Latest / Becker’s Healthcare Podcast / Brett Caplan, Director & Peter Winslow, Managing Consultant at Berkeley Research Group (BRG

Transcript

Brett Caplan, Director & Peter Winslow, Managing Consultant at Berkeley Research Group (BRG · Becker’s Healthcare Podcast

• 0:00
  This is Scott Becker with the Beckers HealthCare
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  podcast.
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  I'm thrilled today to be joined by two
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  brilliant leaders.
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  We're joined today by Brett Kaplan and Peter
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  Winslow.
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  Brett and Peter spent a ton of time
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  in the managed care and payer space, and
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  they talked to us about what they do.
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  They're with BRG,
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  Berkeley Research Group.
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  Brett,
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  Peter,
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  can I ask you to take a second
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  to introduce yourself
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  and tell us a little bit about what
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  you do and about BRG?
• 0:34
  Yeah. Sure. Great. Thanks, Scott, and and thanks
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  for having us on that podcast. Really excited
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  and and really appreciate it. So as you
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  said, I'm I'm Brett Kaplan. I'm a director
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  here at BRG.
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  I have, over a decade of experience in
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  management consulting in in the health care space,
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  and I primarily spend my time in the
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  in the managed care space or really revenue
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  strategy, reimbursement strategy
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  around managed care contracting, strategic pricing, and complex
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  enterprises, such as multistate, multi hospital systems, academic
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  medical centers, etcetera,
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  and, comprehensive revenue analytics. So think benchmarking, macro,
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  microeconomic
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  review, and and things of that nature. And,
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  really, all of that is to in in
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  service of
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  preparing for negotiations,
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  which we'll we'll touch on a little bit
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  later, but I'll hand it over to Peter.
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  Thanks, Brett.
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  Everybody, my name is Peter Winslow. I'm a
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  managing consultant at Berkeley Research Group. I have
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  about four years of experience in management consulting
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  all within the health care sector. And
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  my primary areas of focus are payer provider
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  contract negotiations,
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  revenue reimbursement strategy development and market trend analysis.
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  And I also serve as the strategic communications
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  and external affairs subject matter expert, within our
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  managed care practice.
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  So great to be here, Scott.
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  No. Thank you so much. And and tell
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  us maybe let's start with a second on
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  payer provider relationships.
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  We're also watch also watching so much fallout
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  and changes in Medicare Advantage right now. Mhmm.
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  Brett or Peter, can what do you take
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  the lead in telling us what trends are
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  you watching in payer provider relationships currently?
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  What are you seeing?
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  Yeah. So so thanks, Scott. I think it's
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  really a perfect storm right now of pressures
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  from an economic perspective, a regulatory perspective,
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  thinking, you know, the uncertainty around Medicaid
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  three forty b site neutrality,
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  and site neutrality,
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  any regulatory shifts stemming from the one big
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  beautiful bill and price transparency that's coming through.
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  And as you mentioned, the Medicare Advantage across
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  that line of business, both from a provider
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  and a payer side,
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  there's rampant,
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  you know, downgrades, denials, delays in payment, prioritization
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  issues, really. So everything is is a an
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  an afflection point from an economic perspective.
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  And,
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  really, that,
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  that leads
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  to tenuous
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  relationships
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  between the payer and provider because it comes
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  down to margin. Right? It's really what we're
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  watching most closely as hospital margins,
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  being
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  very uncertain today,
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  being compressed today. And now more than ever
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  is why our clients are dependent
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  on the outcomes of these managed care contract
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  negotiations
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  to strengthen their source of the negotiated revenue
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  that they have and try to protect that
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  revenue through securing more favorable contract language.
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  Yeah. And and what I'll add is
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  is, Scott, that we're we're really seeing we're
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  continuing to see an increasingly
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  contentious negotiation landscape between
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  providers and payers. And, I mean, it's not
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  centered exclusively around reimbursement rates even though both
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  sides are under
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  tremendous
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  financial pressure. I mean, on the provider side,
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  hospitals,
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  health systems alike continue to shoulder
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  challenges associated with labor,
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  supply chain, capital constraints. You know, these these
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  are
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  by no means new issues, right, all while
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  trying to maintain,
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  you know, quality and access for their patients.
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  But on the payer side, there's a growing
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  scrutiny
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  from regulators and employers demanding cost containment, media
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  and public skepticism, which has been skyrocketing over
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  the last couple of years. And, you know,
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  while inflationary pressures of aging population and and
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  rising utilization
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  compress their margins. So, I mean,
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  what makes this
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  moment particularly volatile? I'd I'd say that
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  American health care is a hot button divisive
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  topic at the center of discussions touching really
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  our our broader economic and political climate. These
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  these disputes within the health care sector
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  are are no longer isolated events. I mean,
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  they're really proliferating at a rapid speed
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  with increasingly significant implications.
