Latest / Becker’s Payer Issues Podcast / Alan Cohen, Co-founder and Chief Product Officer at Centivo

Transcript

Alan Cohen, Co-founder and Chief Product Officer at Centivo · Becker’s Payer Issues Podcast

• 0:00
  Hello, everyone. This is Jacob Emerson with the
• 0:02
  Becker's Payer Issues podcast. Thrilled today to be
• 0:04
  joined by Alan Cohen, who's the cofounder and
• 0:07
  chief product officer at Sentivo.
• 0:09
  Alan, thanks so much for taking the time
• 0:11
  to be with me on the podcast today.
• 0:13
  Yeah. I'm happy to, Jake. I'm very happy
• 0:15
  to be here today. Yeah. And before we
• 0:17
  dive into everything we wanna talk with you
• 0:18
  about, actually, a pretty specific topic and everything
• 0:21
  going on there, can you tell us a
• 0:22
  little bit more about yourself, your background in
• 0:24
  health care, and what it is that you
• 0:26
  do today at Sentivo?
• 0:28
  Sure.
• 0:29
  So I've had a pretty long at this
• 0:31
  point, but varied career in kind of health
• 0:33
  coverage and health care.
• 0:35
  I started my career,
• 0:37
  in, you know, working for health plans. I
• 0:38
  worked for, you know, three different health plans,
• 0:40
  some of the major health plans in this
• 0:42
  country at the time, at least. You know,
• 0:44
  Prudential was the, was was the first one,
• 0:46
  also, Cigna and MassMutual.
• 0:49
  I then started,
• 0:50
  one of the first Internet based employee benefits
• 0:53
  companies called Online Benefits,
• 0:55
  where we were doing kinda, you know, something
• 0:57
  that's really common now, like doing enrollment and
• 0:59
  communication
• 1:00
  all online. And so people don't have to
• 1:02
  fill out paper forms. Well, actually, the company
• 1:04
  I started was one of the first companies
• 1:06
  doing that. I ran that company for about
• 1:08
  ten years.
• 1:09
  And then I sold we sold it to
• 1:11
  a public health care IT company named Adam,
• 1:13
  a d a m, a very well known
• 1:16
  company in kind of the health care information,
• 1:18
  space.
• 1:19
  And then I began,
• 1:22
  one of the first actually, the first,
• 1:24
  benefits exchange company. This idea of of of
• 1:27
  giving employees money and letting them shop for
• 1:29
  benefits,
• 1:29
  which was a, you know, kind of a
• 1:31
  hot idea for a while. That company is
• 1:33
  called Liaison.
• 1:34
  We were the first benefit exchange,
• 1:36
  you know, company that really trying to kind
• 1:38
  of create competition
• 1:39
  among among health plans competing competing for members.
• 1:42
  This is all pre ACA. So the idea
• 1:44
  of these health care exchanges in in part
• 1:46
  came from the the work that we did.
• 1:48
  I also spent some time at,
• 1:51
  Willis Towers Watson, you know, the,
• 1:54
  actuarial consulting firm.
• 1:56
  And then,
• 1:57
  now going back five years ago, I was
• 1:59
  one of the founders of Sentivo. We are
• 2:01
  a, a new health plan working exclusively
• 2:04
  with, high performing clinically integrated providers and accountable
• 2:08
  care organizations
• 2:09
  to really try to try to deliver cost
• 2:11
  effective, high quality health care,
• 2:14
  you know, to to employers and, you know,
• 2:16
  their employees and members.
• 2:17
  Also, by way of academic background,
• 2:20
  I have a, MBA from Columbia University in
• 2:22
  London Business School, and I also have an
• 2:24
  Miles per hour from Johns Hopkins. And so,
• 2:26
  you know, pretty varied career
• 2:28
  in different parts of kind of the health
• 2:30
  coverage,
• 2:31
  kind of world. But one thing that always
• 2:35
  seems to be a recurring theme is is
• 2:37
  health care inflation and trend. No matter where
• 2:39
  I go, it's it's something that that we're
• 2:41
  always trying to talk we're always talking about.
• 2:42
  We're always talking about trying to figure out
• 2:44
  ways to kind of bend the bend the
• 2:45
  trend curve,
• 2:47
  and, you know, simultaneously
• 2:49
  help, people get have access to high quality
• 2:52
  health care that's not frankly gonna
• 2:54
  gonna gonna, you know, financially, you know, harm
• 2:57
  them or financially harm their, you know, their
• 3:00
  employers.
