Latest / Becker’s Payer Issues Podcast / Rob Andrews, Chief Executive Officer of the Health Transformation Alliance

Transcript

Rob Andrews, Chief Executive Officer of the Health Transformation Alliance · Becker’s Payer Issues Podcast

• 0:00
  Hi, everyone. This is Elizabeth Caslow with the
• 0:02
  Becker's Payer Issues podcast.
• 0:04
  I'm thrilled today to be joined by Rob
• 0:06
  Andrews, chief executive officer of the Health Transformation
• 0:09
  Alliance. Rob, thank you so much for joining
• 0:11
  us today. Thank you, Elizabeth. It's good to
• 0:13
  be with you again.
• 0:14
  Yeah. So before we jump in, can you
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  just fill in our audience, tell us a
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  little bit more about yourself, your career background,
• 0:22
  and your role at the Health Transformation Alliance?
• 0:24
  I've been really fortunate to have a chance
• 0:27
  to see health care from a lot of
• 0:28
  perspectives.
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  I served in the US House of Representatives
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  for twenty four years
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  and was very much involved in helping to
• 0:37
  write and implement the Affordable Care Act. So
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  I saw the problem through the eyes of,
• 0:42
  my constituents and a policymaker.
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  I was helped to form
• 0:48
  the HTA eleven years ago. The HTA is
• 0:50
  a coop
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  that's owned by more than 80 large US
• 0:54
  employers,
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  and we bargain collectively in the marketplace to
• 0:58
  try to get better outcomes and better value,
• 1:01
  better consumer experiences.
• 1:03
  So I've gotten a chance to understand health
• 1:05
  care from
• 1:06
  the point of view of the players in
• 1:08
  that ecosystem.
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  I think most importantly, I've gotten a chance
• 1:12
  to understand health care as a dad
• 1:14
  and a spouse
• 1:16
  and,
• 1:17
  father of a internal medicine doctor. My older
• 1:20
  daughter is a physician, practicing physician.
• 1:23
  And I've certainly understood
• 1:25
  the highs and the lows. The
• 1:27
  the the wonderful feeling of having a healthy
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  grandson born,
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  this terror terror of having a scary diagnosis
• 1:36
  for a member of your family,
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  the frustration
• 1:39
  of having to struggle to get a $12
• 1:41
  co pay adjusted because it's wrong. I mean,
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  I've experienced it all,
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  and I try to bring all of those
• 1:48
  experiences to the work that we do here
• 1:49
  at the HCA.
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  Considering all of those angles that you're approaching
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  these issues from, what's the single biggest misconception
• 1:57
  for payer executives right now?
• 2:00
  The single biggest,
• 2:02
  misconception for payer executives is that the fight
• 2:05
  in Medicare Advantage will always be over
• 2:08
  how much the annual bump is.
• 2:11
  We are headed toward today when the fight
• 2:13
  is going to be
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  how quickly and how effectively
• 2:16
  people produce
• 2:18
  high value outcomes
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  for getting paid. And you might say, well,
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  the system's never really gonna evolve to that.
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  Well, that's what people who support regular Medicare
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  said when Medicare Advantage was first enacted
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  in the first decade of this millennium. It
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  was a sort of exotic.
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  It was called Medicare plus choice.
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  It was an exotic program
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  that people said, oh, not many people will
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  sign up. We know now that what's happened
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  is a significant majority
• 2:47
  of new enrollees every year go for Medicare
• 2:50
  Advantage over regular Medicare.
• 2:53
  And I think we're approaching the point, if
• 2:55
  we haven't already reached it, where a majority
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  of Medicare recipients are MA patients.
• 3:01
  I think the main reason we've seen the
• 3:03
  growth in MA,
• 3:04
  and this is
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  I almost chuckle when I say this.
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  Dealing with MA providers is less frustrating
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  for a consumer
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  than dealing with regular Medicare.
• 3:17
  It's it's people are voting with their feet
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  for convenience.
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  The next step, I think, where they will
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  vote with their feet is where do I
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  get a better outcome for myself and a
• 3:27
  better experience?
