88 episodes

Listen in as Suzanne Delbanco, Executive Director of Catalyst for Payment Reforms, dials up health care leaders to discuss some of the biggest questions we face today.

Listening In (With Permission): Conversations About Today's Pressing Health Care Topics Catalyst for Payment Reform

    • Health & Fitness
    • 4.7 • 6 Ratings

Listen in as Suzanne Delbanco, Executive Director of Catalyst for Payment Reforms, dials up health care leaders to discuss some of the biggest questions we face today.

    Linda Schwimmer on the health of New Jersey’s small group insurance market

    Linda Schwimmer on the health of New Jersey’s small group insurance market

    Andréa Caballero, MPA, speaks with Linda Schwimmer, JD, President and CEO of the New Jersey Health Care Quality Institute (Quality Institute) to learn about a pressing issue: the health of New Jersey’s Small Group Insurance Market. This market, which covers employers with 2-50 employees in the Garden State, is on the precipice of a downward spiral. At its height, it covered upward of 1 million consumers, but now its enrollment is hovering at about 300k consumers with the further threat of adverse selection creating an imbalanced risk pool. Without doing something to address this issue, the small group market, which offers small businesses a secure option for comprehensive health insurance, may effectively disappear in the Garden State. New Jersey is not alone; due to the COVID-19 pandemic as well as changes in health insurance regulations in the U.S., there is concern for the health of small group insurance markets all across the country.

    Linda Schwimmer explores how the health of the small group market impacts self-funded employers, the rise of alternative employer-sponsored health plans known as level-funded insurance, and, finally, what the short and long-term policy solutions are for strengthening the small group market. Interestingly, regulations that prohibit the use of high-value purchasing strategies, like site of service-based payments, reference pricing, and preferred drug lists, may be negatively impacting the small group market. While this episode strays a bit from CPR’s focus in self-funded health care coverage, it provides important insights on the interconnectedness of the health insurance ecosystem at large. As Linda points out, when one insurance market is suffering, there are implications for the health system as a whole.

    For more information on this topic, read the Quality Institute’s July 2020 White Paper, “Short and Long-Term Strategies to Support Health Care Affordability and Price Transparency for Small Employers and Consumers in New Jersey. https://www.njhcqi.org/wp-content/uploads/2020/07/Short-and-Long-Term-Strategies-to-Support-Health-Care-Affordability-and-Price-Transparency-for-Small-Employers-and-Consumers-in-New-Jersey.pdf

    • 17 min
    Rick Abbott on lowering costs by focusing on quality

    Rick Abbott on lowering costs by focusing on quality

    Suzanne Delbanco chats with Rick Abbott, VP of Product and Market Solutions at Premera Blue Cross. Premera Blue Cross is a health plan in the Pacific Northwest, serving about 2.2 million members with customers ranging from large tech companies to family-owned grocery stores.

    Suzanne and Rick discuss if narrow networks, also known as high-performance networks, represent a viable way to lower prices in the employer-sponsored health insurance market. Historically, employers have demanded broad access PPO networks that include the vast majority of providers and hospitals in their region. This trend has somewhat impeded health plans from using their volume to negotiate steeper discounts from providers. Rick describes how creating narrow networks based on provider quality provides a real opportunity to lower costs by both reducing wasteful spending on unnecessary or harmful care and by negotiating discounts from higher-quality providers in exchange for higher volumes of patients.

    Suzanne and Rick also discuss the opportunities and obstacles for employers interested in pursuing alternatives to the incumbent health plans, like alternative third party administrators or group purchasing initiatives. Rick points to Premera’s 85-year history as an important value-add for customers, allowing the health plan to implement strategic initiatives at scale. For instance, Premera Blue Cross recently launched a “virtual-first” health plan that allows members to designate a virtual network of providers as their primary care providers.

    • 10 min
    Chris Cigarran on why the status-quo is riskier than trying something new

    Chris Cigarran on why the status-quo is riskier than trying something new

    Suzanne Delbanco connects with Chris Cigarran, CEO of Imagine Health, an alternative health plan offering curated provider networks in select markets across the country. Prior to Imagine Health, Chris built the employer and government sales division of a wellness company and has also served as Chief HR Officer.

    To begin the interview, Suzanne lays out a pain point many self-insured employers are facing: the significant consolidation on the hospital, health system, and provider market. As the buyers of health care, employers do not have enough leverage to keep prices in check. Chris approaches this obstacle from the provider point of view, explaining that health system CEOs, like CEOs in other businesses, require customers to deselect their competitors in order to receive discounts. If a health plan or employer isn’t willing to steer their plan participants to certain providers and away from others, it limits their ability to negotiate more effectively in the provider marketplace.

    Suzanne and Chris examine the historical insistence among employers for broad access Preferred Provider Organization (PPO) health plans as a root cause of health care price inflation. This may be changing, as employers prepare to weather the current recession. Prior to the COVID-19 pandemic, employers were looking to add services in health benefits as opposed to making changes to save money. Now, employers are looking at reducing their health care spending as a way to avoid laying off employees.

    Chris Cigarran speaks to the power of the status-quo from a change management perspective. What’s clear is that the health care status quo is not meeting the needs of consumers, with the most blatant example being a patient with chronic conditions having to reach an exorbitant family deductible before their insurance kicks in.

    Chris Cigarran and Suzanne Delbanco also discuss the Medicare Plus contracting model pioneered by Montana’s state employee health plan. Chris shares his fascination with this novel way to approach health care. While the viability of this model is unclear, what is clear is the need for further experimentation.

