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Where Payer Strategy Meets Execution With Benefitbay CEO Brandy Thompson · Becker’s Healthcare 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 Health Care Podcast.
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  I'm Scott King. Thrilled today to be joined
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  by a very special guest who's speaking with
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  us at our spring payer issues roundtable, and
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  that's Brandy Thompson, chief executive officer of Benefit
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  Bay. Brandy, how are you doing today? Thanks
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  so much for joining us.
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  I'm doing great, Scott. Thanks for having me.
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  Always a pleasure. Of course. And, you know,
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  we have a lot of big topics, to
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  dive into here with with health plans and
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  and health care. But before we do that,
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  I was wondering if you please just share
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  a little bit about your background and your
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  career journey.
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  Yeah. Absolutely.
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  I am the CEO and cofounder at Benefit
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  Bay, and my career journey was up through
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  operations and finance. I've got an undergrad in
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  accounting and a master's degree in business administration
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  with a major in finance there as well.
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  I was really motivated
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  to solve health care challenges from being in
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  that operations and finance seat,
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  knowing that your people are,
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  you know, tackling
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  their work life balance, their families, everything, that
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  they're tackling, but also tackling what the employer
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  and the business needs to tackle from, being
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  able to afford benefits
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  and then being able to control those outcomes.
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  And so health care really meets at the
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  intersection there, and that's what brings the passion
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  for Benefit Bay and what we do here
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  in trying to make an impact in defining
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  contribution for employers
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  and be the enabler for the broker consultant
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  to provide that consultant of value to their
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  client.
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  Thanks, Brandy. I appreciate you giving that background
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  info and and sharing the mission there of
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  Benefit Bay. And the first topic I wanted
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  to get to
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  is how are your relationships with providers changing,
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  you know, as both sides
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  face cost pressure and workforce shortages?
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  Yeah. I mean, that's been a real pivotal
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  change for the payer side. I think there's
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  two things that are crossing at this intersection,
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  which is that there is
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  wild adoption in individual coverage, health care reimbursement
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  arrangements out there in the market. So they've
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  got cost pressures to service individual policies for
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  employer groups.
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  And that side of the house may not
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  have had as much technology investment in the
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  past. So what we've seen is that
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  the relationships are really growing with the providers
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  because they are facing administrative cost pressures,
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  and they also have workforce shortages.
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  So they have to invest in the technology
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  outcomes to improve the member experience.
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  We've seen a lot more motivation from the
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  payer side to do that, and we've also
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  seen the payers motivated
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  to ensure that they're integrating direct so that
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  they're not driving up the cost of that
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  individual product or that plan
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  administration.
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  Yeah. You know, it's it's been an interesting
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  week. I've I've been speaking with some providers
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  and some payers, and it seems like just
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  with regulatory pressures on both sides,
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  people are just kind of both coming to
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  the table and then on both sides and
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  and being like, you know, like, we're going
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  through this pressure. I know you're under that,
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  and they're like, let's just try to get
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  something done. Is that kinda what you're seeing
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  too? Is, you know, maybe there is a
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  little more compromise right now just because everybody's
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  up against so much. Yeah. I just think
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  there's a motivation to solve the problem. I
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  think there hadn't always been a willingness to
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  face that
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  the legacy technology was causing a problem, that
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  the way we've always done health care was
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  causing a problem,
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  that all of the additional administrative barriers that
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  were created and pre auths and various processes
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  were causing provider and access to care challenges.
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  And I think there's enough of
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  just a momentum
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  overwhelming across all aisles, across all pieces to
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  say, we've gotta be able to do this
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  better. Come on. We're smart people. Let's solve
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  these problems.
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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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  So I think in that same
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  I think in that same breath, I've seen
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  a lot of momentum. I've seen a lot
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  of excitement.
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  But where the,
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  payer execution
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  is still
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  especially in our industry, in our side of
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  the aisle is
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  carriers, they'll they'll develop a strategy a couple
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  of years ahead. And so the execution just
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  isn't there where the market momentum is at
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  the time. So there's still a lot of
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  those pain points. So we know they have
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  the investment. We know they have the right
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  ideas. We know their executives are coming to
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  the table,
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  but they move like such slow cruise ships.
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  So so to turn and move the iceberg
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  is not something that they can do. And
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  so we're we're constantly taking on ice and
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  taking on water, right, due to the, speed
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  at which these payers can move. I think
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  operational
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  execution, I think they're they're dealing with,
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  you know, it's it's tough recruiting environment to
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  recruit talent into health insurance or
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  into any of the, payer side or provider
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  sides of health care due to all of
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  the things that are they're facing. So being
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  able to have the right resources to solve
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  the problem and to do it quickly
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  is, I think, two of the things that
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  are not aligned. The strategy is starting to
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  get there. The ability to execute the the
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  operational strategy on time where the market's
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  Absolutely. You don't just need the right strategy
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  or solution. You need that that quick execution
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  these days.
