Latest / Becker’s Payer Issues Podcast / Rob Andrews on Employer Led Health Care Reform and the Future of Health Plans

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Rob Andrews on Employer Led Health Care Reform and the Future of Health Plans · Becker’s Payer Issues Podcast

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  This is where health insurance leadership comes together.
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  Becker's fourth annual spring payer issues roundtable brings
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  together over 400
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  payer and health plan executives and more than
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  100 speakers to Chicago April.
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  This year's event includes keynote conversations with the
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  industry's top leaders and former president George W.
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  Bush. For the full agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  here in Chicago.
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  Hello, everyone, and welcome to the Becker's Healthcare
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  Podcast. I'm Scott King, thrilled today to be
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  joined by a very special guest, Rob Andrews,
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  chief executive officer of Health Transformational Alliance. Rob,
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  how are you doing today? Thanks so much
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  for joining us. God, I'm doing great, and
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  it it's nice to have a chance to
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  be with you. I appreciate your time. And,
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  you know, we have a lot of big,
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  topics to get into here with with health
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  plans and and, you know, the health in
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  general
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  across the board. But before we we dive
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  into those, Rob, you just tell us a
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  little bit about your your background and your
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  career journey.
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  Well, I had the honor of serving in
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  the US House of Representatives,
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  for about twenty five years,
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  during which by the time the Affordable Care
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  Act was enacted, and I was privileged to
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  be a part of that,
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  representing a district in New Jersey. When when
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  I left the Congress, I started practicing law
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  and was given the chance to represent a
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  group of companies that
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  were interested in binding together to form what
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  became the HTA,
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  which is a group that combines the data
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  and the purchasing power and the experience and
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  judgment
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  of a lot of major American companies.
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  We're now up to over 80 companies.
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  And our our job really is to
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  look for the highest value care,
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  not the cheapest care, but the highest value
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  care that produce the best results. So I've
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  had a chance
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  to experience health care as a as a
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  dad,
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  you know, as a parent, as now as
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  a grandparent,
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  as a public servant
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  legislator,
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  and now as someone, helping to lead the
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  HTA. So I feel very blessed.
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  That's certainly a lot of different perspectives with
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  health care, and we appreciate you blending them
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  to us for this podcast, Rob. And kind
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  of the first topic I want to get
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  to is
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  how are your relationships with providers changing
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  as both sides face cost pressure and workforce
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  shortages?
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  I think they're changing for the better because
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  both sides see the
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  opportunities
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  that come with the challenges that, providers have.
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  Well, everyone
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  who listens to this podcast
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  knows
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  that,
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  health care providers under extreme financial pressures,
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  reimbursements
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  are
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  lagging, in some cases being cut.
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  Demands are growing, particularly with an increasingly elderly
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  population.
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  It's hard to find and retain talented men
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  and women to work in health care fields.
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  It's a really tough time to be running
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  a provider system or contributing to running one.
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  At the same time, employers are beset by
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  a series of challenges.
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  The costs keep going up 9% last year
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  across the market.
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  The quality isn't necessarily going up.
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  The demands and challenges of the employees in
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  the workforce are as high as they've ever
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  been. So I think what you're finding is
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  provider systems and employers are looking for ways
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  to
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  take advantage of,
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  was it Rahm Emanuel said, never let a
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  good crisis go to waste. Right.
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  The the there there's some critical problems have
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  to be solved, and I think more and
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  more
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  employers and providers are looking for a way
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  to solve them together.
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  Not to the exclusion necessarily of carriers or
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  PBMs, but
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  probably with those groups playing a less important
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  role
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  and providers and employers playing a more prominent
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  and primary role.
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  So, Rob, you kinda think that because both
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  providers and payers are are both under, you
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  know, different kinds of pressures and challenges. There's
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  almost a united front
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  in that relationship with, like, we're both dealing
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  with a lot right now. Let's just try
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  to work together the best we can. Is
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  that kinda what you've been seeing?
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  I do. I I think it's evolving in
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  that direction, and
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  the math tells you why.
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  By and large, provider systems are either operating
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  at a very thin margin
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  or an in nonexistent
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  margin. They're operating in the red.
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  Employers
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  are paying,
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  in some cases, double digits more than they
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  paid in other years, but certainly in the
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  high single digits.
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  So where is the money going?
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  Right? If you've got a an environment where
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  employers are paying 9% more, but providers have
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  seen their margins
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  cut by two thirds or disappearing.
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  You know, the money is is going, in
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  some cases, to,
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  middlemen who provide some important functions. I'm not
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  in any way
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  demeaning
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  the work that some of those groups do.
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  But is it the right share? Is it
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  the right share? And I think the answer
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  is usually no.
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  So looking for a way to reallocate that
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  money so the person,
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  you know, seeing triaging the patient in the
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  emergency room or doing physical therapy with the
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  patient or performing surgery or delivering the baby
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  or
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  you're doing the actual healing work,
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  that more of the money goes to the
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  provider and less of it goes to the
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  people in the middle. I think that's a
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  common cause for employers and providers.
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  I think you're right, Rob. And, you know,
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  you you discussed real real allocating that that
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  money, but where do you see the biggest
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  gap today when you look at,
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  you know, payer strategy and operational execution?
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  I think the biggest gap is the,
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  lack of meaningful competition
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  among carriers.
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  I think carriers should
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  be competing on the basis of outcome.