• 3:01
  Sure. Absolutely. Well, appreciate you giving us that
• 3:03
  rundown, and let's dive right in and talk
• 3:04
  about some of the health care trends we're
• 3:06
  seeing right now. Certainly, as we go into
• 3:08
  next year, some pretty unprecedented changes,
• 3:12
  as we head into 2026 and what is
• 3:14
  looking like a pretty big increase for people
• 3:16
  all over the country when it comes to
• 3:18
  ACA coverage and and premiums.
• 3:21
  Obviously, as as you know, there's there's a
• 3:22
  lot of limbo right now over the enhanced
• 3:24
  subsidies.
• 3:25
  There's worsening market morbidity that's really been dampening
• 3:28
  earnings for the big players in this market.
• 3:31
  And now we're seeing all over the country
• 3:33
  the proposed rate filings with premium hikes. We've
• 3:36
  seen as high as over 50%
• 3:38
  in in certain states, certain markets, but,
• 3:41
  it seems that the average proposed increase right
• 3:43
  now is around 18%.
• 3:45
  So give us your perspective on this, Alan.
• 3:47
  Given what you what you've seen, the history
• 3:49
  of this market,
• 3:51
  what's what's driving these increases, and what's how
• 3:53
  should we be thinking about this right now?
• 3:55
  Yeah. I think the first thing is look.
• 3:57
  These are shockingly high increases. And, you know,
• 3:59
  in this,
• 4:01
  you know, in this area, we've kind of,
• 4:02
  in some ways, gotten dull to the whip
• 4:05
  of of of rising inflation. But I think
• 4:07
  we have to realize that, you know, that
• 4:09
  the, you know,
• 4:11
  rises in health care costs, which then create
• 4:13
  rises in premium or changes in, you know,
• 4:16
  the the pool
• 4:18
  of of who is covered, which causes rise
• 4:20
  in premium.
• 4:21
  They they just have to stop. Right? I
• 4:23
  mean, we're we're you know, I I feel
• 4:25
  like we've been talking about this. It looks
• 4:27
  me. I've been talking about this since I
• 4:28
  entered this industry in 1989, which is quite
• 4:31
  a long time ago. But but I do
• 4:32
  think it has been a, you know, kind
• 4:34
  of long, long path going off a cliff.
• 4:36
  Right? So we we can't be kind of
• 4:38
  dull to these things. And and I think
• 4:41
  this is, you know, a reemergence
• 4:43
  of of health care and and health coverage
• 4:47
  or premium
• 4:48
  inflation. And it's not, you know, it's not,
• 4:51
  you know, solely, you know, you know, segmented
• 4:54
  into the ACA markets. I think ACA markets
• 4:56
  might be the kind of sharp end of
• 4:58
  the spear
• 4:59
  for a lot of reasons, but but we're
• 5:01
  seeing this in in the employer coverage as
• 5:03
  well for, you know, for insured employers. We're
• 5:06
  seeing it in in, in employer coverage for,
• 5:09
  you know, for self funded employers.
• 5:12
  And, really, it is a a broad phenomenon
• 5:15
  that is occurring in all different aspects of
• 5:18
  of health coverage, and it's one that we
• 5:20
  we must attack. I mean, we, you know,
• 5:22
  we we we can't go through kind of
• 5:24
  yet another, you know,
• 5:26
  cycle of of double digit inflation
• 5:29
  because we've gotten to the point in in
• 5:31
  our industry here that I mean,
• 5:34
  it has become unaffordable, unaffordable for companies, unaffordable
• 5:38
  for people. I mean, you know, you know,
• 5:39
  the the last the last cycle of of
• 5:42
  cost increases
• 5:43
  were mitigated by
• 5:45
  by raising deductibles. Right? I mean, you know,
• 5:47
  deductibles,
• 5:49
  we used to have $500 deductibles, dollars 1,000
• 5:51
  deductibles.
• 5:52
  They would only apply to to, you know,
• 5:54
  to hospitalization and surgery. And then, you know,
• 5:56
  now with with high deductible health plans that
• 5:58
  are HSA qualified, I mean, people have 2,000,
• 6:00
  3,000, 5,000, dollars 6,000 deductibles, 10,000, dollars 15,000
• 6:04
  are out of pocket maximums. I mean, these
• 6:06
  are individuals that have,
• 6:08
  you know, a few thousand dollars of,
• 6:10
  in the bank, and they have and what
• 6:12
  has happened is
• 6:14
  they have become, you know, functionally uninsured.
