Latest / Becker’s Payer Issues Podcast / Building Better Health Plans for Small Businesses with Meredith Duncan

Transcript

Building Better Health Plans for Small Businesses with Meredith Duncan · Becker’s Payer Issues Podcast

• 0:01
  - The payer provider relationship has never been simple,
• 0:04
  - but what's happening now is something different.
• 0:07
  - Value based models are maturing unevenly,
• 0:10
  - prior authorization
• 0:11
  - reform is reshaping workflows on both sides, and
• 0:14
  - affordability pressure is intensifying.
• 0:17
  - The organizations that figure out how to collaborate
• 0:19
  - genuinely, not just contractually,
• 0:21
  - are the ones that will set the terms
• 0:23
  - for what comes next.
• 0:24
  - Becker's fifth annual fall payer issues roundtable brings
• 0:27
  - together more than 500 executive level attendees
• 0:30
  - and 70 plus speakers for two days of
• 0:32
  - focused senior level conversation
• 0:35
  - on benefit design, network strategy, transparency,
• 0:38
  - and the financial and regulatory dynamics that are
• 0:41
  - redefining how care gets paid for. Join us
• 0:44
  - November second and third at the Swiss Hotel
• 0:46
  - Chicago.
• 0:47
  - For the agenda and event details, visit beckerspayer.com
• 0:50
  - and click on the events tab in the
• 0:52
  - upper right.
• 0:54
  - Hi, everyone. This is Elizabeth Caslow with the
• 0:57
  - Becker's Payer Issues podcast.
• 0:59
  - I'm excited today to be joined by Meredith
• 1:01
  - Duncan, president and CEO of Texacare.
• 1:04
  - Meredith, thank you so much for joining us
• 1:06
  - today. Thank you so much for having me.
• 1:08
  - Of course. And so before we jump in,
• 1:10
  - can you tell us a bit more about
• 1:12
  - yourself, your health care career background,
• 1:15
  - and your current role at Texacare?
• 1:17
  - Absolutely.
• 1:19
  - So I... I've listened to your podcast in
• 1:21
  - the past. I know many of us that
• 1:23
  - found ourselves,
• 1:24
  - find ourselves working in health care didn't necessarily
• 1:26
  - start in health care, and I'm included in
• 1:29
  - that. I started my career
• 1:31
  - actually, in San Francisco working in consumer packaged
• 1:34
  - goods and I
• 1:35
  - led marketing research for a large ice cream
• 1:38
  - company
• 1:38
  - early in my career.
• 1:40
  - And
• 1:41
  - I transitioned into health care through my graduate
• 1:44
  - degree at UCLA.
• 1:46
  - But what really got me interested in health
• 1:48
  - care early on was some of the the
• 1:50
  - the challenges that my parents were experiencing.
• 1:53
  - Navigating the health care system and
• 1:56
  - that's been decades ago. I don't know that
• 1:58
  - it's improved much, since then, but my dad
• 2:01
  - ended up having
• 2:03
  - spine surgery.
• 2:04
  - He was readmitted to the hospital twice
• 2:07
  - and he really has not ever recovered.
• 2:10
  - So, and and now I know he had
• 2:12
  - an unnecessary spine surgery,
• 2:15
  - really, didn't do him any good. It actually
• 2:17
  - created more harm than good. And so that's
• 2:20
  - what really got me interested in health care
• 2:21
  - and I'm super passionate about transforming this industry.
• 2:25
  - I've spent time on the provider side. I've
• 2:28
  - spent time on the payer side.
• 2:30
  - I love that I've been able to see
• 2:31
  - kind of, each side of the of the
• 2:34
  - equation,
• 2:35
  - and the benefits and the challenges that both
• 2:38
  - experience.
• 2:39
  - And at TexaCare, I'm really excited to to
• 2:42
  - serve as president and CEO. We're a health
• 2:44
  - affiliate of Texas Mutual, which is the largest
• 2:47
  - workers' compensation insurer in the state.