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  Providers can't afford
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  to adopt a passive stance or rely on
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  the prospect of resolution through pair negotiation,
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  you know, on its own. You know, what
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  we what we think about with clients is
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  establishing a comprehensive,
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  you know, out of network strategy. You know,
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  that's become imperative. It's and to serve as
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  a means to ensure, you know, equitable positioning
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  of that organization,
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  safeguarding their financial stability, and really preserving
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  the continuity of care when contract discussions
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  reach an impasse.
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  So that's that's kind of what we're seeing.
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  And and we see these tenuous negotiations,
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  you know, across the country. I mean, UMass
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  Memorial Hospital, Blue Cross Blue Shield of Massachusetts,
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  recently resolved one,
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  in North Carolina. Cigna and u a UNC
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  Health were were at bat with one another,
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  and UHC was was also kinda duking it
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  out with WakeMed and and Lehigh Valley Health
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  Network. So there are many, many others across
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  the country, but those are just a couple
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  that that pop in top of mind.
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  And is there gonna be more tension in
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  these payer provider negotiations? Seems like we go
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  through cycles the last ten, twenty years. With
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  some years, things seem pretty copacetic.
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  Other years, a lot of tension.
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  What's the temperature currently?
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  I think, to the points we were raising
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  earlier, just the economic realities.
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  I think there is some tension,
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  that's going to continue, but at what point
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  will it ultimately lead to more,
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  you know, more partnership related is what I'm
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  hoping for. And what we try to advise
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  our clients is let's try to find some
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  common ground. Let's find some win win scenarios
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  when possible,
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  but ultimately be ready for those 10 tenuous
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  kinda
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  conversations and tenuous negotiations moving forward.
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  Thank you. And and talk about as you
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  head into next year,
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  BRGs had this great growing practice,
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  brilliant management consulting and leadership.
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  When you look at this next year, what
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  are you most focused on and excited about
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  heading into 2026?
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  Yeah. Thanks, Scott. And I I think you
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  hit it right on the head with that
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  one really. It's we're we're in a growth
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  mode, from a firm perspective primarily or or
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  a lot in our health care space.
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  We're making some big investments, which I'm really
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  excited about, bringing
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  expertise from enterprise strategy, managed care contracting and
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  financial management,
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  clinical and operational
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  diligence, and and bringing all the pieces
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  of the health care industry together in an
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  integrated way. So and we just announced that
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  our our leader of Rich Bay Bainer coming
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  to to the firm. So really excited about
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  the investments and strategic investments from our firm
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  that we're making and what it's gonna do
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  from a professional standpoint, but more importantly, from
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  our clients and how we're gonna be driving
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  really great impact from a client perspective
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  in the marketplace. So, more to come from
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  a BRG in the market, and I'm excited
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  to to be a part of it.
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  Absolutely. And just and just to reiterate Brett's
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  points, I mean, we we were able to
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  join in in a group of
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  really intelligent and passionate
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  leaders. I mean, there there are people at
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  this firm that
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  are incredibly impressive and contribute so much to,
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  you know, developing health care solutions that benefit,
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  you know, not only our clients, but the
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  patients that they serve.
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  And and it's just
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  such a great opportunity to to be at
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  BRG and and to see
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  what we're we're actively building out and and,
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  you know, like Brett said, much more to
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  come, and and we're very excited for what's
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  coming down the road.
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  And and, Brett, I'll ask you this question.
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  You come from a brilliant family of physicians
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  and lawyers
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  and and, actually, athletes as well.
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  Do you ever feel like that you're on
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  the right side of history
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  by moving into consulting in health care versus
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  law or medicine
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  or or sports?
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  How do you look at that?
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  Thanks, Scott.
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  So I I like to think I take
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  the the good of both, my my paths
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  that I've seen,
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  ahead of me. I really appreciate in the
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  health care world of really having the altruistic
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  helping people aspect. But,
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  at the end of the day, the lawyer
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  in me in in brokering conversations, working with
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  people, and and the administrative side of the
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  health care industry to kinda move it forward,
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  my job is hopefully to make, the clinician's
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  job easier. So I'm trying to fuse the
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  two of them. And, you know, if you
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  think about it, everything's a little bit of
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  a sport, so that's, I think, part of
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  the negotiation in me too. So I do
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  my best to try to to blend all
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  of my background together and and take what
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  I think is is the good, and and
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  move it forward. So
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  You are a remarkable leader, and by chance,
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  I happen to know some of, Brett's family.