• 6:17
  I mean, you are functionally uninsured
• 6:19
  when you can't afford your deductible and you
• 6:21
  can't afford your out of pocket maximum.
• 6:23
  And so we have you know, in in
• 6:25
  kind of the last cycle of health care
• 6:27
  costs,
• 6:28
  increases, we were we, you know, we mitigated
• 6:31
  that in the industry by just jacking up
• 6:33
  deductibles to the moon. Right? And then hoping
• 6:35
  people would put money in HSAs,
• 6:38
  which, you know, some people did, but a
• 6:39
  lot of people you you can't put the
• 6:40
  money in HSA if you don't have the
• 6:42
  money. Right? And so we don't have that
• 6:44
  escape valve anymore,
• 6:45
  because our our the deductibles are as high
• 6:48
  as really they can be. They're they're they're
• 6:50
  they're getting close to, you know, a you
• 6:51
  know, ACA limits.
• 6:54
  And so, you know, it's really gonna be
• 6:56
  very difficult for the entire industry. When I
• 6:58
  say industry, I I mean I mean health
• 7:00
  care providers.
• 7:02
  I mean insurance companies. I mean health plan
• 7:05
  administrators. I mean employers.
• 7:07
  It's gonna be horrible for all of us
• 7:10
  if we don't find ways to mitigate,
• 7:13
  you know, these broad cost increases.
• 7:15
  And and, again, there's a a whole series
• 7:17
  of reasons why. And, Jacob, would you like
• 7:19
  me to go into some, you know, some
• 7:21
  some reasons on on why why I think
• 7:24
  we're seeing these cost increases like you mentioned?
• 7:26
  Yeah. Absolutely. I mean, give us some specifics
• 7:28
  on on exactly what is driving this
• 7:31
  industry wide. Yeah. No. So I I think
• 7:33
  they they fall into a few buckets. Right?
• 7:35
  I think one bucket is just rising health
• 7:38
  care costs and rising inflation. Right?
• 7:40
  I mean, we know that that health care
• 7:43
  costs,
• 7:44
  the health care inflation, you know, historically has
• 7:47
  has for decades and decades rose significantly
• 7:50
  above, you know, consumer price index. Right?
• 7:54
  But in, you know, in the last ten
• 7:56
  years,
• 7:56
  it had been closer to the consumer price
• 7:59
  index than it had been, you know, previous.
• 8:01
  I I but but we're going through another
• 8:03
  cycle now of of simply higher cost inflation.
• 8:07
  Right? And so so if you, you know,
• 8:08
  again, if we wanna use the number of
• 8:10
  15%
• 8:11
  or 18%,
• 8:12
  you know, for premium increases like you you
• 8:15
  mentioned, you know, the ACA, you know, going
• 8:17
  up 18%. Well,
• 8:19
  eight to 10% of that so eight to
• 8:22
  10 points of that is is really due
• 8:25
  to just inflation in health care costs.
• 8:29
  And so, you know, some some you know,
• 8:31
  there there you know, there's some culprits in
• 8:33
  there. Right?
• 8:35
  Drug costs are rising significantly,
• 8:38
  faster than, the medical expenses.
• 8:41
  You know, the advent of GLP ones,
• 8:43
  has been kind of, you know, certainly a
• 8:45
  boon
• 8:46
  to,
• 8:47
  to people who, who are who are overweight
• 8:49
  and have used them for weight loss and
• 8:51
  and lose them to control diabetes and use
• 8:53
  them, but they're also quite expensive. Right? And
• 8:56
  they have and they have and unlike
• 8:58
  many, in fact, unlike almost all
• 9:01
  very expensive drugs that are are segmented to
• 9:04
  a small part of the population,
• 9:06
  you know, GLP ones,
• 9:08
  thirty, forty, fifty percent of the American population
• 9:11
  could potentially be using GLP ones,
• 9:14
  if they chose, right, to,
• 9:16
  due to either diabetes or
• 9:19
  prediabetes
• 9:20
  or, or or obesity.
• 9:23
  And so that is certainly, you know, increasing,
• 9:27
  costs as well. And so we we so
• 9:29
  so we have at its base, at its
• 9:31
  foundation,
• 9:32
  just, you know, a an inflationary
• 9:34
  environment
• 9:35
  in, in health care costs. So health care
• 9:38
  costs, think about medical and prescription combined. Right?
• 9:41
  That that is higher than the past. Right?