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  Who makes me feel better?
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  Who solves my problems?
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  Who's more accessible to me? So I think
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  the competition
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  in the future
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  among the MA providers will be about that,
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  not over whether we have a 2.8
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  bump or a 0.9%
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  bump.
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  And, you know, for our listeners, the time
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  that we're recording this was right after that
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  increase was finalized.
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  So very timely for you to bring that
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  up.
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  You know, focus in the call I read
• 3:58
  it in Becker's today, so that's how it
• 3:59
  goes. Well, I'm so glad to hear that
• 4:01
  you read the story that I actually wrote.
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  So,
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  but I would love to talk about self
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  funding a bit considering HTA's focus.
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  So there are a lot of carriers that
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  are offering self funding solutions and also other
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  alternative solutions. I know we've talked about this
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  in previous interviews that are trying to challenge
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  traditional carriers,
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  and their models. So in what scenarios do
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  employers
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  look to go around big legacy players in
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  this space?
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  Employers look to go around the big legacy
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  players when
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  when they hear no too often
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  from a big carrier.
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  So if an employer says, look,
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  we're not getting
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  the kind of early cancer screenings that we
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  wanna get. We're not getting as many as
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  we wanna get.
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  And, therefore, we wanna bring in a point
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  solution.
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  And, therefore, they get eighteen months worth of
• 4:55
  negotiation with the carryover data sharing with the
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  point solution.
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  Or when they say, look, we we have
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  a problem with,
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  preterm birth. Too many of our moms are
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  giving birth early in the pregnancy. It's problems
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  for the baby, problems for the mom. We
• 5:11
  know that there are successful interventions would help
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  prevent that and make the baby and the
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  mom healthier.
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  You know, we we want you, carrier, to
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  pay attention to
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  which providers and which OB practices are better
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  at preventing preterm births than those are not.
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  And you get a year and a half
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  of, well, we really can't do that because
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  that's tearing and steering, and
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  we don't really get involved in the business
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  of helping degrade providers.
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  When the no's outweigh the reasons to stay,
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  the members are inclined to move.
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  And so I would say to the carriers
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  that they're either gonna have to start to
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  say yes more often
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  or be more susceptible to competition
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  from,
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  the TPAs and the smaller organizations
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  out there.
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  So you brought up the maternal health example.
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  Just as a follow-up, you know, I've been
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  tracking a couple of insurers of different sizes
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  rolling out more specialized
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  programs,
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  whether that's with maternal health or chronic conditions,
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  other things like that.
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  When are those initiatives
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  actually effective versus
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  more of just saying we're covering our bases
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  here? Those initiatives are effective when you get
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  the chance to look at data that tells
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  you whether they're effective.
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  One of the assets of the HPA is
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  a data platform
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  that has 5,300,000
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  lives in it going back fifty one months.
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  And we generally have enough data
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  for different solutions to see whether they work
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  or not. Just talking to one of our
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  team members today about one of our large
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  manufacturing members
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  that is operating on the assumption that the,
• 6:54
  the maternal care program prenatal care program of
• 6:57
  their carrier
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  is good,
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  so they wanna steer more people toward it.
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  Well, we said, is it really good?
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  Well, the carrier says it. Of course, the
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  carrier says it is.
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  We wanna approach this with an open mind.
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  If it's if it really is good, more
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  power to the carrier,
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  and we wanna help the employer steer more
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  pregnant moms toward that program. But if it
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  isn't,
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  we want the employer to know that as
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  well.
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  So much of this is about being able
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  to keep score
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  by having access to data.
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  And,
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  so
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  we believe
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  that partners that are willing to share that
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  data, that if the carrier would say, yeah,
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  we 10,000 women participated in this program.
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  And when they're measured against the control group
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  of women who didn't participate in the program,
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  here's why we're better.
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  That's the kind of questions employers are asking.
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  When payers and providers are fighting over contracts,
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  employers are stuck in the middle very often.
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  So what would better alignment look like? And,
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  you know, can you touch a little bit
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  more on that data driven focus and how
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  that might play into contracting arrangements?
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  Alignment comes when there's compromise on both sides.
