the founder of Clean Slates, Samantha Jacobson? Sam, thanks for joining our little show here today.
       
      Samantha Jacobs:
      Oh, thank you very much for having me, Brian. I appreciate it.
       
      Brian Urban:
      This is going to be a lot of fun. We've gotten to know each other a few times before the recording here, and we're going to get to know each other a little bit more and starting with how Clean Slates got started would be the obvious question. But I want to go back before that. Let's talk about who you are, who Sam is, how this got started and why you got into this work. Let's really get to know Sam here off the top.
       
      Samantha Jacobs:
      Sure. So professionally, my background is as an executive in for-profit healthcare providers outside the hospital setting. So specifically, I specialize in medical and billing collections for products and services that patients receive. I have a deep understanding of the challenges that patients face, being able to pay their medical bills, especially with the rise of the high deductible plans. Then I also have a lot of experience in putting financial assistance programs in place for providers. So my professional experience is pretty much tailor-made to this non-profit, but on a personal level, I think I was actually just born to stumble into it. I grew up in a single-parent household, and we didn't have medical and dental insurance. I was in my early teens when my mom started having the severe abdominal pain. She didn't go to the doctor because we didn't have insurance, and she was worried about the cost, thought it would pass.
       
       
      A few days later, her gallbladder burst and we're at home. She's in severe pain. She won't let me call an ambulance because she's worried about the cost. So I call my grandparents, they come over, take us to the hospital. She was in the hospital for five or six days, almost passed away from what should have been a routine surgery, and it was all because she couldn't afford it. She was worried about what that out-of-pocket was going to be and how she was going to pay it. So she thought she could grin and bear it and make it through. Sometimes you can, but sometimes you can't. My grandma, her mom, was another example a few years later. When she turned 65, she qualified for Medicare so she could get her mammograms.
       
      She should have started them in her early 40s, but she didn't. Again, she didn't have medical insurance. So that first mammogram showed advanced stage of breast cancer. Yeah, it had a spread, and so she passed away within a year of that diagnosis. Again, we know that breast cancer has a very high survival rate if you catch it early. So again, it goes back to that preventative not going to the doctor because you're cost concerned. Myself, much less dire situation, but having been brought up in that household, seeing that we don't seek medical or dental care unless it's emergent. When my wisdom teeth started coming in, it hurt. They started hurting more. By the time that I finally said something about it because I knew we didn't have the money, I was already at the point where I had teeth that were breaking and root canals that were needed.
       
      So at 16 years old, I had my first extraction instead of a root canal, and by 22 I had dentures. So for the next 20 years of my life, that was an everyday reminder of the decision of the care that I could afford because I was in pain and I needed to deal with that pain right then versus the care that I should have gotten. So luckily in my 40s, I was at a point where I'd been able to save money and I got dental implants. But if you look at my mom, my grandma, myself, it's all the same story that the care that we ended up getting was a heck of a lot more expensive than the care that we should have gotten if we would have gone into the doctor or the dentist right away.
       
      So I think for me, it's just a very personal mission because I know that a lot of these medical debts are out of necessity. It's not frivolous, and a lot of these people are stuck because they're in a situation of poverty. Kids do what they see, so they see their parents not go to the doctor. So if your family is not regularly getting medical care, you're more likely not to, which means the care you're going to get is going to cost you more later. I don't think it should be a decision where people are choosing between putting a roof over their kids' heads or feeding their kids and getting proper medical treatment for themselves. So I started Clean Slates to be able to help people who don't have the money to be able to pay their medical bills.
       
      Brian Urban:
      Sam, I love you for sharing that story about your family, mother, grandmother, yourself. I think a lot of amazing leaders we have on the show share a very common thread with what you've just described, which is, at the root of why they're wanting to make an impact in the ecosystem is a personal experience, a personal struggle that they want to help others avoid or alleviate if they're struggling in something like that now. This just shows the society that we live in today, we're not for each other.
       