• 9:43
  We we were we were kind of in
• 9:44
  a four to 6%,
• 9:47
  health care inflation
• 9:48
  range, and now we're at an 8% to
• 9:50
  10% health care inflation range. But but the
• 9:52
  premium cost increases that you talked about were
• 9:55
  significantly more than that because this is only
• 9:56
  one component
• 9:58
  of of what's called, you know, premium or
• 10:00
  even medical trend, what we call a trend,
• 10:02
  which is different than inflation.
• 10:04
  A number of other things that are happening
• 10:07
  that,
• 10:08
  that the insurance companies are are looking at
• 10:10
  and worried about are things like the enhanced,
• 10:13
  you know, the the expiration of the enhanced
• 10:15
  premium tax credits.
• 10:17
  So the expiration of the enhanced premium tax
• 10:20
  credits, which essentially is going to make,
• 10:23
  health insurance coverage
• 10:26
  less affordable,
• 10:27
  more expensive
• 10:28
  for a significant number of Americans. Right? Because
• 10:32
  they're not gonna get their enhanced premium tax
• 10:34
  credit anymore. And so so their costs are
• 10:36
  gonna go up. And we know what happens,
• 10:39
  especially in an environment where, remember, at the
• 10:42
  beginning of the ACA, there was man you
• 10:44
  know, it was mandatory health coverage. Well, the
• 10:46
  mandatory health coverage has now been repealed. Right?
• 10:49
  We don't have we don't have to have
• 10:51
  insurance in this country. Right? Right. And so
• 10:54
  if health care if health care,
• 10:57
  you know, if if the effective
• 10:59
  cost
• 11:00
  for health insurance goes up, right,
• 11:03
  then you're gonna have more people who opt
• 11:06
  not to have health insurance on the particularly
• 11:09
  on the individual market. And those people who
• 11:11
  opt to have not had health insurance, you
• 11:13
  know, we know, we've seen it historically,
• 11:15
  are gonna be those people who are healthier
• 11:18
  and have less health care expenses. And so
• 11:20
  what that is gonna do is it's going
• 11:22
  to worsen the risk pool. And so the
• 11:24
  risk pool will will get worse,
• 11:27
  because the
• 11:28
  the people who are you know, who have
• 11:30
  lower health care expenses will will opt out
• 11:33
  of the pool because there's no longer
• 11:35
  a mandatory
• 11:36
  requirement to have health insurance.
• 11:38
  And that is going to kind of increase,
• 11:42
  increase costs for everyone who's remaining. And I
• 11:44
  I saw the Keisei Family Foundation estimate that
• 11:47
  that, you know, they think about four points
• 11:49
  of the, of of this, you know, let's
• 11:51
  call it 18%
• 11:53
  is is likely due to, due to just
• 11:55
  that due to the worsening of the health
• 11:56
  pool,
• 11:57
  you know, due to the,
• 11:59
  expiration of premium tax credits. And then we
• 12:01
  have a number of other things that are
• 12:03
  going to,
• 12:04
  make health care costs for, again, the commercially
• 12:08
  insured. So people who get their get coverage
• 12:10
  through,
• 12:11
  their employer or get coverage individually. It'll it'll
• 12:15
  make their cost more expensive.
• 12:17
  The most recent budget bill that was passed
• 12:19
  is gonna reduce,
• 12:21
  reduce the number of people on Medicaid. Right?
• 12:23
  And and people who are who currently are
• 12:25
  on Medicaid, it's gonna substantially reduce them according
• 12:28
  to the, the congressional budget office of CPO.
• 12:31
  Those people are gonna gonna no longer have
• 12:33
  coverage. That's gonna create on more uncompensated care
• 12:36
  for health care providers. And when health care
• 12:38
  providers have a greater level of uncompensated care,
• 12:41
  well, they still have to keep the lights
• 12:43
  on. Right? They still have to pay for,
• 12:45
  you know, for all of their inputs,
• 12:48
  in health care. They have to pay the
• 12:50
  salaries of all their health care providers to
• 12:52
  deliver that great health care that they do.
• 12:54
  And so they have to then shift the
• 12:57
  costs from,
• 12:58
  from this case, kind of uncompensated care into
• 13:01
  the only place they can shift cost to,
• 13:03
  which is the commercial market. Right? You can't
• 13:04
  shift costs in the Medicaid. Those rates are
• 13:07
  pretty much what they are. You can't shift
• 13:08
  costs to Medicare. CMS determines what those costs
• 13:11
  are, what those rates are. So you shift
• 13:13
  the cost to the commercially insured.