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  And the compromise we'd like to see from
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  providers
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  is that they are more sensitive to the
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  overhead costs
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  and site of care costs that drive things
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  up. That that someone I was talking to
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  yesterday told me that
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  he
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  had a member of his family who needed
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  a surgical procedure,
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  and there were three different prices for the
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  same doctor in the same health system depending
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  upon the site of care. It was $3,500
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  at one site,
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  $7,500
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  at another site, and $13,000
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  at a third site.
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  Same same surgeon, same procedure.
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  Hospitals need to do a better job of
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  eliminating the cross subsidy that raises prices.
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  Carriers need to do a better job
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  of not burdening
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  providers
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  with too much slow pay, which is like
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  an interest free loan from the provider to
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  the carrier,
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  and then too much bureaucracy to determine,
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  you know, whether the procedure is approved. I
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  noticed today,
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  again, probably in one of your articles, that
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  prior auth is down 11%
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  versus before the
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  before the commitment was made to reduce it.
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  So, look, good compromises or good agreements are
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  made when both sides compromise,
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  and we think those are compromises that both
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  carriers and and,
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  providers could make.
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  I was actually interviewing someone a few weeks
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  ago about,
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  a self funding
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  model that they were focused on and how
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  they're trying to shift a lot of people
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  or a lot of employers who work with
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  health systems normally
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  to independent
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  providers and communities.
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  How
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  feasible do you think that is,
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  to execute something like that?
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  It's not easy to do, but it's worth
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  doing, and therefore, it is feasible if the
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  results are better.
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  The the again, I find that,
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  a lot of the health care debate is
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  whether Kmart is better than
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  Target.
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  The real question is, is Amazon better than
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  Kmart and Target?
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  Who's gonna build a system
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  that is consumer driven, consumer friendly, less expensive,
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  and more convenient?
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  And if it's in if it's an independent
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  player, I think that player is gonna win.
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  If it's a player that's embedded in big
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  providers or big carriers, I think that system
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  is gonna win. It's less about
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  what the ownership structure looks like and more
• 10:53
  about what the objectives of the organization are.
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  And,
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  you know, we're looking for organizations that wanna
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  say,
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  we want consumers to feel a lot better
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  about their experience.
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  We want them healthier
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  as a result of the experience.
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  And we understand it will cost maybe a
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  little more at the beginning,
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  but it'll save a lot in the end.
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  I would use as an example,
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  who really gets up every morning and worries
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  about medication adherence?
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  We it's it's a it's a fact of
• 11:23
  life
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  like the sun rises in the East
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  that a diabetic who stays current with their
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  metformin is gonna have a better result than
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  one who doesn't.
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  Who's doing something about that?
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  And it doesn't really matter so much to
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  us
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  if the if the someone is owned by
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  private equity or is a five zero one
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  three owned by a hospital or whether it
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  is a carrier or a PBM.
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  Who's getting the job done?
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  And,
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  I think
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  the biggest disease in US health care is
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  the repetition disease.
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  Probably most of the problems I've mentioned here
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  in our discussion have been
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  around for thirty or forty years. There's nothing
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  new about any of these problems.
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  What I hope will be new is that
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  new players will come into the market or
• 12:12
  old players
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  will solve these problems in the market.
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  In an economy where more and more consumers
• 12:19
  are more and more result driven,
• 12:21
  I want what I want delivered to my
• 12:23
  doorstep at a price that I think is
• 12:26
  right by this afternoon at 04:00.
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  That's the opposite of health care.
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  Whomever can make that happen for consumers in
• 12:33
  health care is gonna be the winner,
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  And we think there should be a robust
• 12:37
  competitive market to see who wins.
• 12:41
  Are there any concerns you're hearing from employers
• 12:44
  in your recent discussions with them that you
• 12:47
  wanna bring up, whether it's about, you know,
• 12:48
  kind of that consumer push for more direct
• 12:51
  access?
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  Anything similar to that that has kind of
• 12:55
  been dominating your conversations lately.
• 12:58
  The great hockey player Wayne Gretzky
• 13:00
  said infamously
• 13:02
  that great players are not where the puck
• 13:04
  is. They're where the puck's going.