      It's a business first. It's not a person-first model in healthcare. Thank God for Clean Slates and the work that you're doing. I'm just thrilled to have a leader with your voice, not only in the nonprofit world, this is something you started up. This is not your full-time gig either. So you know the world very well in terms of the healthcare economy, and I got to get right into Clean Slates here. So it's young, it's making an impact, and you are a big part of that. So tell us who Clean Slates is today, how long you've been established and some of the early impacts that you've had.
       
      Samantha Jacobs:
      So Clean Slates is young. We're less than a year old. We're just about six months right now. We're really focused on helping those economically-challenged people. There's a whole bunch of people with medical debt. I can't help the whole world, maybe one day, but today-
       
      Brian Urban:
      I think a lot of people are going to be on your side knowing what you're doing. Keep going.
       
      Samantha Jacobs:
      Yes, sir. So Clean Slates, our entire board of directors, we're all volunteers. We all have full-time jobs. We do this, we're passionate about it. We're all from the healthcare industry. We have several other volunteers as well that aren't board members. We're all actively hands-on involved in getting with the patients, with the creditors and really trying to make a difference, and that's what we're trying to get out of the nonprofit. So Clean Slates, again, we're trying to help those people that need it the most.
       
      So our current criteria that we have set is 200% of the federal poverty limit, or if their income is 10%, excuse me, if their medical debt is 10% or more of their annual income. So either you're at 200% of the federal poverty level or less or your medical debt is 10% of your total income. In healthcare, we throw terms around sometimes and we know what they are and it's assumed that everybody else does. But just from a context standpoint, we talk about the federal poverty level. When I say 200%, and I don't know if all your viewers really understand what that means, so just to put it-
       
      Brian Urban:
      I don't think so.
       
      Samantha Jacobs:
      ... into context. Oh, go ahead.
       
      Brian Urban:
      Yeah, let's go through it.
       
      Samantha Jacobs:
      Yeah. So to put it in context, a family of three, the federal poverty level, 200% of it would be $25,800 a year in income. That's a shocking number to me, right?
       
      Brian Urban:
      Yeah.
       
      Samantha Jacobs:
      I don't really care what state you live in, what city you live in, how cheaply you can get housing, $26,000 a year to support a family of three gross, that's your gross income is just crazy. 28% of our population in the United States is living at or below that threshold. So it's a crazy amount of people that really need the help. This is a razor-thin income that they're living on. One small doctor's bill, a $50 bill can tip the scales of what they can afford. So these people are really struggling just making ends meet, so there's no discretionary income to be able to pay for surprises like medical debt. Knowing that these people are already dealing with that stress, you owe somebody money, they're calling you, they're mailing letters to you, you probably owe several of them, so we wanted to really put the patient first in our process and think like the patient, "What is going to make this easy for the patient?"
       
       
      A lot of financial assistance programs out there that do exist are complicated. It's a lot of paperwork. It's burdensome for the patient, and we wanted to make that just a really simple process for people to be able to receive help from us. So our workflow is very patient centric. They go to the website, the eligibility screen takes about a minute. Then they get a email almost instantaneously telling them if they met the qualification requirements or not. If they did, then they get a link to the application, takes about five to 10 minutes to complete. Then from there, we start working on their medical debt. They get emails as we're resolving each one individually so we keep in communication with them. So we really just wanted to look at it from a, if we were a patient, what would we want and how can we make this as simple as possible so anybody could do it?
       
      Brian Urban:
      I love that, and that's your model in its simplest form. I think for a lot of people looking outside in, man, how do you help resolve someone's medical debt? How do you help influence them to trust you to do something like this? How do you partner with hospitals to buy that medical debt, etc. I think that's a very challenging thing, but you broke it down in a simple way because simply it's about seeing how one would fit into the criteria of applying for this, apply to it. Then your team works through each individual debt as a line item it seems like, and then you start to relieve that debt and then they get noticed of this debt. I would imagine when someone sees a note or email communication from you all that their medical debt has been taken care of, I couldn't imagine the feeling that they have. I'm sure there's so many good stories you're starting to collect and probably so many more on the future, but I would imagine that's an amazing feeling.
       