• 2:50
  - And we were launched in 2024.
• 2:52
  - We've grown quickly,
• 2:54
  - starting in West Texas. We're a Texas based
• 2:57
  - company and really committed to serving
• 3:00
  - all Texans across markets.
• 3:02
  - And we're also operating in El Paso, San
• 3:04
  - Antonio, and Houston, and we got more markets
• 3:06
  - on the way. That's great to hear. So
• 3:09
  - I would love to get a little bit
• 3:10
  - more background on TexiCare just for our listeners
• 3:12
  - who may not be familiar. Can you walk
• 3:14
  - us through
• 3:15
  - TexCare's offerings
• 3:17
  - and your business model?
• 3:19
  - Absolutely. So I alluded to this earlier. We
• 3:22
  - are... We like to say we're created for
• 3:24
  - Texans by Texans. I'm a native Texan. I'm
• 3:27
  - super passionate about serving my neighbors.
• 3:29
  - And we believe that when
• 3:32
  - businesses and especially small to mid sized businesses
• 3:34
  - can offer health care coverage to their employees,
• 3:37
  - they will have a healthier workforce
• 3:39
  - and it'll create an overall more productive,
• 3:42
  - you know, business and then economy for us
• 3:44
  - in Texas. Unfortunately,
• 3:47
  - 73%
• 3:48
  - of, small businesses in Texas
• 3:51
  - don't offer health care coverage today.
• 3:53
  - They want to. They're really challenged with this.
• 3:55
  - They wanna take care of their employees, but
• 3:57
  - they're not always able to offer these solutions.
• 4:00
  - So when we were designing TexaCare
• 4:03
  - in our health care coverage options, we really
• 4:05
  - wanted plans that were meant to be used,
• 4:07
  - something we're really committed to. We heard from
• 4:10
  - small business owners that they spend a lot
• 4:12
  - of money on on health benefits for their
• 4:14
  - employees and sometimes their employees can't even afford
• 4:17
  - to access those benefits.
• 4:19
  - So our our plans are a little bit
• 4:20
  - unique. We include, one free visit, per year
• 4:25
  - in many different specialty types, in our total
• 4:28
  - care plan. So it's $40
• 4:31
  - visits per year per member
• 4:34
  - to categories like primary care, urgent care, mental
• 4:38
  - health.
• 4:39
  - And we're excited, that just in in next
• 4:42
  - year, we're launching Total Care Plus.
• 4:44
  - That'll really take those zero dollar visits where
• 4:46
  - there's four today. We're gonna offer unlimited,
• 4:50
  - visits to primary care, mental health, and specialists.
• 4:53
  - These are the types of providers that most
• 4:56
  - folks need to access on a regular basis.
• 4:58
  - If you have kids,
• 5:00
  - they need to go to the doctor a
• 5:01
  - couple times a year. They're probably gonna get
• 5:03
  - sick at some point. If you're a diabetic,
• 5:05
  - we want you to be able to manage
• 5:06
  - your diabetes
• 5:08
  - without having to go to the hospital. So
• 5:10
  - we've really designed plans intentionally that are meant
• 5:13
  - to be used and and meant to be
• 5:14
  - used with those preventive benefits in mind.
• 5:17
  - So I know when we chatted at the
• 5:19
  - beginning of this year, I think I asked
• 5:21
  - about cost performance,
• 5:23
  - and, you know, given that tech secure is
• 5:25
  - relatively new, I'm wondering if you still have
• 5:27
  - any... If you have any insights,
• 5:29
  - a few months since that previous conversation.
• 5:32
  - Yeah. We're still we're still really
• 5:34
  - early.
• 5:35
  - And
• 5:36
  - with our size, there's just a lot of
• 5:38
  - volatility with claims.
