Latest / Becker’s Payer Issues Podcast / Rethinking Employer Health Plans for Affordability with Jeff Bak

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Rethinking Employer Health Plans for Affordability with Jeff Bak · Becker’s Payer Issues Podcast

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  This is where health insurance leadership comes together.
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  Becker's fourth annual spring payer issues roundtable brings
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  together over 400
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  payer and health plan executives and more than
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  100 speakers to Chicago April.
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  This year's event includes keynote conversations with the
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  industry's top leaders and former president George w
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  Bush. For the full agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right. We're looking forward to hosting you
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  here in Chicago.
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  Hello, everyone. Welcome to Becker's Healthcare Podcast. I'm
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  Scott King. Thrilled today to be joined by
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  a very special guest, Jeff Beck, president and
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  chief executive officer with Imagine three sixty. Jeff,
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  how are you doing? Thanks so much for
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  joining us. Appreciate it. Yeah, Scott. Thanks for
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  having me. Looking forward to today.
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  Yeah. You know, we have a lot of
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  big topics to get to in in health
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  care and with health plans,
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  specifically here with you. But just wondering before
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  we get to all that, if you can
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  please tell us a little bit about your
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  background and your, career.
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  Yeah. You know, I'm a bit of a
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  lifer in health care. I've been doing it
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  for thirty years,
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  you know, twenty years or so in in
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  the private equity framework working for,
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  and with PE firms to help companies grow
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  and and,
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  improve
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  the services they're providing the industry.
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  And the past, seven years, I've been working
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  with what is Imagine three sixty,
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  where the mission is we're trying to help
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  American families afford, you know, group health care.
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  And, you know, we we exist because we're
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  super innovative on trying to figure out ways
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  to do that more affordably
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  without sacrificing
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  the member's experience. And so,
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  a lot of evolution,
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  a a lot of things that we've put
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  together to try to make all that come
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  to fruition. And and, we're we're having some
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  nice growth, and so we're pretty optimistic about
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  the future.
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  I appreciate you sharing your background information there,
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  Jeff, and great news about the growth.
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  Just first thing I wanted to ask you,
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  how are your relationships
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  with providers changing as both sides face cost
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  pressure and workforce shortages?
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  Yep. You know, for us, we're we're,
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  we're pretty predictable on what we reimburse
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  the the providers.
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  We we use a formulaic approach so they
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  know what they're gonna get paid.
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  We pay timely,
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  and we also have a high percentage of
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  all the members and employees that we work
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  with who who pay their deductibles and out
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  of pockets. And so in our book of
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  business, there's not a big chase factor.
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  And I think those three things kinda combined
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  make for
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  a a a good relationship starting point. Not
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  to say that we don't have, on occasion,
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  providers that wanna get paid a little more.
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  We do. But,
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  on par, you know, 97
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  plus percent of the time,
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  we we feel like we're delivering real good
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  value, and we're doing it quickly,
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  and everybody seems to be in a good
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  spot.
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  Where do you see the biggest gap today
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  between payer strategy and operational execution?
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  Yeah. You know, I I think in in
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  in the employer
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  sponsored health care arena,
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  there's just a lot of
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  limitations,
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  on what's available. And and, you know, I,
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  we've done a lot of thinking on this,
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  and I I kind of equate it to
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  you know, we'd all like to
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  drive a Range Rover. Right? It's a beautiful
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  car. It works great. Looks good in the
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  driveway,
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  but it's an expensive proposition. It's not for
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  everybody. And I think the
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  the way most employer benefit plans have been
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  created
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  is every everybody gets a a a Range
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  Rover,
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  you know, a broad panel PPO,
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  tons of choice,
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  but it's expensive.
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  And so our
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  idea is can we
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  can we narrow, right,
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  the the number of,
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  points of care and access? Still still citing,
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  you know, high quality,
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  sites of care,
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  and and and try to reduce the cost
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  so that an employee who may be not
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  be making
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  a lot of money can afford
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  to first, you
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  know, afford the coverage, right, with their contributions.
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  And can we put in a reasonable amount
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  of out of pocket,
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  before they can
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  use their plan,
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  you know, like a co pay or a
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  much smaller deductible level? Because what we're seeing
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  is it's very expensive.
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  Not everybody can afford it. And then when
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  it come times to use it,
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  people aren't using their plan because there's a
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  barrier to entry, which is a high deductible
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  and a lot of out of pocket costs.
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  And it's just not good long term for
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  the industry.
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  And so we try really hard to make
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  those two things work well,
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  for members.
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  Do do you think it might be kind
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  of a long battle in addressing those limitations
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  that you mentioned with the employee health plans?
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  I I don't think so. I you know,
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  I we're having success today. We're seeing good
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  adoption.
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  We're getting more done with carrots than we
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  are with sticks. So employees and their families
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  really appreciate
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  lower dollar access,
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  to care.
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  And,
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  you know, we'll take we'll take guidance, and
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  and and we'll take some steerage
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  and ask the question, you know, if I've
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  got four or five hospitals to choose from
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  in town
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  and, you're telling me hospital a and b
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  are somewhat of equal quality,
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  and hospital a has nearly no out of
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  pocket, and hospital b's got a 5,000, I'm
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  going to hospital a. You know? And I
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  think people are asking for that type of
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  data
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  and that type of design point
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  in order to kinda reduce the overall cost.
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  And, you know, with our solution,
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  we off it's you know, for smaller employers,
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  maybe we'll replace what's historically been,
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  you know, the broad panel PPO from BUCA.
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  With larger employers,
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  they're not gonna replace everything
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  overnight. What they will do, though, is they'll
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  bring our solution in as as a,
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  you know, as an alternative
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  option,
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  so call it a dual option,
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  where
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  employees can choose with their wallets and with
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  their comfort level and and decide which plan
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  they wanna have at open enrollment typically with,
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  quite a bit of savings and maybe a
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  little less choice. But, you know, that that
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  trade off has to happen if you're gonna
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  save some money in health care.