    This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers. Funded by the Commonwealth Fund, CPR is assembling insights into the forces that can facilitate or hinder purchaser efforts to amass volume. Keep an eye out for more interviews on this topic.

    • 19 min
    Ashok Subramanian on why unit price is still a big deal

    Ashok Subramanian on why unit price is still a big deal

    Suzanne Delbanco interviews Ashok Subramanian, CEO and Founder of Centivo Health, an alternative Third-Party Administrator (TPA) that emphasizes value-based direct contracting and utilization of high-quality providers. Prior to Centivo, Ashok founded Liazon, a private benefits exchange acquired in 2013 by Willis Towers Watson.

    Suzanne and Ashok explore how employers can put downward pressure on health care prices, a critical topic given how much consolidation is happening among providers. Ashok emphasizes that unit price can’t be ignored in the pursuit of lower total cost of care. He suggests that health care purchasers aggregate volume in order to reduce costs, a key purchasing strategy in other sectors of the American economy.

    In addition to describing Centivo’s method of structuring customized provider networks, Ashok provides health plan examples of programs that attempt to shift care to certain providers. Ashok highlights the obstacles large health plans face when trying to execute a curated provider network, especially when they operate in multiple lines of business.

    Suzanne’s final question to Ashok explores the possibility of employers joining in groups to purchase health care together. Ashok comments that this type of purchasing is just another avenue to aggregate volume in pursuit of better deals from health care providers. He reinforces that employers are also looking to secure other capabilities from their contracted providers, like same-day access and care continuity within virtual care delivery. These additional sources of value may be as important to employers as the potential cost savings.

    Ashok Subramanian leaves listeners with an empowering outlook. While a lot of purchasers may lack the confidence to have a voice in conversations with local providers, they actually have a lot more strength in these conversations than they might expect.

    This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers. Funded by the Commonwealth Fund, CPR is assembling insights into the forces that can facilitate or hinder purchaser efforts to amass volume. Keep an eye out for more interviews on this topic.

    • 17 min
    Alan Muney, MD, on why large health plans have a total cost of care advantage

    Alan Muney, MD, on why large health plans have a total cost of care advantage

    Listen in as Suzanne Delbanco connects with Alan Muney, MD, MHA, former Chief Medical Officer of Cigna, former CEO of Equity Healthcare, and current health care advisor to multiple venture equity firms. Suzanne asks Alan a fundamental question: how can employers counterbalance the high and rising prices of health care providers? His answer: look at health care spending in a total cost of care format instead of focusing on unit prices.

    Drawing on his wealth of experience examining health care marketplace dynamics, Alan shares why the major incumbent health plans, especially those who have been acquired or have acquired pharmaceutical management companies, have a competitive advantage. Because drugs are such an important cost component, integrating pharmaceutical and medical utilization management gives these larger health plans end-to-end control over total cost of care.

    Suzanne points to the fact that, despite aggregating volume and negotiating unit cost discounts, incumbent health plans have failed to keep prices in check. Now new entrants to the Third-Party Administrator (TPA) market are trying to seize on these pricing failures. Dr. Muney asserts that while the new carve-out vendors may bring innovative capabilities - like using data to build high-quality provider networks- they lack the economies of scale and the total cost of care control that the larger incumbent health plans have acquired.

    During the interview, Suzanne and Alan Muney discuss why past efforts among employers to purchase health care as a group have failed and strategies employers can consider moving forward. Alan Muney recommends that employer coalitions move to total cost of care contracts including pharmacy.

    This interview is part of CPR’s current work to understand whether group purchasing efforts can secure better health care value for employer-purchasers. Funded by the Commonwealth Fund, CPR is assembling insights into the forces that can facilitate or hinder purchaser efforts to amass volume. Keep an eye out for more interviews on this topic.

    • 16 min
    Anna Sinaiko on lessons learned from 40 years of consumerism in health care

    Anna Sinaiko on lessons learned from 40 years of consumerism in health care

    Listen in as Suzanne Delbanco chats with Anna Sinaiko, PhD, Assistant Professor at the Harvard T. H. Chan School of Public Health. Anna Sinaiko studies patient or individual decision making in health care settings, often referred to as consumerism in health care. She and her colleagues are currently wrapping up a synthesis of evidence from the last 40 years of health care consumerism initiatives. By looking backward at past price and quality transparency efforts and employer-led benefit design programs, Sinaiko hopes to inform future policies aimed at helping patients make informed decisions in today’s complex health care market.

    The research will be a welcome asset for benefit managers, helping them understand patient attitudes and preferences around health care choices as well as what types of policies have successfully steered patients toward higher-value providers. In the podcast, Anna Sinaiko also speaks to the ineffectiveness of shifting costs to consumers through higher deductibles, a strategy that may be tempting to employers as a way to reduce costs during the current economic downturn but that research shows is ineffective in helping patients be better consumers.

    • 14 min

Customer Reviews

4.7 out of 5
6 Ratings

6 Ratings

JoshCrist ,

Timely, insightful and actionable! 🙌

Whether you’re well established as a healthcare innovator, or just getting started as a catalyst for change - this is a must-listen podcast for you! Suzanne does an incredible job leading conversations that cover a huge breadth of topics related to the ins and outs of building a thriving healthcare ecosystem - with leaders who’ve actually experienced success themselves. Highly recommend listening and subscribing!

bahiababe ,

Great podcast

I love the short length and the caliber of the interviewees

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