Latest / Becker’s Healthcare Podcast / Rob Andrews, Chief Executive Officer of the Health Transformation Alliance

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Rob Andrews, Chief Executive Officer of the Health Transformation Alliance · Becker’s Healthcare Podcast

0:00
Hi, everyone. This is Elizabeth Caslow with the
0:02
Becker's Payer Issues podcast.
0:04
I'm thrilled today to be joined by Rob
0:06
Andrews, chief executive officer of the Health Transformation
0:09
Alliance. Rob, thank you so much for joining
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us today. Thank you, Elizabeth. It's good to
0:13
be with you again.
0:14
Yeah. So before we jump in, can you
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just fill in our audience, tell us a
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little bit more about yourself, your career background,
0:22
and your role at the Health Transformation Alliance?
0:24
I've been really fortunate to have a chance
0:27
to see health care from a lot of
0:28
perspectives.
0:30
I served in the US House of Representatives
0:32
for twenty four years
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and was very much involved in helping to
0:37
write and implement the Affordable Care Act. So
0:39
I saw the problem through the eyes of,
0:42
my constituents and a policymaker.
0:45
I was helped to form
0:48
the HTA eleven years ago. The HTA is
0:50
a coop
0:52
that's owned by more than 80 large US
0:54
employers,
0:56
and we bargain collectively in the marketplace to
0:58
try to get better outcomes and better value,
1:01
better consumer experiences.
1:03
So I've gotten a chance to understand health
1:05
care from
1:06
the point of view of the players in
1:08
that ecosystem.
1:09
I think most importantly, I've gotten a chance
1:12
to understand health care as a dad
1:14
and a spouse
1:16
and,
1:17
father of a internal medicine doctor. My older
1:20
daughter is a physician, practicing physician.
1:23
And I've certainly understood
1:25
the highs and the lows. The
1:27
the the wonderful feeling of having a healthy
1:30
grandson born,
1:32
this terror terror of having a scary diagnosis
1:36
for a member of your family,
1:37
the frustration
1:39
of having to struggle to get a $12
1:41
co pay adjusted because it's wrong. I mean,
1:43
I've experienced it all,
1:46
and I try to bring all of those
1:48
experiences to the work that we do here
1:49
at the HCA.
1:51
Considering all of those angles that you're approaching
1:54
these issues from, what's the single biggest misconception
1:57
for payer executives right now?
2:00
The single biggest,
2:02
misconception for payer executives is that the fight
2:05
in Medicare Advantage will always be over
2:08
how much the annual bump is.
2:11
We are headed toward today when the fight
2:13
is going to be
2:14
how quickly and how effectively
2:16
people produce
2:18
high value outcomes
2:20
for getting paid. And you might say, well,
2:22
the system's never really gonna evolve to that.
2:26
Well, that's what people who support regular Medicare
2:29
said when Medicare Advantage was first enacted
2:31
in the first decade of this millennium. It
2:33
was a sort of exotic.
2:35
It was called Medicare plus choice.
2:38
It was an exotic program
2:40
that people said, oh, not many people will
2:42
sign up. We know now that what's happened
2:45
is a significant majority
2:47
of new enrollees every year go for Medicare
2:50
Advantage over regular Medicare.
2:53
And I think we're approaching the point, if
2:55
we haven't already reached it, where a majority
2:57
of Medicare recipients are MA patients.
3:01
I think the main reason we've seen the
3:03
growth in MA,
3:04
and this is
3:06
I almost chuckle when I say this.
3:09
Dealing with MA providers is less frustrating
3:12
for a consumer
3:14
than dealing with regular Medicare.
3:17
It's it's people are voting with their feet
3:19
for convenience.
3:21
The next step, I think, where they will
3:22
vote with their feet is where do I
3:24
get a better outcome for myself and a
3:27
better experience?
3:28
Who makes me feel better?
3:30
Who solves my problems?
3:32
Who's more accessible to me? So I think
3:35
the competition
3:36
in the future
3:37
among the MA providers will be about that,
3:40
not over whether we have a 2.8
3:43
bump or a 0.9%
3:45
bump.
3:47
And, you know, for our listeners, the time
3:49
that we're recording this was right after that
3:51
increase was finalized.
3:53
So very timely for you to bring that
3:55
up.
3:56
You know, focus in the call I read
3:58
it in Becker's today, so that's how it
3:59
goes. Well, I'm so glad to hear that
4:01
you read the story that I actually wrote.