• 13:15
  Those are people who are insured through employers
• 13:17
  or insured through their own their own, individual
• 13:20
  insurance. And so that cost shifting
• 13:22
  is gonna increase,
• 13:24
  increased costs as well. And that's the thing
• 13:26
  that, you know, the insurance companies are trying
• 13:28
  to predict what you know, how much cost
• 13:30
  shifting is gonna occur over the next, you
• 13:33
  know, year or so,
• 13:35
  you know, due to due to that. And
• 13:36
  then then I think another you know? And
• 13:38
  then there's, you know, even even maybe little
• 13:41
  in quotes things like like tariffs are gonna
• 13:43
  increase input cost. Right? I mean, you know,
• 13:45
  the tariffs that are starting to come in
• 13:48
  now are gonna increase the input costs for
• 13:50
  health care providers in a variety of ways,
• 13:53
  and then they, in turn, have to increase
• 13:55
  their costs above, let's say, a regular inflation
• 13:58
  rate,
• 13:59
  in order to, you know, financially survive. So
• 14:02
  we have, like,
• 14:04
  four or five things all hitting us at
• 14:05
  the same time, which is the which is
• 14:08
  resulting in that, you know, like you said,
• 14:10
  maybe 15 to 20% increase Yeah. In premium,
• 14:13
  which is a combination of all these different
• 14:15
  things. But is it is it a foregone
• 14:17
  conclusion at this point, Alan, that the enhanced
• 14:19
  subsidies will not be extended? I mean, what
• 14:21
  are you hearing both within the industry among
• 14:24
  lawmakers?
• 14:25
  Is this where we should be operating from
• 14:28
  at this point?
• 14:29
  Yeah. I I think the general consensus
• 14:31
  is that they will not be extended because
• 14:33
  the extension is just too expensive. Yeah. I
• 14:36
  mean, look. We we we just passed a
• 14:38
  budget bill that radically increases
• 14:41
  our
• 14:41
  our deficit. Right? According again, not to me.
• 14:44
  It's not a political statement at all. Kind
• 14:46
  of the congressional budget bills, the CBO. The
• 14:48
  CBO
• 14:49
  scores all these things in a very, you
• 14:52
  know, nonpartisan,
• 14:53
  you know,
• 14:55
  mathematical way. Right?
• 14:57
  We are going to,
• 14:59
  increase
• 15:00
  our deficit. And so I think anything
• 15:02
  you know, after kind of the passing of
• 15:05
  the most recent budget bill, anything that's gonna
• 15:07
  increase
• 15:08
  cost to to our government, which doesn't have
• 15:10
  the money to pay it. Right? Increasing deficits
• 15:12
  mean very simply. Right? We don't have the
• 15:15
  money to pay for these things, so we're
• 15:17
  gonna take out more debt. Right? Yeah. I
• 15:19
  think it's gonna be very hard,
• 15:21
  you know, to to get anything passed that
• 15:24
  is going to,
• 15:25
  significantly
• 15:26
  increase,
• 15:27
  our federal deficit. Yeah. So I would not
• 15:30
  bet that the enhanced premium tax credits will
• 15:34
  will be extended Sure. Because we're just not
• 15:36
  in a place right now in this country
• 15:38
  where it's gonna be easy to increase government
• 15:42
  spending. Yeah. 100%. And, you know, it's interesting.
• 15:44
  We've been seeing some,
• 15:46
  industry analysis online from executives at health plans
• 15:49
  saying that just this year alone, these subsidies
• 15:51
  have cost over a $130,000,000,000
• 15:53
  in one year. And that's that is way
• 15:55
  over what the CBO had previously estimated, which
• 15:58
  is around 330,000,000,000
• 15:59
  in a decade. So to your point, just
• 16:02
  an extreme amount of money that these subsidies
• 16:04
  are costing.
• 16:06
  So, okay, the subsidies aren't extended.
• 16:09
  Ultimately, what does that mean for the stability
• 16:11
  of the ACA market? What happens
• 16:13
  to to this segment moving forward?
• 16:16
  Well, you know, unfortunately, you you we we
• 16:18
  could see the ACA market get into, you
• 16:20
  know, real a real death spiral. Right? Which
• 16:23
  is,
• 16:24
  so, again, the elimination
• 16:26
  of the PTCs,
• 16:28
  again, increases the effective.
• 16:30
  Right? Not the the gross premium is
• 16:33
  let's say let's just use simple numbers. Let's
• 16:35
  say an insurance company is charging $600 a
• 16:38
  month. That's gross premium.
