An Interview with Zero CEO James Millaway



An interview with James Millaway, CEO of Zero, a firm that offers $0 out-of-pocket care to employees of self-insured firms.


Tell me about Zero’s mission and history.

The legacy healthcare system we have to come to rely on in the U.S. is simply not sustainable. Costs continue to rise, quality varies widely, and the member experience leaves much to be desired. Healthcare should be affordable and accessible and people deserve a world-class experience. While our primary customer at ZERO is the self-funded employer health plan our most important stakeholder is the plan member. We exist to help accelerate a shift towards a member-first economy, a healthcare economy designed to deliver the best combination of cost, quality, and convenience. We are here to empower the employers and providers helping to drive this shift. 


How big can Zero become? 

The sky is the limit. Nobody has nailed the member experience and even we as insiders and change agents are still learning every day. Employers and plan members alike are searching for the one advocate, the one name that they can always trust and that is who we hope to be. So long as we stay focused on plan members’ needs, we have a real opportunity to be the brand people trust. 


How should health care purchasing success be measured? Claims reduction, Net Promoter Score (NPS)? 

You have to measure both. We are all searching for the elusive combination of cost, quality, and convenience. All three of those metrics matter and that is how you determine true value in healthcare and really everything else as well. You should be able to access the care you need without breaking the bank and it should be a word-class experience. We are living through the greatest transfer of wealth in the history of our country as our current system has stagnated the wages of working-class Americans1to prop up an outdated and underperforming healthcare system. We all have a responsibility to help fix it. 


What’s Zero’s impact on member satisfaction, savings, and claims reductions?

We are always focused on the member first so the member experience is critical. We track the member experience using Net Promoter Score (NPS). Our NPS is 94. It’s certainly higher than we initially expected but we also knew plan members were hungry for an entirely different experience. Our platform delivers average plan savings of 46%2, and allows high-quality providers to reach more members, adding incremental volume. We are all driving towards one simple goal: half the cost and 10x the delight.


Does Zero integrate with any other solutions? 

Absolutely. We have integrations with all kinds of partners – on-site/near-site clinics, direct primary care clinics, health advocacy and navigation solutions, analytics platforms, insurance companies, and third-party administrators (TPAs). We are often the entry point into the healthcare system beyond the primary care clinic but we are just one part of the high-performance benefit stack. It’s critical for our success and the success of our plan members that we work openly with everyone. 


What advice do you give friends and family about healthcare purchasing decisions?

First, ask questions. I think Choosing Wisely has done a really good job of teaching us how to ask the right questions. Do I really need this test? What are the risks? Are there safer options? What if I do nothing? What will this cost? Beyond that, I encourage people to look for quality metrics when they can as quality varies widely from hospital to hospital and physician to physician. Recommendations from your friends on Facebook or your Aunt Donna don’t predict outcomes well; you really need to know the types of outcomes to expect: mortality rates, complications, infections, readmissions, etc. 


If not CEO of Zero, what would you be doing? 

That’s a great question. I would still be involved in healthcare as there is just so much room for improvement. Until everyone can get the care they need without worrying about financial barriers there is still work to be done. 


Edited for clarity. Emphasis is mine. Disclosures: my personal healthcare coverage is a $5,000 deductible cost-sharing plan (non-ACA compliant). Healthcare investments: Cigna, Fitbit (pending deal close by Google), HealthEquity.

Photo by Edu Lauton on Unsplash

  1. commercial healthcare inflation over the last 10 yrs has averaged 4-5% per year and deductibles have tripled in that time period
  2. average savings % on elective procedures arranged via Zero”
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