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  Yeah. Something else something else I wanna ask,
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  Brandy, is what's one investment or initiative you
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  believe will most reshape how health plans operate
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  over the next two to three years?
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  Yeah. I think I I think an investment
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  in, one, taking a look at their compliance,
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  narratives.
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  I I believe there's still a lot of
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  administrative mindset or long tenured
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  individuals inside the payer systems that believe they
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  have to receive a fax. Right? And so
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  taking a look at some of that older
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  mindset, looking at where is the compliance, where
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  does it really sit, is there a way
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  that we can do this in a more
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  effective manner that's less administrative
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  lift on all parties and that can be
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  executed,
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  operationally efficient.
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  The other thing I think is is gonna
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  make a difference is an ability to recruit
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  top talent into this space that wanna solve
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  this problem with the right motivators.
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  And
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  I think that will
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  overwhelmingly reduce the cost of delivering health care
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  or at administrating at the payer side.
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  If you could change to one regulatory or
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  industry practice tomorrow, so very, very quickly, very
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  soon, to improve, affordability and access, what would
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  it be and why?
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  It this is gonna be a little self
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  serving, but I would correct the lowest cost
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  silver affordability guidelines. Do not be on the
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  on exchange product that could be heavily regulatory,
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  and changed,
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  which is what we experienced recently, and have
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  that be on
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  in a way that it could be charged.
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  The affordability could be calculated on the off
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  exchange silver product for the employer that would
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  move speed to quote in this environment. It
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  would also
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  accelerate a pace for employers to be able
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  to make decisions
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  and make choice available to their employees and
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  drive consumer accountability and health care decisions
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  with those employer dollars and with their own
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  dollars that are coming out of their paycheck.
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  And the last thing I want to ask
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  you, Brandy, what issue is putting the most
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  pressure on health plan margins right now, and
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  how are you responding differently to that, this
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  year in 2026?
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  Yeah. I think for health plans, overwhelmingly, there's
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  just there's 10 people in the food chain
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  before access to care is even there. So
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  Yeah. The the provider of the care, so
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  the physician, you know, they've done years of
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  medical school, and they wanna be able to
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  provide the right
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  outcome for their patients, and they're driven by
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  the right motivators.
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  However, they have to see a huge number
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  of patients. They have to follow a set
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  of rules to even be,
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  getting that pre authorization to be able to
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  provide that care to their individual patient. So
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  those providers
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  or those payers
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  need to be able to deliver those answers
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  quicker. And I don't think AI is the
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  answer. We've seen a lot of incorrect denial
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  rates and and and a lot of, items
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  that have caused risk there. I think what
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  we need to do is get out of
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  our own way in some of those routine
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  care
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  access challenges. I think the health plan margins
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  are for any health plan to grow. They
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  I I heard the stat at Becker's Healthcare,
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  and I I would misquote it if I
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  tried to quote it right now. But it's
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  it's basically they've gotta grow by three admins
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  for every x, you know, percentage of the
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  health plan growth, and that's because of the
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  lack of efficiency and operational efficiencies in the
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  system. I think the other thing we've gotta
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  stop doing is inserting middlemen into all of
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  the processes.
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  So one of the things that we we
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  do here to remove that pressure is make
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  sure that we're going direct to the health
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  plan. So the techno our technology connects direct
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  to that health plan,
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  and we are remitting
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  directly to that health plan. And so reconciliation
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  can help in between those same two parties
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  who are accountable.
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  When you insert multiple people into the food
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  chain or into the cost of service, you
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  have multiple break points. You also have a
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  cost for each one of those solutions,
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  and so that drives up the cost. In
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  most instances, it's ten to fifteen percent in
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  all of the people that are receiving some
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  portion
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  out of that health care plan that hasn't
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  doesn't have anything to do with the access
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  to care for the member. And so I
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  think that those are the those are the
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  pressures they're receiving.
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  That's what's affecting the margins and their ability
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  to respond
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  and respond quickly and have the talent at
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  the table to deliver a less administrative outcome
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  that is still meeting compliance
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  and think outside of the thirty year box
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  that that has been built around the payer
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  system is gonna be how we improve those
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  margins and we improve access.
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  Well, Brandy, thanks so much for sharing your
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  great and and unique perspective with us. It
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  was awesome to have you on the podcast.
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  It was a wonderful conversation. Look forward to
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  you speaking with Becker's, in April.
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  Yeah. I'm looking forward to it, and I
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  can't wait to hear from, more health plans
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  that are looking to solve the problem. Thought
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  sharing is how we're gonna solve this problem.