• 16:39
  But now let let's imagine that an individual
• 16:42
  is getting a $200,
• 16:44
  you know, credit. Right? So the effective premium
• 16:47
  for that individual is $400.
• 16:49
  But if that credit goes away, now the
• 16:51
  effective premium of that individual is $600.
• 16:54
  Well, this individual made a buying decision
• 16:57
  with four with a $400 cost. Is that
• 16:59
  insurance worth the $400
• 17:01
  cost? Right?
• 17:03
  Now now this individual is gonna have to
• 17:05
  buy make a buying decision. Is that insurance
• 17:07
  worth the $600 cost? And and we know.
• 17:09
  You know? Look. Look.
• 17:11
  This is you know, there's there's real elasticity
• 17:13
  in this market. As costs go up,
• 17:17
  less there's less people who purchase it. Right?
• 17:19
  More people make the decision to say, you
• 17:21
  know what?
• 17:22
  I'm I'm not gonna buy health insurance. Again,
• 17:24
  you know, this this all would be very
• 17:26
  different if we were still in a mandatory
• 17:28
  insurance environment,
• 17:30
  you know you know, right after the passing
• 17:32
  of the ACA. But since that has been
• 17:34
  repealed,
• 17:35
  we we now it is not a law
• 17:37
  that you need to have insurance. And so
• 17:40
  you'll have a segment of the population
• 17:42
  who opts not to have insurance. And it
• 17:44
  and, you know, I think, you know, there's
• 17:45
  good industry analysis
• 17:47
  on on, you know, on on projections on
• 17:49
  what that segment of the population is, and
• 17:51
  it's significant. Right? There's a significant number of
• 17:53
  people who opt not to have insurance, and
• 17:56
  what that will do is that will worsen
• 17:58
  the pool. And so what the insurance company
• 18:00
  is trying to do now is predict
• 18:03
  what that kind of what that pool what
• 18:05
  that pool is gonna worsen to. Right? Because
• 18:07
  what you have again, let's just use, you
• 18:09
  know, simple numbers. I don't I'm not I'm
• 18:12
  not claiming that these were these is what
• 18:14
  this is exactly what's gonna happen. But let's
• 18:15
  say 10% of the people who are buying
• 18:18
  individual insurance now opt to not to have
• 18:20
  individual insurance because of the of the,
• 18:23
  because of the lack of the PTCs.
• 18:26
  We know that
• 18:27
  that that that on average, those people who
• 18:29
  opt out of insurance,
• 18:31
  coverage are a significantly healthier population than the
• 18:35
  me. Right?
• 18:36
  And so what you've done now is the
• 18:39
  remaining, in this case, 90%,
• 18:42
  have higher
• 18:43
  average health care expenses. You you essentially worsen
• 18:46
  that pool. Right? And so now,
• 18:49
  the premium need to cover those expenses
• 18:52
  is higher. Right? And what that'll create is
• 18:54
  another cycle of people who say, well, now
• 18:56
  that the price goes from $600
• 18:58
  to
• 18:59
  $700
• 19:00
  because it's a worse pool, well, that's a
• 19:02
  whole another segment of people who will decide,
• 19:04
  I don't need to have coverage. Right?
• 19:07
  And you can get into, again, what's called
• 19:08
  death spiral,
• 19:10
  where as the costs keep going up, you
• 19:13
  have less and less people opting for coverage.
• 19:15
  And every time you lose people, in this
• 19:18
  case, you're losing people who are on the
• 19:21
  on on average. Again, not every one of
• 19:23
  them. There's always gonna be someone you lose
• 19:24
  that all of a sudden has a medical
• 19:27
  expense. But on average, you're lose you're losing
• 19:29
  people who have lower health care expenses, which
• 19:32
  again worsens your pool, which cause you to
• 19:34
  increase your rates again. Right. So it could
• 19:36
  get into a death spiral where we're really
• 19:39
  seeing a smaller and smaller pool of people
• 19:41
  buying coverage
• 19:43
  that that is essentially a riskier and riskier
• 19:45
  pool with higher and higher premium rates. Absolutely.
• 19:49
  So you've got this smaller pool. You've got
• 19:51
  millions peep of people uninsured that were previously
• 19:53
  not. What does that mean for a company
• 19:56
  like Scentivo, Alan?