      Samantha Jacobs:
      Yeah, it is. So the first thing we try to do is see if there was financial assistance available through the provider. That's going to be the best route. A lot of these people at 200% federal poverty level, they're going to qualify for that financial assistance. It's a different story for the people that their medical debt is 10% or more of their income. They may not meet those financial assistance qualifications. It really depends on how much time has passed as well and what the type of provider is, because financial assistance isn't a requirement that organizations provide that type of service to patients. So the first thing we do is set about researching it. Unfortunately, outside of the hospital setting, most of the providers don't actually publicly post this information. So we do try websites, but it usually results in us having to call the provider and get to the right person to find out is there financial assistance program available? Is the time of debt still active? Meaning if it was a year, is this debt too old for that now?
       
       
      Once we've exhausted all of that, we've done the research, we figured out financial assistance is an option. We help the patient fill out all the paperwork, get it into the provider and try to take advantage of that because for us, that's an administrative cost. We have a volunteer that's doing that work, but there's no actual outlay of any donation dollars needed in order to make that happen. Now on the flip side, if financial assistance isn't an option or it just isn't an option anymore, that's where we utilize the money from donations, and that's where we're going to go to the settlement route. So we do show the creditor, whether it's the provider or now a collection agency maybe has purchased it, this patient doesn't have the means to pay you. We make a very small settlement offer to try to get the account closed out, basically, "accept this amount in full." Then we send the check directly to that party that whoever the debt is actually owed to. So for every $100 that's donated to us, we expect to be able to relieve at least $1000 in debt.
       
      Brian Urban:
      Wow. That unit level, I think, is really helpful, what comes in and what the output is in terms of debt alleviation. As you were describing that, Sam, I was just thinking about the complexity one has when they're filling out a Medicaid re-enrollment form. If you've ever seen those for our audience, it's lengthy, it's up to you, and sometimes I would say it's quite antiquated. It's mail based. It's not always electronic based. So there's some variation in the barriers that could exist for an individual re-enrolling in Medicaid. A lot of these individuals in terms of gross median income are eligible for Medicaid and there's gray areas. They can come in and off of eligibility each month in terms of what they might be taking in with new earned income.
       
      But this seems like you're right there, locked arm partnership, helping individuals get their debt alleviated, looking at what exists from a provider perspective. A lot of providers do not have their payment assistance models or programs on their website to be actively used, so you have to do a little bit of hunting it sounds like. This is quite amazing. It's pulling out all the other fissures that exist right now, and I love that you're playing a bridge for those big fractures in the landscape here of helping someone alleviate medical debt. So with all that said-
       
      Samantha Jacobs:
      Well, we-
       
      Brian Urban:
      ... Sam, you got me just... Oh, go ahead. I just love where we're going. Go ahead. Where were we going?
       
      Samantha Jacobs:
      Sorry, there is just one other piece of the model that we do as well. So what I just described is really dealing with what exists. That's what they've already incurred. It's what already is owed to someone. We're also trying to set the patient up for success for future medical bills. So the second half of what we do is outreach to the patients. So we want to be able to make sure that they can be more informed for future medical care. So some of the types of things I know won't get into the exhaustive list, but some of the types of things that we recommend to the patients, don't be afraid to ask how much? "How much is this going to cost me?" Whether it's a service or a product, you know how much it is at Walmart? Ask at your provider's office too. It's okay for them to take a few more minutes to get that answer for you. If you have insurance, a lot of us, even myself, have high deductible plans, so it can be better for you to pay a self-pay rate than pay the deductible.
       
      So it's an important comparison point. So it's okay to ask for that, "What is your self-pay rate compared to what it's going to be if you are an insured patient?" Ask if they have a financial assistance or charity care program, and if so, how do you apply? A lot of providers will give you a payment plan at $0 interest, so no interest rate at all. You just have to ask. They're not going to offer it to you, but if you inquire about it, they'll set you up for pretty small dollar amounts on a monthly basis with no interest. Then shop around, especially if you're getting a product, see how much it's going to be on Amazon or your local pharmacy compared to how much it's going to be there at the provider setting. So that's just a handful of things that we're trying to give tools to be able to use to make that next care visit hopefully not turn into a medical debt that they can't pay.
       