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  What's one investment or initiative you believe will
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  most reshape how health plans operate over the
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  next two to three years?
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  Yeah. I you know, I'm a big proponent
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  that when you bring together
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  as many as the pieces of the car
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  or, you know, as many of the parts
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  of the car as possible
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  and can talk through,
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  you know, an entire end to end solution.
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  And that end to end solution
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  has its primary objective and goal of trying
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  to
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  save as much as you can for each
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  is each of the pieces and parts, whether
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  that's
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  how you administer it,
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  whether that's your narrow network strategy or your
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  out of area RVP strategy,
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  you know, whether that's a pharmacy benefit solution
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  that's transparent
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  and doesn't wanna take any, skin from the
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  rebates.
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  Like, the objective is if you can put
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  that together and get a compelling value proposition
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  that says it's turnkey,
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  you're gonna save 25 or 30% over what
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  you're spending right now. And and good news,
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  there's kind
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  of one quarterback
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  for all your needs, whether that's a clinical
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  need
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  or a make an appointment need
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  or just a general question about I need
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  my ID card.
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  The the ability to control the member experience
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  when you have all those pieces and parts
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  together
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  and your main objective has been what's the
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  lowest common price denominator we can pea we
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  could put together and put that in a
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  package
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  and then just service the heck out of
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  it and make members really feel like,
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  they they came to the right spot, and
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  you're gonna be really prescriptive on where to
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  use care
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  and and as importantly, be there when they
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  need you from a clinical perspective.
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  You know, it's gone a long way. I
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  think the other thing I would say quickly
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  is, you know,
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  being able to build enough trust with employees
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  and their families
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  over the course of a year
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  where you could reach back out to them
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  and say, you know, you're getting this particular
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  specialty drug at a site that is five
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  times more expensive than doing it at another
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  site, and they're both in your community.
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  You could save some money. The employer and
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  plan could save some money.
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  You know, will you trust us on this
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  one and make the change? And so getting
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  permission and building trust to be able to
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  have a conversation about changing site of care
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  is critically important. Not everybody can do it.
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  We we feel like it's one of our
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  specialties, and I think that's another big thing
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  that we're gonna
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  see as a reshape,
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  in the future.
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  Absolutely. And you mentioned a lot of great
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  ways to to serve members there as well.
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  And, Jeff, if you could change one
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  regulatory
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  or industry practice tomorrow to improve affordability and
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  access? What would it be and why?
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  You know, it this is a bit self
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  serving,
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  and maybe a more more narrow answer than
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  you might get from another health plan. But,
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  like, we don't enjoy the benefit of, brand
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  recognition, at least not yet.
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  And so when you're not, a Blues logo
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  on a card or, you know, a UnitedHealthcare,
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  on the front door,
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  you really need to fight for, mental shelf
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  space, and you need to really help the
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  brand what it is we're trying to do.
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  And a lot of brokers who do all
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  of our selling, right, we're a broker driven
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  business,
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  have a misconception
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  about Imagine three sixty or what I'll say
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  alternative health plan solutions.
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  We did a we did a a broad
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  survey,
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  reached out to hundreds of brokers with a
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  third party,
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  and and the the reveal was that
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  a lot of brokers
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  think they know what an alternative health plan
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  is that uses reference based pricing. But when
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  you ask them to cite a few basic
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  statistics,
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  they'll say things like, well, they probably only
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  save five or 10%,
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  and you're gonna get balance bills, you know,
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  50% of the time,
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  and you can't access
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  the facilities
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  and the doctors you wanna access.
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  And when we tell them today's facts, which
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  are, hey. 97%
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  of the time,
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  providers accept the reimbursement.
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  And 99%
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  of the time, you can see the provider
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  you want to see,
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  and you don't save five or 10. You
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  save 20 or 25, and we'll guarantee it.
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  The the the broker sentiment changes
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  almost immediately to, yeah, I do that tomorrow.
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  And it's our job to figure out how
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  we get that message out there
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  and to make sure that that's what people
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  are hearing because if they're if they're not
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  hearing it and believing it, they're not gonna
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  take it to their employers.
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  The last thing I wanted to ask you,
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  Jeff,
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  what issue is putting the most pressure on
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  health plan margins right now in your eyes,
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  and how are you responding differently in 2026?
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  Yeah. I mean, we're
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  we're trying to,
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  be really
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  mindful of the fact that we're not asking
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  people,
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  to do anything we wouldn't do ourselves. We're
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  we're on our own health plan.
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  All of our 1,600 employees use the Imagines
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  three sixty approach.
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  We've got hundreds of thousands of other employees
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  and,
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  you know, hundreds of referenceable clients that are
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  doing it as well,
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  and they all have a member experience that
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  they would tell you is better than average,
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  better than the average market.
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  We have thing like you know, we we
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  track a lot of stuff. NPS score is
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  at 78%.
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  Member satisfaction,
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  on any call that we take 98%
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  with a savings that's really material. And so
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  we think that
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  pairing those two things,
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  really pro really creates for us a a
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  differentiator in the market, and I think it
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  allows people to get the best of both
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  worlds, an experience you can be proud of
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  and savings you can bank. In fact, we
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  guarantee our savings so that if we don't
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  meet the numbers
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  that we've all committed to,
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  we make you whole on that dollar for
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  dollar. And so it it it's not something
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  you have to take a leap of faith
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  on. It's something you can take to the
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  bank.
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  Jeff, thanks for joining the podcast and for
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  a great conversation. I look forward to working
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  with you again soon. Yeah. Likewise. Thanks for
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  the time.