• 13:07
  Where we think the puck is going is
• 13:09
  a tsunami
• 13:11
  of gene therapy and cell therapy claims.
• 13:15
  Today, gene therapy is for extremely rare and
• 13:19
  exotic diseases like sickle cell anemia
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  or horrible respiratory diseases for infants.
• 13:26
  Thank God there are solutions happening right now
• 13:29
  saving people's lives.
• 13:30
  We think there's gonna be an evolution of
• 13:33
  gene therapy away from exotic to just exotic
• 13:36
  diseases
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  to more common ones like type one diabetes
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  or skin cancer
• 13:42
  or alcoholism.
• 13:44
  When that occurs, and I think it's when,
• 13:46
  not if,
• 13:48
  we see a tsunami of high cost claims
• 13:50
  that are gonna have to be paid by
• 13:52
  someone
• 13:54
  because I don't see a society I don't
• 13:56
  wanna live in a society when someone says,
• 13:58
  yeah, We could cure your son of type
• 14:00
  one diabetes, but we're not covering it. I
• 14:03
  don't think that should happen or is gonna
• 14:05
  happen.
• 14:06
  But the cost of these therapies is gonna
• 14:08
  be monstrous compared to the present spend.
• 14:12
  Where we think the market will eventually go
• 14:15
  is a hybrid model
• 14:17
  where very high cost claimants are dealt within
• 14:20
  a fully insured product
• 14:22
  that is capped by a premium,
• 14:25
  where the risk bearing entity has both the
• 14:27
  expertise and the incentive to get a great
• 14:29
  outcome for the patient,
• 14:31
  and where the sprained ankles and normal pregnancies
• 14:34
  and knee operations are left in the
• 14:39
  are the normal knee operations are left in
• 14:42
  the the fully the self insured model. That
• 14:45
  company doesn't exist yet. I bet it does
• 14:47
  in five years or less. And, it it
• 14:50
  could be the big three. It it, it
• 14:53
  could be the buccas. It could be a
• 14:56
  new player. It could be someone not in
• 14:58
  health care right now.
• 15:00
  But you you would have,
• 15:02
  I'm I this is literally true, I think,
• 15:04
  that,
• 15:05
  people came into Blockbuster Video in the eighties.
• 15:09
  And so now we really ought to think
• 15:11
  about
• 15:12
  a product where people can watch movies on
• 15:15
  their home computer.
• 15:17
  And they said, that's a really stupid idea.
• 15:19
  We're not gonna do that.
• 15:21
  Well, hello, Netflix.
• 15:23
  I'm sure it seemed bizarre the first time
• 15:27
  the creators of Uber got together and said,
• 15:29
  you know, if ordinary citizens just made themselves
• 15:32
  available as temporary drivers and
• 15:35
  picked people up at their house and dropped
• 15:36
  them off where they wanna go and have
• 15:39
  their credit card information on file. And
• 15:43
  that seems like a really bizarre thought that
• 15:45
  who would really do that? Hello, Uber.
• 15:48
  That health care is going there.
• 15:51
  And the reason it's going there is, I
• 15:53
  think, closely tied to the tsunami
• 15:56
  of gene and cell, gene and cell, therapies
• 15:59
  that are coming in the very near future.
• 16:03
  How do you recommend these new entrants or
• 16:06
  even, you know, current players that are going
• 16:08
  into that space with the more segmented pharmacy
• 16:11
  approach?
• 16:12
  How do you recommend they build trust with
• 16:14
  employers as employers are used to more traditional
• 16:16
  models?
• 16:18
  Step one is know your customer.
• 16:20
  It's not the CEO of the company.
• 16:23
  It's probably not the CHRO or the CFO.
• 16:26
  It is a benefit lead who is three
• 16:29
  or four steps down the ladder from the
• 16:31
  very top of the company,
• 16:33
  but whose job it is to make the
• 16:34
  plan work every day.
• 16:36
  And she or he, it's usually a she.
• 16:40
  You have to earn that trust.