• 19:58
  So so, again, at Scentivo, I and I
• 20:00
  I think that
• 20:01
  and what we do is really try to
• 20:04
  take a a kind of different a different
• 20:06
  path to say that if we can just
• 20:08
  keep doing the same things that we're doing
• 20:10
  in kind of health coverage,
• 20:12
  we're just gonna be all running off this
• 20:14
  cliff. Right? And so what I think that
• 20:16
  every, you know, company has to think about,
• 20:18
  what every individual has to think about if
• 20:20
  they're purchasing individual insurance is
• 20:22
  how is your health coverage provider
• 20:25
  thinking about controlling
• 20:27
  costs
• 20:29
  this year, but also five years, ten years
• 20:31
  down the line? And so what we do
• 20:33
  at Sentivo
• 20:35
  is we we build,
• 20:37
  plans that are called high performing. They're plans
• 20:40
  that will
• 20:42
  increase at a
• 20:43
  significantly lower first of all, they save money
• 20:46
  right away, and then they increase at a
• 20:48
  significantly lower rate than,
• 20:50
  you know, than kind of, let's say, general
• 20:52
  regular
• 20:53
  insurance coverage. Right? Well, why? Because we work
• 20:56
  with providers who themselves are high performing. These
• 20:59
  accountable care organizations or clinically integrated networks who've
• 21:02
  been designed
• 21:04
  to really kind of meet the aims of
• 21:06
  health care. You know, they they they're designed
• 21:07
  to improve the patient experience, to improve the
• 21:10
  health of the population, to reduce
• 21:13
  the total cost of care health care in
• 21:15
  the future and to reduce inequities of health
• 21:16
  care. And so we build our networks around
• 21:20
  high performing providers, organizations like, you know, like
• 21:24
  Mount Sinai here in New York, like Orlando
• 21:26
  Health in in, in in, in Florida, like
• 21:29
  Bowers, Scott and White in Texas,
• 21:32
  like MoroCare in California. These are organizations that
• 21:35
  are delivering high quality, cost effective healthcare. And
• 21:38
  we build our networks exclusively around them, really
• 21:40
  allowing them to be accountable
• 21:42
  for all the care in their
• 21:45
  geographic footprint. And then what we also do
• 21:47
  is we make sure that people, that members,
• 21:50
  you know, that you know, think about you
• 21:51
  know, we work with employers. So an employer
• 21:54
  has employees that become our members, that become
• 21:56
  our health care partners' patients, but they're the
• 21:58
  same person. Right? Here's an employee or a
• 22:00
  member and a patient. Well,
• 22:03
  what these, what these members do is they
• 22:06
  align themselves with,
• 22:07
  with high quality advanced primary care providers,
• 22:11
  like patient centered medical homes that are part
• 22:13
  of these clinically integrated networks and ACOs
• 22:16
  that really can organize
• 22:18
  and coordinate their care throughout their their kind
• 22:21
  of health care journey. And really have have
• 22:24
  the organization. Again, this this these are teams
• 22:27
  of people, you know, health you know, primary
• 22:29
  care teams who are really thinking about the
• 22:31
  health of the population that they're managing, thinking
• 22:33
  about their each of their patients journey, providing
• 22:36
  patient centered,
• 22:38
  high quality cost effective care. And they're going
• 22:41
  to help manage that health care,
• 22:43
  you know, through the person's lifetime.
• 22:45
  And we firmly believe and we've seen now
• 22:47
  for over five years of experience
• 22:50
  that building building networks with these great health
• 22:53
  care providers and making sure that every member
• 22:56
  has a, you know, patient centered medical home
• 22:59
  level,
• 23:00
  advanced primary care team
• 23:02
  that is patient centered and really kind of
• 23:05
  quarterbacking and coordinating their care, not only does
• 23:08
  that significantly reduce cost right away, like, right
• 23:10
  away, like, next, you know, next year, but
• 23:13
  more importantly,
• 23:14
  it also
• 23:15
  improves the health of the population,
• 23:17
  which
• 23:18
  reduces costs in the future. And, again, we
• 23:20
  work with with employers,
• 23:22
  and so it is, you know, it is,
• 23:24
  you know, it is people work for companies
• 23:26
  and their family members. We've seen,
• 23:30
  you'll see hypertensive control go up significantly, diabetic
• 23:33
  control go up significantly,
• 23:35
  early cancer detection significantly increase. And all these
• 23:38
  things, you know, they bend the curve. Right?