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  Who helps to make people healthier?
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  Not on the basis of rates or discounts.
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  Now discounts are important.
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  No one wants to overpay for something, but
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  I don't think anybody wants the cheapest mammogram
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  for their daughter or their wife,
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  or, you know, the cheapest cancer screening for
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  their husband or their brother. I I I
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  think if we could create a world where
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  carriers competed on the basis of delivering great
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  outcomes
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  and providers were a part of that in
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  a fair way, then I think employers and
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  consumers would benefit.
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  What's one investment or initiative you believe will
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  most reshape how health plans operate over the
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  next two to three years?
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  I think it will be the emergence of
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  technologies that can match the right drug with
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  the right patient,
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  which doesn't really happen very often now. Formularies
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  are written,
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  frankly, with economic
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  considerations
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  in mind.
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  But we know from looking at at genetic
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  studies and we know from looking at comorbidities,
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  some drugs
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  are incredibly beneficial
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  for a patient.
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  Many of them are.
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  Some are expensive but ineffective,
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  and a few can even have a harmful
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  impact, particularly if if mixed with other drugs
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  that that are the patient's taking. So I
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  think you're gonna see the market move toward
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  more personalized formularies
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  where physicians
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  and others writing prescriptions
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  are privy to information that would help understand
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  whether this is the right drug for the
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  person. And
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  that, I think, will lead to much better
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  outcomes.
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  Fewer cardiac incidents,
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  you know, fewer
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  gastro
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  gastro
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  incidence
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  and so forth. I think that's something that's
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  on the horizon
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  and could be very positive.
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  I think it's really interesting, Rob. You know,
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  we talk about a lot of ways to
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  use using emerging technology
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  in the patient journey and and to personalize
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  things more. But having that specific that right
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  medication for a patient, now you said it's
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  on the horizon. Do we think that that
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  it's something that could happen sooner or rather
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  than later with all the emerging tech we're
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  seeing?
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  I think it'll happen sooner rather than later
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  for two reasons.
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  The first is
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  in in an economy where health care costs
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  are burgeoning,
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  drug costs are growing the most. It's the
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  biggest pain point, whether it's GLP ones or
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  or,
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  you know, the immune
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  autoimmune drugs.
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  So there's a lot of attention being focused
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  in the area. And then second is the
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  advance of AI,
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  the ability of AI to understand the relationship
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  among drugs,
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  drugs with certain comorbidities,
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  the genetic characteristics of the patient.
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  I think
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  pharmacogenomics,
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  which was fairly exotic and expensive a decade
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  ago,
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  will become a lot more common and less
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  expensive.
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  It'll be used by more providers,
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  and it'll lead to better outcomes. That that's
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  something I think is on the pretty near
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  term horizon.
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  If you could change one regulatory
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  or industry practice tomorrow
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  to improve affordability and excess, what would it
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  be and why?
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  Gag clauses and agreements between providers and network
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  builders
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  and, drug,
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  PBMs in the case of drugs.
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  Markets I think markets fundamentally work,
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  and markets work when there is meaningful transparency
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  for people who are buyers in that market.
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  We have erratic transparency
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  right now.
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  A lot of payers, whether they're employers or
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  health plans or individuals,
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  don't really know what they're paying.
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  There's this vast difference between the,
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  you know, the the charge that's on your
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  bill, the charge rate, and what's really being
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  paid.
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  You can't have an effective market unless people
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  know what the real cost is that they're
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  being asked to bear and what the benefit
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  of it is. So
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  I I think
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  a legislative approach that would,
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  you know, open the kimono,
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  let let pricing be known,
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  I think would disrupt the industry in a
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  positive way, and I think it's coming.
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  The last thing I want to ask you,
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  Rob, what's
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  what is the issue you think is putting
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  the most pressure on health plan margins right
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  now,
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  and how are you going to respond differently,
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  or or have you even started to respond
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  differently in 2026?
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  When you say health plans, do you mean
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  employer sponsored health plans?
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  Yes. Yeah. I think what's putting the most
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  pressure now is, GLP ones in the short
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  run.
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  Many more people are taking these drugs. They're
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  still very expensive.
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  They have good benefits. I mean, they they
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  do
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  work for a lot of consumers in a
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  lot of situations. So I think that
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  what you're gonna see is employers looking toward
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  creative ways to take advantage of some of
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  the direct pricing
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  that's being offered by the drug manufacturers.
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  You can't read,
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  Becker's
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  any day and not read a story about
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  a drug company
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  that's offering a price for GLP one through
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  its consumer portal that's, like, less than half
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  of what employers are paying in their health
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  plans. Well, that's just not gonna sustain itself.
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  If a
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  if a drug is being sold for a
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  $190
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  a month to someone who puts their credit
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  card down,
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  but it's $500
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  a month net of rebates for employer plan,
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  employers are gonna do something to change that.
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  They're either gonna work around it and
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  try to reimburse the consumer, or they're gonna
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  insist that the PBMs and
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  the manufacturers
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  normalize that price. So
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  I think that's what's putting a lot of
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  pressure on, and that's the direction in which
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  you'll see it go. Rob, thanks so much
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  for joining us on the podcast. It was
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  a great conversation. Look forward to having you
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  speak, in the spring at our Payor Issues
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  Roundtable. Scott, I'm sure Chicago will be a
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  great experience, and thank you for making it
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  so.