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  I'm gonna ask you one more question, and
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  you do not have to answer this.
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  Okay. Who is a better athlete, Mickey or
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  Gary?
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  Oh, that's that's a tough one. I think
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  it depends on the sport, but I'd be
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  remiss to say,
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  that my uncle did play Michael Jordan back
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  in in high school days. So that'd be
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  a tough one. That'd be a tough one.
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  That's a very well well way of stating
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  it without offending your father. I think that
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  was really well put. I I have to
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  tell you, it's it's a pleasure to visit
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  with the two of you. Aside from knowing
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  a little bit of Brett's family, brilliant, brilliant
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  people,
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  Peter and Brett are brilliant,
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  leaders and management consultants at BRG.
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  Brett or Peter, take the lead on the
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  next question.
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  Advice to emerging leaders, emerging careerists,
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  what what advice would you give to emerging
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  leaders, emerging professionals?
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  Yeah. I think, really, there's two that I
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  would like to to voice. First is be
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  curious. Right? We're in such a a complex
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  world of that's ever changing. So being a
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  lifelong learner, and I think that's why I
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  I chose consulting, it's all about lifelong learning
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  and just driving personal growth through learning a
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  new skill, deeper understanding of anything in your
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  area of expertise or not in your area
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  of expertise too. Trying to keep pace with
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  all the change that's happening in in not
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  just the health care industry, but but industries
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  writ large around AI, etcetera. So I think
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  just being curious is something that never stopped
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  learning,
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  is is something I definitely,
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  continue to to tell people as as whoever
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  listens to me, and and Peter probably is
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  is, rolling his eyes as I say that
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  because I've definitely told him to him too.
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  But the other one I think is is
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  about being a kind of a self starter
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  and looking for ways to make
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  somebody else's life a little easier.
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  Again, whether that's
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  your boss or your manager, a client, a
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  colleague, or even a friend, by lending a
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  hand or or stretching your role, you will
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  advance to wherever that next step may be
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  professionally and personally. If you just think about
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  how can I make that that person's life
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  a little bit better, a little bit easier,
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  a little bit more manageable?
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  But but I think that's that last point
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  is so well taken and so well stated.
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  People often don't realize in a professional organization
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  or any business, whatever you're doing, so much
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  of what you do
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  is about trying to help whoever you're working
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  with make things a little bit easier, a
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  little more concise, a little bit better,
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  and and and to solve problems rather than
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  to create more problems. I just I just
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  love that actually.
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  Peter, let me turn it to you. Any
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  piece of advice you could give to emerging
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  leaders?
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  Yeah. Absolutely.
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  And and I really kinda draw on
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  some of my past experiences.
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  You know, before I I put the consulting
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  hat on, I was an investigative reporter based
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  in Chicago. And,
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  you know, one of the things that has
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  done me personally very well and that that
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  I see really effective leaders doing is is
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  is networking and just being open to connections.
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  I mean, Scott, you're one of the best
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  to do it yourself. I mean, you know,
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  the way that we are able to to
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  get connected and just build these bridges and
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  start forming a relationship has, you know,
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  been invaluable, and it's something that, you know,
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  I'm looking forward to going into the future.
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  But, I mean,
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  effective leaders really recognize that networking isn't just
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  about, you know, collecting contacts or filling the
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  Rolodex. Right? It's about cultivating meaningful relationships. So
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  they invest time in the individuals. They they
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  listen. They and and they build this trust
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  and and and curate a broad and diverse
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  contact list. So, you know, these connections
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  benefit both their personal growth and their organization's
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  success. I mean, they open doors to collaboration,
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  innovation,
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  problem solving,
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  and and it makes
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  networking
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  a a strategic leadership skill rather than seeming
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  like a transactional activity.
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  And I think that point of developing real
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  relationships
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  versus a transactional
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  activity is is right on. I mean, the
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  more that long term people are available to
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  each other, it it's not so much you
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  do this, I gotta get that, or vice
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  versa. It's more, you know, over time, you
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  figure out where there's synergistic opportunities for people
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  and that work for everybody. And and I
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  think that's right on. I think that's just
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  a very I think that's a great perspective
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  on networking and relationship building
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  versus the alternative, which is everything's good, bro,
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  quorum, transactional, which is very short lived and
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  and leads to very flawed relationships, quite frankly.
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  Right. Brett and Peter, I I wanna thank
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  you both for taking the time to join
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  us today on the Becker's Healthcare podcast.
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  For me, this is a tremendous pleasure to
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  visit with the both of you. Thank you
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  so much for taking the time and joining
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  us. Thank you. Thank you, Scott. The pleasure
• 14:17
  is ours. Thanks, Scott.