• 23:41
  And so these you know, by by making
• 23:44
  sure that the population is you know, the
• 23:46
  population of people are as healthy as they
• 23:48
  can be and really, you know, watching out
• 23:50
  for them, we can reduce the long term
• 23:52
  cost of health care by working with these
• 23:54
  wonderful health care providers that we partnered with.
• 23:57
  And what we do is we do we
• 23:58
  do what's called a value based contract with
• 24:00
  them, where instead instead of getting paid for
• 24:02
  every little teeny unit of care, you know,
• 24:04
  we really work a, a value based arrangement
• 24:07
  with them, which is as they deliver greater
• 24:09
  value,
• 24:10
  they they earn they earn great rewards for
• 24:12
  that. And so it's it's really you know,
• 24:14
  because, like, health care transformation can't happen without
• 24:16
  health without payment reform. And we're trying to,
• 24:19
  you know, with our health care partners, kind
• 24:21
  of lead that payment reform to a pay
• 24:23
  for value approach as a pay for, like,
• 24:25
  each unit of of care. But that only
• 24:27
  works if you're really working with these types
• 24:29
  of health care providers that have organized themselves
• 24:32
  in a way that they can deliver high
• 24:34
  value care and also really giving them that
• 24:37
  kind of control
• 24:38
  like we do by building our networks really
• 24:40
  exclusively around that. And so and so that's
• 24:43
  the way, you know, our approach
• 24:45
  to, you know, to fighting this problem with
• 24:47
  rising health care costs. And what I would
• 24:48
  say to,
• 24:49
  you know, to to health care providers out
• 24:52
  there is to find organizations
• 24:53
  kind of like us that are that are
• 24:56
  really trying to work with the health care
• 24:58
  providers
• 24:59
  to really, yeah, to
• 25:01
  to meet those aims that we all have
• 25:03
  the same aims. Right? We improve the patient
• 25:05
  experience,
• 25:06
  improve the population,
• 25:08
  the the health the health of the population,
• 25:10
  reduce the total cost of care, reduce inequities.
• 25:12
  We we're all on the same side. So
• 25:14
  health care providers
• 25:15
  should find organizations like us to work with,
• 25:18
  and employers should demand
• 25:21
  for for their providers of health coverage that
• 25:23
  they have a real viable long term strategy
• 25:27
  to to make sure that their employees and
• 25:30
  their family members are gonna have have access
• 25:32
  to high quality health care that is gonna
• 25:34
  be affordable now and affordable in five years,
• 25:37
  ten years, and forever.
• 25:39
  Fantastic. Well, Alan, take one minute.
• 25:42
  Talk to our audience. Give us your last
• 25:44
  bits of advice, all the health plan leadership
• 25:46
  listening in from all over the country.
• 25:49
  Last parting words you wanna share with them?
• 25:51
  I'd say we gotta change.
• 25:53
  I mean, you know, it's
• 25:56
  we are and I know it it it
• 25:58
  kind of becomes an old saw. It's like,
• 26:00
  well, you know, health care costs are going
• 26:02
  up so much. At some point, it's gonna
• 26:03
  break.
• 26:04
  It's going to break. And so we need
• 26:07
  to change. You know, we if if we
• 26:10
  are unhappy
• 26:11
  with,
• 26:12
  with with the cost of health care and
• 26:14
  maybe the unequal delivery of health care in
• 26:17
  this country,
• 26:18
  we need to look at ourselves in the
• 26:19
  mirror. And we're the ones in the industry,
• 26:21
  and we're the ones who've created this. And
• 26:23
  so we're the ones who need to change
• 26:24
  it. And so, you know, challenge
• 26:27
  the status quo,
• 26:29
  you know, work with health care per health
• 26:31
  care providers
• 26:32
  and and and, you know, health insurance companies
• 26:36
  or health plan administrators need to work together
• 26:38
  to solve this problem. And we cannot accept
• 26:41
  the status quo because the status quo has
• 26:42
  taken us right off a cliff.
• 26:45
  Alrighty. Good stuff. Alan, thank you very much
• 26:47
  for taking the time to be with me
• 26:48
  on the podcast, for sharing your insights with
• 26:50
  our audience. We really appreciate it.
• 26:52
  Thank you very much, Jacob. This was this
• 26:54
  was really fun for me too, and and,
• 26:56
  and hopefully, it was, it it'll be very
• 26:59
  useful for all the listeners. Yeah. I definitely
• 27:01
  think so. To our listeners, if you wanna
• 27:03
  listen to more podcasts from Becker's Healthcare, you
• 27:05
  can visit beckershospitalreview.com.