      Brian Urban:
      I love that, Sam, because that's actually where I was going to go is, is there a literacy component of this? And there is. You go deep into actually helping them not only learn about their options, but how to navigate that through conversation and being inquisitive and wanting to know what is available to them, and how is help afforded to someone who needs help? I'm glad you said that. It's so funny, we had baby number two not too long ago, and even though I have employer-sponsored health insurance, it doesn't cover everything, of course. Physicians still need to get paid as a system and as a practice and everywhere in between. So there are a lot of good groups out there that will say, "Hey, pay X per amount per month. There is no finance charge. We just simply want you to pay for the services rendered, whatever they were."
       
      Samantha Jacobs:
      Right. Sorry, Brian, but a lot of those providers won't turn you over to a collection agency. It's not a guarantee, but a lot of providers won't turn you over to collection agency as long as you've made a payment within the last 30 days. So they're looking at those accounts that are aging out, those ones that aren't making payments. So it's not a guarantee ever if you have an outstanding balance that's technically past due because it was all owed in 30 days, but there is a very good chance that they're not going to because they're making the payments.
       
      Brian Urban:
      Yeah, that's helpful too. It's also the strategy of how an account receivable works as well. I think it's great, I was going to save a fun comment for last, but I'm hopeful that the term collection agencies will be retired in our society across industry, not just healthcare. I think being able to put trust as a currency back in the pockets of healthcare, having programs like yourself is influencing that and getting away from the bad form of having some of these collections agencies. Not saying they're bad folks, but maybe the time is up for a big transformation, and I think Clean Slates is helping influence that. Well, hey, Sam, I want to get to some interesting stats here. I don't think our audience is very aware of the space, so I jotted a few stats I wanted to run by you here and get your just gut reaction on.
       
      So Commonwealth Fund, if you're familiar with them, I know you are, back in '21, they had a big estimated figure of about $88 billion in medical debt on the consumer credit card side of our purchasing behaviors. That's how much money in aggregate people have put on their consumer-based credit cards to pay for medical care. That is a huge quantity. The White House here in December '23 estimated about 100 million U.S. adults have some form of medical debt that they can't afford per month or really looking out over the year as is associated with their fixed costs and their income. Then RetireGuide reported about 66% of household individual bankruptcies are a direct result of medical expenses. The list definitely goes on. I stopped at three. But what does that tell you? What does tell you personally?
       
      Samantha Jacobs:
      Thank you for stopping at three 'cause I might not have been able to keep track on 10. I think those are really scary figures, and they're really calling out that we need to take action. If you think about that White House report, you said 100 million, so that would be about 1/3 of Americans are struggling to pay medical bills. That jives with other stats that we see in the industry too. So if you think about that, more Americans have healthcare now than ever before, which is great, unless it's like I talked about earlier, the high deductible plans.
       
      So even as our insured population is increased, the number of people that have the high deductible plans has increased too at a pretty alarming clip where at 25% more people have high deductible plans and 2022 than they did in 2013. It's about 55% of the population has a high deductible plan. When you think about those people that have that plan, you're basically betting, you're gambling that you're not going to get sick. Something bad isn't going to happen to you because you're exchanging the low monthly premium in exchange for this high deductible if something happens. At some point in your life you're going to be wrong, right?
       
      Brian Urban:
      Yep.
       
      Samantha Jacobs:
      Is it going to be 10 years or three years? You don't know and what's it going to be?
       
      Brian Urban:
      Scenario or condition, you're right. Yeah. Yeah.
       
      Samantha Jacobs:
      Right? But you're going to be wrong. So that's concerning because when you think back to that 20% of the United States is living below the 200% of the federal poverty level, these people don't have savings. They don't have savings, and they certainly don't have savings high enough to cover a five or $6,000 high deductible plan. So it's alarming to me that we have that many people that are struggling for medical bills. Clean Slates is an organization, there's no way that we can help 100 million people. I'd love to, but I can't. So I think that collectively, we need to do more as a healthcare industry. When you think about that, each individual provider's office has the opportunity no matter what type of provider you are to help your patients. You can't solve the whole United States problem, but you can help your patients.
       