• 16:42
  She's heard a million times that all I
• 16:44
  can save you 15% on your medical spend.
• 16:47
  Some of our members whimsically say to me,
• 16:49
  you know, tomorrow I'm gonna have six meetings
• 16:51
  with Point Solutions,
• 16:53
  and I'm gonna hire them all, and I'll
• 16:55
  save 90% of my medical spend, six times
• 16:58
  15. I mean, they they know that that's
• 17:00
  not true.
• 17:01
  The way that you earn their trust is
• 17:03
  to show them the data,
• 17:06
  give them references of people you've done good
• 17:09
  work for,
• 17:10
  tell them the truth. Your product isn't always
• 17:13
  perfect. It's not always gonna work. It's not
• 17:15
  easy to implement.
• 17:17
  And let them know that when all hell
• 17:18
  is breaking loose, she'll be there as their
• 17:20
  partner.
• 17:21
  I mean, this is the person who
• 17:23
  if 90 people show up at a radiology
• 17:26
  lab today and all of them get their
• 17:28
  appointments canceled
• 17:29
  because there's some administrative glitch, it's that problem
• 17:33
  lands in their lap.
• 17:35
  That's what they're worried about today.
• 17:37
  If you help them solve that problem, you
• 17:39
  earn their trust.
• 17:41
  If you tell them that, no. No. They
• 17:42
  need to take an hour and read your
• 17:44
  pitch deck about how they're gonna say 15%,
• 17:48
  you're slamming the door in their fingers.
• 17:52
  Do you have any final thoughts or advice
• 17:54
  for industry leaders as we wrap up our
• 17:56
  conversation today?
• 17:58
  Be proud of the industry that you are
• 17:59
  in.
• 18:01
  Naturally, people in health care gravitate to what's
• 18:03
  wrong and how to fix it. That's our
• 18:05
  job.
• 18:06
  But what isn't wrong, what's right, and how
• 18:09
  to sustain it is
• 18:11
  this is an amazing place to get care.
• 18:15
  Sovereign potentates come here to get their care
• 18:18
  for a reason.
• 18:20
  Because there are heart transplants happening today in
• 18:23
  small hospitals that would have been unimaginable
• 18:26
  forty years ago.
• 18:28
  There are children who will be born today
• 18:30
  who weigh a pound and a half,
• 18:32
  who will survive to be full, thriving, healthy
• 18:35
  adults.
• 18:36
  There are cancer survivors who would have never
• 18:39
  survived,
• 18:41
  ten years ago, fifteen years ago because the
• 18:43
  advances that have been made in detection and
• 18:46
  surgery and chemotherapy.
• 18:48
  We should be proud of this system.
• 18:51
  We should be concerned about its inequities,
• 18:54
  its inefficiencies,
• 18:55
  its shortcomings,
• 18:57
  but let's not throw the baby out with
• 18:59
  the bathwater.
• 19:01
  Now I
• 19:03
  in our own families, we can I can?
• 19:05
  I think we all can point to some
• 19:08
  story that is miraculous about something that was
• 19:11
  done to help someone we love.
• 19:13
  That didn't happen by accident. It happened because
• 19:16
  we have
• 19:17
  a lot of good people in the health
• 19:19
  care system who can do great things.
• 19:21
  Let's try to unleash their talents so they
• 19:23
  could do more. I guess I'd put it
• 19:25
  to you this way.
• 19:26
  I would hope that the most valuable player
• 19:29
  in the health care system would be
• 19:32
  a maternity
• 19:33
  health nurse who helps convince, a mom to
• 19:36
  take better care of herself
• 19:38
  so the baby's healthier than she is, not
• 19:40
  someone who's great at upcoding
• 19:42
  so the hospital can collect more revenue. That's
• 19:45
  what we need to do is fix a
• 19:47
  system where that maternal nose nurse is the
• 19:50
  rock star, and the upcoder
• 19:52
  is shows some value, but is not the
• 19:55
  rock star of the team.
• 19:57
  Well, Rob, thank you so much for joining
• 19:59
  us today, and I'm looking forward to continuing
• 20:01
  this conversation going forward.