John Samuels is the founder and CEO of Wellworth, an advisory firm that helps family offices navigate the health care system. Samuels, who previously worked at Northwell Health and Mount Sinai Beth Israel hospitals in New York, shares how health and wealth advisers can work in tandem for a family office.
After a career working in hospitals, what led you to start a health care advisory firm?
After 20 years in health care leadership, I identified a gap in the market. There are great doctors and hospitals, but people sometimes need better care. Family office families often have complex health care needs, so we take a holistic approach to care and advise on all aspects of health care management, including physical and behavioral health, addiction treatment, elder care and even health insurance coverage. Only a team of health and wealth experts attuned to these specific needs can deliver such a unique health care advisory.
How does a health care adviser compliment other financial advisers to a family office?
Like wealth advisers, we take a holistic approach to mitigate risk, but risk associated with health care as opposed to wealth. Not having a plan that models and accounts for health care expenses, choosing the wrong doctor or treatment, or having insufficient health care insurance are common risks. We work closely with other advisers on a family’s team, providing solutions to health insurance concerns, modeling pricing of care and ensuring their families get the best care.
We are the glue between the doctor, family, patient, insurance company and the health care system. We share critical information, ask relevant questions and understand the hidden incentives in the health care system. Plus, we know how health insurance works.
Since families prioritize their health care similar to their wealth, health advisers need to be aware of when to refer, what to look out for, as well as have a plan for referrals.
Can you share an example of your health care services working with other family advisers?
One client of ours has Parkinson’s disease, lives alone at home and has an unsteady gait and addiction concerns. After his intake and onboarding with Wellworth, his multi-family office was apprised of his emergency plan, should they identify something that could be concerning. One evening the multi-family office contacted Wellworth during off-hours when they received an odd call from him with an out-of-character request for a donation. Upon notification, Wellworth investigated his situation and discovered that he had a change in mental status, which turned out to be due to a urinary tract infection. This collaboration of advisers helps family office families get better care.
How do you see family offices addressing mental health or issues such as overspending and addiction?
We believe that experts should manage complicated situations, like hiring a tax attorney to handle our taxes. The role of a family office is to be keenly aware of these potential problems associated with mental health, addiction and overspending. Once the concern is identified, advisers should connect the family member to the appropriate expert, care facility or program. After that thoughtful referral is made, the adviser should follow up to ensure that the issue is resolved.
How do you see health care evolving between generations?
Unfortunately, health insurance is not getting simpler. We are seeing more hospitals and insurance companies sparring over hospital coverage. Large hospital systems may no longer accept a commonly used health insurance plan. We are also witnessing more red tape and obstacles to access to care, plus more options for care and treatment, like health apps, telemedicine companies and wellness programs — all of which makes access to care easier.
However, it complicates the coordination of care and holistic treatment. For instance, accessing medical records becomes more challenging for doctors. These kinds of situations can significantly impact the delivery of care. We have a client with a planned surgery whose hospital and doctor were threatening to no longer cover her care at that particular hospital.
When does your planning process start with family offices, and how do you approach end-of-life health care?
When I worked in a hospital, we used to say, “Discharge planning starts on day one.” We believe health care expenses and treatment plans and coordination should be planned as soon as possible. Family office advisers employ a year-end review of one’s portfolio; a health adviser should at the least have an annual review to ensure that people have the right doctors, are addressing their treatment needs, have a plan in the case of an emergency and have the right health insurance coverage.
This can sometimes translate to a health adviser and wealth adviser talking about the cost of care in the coming year or an attorney and a health adviser talking about end-of-life documents.
In terms of end-of-life planning, we support the family as much as possible. This sometimes involves suggesting palliative care to get involved early, attending palliative care appointments and working with the family and legal team to ensure documents are in order. Lastly, our team focuses on addressing mental health issues that can arise during this time, something that’s often overlooked.
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