• 5:41
  - I mean, overall, we're we're performing well and
• 5:43
  - we continue to grow.
• 5:45
  - But
• 5:46
  - I do see that the cost for small
• 5:48
  - business owners in Texas,
• 5:50
  - they're they're... It's... They're caught in a really
• 5:52
  - impossible position.
• 5:54
  - Like I said earlier, they wanna take care
• 5:55
  - of their employees. They wanna be able to
• 5:57
  - offer benefits,
• 5:58
  - but premium increases are, you know, sometimes outpacing
• 6:02
  - their budget.
• 6:03
  - And I don't know if you saw this
• 6:05
  - article that was published last month in JAMA
• 6:08
  - health forum,
• 6:09
  - just was released I think last... Not... Actually
• 6:11
  - last week, not last month.
• 6:13
  - I've been sitting with it. I'm still I'm
• 6:15
  - still digesting it and I've been talking to
• 6:17
  - other health care leaders.
• 6:18
  - But what this article found was that increases
• 6:22
  - in health care spending
• 6:24
  - accounted for 91%
• 6:26
  - of the overall growth in premiums
• 6:28
  - from 2011
• 6:30
  - to 2024.
• 6:32
  - So although we're early at TEXACARE, we're watching
• 6:35
  - information like this and what we're... We understand
• 6:38
  - from that article is that it's really
• 6:41
  - the healthcare costs that are driving these premium
• 6:43
  - increase and,
• 6:45
  - you know, during that same time in the
• 6:46
  - article it stated the insurer
• 6:48
  - markups decreased by 4%. So margins and admin
• 6:52
  - spending are going down on the insurance front.
• 6:54
  - What's really driving these premiums
• 6:56
  - are the health care costs.
• 6:58
  - So we're early.
• 7:00
  - We're watching it
• 7:02
  - and like I mentioned earlier,
• 7:04
  - we've designed plans that are really meant to
• 7:06
  - encourage preventive care
• 7:08
  - and typically, right, primary care and even specialty
• 7:11
  - care. These are the lower cost modalities of
• 7:14
  - care and we want people to use those
• 7:17
  - types of care
• 7:18
  - so that they prevent
• 7:20
  - more expensive hospital visits down the road. That's
• 7:23
  - the goal.
• 7:24
  - And additionally,
• 7:25
  - one way that we're also thinking about cost
• 7:27
  - is making sure that folks have
• 7:29
  - access to virtual care.
• 7:31
  - All of our plans include $0
• 7:34
  - virtual care. And then as we look to
• 7:37
  - January, we're actually going to embed
• 7:39
  - virtual primary care into our plans as well,
• 7:43
  - which means that folks can choose a primary
• 7:45
  - care physician, schedule an appointment, and have an
• 7:48
  - ongoing relationship
• 7:49
  - with a PCP
• 7:51
  - that is virtual. And that'll be,
• 7:54
  - included in our plans as well starting in
• 7:55
  - January.
• 7:57
  - I've been talking to some other plans about
• 7:59
  - their virtual offerings, so it's really cool to
• 8:01
  - hear what's coming out next year from y'all.
• 8:04
  - I also wanted to ask, TexaCare recently grew
• 8:07
  - to serve businesses with up to 500 employees,
• 8:10
  - which was double its previous cap. So can
• 8:13
  - you walk me through that decision and why
• 8:15
  - that's happening now?
• 8:17
  - Sure. So
• 8:18
  - we launched,
• 8:19
  - and our mission really is to serve small
• 8:21
  - to midsize businesses in Texas.
• 8:24
  - The market is asking us to help them.
• 8:27
  - And so we were serving businesses,
• 8:30
  - like you mentioned, up to about 250
• 8:32
  - employees,
• 8:33
  - and we just continue with our agent partners,
• 8:36
  - our broker partners. They're asking us, can you
• 8:38
  - take larger customers?
• 8:40
  - And we absolutely can.