      Put into place a financial assistance program, a thoughtful one that's fair, that's easy for patients to be able to access, to know that it exists and to complete it. You can partner with well, Brian and FinThrive to be able to really reduce the administrative burden for the provider and the patient so it's a simple process. So there really isn't a good excuse not to put one in. The patients are going to need the products, right? They're going to need your services, whichever it is that you're selling, and the cost of you to chase these patients who have no means to pay you, they don't have the money to pay you.
       
      So you're burning a dollar bill every time you mail a statement out to them, they can't afford to pay you. It doesn't matter if you mail them 30 times, it's just adding stress for them and clogging up your AR. So there's a real cost that providers have to try to chase these patients who have no economic means to be able to pay. I'd rather just sort them out and say, "Okay, these are the ones that meet our criteria, and we're going to go ahead and absolve these balances, because it doesn't make any sense for me, forget the patient for just a second, it doesn't make sense for me as a provider's office to chase this and it's best for the patient." It's a win-win in my head at least.
       
      Brian Urban:
      I'm glad you said that because I think a lot of healthcare systems, large and small and health centers, primary care, surgical boutique centers, everywhere in between, they get so stuck in their operating model that they forget about the unique instance that might come up. Based on the statistics that we've talked about, it's more commonplace than ever that a provider will see something like this in the operations that they have in place, will have a wrench thrown in it. So this type of preparedness shows that you're thinking about the person, not the patient or the member, but the human being that you're interacting with and providing healthcare to and what you're considering in their life situation that might come up. I love that you said that. That is very powerful. It's one thing that you said today that everyone can take away, it's how can you put together a thoughtful payment model or payment assistance model for the lives you serve? I love that, Sam.
       
      Samantha Jacobs:
      That's right.
       
      Brian Urban:
      I love that.
       
      Samantha Jacobs:
      If I could go back too to that 88 billion in credit-
       
      Brian Urban:
      Please do.
       
      Samantha Jacobs:
      ... card debt?
       
      Brian Urban:
      Please do.
       
      Samantha Jacobs:
      That one scares me a lot. So if you're paying on a credit card because you want to get the points, you want to get a free trip to Cancun, okay, that's great. But if you are paying on the credit card because you're just trying to get out of this doctor's office or out of this provider's office and you don't actually have the money to pay that, the worst thing you can do is pull out your credit card. They're going to charge you 30% interest immediately. I already told you that most providers will offer you a payment plan for $0, and as soon as you make that payment on a credit card, you have no ability to go back for financial assistance. You have no ability to get that zero interest payment plan that a lot of providers will offer you. More importantly, if you find yourself in a situation where you can't afford to pay it, you've officially changed the class of that transaction.
       
      It's not medical debt anymore, it's a financial transaction. I can't help you. Clean Slates can't help you. If you come to me and you say, "Hey, I put on my credit card a $500 medical bill." I'm going to say "I'm really sorry, but it's now officially a credit card bill, and there's tax implications for organizations to relieve that type of debt for you. I can't do it." So it's a real challenge that many people are pulling their credit cards out and I just... Everybody put their credit cards back in their wallet. Don't do it unless you really can afford to pay it when the bill comes at the end of the month.
       
      Brian Urban:
      Yeah, and it's interesting because I think there's definitely a behavior, a cognitive pathway that takes place when any U.S. citizen has available credit to use. I think we could all be weakened to that construct as our human condition probably allows itself to be is, "I feel obligated to pay. I have no means of pay. I don't know the options. I'm not sure. I have this, I'm going to use this." Then that behavior becomes a habit that's almost etched in stone in a lot of ways. So I'm glad that you said that. Know your options. Clean Slates can help in terms of the literacy there. So I love that second part of your model because it goes deeper to helping the person.
       
      I'm glad you went back to that stat. So Sam, I got to ask you, trust is very difficult to measure. I think there's been a lot of different philosophical perspectives on how trust is gained and how can you measure it in certain studies from a qualitative perspective or quantitative perspective. But I am interested in terms of the trust that exists here. Do you feel your model is starting to or will it help improve trust back in healthcare so individuals seek healthcare in a more preventative way and perhaps avoid costly hospitalizations or going to an ER with an exacerbated condition? Do you think your model is having that type of influence?
       
      Samantha Jacobs:
      I would say that would be an outstanding outcome, 100%. I would love for that to happen, because we're helping relieve the debt and we're helping them know what questions to ask, what to think about as they're approaching medical care in the future. I certainly hope that people are going to start seeking care sooner, to think about my mom and my grandma, how much more it cost for a five-day hospitalization for my mom and multiple surgeries and everything else for my grandma because they let it go on so long. So absolutely best case, but I'm also a realist. So I think that that type of change, that's a belief change. That's something that you've grown up and you've spent the last 30 years, 40 years, 60 years of your life believing that medical care or dental care is not attainable, that it's not needed unless you are practically dying.
       
      So while I'd like to think that those people are going to see this as a ray of hope and say, "I can afford this. I can take care of myself," the reality is these people are also struggling to try to pay the bills. If you ask them, if you ask probably any parent, "Would you rather spend $1000 taking care of yourself or would you rather spend $1000 investing in your child's future? I think they're going to go the route of the child's future. What I'm hopeful for, though, is that the next generation, their children, their grandchildren, that they'll seek more preventative care for them and make sure that they're getting the care that they need, not putting into a situation, "Well, are you really that sick? Are you sure you need to go to the doctor? Could you wait another day? Let's see if it clears up on its own," so that we get better health habits in the next generation. I would be super thankful if anybody that we're helping does change their behaviors. But more practically, I think it'll be their next generation down that'll really benefit from that preventative mindset change.
       
      Brian Urban:
      I love that you're honest with that answer and not over-the-top ambitious or excited off the early success and impact that you've already had at Clean Slates. Generational impact is the long-term sustainable vision. I love it that you said that, and that leads me into where Clean Slates is going, Sam. So let's take a look into the future here. Five plus years, you're not six months into the space now. You're maturing. You're having a notable impact and perhaps even impacting behavior from healthcare providers, billing practices, maybe even policy. You're matured now. What's the big vision? What do you think ultimately Clean Slates will turn into?
       
      Samantha Jacobs:
      Well, our goal is to help 500,000 patients over the next five years to be free of medical debt. But my loftier hope would be that in 10 years there's no need for Clean Slates. We're here to fill a need because we have challenges as a country. If you keep up at all, I'm sure you do, Brian, on legislation, there's things going on at the federal and at the state level that could completely change the landscape of the healthcare industry if they're put into place. We all know that takes time and things like that. But one of the major ones is not allowing medical debt to be used to calculate a credit score or not even allowing medical debt to be reported to the credit bureaus at all, that would be massive. Either one of those would be major.
       
      They both have the same outcome of it not affecting your credit. The credit bureaus did this collectively a few years ago when they decided it's basically an extension of what they decided to do when they said, "Hey, we're not going to allow medical debt under $500 to be reported on credit your reports anymore," which it was a great step, a great step in the right direction. I say it's a step because even though it's not able to be on your credit anymore under $500, and if this legislation ever passed, maybe no medical debt, that doesn't mean that the people can't come after you. That doesn't mean the providers and the collection agencies can't sue you, garnish your wages, put liens on any property that you might own or ever own. So it's a step, but it's not a silver bullet. It's only addressing the credit impact. It's not actually addressing the medical debt itself.
       
      Brian Urban:
      You're right. It's not addressing possible legal implications that could be leveraged. But you're right, I think in large part, a black and white statement here, credit bureaus have never been helpful to our society, and they've made a monumental step in being helpful in terms of their responsibility of capturing all this data. Now they're putting it into action and actually saying, "You know what? This isn't helping individuals be able to thrive in our economy or have our economy thrive itself collectively. This is not something we need to be reporting on anymore. We need to give these individuals a chance to be able to restart themselves because of what's happening in the healthcare society overall." So it's a huge kudos to them, and I'm really excited for where it's going to go into the future, especially with the influence that you're having from a philanthropic perspective, Sam. So I got to ask you, it's a beautiful vision and you put numbers to it, so you took me back a bit there, but what about the barriers? What do you see as a hard barrier to your growth and your impact here?
       