• 8:42
  - It's new. We're just kind of rolling this
• 8:44
  - out now,
• 8:45
  - but we know that those are still really
• 8:49
  - small businesses. Right? If you've got 400 employees,
• 8:51
  - that's still a pretty small business.
• 8:54
  - And
• 8:55
  - those businesses just like an, you know, customer
• 8:57
  - that has, 20 employees, they're often struggling with
• 9:00
  - that same infrastructure.
• 9:02
  - Meaning, they may not have a robust HR
• 9:05
  - department.
• 9:06
  - They may not have all of the kind
• 9:08
  - of infrastructure that a really large company with
• 9:10
  - 5,000 or 10,000 or a 100,000 employees has.
• 9:14
  - So,
• 9:15
  - it's it's really a similar type of market.
• 9:18
  - It just,
• 9:19
  - enables... You know, we're kind of responding to
• 9:21
  - the market request.
• 9:23
  - I know you say it's kinda similar, but
• 9:24
  - have there been any challenges that have come
• 9:26
  - up, with serving those larger employers?
• 9:30
  - No. And and we actually are just beginning
• 9:32
  - to quote those larger employers now. So we,
• 9:36
  - you know, we've got we've got customers that
• 9:38
  - are, you know, 200 to 250,
• 9:41
  - employees.
• 9:42
  - And
• 9:43
  - we don't really see a big difference.
• 9:45
  - You know, part of our mission was to
• 9:48
  - really make sure
• 9:50
  - that there is another option for the very
• 9:53
  - small businesses.
• 9:55
  - And you talk to lots of health care
• 9:57
  - entrants across the country.
• 9:59
  - Many of them aren't actually focused on businesses
• 10:02
  - with less than 50 employees or less than
• 10:05
  - 25 employees.
• 10:06
  - We serve customers all the way down to
• 10:08
  - two employees.
• 10:09
  - So
• 10:10
  - we are serving very, very small businesses.
• 10:13
  - And as we move up market,
• 10:15
  - it's really... It's the same type of work.
• 10:19
  - In many ways, sometimes those smaller businesses need
• 10:21
  - a little bit more support than the larger
• 10:23
  - businesses.
• 10:25
  - I also wanted to hear a little bit
• 10:27
  - more about as you're courting
• 10:29
  - these businesses, what has demand looked like so
• 10:32
  - far?
• 10:33
  - We we are... You know, we're in kind
• 10:36
  - of a limited number of markets today.
• 10:39
  - Still many many of... Most of the West
• 10:41
  - Texas markets, El Paso, San Antonio,
• 10:44
  - Houston,
• 10:45
  - we are seeing a lot of demand. And
• 10:48
  - if I look at our quote volume kind
• 10:49
  - of year over year, even month over month,
• 10:51
  - it just continues to increase.
• 10:54
  - I think Texas businesses
• 10:56
  - are looking for alternatives.
• 10:58
  - They're really challenged with cost
• 11:01
  - in service, and they're looking for options. So
• 11:05
  - we're seeing some great some great quote activity
• 11:07
  - and and volume coming through.
• 11:10
  - That's great to hear. And one other thing
• 11:12
  - I wanted to ask about as a follow-up
• 11:13
  - to something we were chatting about earlier in
• 11:15
  - regards to virtual care,
• 11:17
  - and how you're talking about the possibility of
• 11:20
  - members meeting with virtual primary care providers.
• 11:23
  - Do you have concerns about members just working
• 11:25
  - with virtual care? Or do you... And do
• 11:28
  - you believe there's a place for in person
• 11:30
  - primary care? Or how are you approaching,
• 11:32
  - that whole situation?
• 11:35
  - Absolutely.
• 11:35
  - I feel really strongly. I think there is
• 11:37
  - definitely an... A place for in person care
• 11:40
  - and I've worked... You know, I used to
• 11:41
  - work on the provider side. I spent, you
• 11:43
  - know, ten years of my career on the
• 11:45
  - provider side and so there's a lot of
• 11:47
  - times when it's really important for a provider
• 11:49
  - to see somebody in person and kind of
• 11:51
  - lay their hands on on that individual.
• 11:54
  - The the virtual primary care, I think, will
• 11:57
  - work really well. And, again, it's new for
• 11:59
  - us. We're we're rolling it out in '27.
• 12:02
  - I think it's gonna work really well for
• 12:04
  - certain
• 12:05
  - types of customers. And we serve... I know
• 12:08
  - you've you've had a lot of folks, on
• 12:10
  - your your podcast talk about rural.
• 12:12
  - We have a lot of customers in rural
• 12:14
  - West Texas. These are
• 12:16
  - these are folks that are, you know, sometimes
• 12:18
  - two hours away from the closest
• 12:21
  - provider.
• 12:23
  - We have members that are literally a two
• 12:25
  - hour drive from our provider.
• 12:26
  - So
• 12:27
  - this is a way for them to help
• 12:29
  - manage diabetes,
• 12:31
  - help take care of some basic things.
• 12:33
  - They're still going to need to go in
• 12:35
  - to do labs and things like that, but
• 12:37
  - it just allows folks the ability,
• 12:39
  - you know, hopefully, to prevent something from escalating,
• 12:43
  - especially in those rural markets. So we're excited
• 12:46
  - because we do have, like I said, a
• 12:48
  - lot of rural
• 12:49
  - members, and I think it'll be a great
• 12:51
  - benefit for them.
• 12:53
  - Another development that I wanted to ask about
• 12:55
  - was how in August, your team forged an
• 12:57
  - agreement with CHRISTUS Health. So how did TexaCare
• 13:01
  - approach that arrangement? And I'm just curious given
• 13:03
  - your background in both the payer and provider
• 13:05
  - spaces,
• 13:07
  - and also how TexaCare is a relatively
• 13:09
  - newer player in this space. What advice do
• 13:12
  - you have for other insurers looking to grow
• 13:14
  - their provider networks?
• 13:16
  - I would say... And, you know, I've heard
• 13:18
  - some other new entrants. It is it is...
• 13:20
  - It can be challenging
• 13:21
  - to build a network of providers.
• 13:24
  - And I don't think, you know, we're alone
• 13:27
  - in those challenges.
• 13:29
  - I did spend a good part of my
• 13:31
  - career on the provider side,
• 13:33
  - and we've got a lot of experience inside
• 13:36
  - the organization.
• 13:38
  - What we're finding
• 13:39
  - successful is we go work with,
• 13:41
  - you know, large hospital systems or even multi
• 13:44
  - specialty groups, etcetera.
• 13:46
  - There's a lot of friction today between providers
• 13:48
  - and payers.
• 13:50
  - And, you know, we're a relationship driven organization.
• 13:54
  - We're local.
• 13:55
  - We're neighbors. We're on board with, you know,
• 13:58
  - provider partners
• 14:00
  - in the various markets that we serve. And
• 14:02
  - your network is really only as strong as
• 14:05
  - the relationships
• 14:06
  - behind it. And and that's really how we're
• 14:09
  - trying to approach these providers is being
• 14:12
  - a
• 14:13
  - a good,
• 14:14
  - you know, straightforward partner, being reliable,
• 14:18
  - paying paying accurately, paying on time,
• 14:21
  - and over time building the trust that I
• 14:23
  - think will strengthen,
• 14:25
  - those relationships.
• 14:26
  - So
• 14:27
  - it's it's taking us a while sometimes to
• 14:29
  - get these contracts across the finish line. We
• 14:32
  - are smaller, so we just aren't bubbling up
• 14:35
  - as the biggest priority.
• 14:37
  - But we're patient, and, you know, I think
• 14:39
  - we're just leaning into those relationships where we
• 14:41
  - can.