      Samantha Jacobs:
      Before I get into that, if you don't mind, I do want to just mention one other thing. At the state level, there's actions happening too. Some states are looking at legislation or have already enacted some legislation to require financial assistance programs. This would be the other major thing that could help basically eliminate the need for nonprofits like myself, like Clean Slates. So if the providers were obligated to offer a financial assistance program, and the challenge there is whether the programs they're going to put in place, well, if they're going to put them in, but are they going to go far enough? So if we look at the Affordable Care Act, it did put a requirement in place for hospitals to be able to be required to have a financial assistance program that's easily accessible to patients, information that people can find without having to hunt, but that's only at the hospital level. If you think about how many other types of providers are out there, again, it's not a bad thing, it's just not a complete solution because you're only talking about the hospitals required to do it.
       
      You can rack up thousands and thousands of dollars with the debt across every other type of provider out here too. So I think for me, the best thing that could actually happen would be for a whole combination of those types of regulations to be passed. Then we are in a situation where we don't actually have any patients that need our help because they all got financial assistance from the provider at the time of service when they were there. It's not affecting their credit, it's not putting them into a lifetime of debt facing bankruptcy or anything else. Until then, which hopefully does happen in my lifetime, but until then, Clean Slates is going to be here ready to help those people. But I did want to talk about that financial assistance piece just because I had alluded to it earlier, talked about it that providers could do this now. You don't have to wait on a legislation. You could proactively put it in place today and start helping your patients tomorrow.
       
      Brian Urban:
      That's the key, proactive nature of what you can start to do. I love that. So let's get to that barrier question. I want to know what's a wall that we need to jump over here?
       
      Samantha Jacobs:
      Well, our biggest barrier is actually balance. So we need to have a patient tied to a volunteer, tied to a donor. So we're not resolving the patients without volunteer time. As I said, we don't have any employees. All of us are volunteers, so we need volunteers in order to be able to make the calls. Then we need donors in order to be able to do the settlements. So if you think about a patient has, let's just say $10,000 in medical debt, then I need $1000 in donations. Let's just say they have three medical bills, I need eight to 10 hours of a volunteer's time. That's all-inclusive. That's their time researching the financial assistance, filling out financial assistance applications, completing settlement offers and talking to the patient, educating the patient for those future bills so that they can be more informed, and so there's a huge time-labor cost here.
       
      It's not a cost because they're volunteers, but I need more of them. So in order to be able to hit that 500,000 patients in five years, we need volunteers and we need donors. So the greatest help that any of your listeners could give to Clean Slates would be to share our website. Well, if you need the help, come to our website. But if you're in a position where you are exposed to people who would potentially meet our criteria, send them to our website. Like I said earlier, it's a simple application process. They can invest 10, 15 minutes of their time total and see if we can help them. Then if you want to volunteer, there's a volunteer page on our website. It has our contact information. I'd love to hear from you. If you want to donate, there's a Donate Now button, so press the button.
       
      Brian Urban:
      Yes.
       
      Samantha Jacobs:
      Feel free to help us.
       
      Brian Urban:
      Yes. We're showing up right now on our podcast where the website is, and obviously your directions on the website and where to go for donation and also for reaching out and testimonials, et cetera, can be found there too. So Sam Jacobson, founding legend of, I'll say now in the future, what a prediction that is of philanthropic innovator? This is just part of what you contribute your time to in the healthcare economy. I can't wait for Clean Slates to mature and to develop and impact all the lives that are going to help in the future, so I love your organization. So thankful that you came on our little show here today.
       
      Samantha Jacobs:
      Thank you, Brian. It was really nice talking to you. I appreciate it, and maybe I'll give you an update. Maybe I'll come back in a year and tell you how we're doing.
       
      Brian Urban:
      I feel a follow-up coming on, Sam. It's going to be a good one. For more exciting insights and excerpts, please visit us at finthrive.com.
       
       

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