• 14:42
  - When you talk about patients,
• 14:44
  - can you give a sense of how long
• 14:46
  - that whole process from beginning to end took
• 14:48
  - to get an agreement?
• 14:50
  - Yeah. I mean, I think it depends on
• 14:52
  - the the provider. We can get some some
• 14:55
  - agreements done in a matter of a few
• 14:57
  - months.
• 14:58
  - Some are taking us, you know, a year
• 15:00
  - or longer.
• 15:01
  - So it kinda depends on the the provider,
• 15:03
  - the complexity, what... What else they have going
• 15:03
  - on. But we are
• 15:08
  - but we are excited about CHRISTUS.
• 15:10
  - We launched, you know, our marketing San Antonio
• 15:13
  - in October
• 15:14
  - 2025,
• 15:16
  - and we're excited to to bring CHRISTUS into
• 15:19
  - that network. They're they're really important trusted provider
• 15:21
  - in the market. So
• 15:23
  - it'll broaden,
• 15:24
  - access options for our tax care members who
• 15:27
  - are excited about it.
• 15:29
  - So we talked about a lot of different
• 15:30
  - things in this conversation. We talked about provider
• 15:32
  - networks. We talked about expansion with the, you
• 15:35
  - know, the businesses you're serving,
• 15:37
  - virtual care. Do you have any final thoughts
• 15:40
  - as we wrap up for other payer leaders?
• 15:43
  - Sure.
• 15:44
  - So I think
• 15:46
  - few things that, you know, if I was
• 15:47
  - gonna kind of think about advice,
• 15:50
  - I mentioned relationships with providers.
• 15:53
  - We we at TexaCare are a very relationship
• 15:55
  - driven organization.
• 15:57
  - We're hyperlocal.
• 15:59
  - And so relationships with providers,
• 16:02
  - for example,
• 16:04
  - you know, I'm the... I was the chair
• 16:05
  - of the Austin Healthcare Council for two years.
• 16:08
  - I remain on that board and that really
• 16:10
  - is all of the local provider partners,
• 16:13
  - in the market.
• 16:14
  - So I'm encouraging my leaders to serve on
• 16:16
  - board and really be
• 16:18
  - at the table with,
• 16:20
  - with our community. So that local relationship is
• 16:23
  - really important.
• 16:25
  - Similarly, investing in broker relationships.
• 16:27
  - We have found as a new entrant
• 16:30
  - and, again, being hyper local
• 16:33
  - and especially in these more rural markets,
• 16:36
  - you know, brokers really are the connective
• 16:39
  - issue
• 16:40
  - between the plans and the businesses,
• 16:42
  - that that we're trying to serve. And so
• 16:45
  - we're out in market, you know, we're in
• 16:47
  - person.
• 16:49
  - I think post COVID,
• 16:51
  - just being able to actually go meet with
• 16:53
  - someone in person goes a really long way.
• 16:55
  - So
• 16:56
  - those relationships are really important, whether it's on
• 16:58
  - the provider side, the agent side, or even
• 17:00
  - just in the community. As I mentioned,
• 17:02
  - serving on boards
• 17:04
  - and being kind of at the table with
• 17:05
  - our neighbors.
• 17:07
  - Meredith, thank you so much for taking the
• 17:08
  - time to chat with us today.
• 17:10
  - Been really great, and I look forward to
• 17:12
  - seeing you at the conference in November. Thanks
• 17:15
  - so much. Yes. Meredith will be at our
• 17:16
  - payer roundtable, everyone, and we're really excited to
• 17:19
  - have her.
• 17:20
  - And for our listeners, if you'd like to
• 17:22
  - hear more podcasts from Becker's Health Care, you
• 17:24
  - can visit beckershospitalreview.com,
• 17:26
  - and you can also learn about our events
• 17:28
  - since Meredith brought it up. Thank you. Have
• 17:30
  - a good one.