4:04
So,
4:06
but I would love to talk about self
4:07
funding a bit considering HTA's focus.
4:11
So there are a lot of carriers that
4:12
are offering self funding solutions and also other
4:15
alternative solutions. I know we've talked about this
4:18
in previous interviews that are trying to challenge
4:20
traditional carriers,
4:22
and their models. So in what scenarios do
4:25
employers
4:26
look to go around big legacy players in
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this space?
4:30
Employers look to go around the big legacy
4:33
players when
4:34
when they hear no too often
4:37
from a big carrier.
4:39
So if an employer says, look,
4:41
we're not getting
4:43
the kind of early cancer screenings that we
4:45
wanna get. We're not getting as many as
4:47
we wanna get.
4:49
And, therefore, we wanna bring in a point
4:51
solution.
4:52
And, therefore, they get eighteen months worth of
4:55
negotiation with the carryover data sharing with the
4:58
point solution.
5:00
Or when they say, look, we we have
5:02
a problem with,
5:04
preterm birth. Too many of our moms are
5:06
giving birth early in the pregnancy. It's problems
5:09
for the baby, problems for the mom. We
5:11
know that there are successful interventions would help
5:14
prevent that and make the baby and the
5:16
mom healthier.
5:17
You know, we we want you, carrier, to
5:20
pay attention to
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which providers and which OB practices are better
5:25
at preventing preterm births than those are not.
5:28
And you get a year and a half
5:30
of, well, we really can't do that because
5:31
that's tearing and steering, and
5:34
we don't really get involved in the business
5:36
of helping degrade providers.
5:39
When the no's outweigh the reasons to stay,
5:42
the members are inclined to move.
5:44
And so I would say to the carriers
5:46
that they're either gonna have to start to
5:48
say yes more often
5:50
or be more susceptible to competition
5:52
from,
5:53
the TPAs and the smaller organizations
5:56
out there.
5:58
So you brought up the maternal health example.
6:00
Just as a follow-up, you know, I've been
6:02
tracking a couple of insurers of different sizes
6:05
rolling out more specialized
6:07
programs,
6:08
whether that's with maternal health or chronic conditions,
6:11
other things like that.
6:13
When are those initiatives
6:14
actually effective versus
6:16
more of just saying we're covering our bases
6:18
here? Those initiatives are effective when you get
6:22
the chance to look at data that tells
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you whether they're effective.
6:26
One of the assets of the HPA is
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a data platform
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that has 5,300,000
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lives in it going back fifty one months.
6:35
And we generally have enough data
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for different solutions to see whether they work
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or not. Just talking to one of our
6:43
team members today about one of our large
6:46
manufacturing members
6:48
that is operating on the assumption that the,
6:54
the maternal care program prenatal care program of
6:57
their carrier
6:59
is good,
7:00
so they wanna steer more people toward it.
7:03
Well, we said, is it really good?
7:06
Well, the carrier says it. Of course, the
7:08
carrier says it is.
7:10
We wanna approach this with an open mind.
7:12
If it's if it really is good, more
7:14
power to the carrier,
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and we wanna help the employer steer more
7:18
pregnant moms toward that program. But if it
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isn't,
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we want the employer to know that as
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well.
7:25
So much of this is about being able
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to keep score
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by having access to data.
7:31
And,
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so
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we believe
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that partners that are willing to share that
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data, that if the carrier would say, yeah,
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we 10,000 women participated in this program.
7:43
And when they're measured against the control group
7:45
of women who didn't participate in the program,
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here's why we're better.
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That's the kind of questions employers are asking.
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When payers and providers are fighting over contracts,
7:57
employers are stuck in the middle very often.
7:59
So what would better alignment look like? And,
8:02
you know, can you touch a little bit
8:03
more on that data driven focus and how
8:05
that might play into contracting arrangements?
8:09
Alignment comes when there's compromise on both sides.
8:13
And the compromise we'd like to see from
8:15
providers
8:17
is that they are more sensitive to the
8:19
overhead costs
8:21
and site of care costs that drive things
8:24
up. That that someone I was talking to
8:26
yesterday told me that
8:28
he
8:31
had a member of his family who needed
8:32
a surgical procedure,
8:35
and there were three different prices for the
8:37
same doctor in the same health system depending
8:40
upon the site of care. It was $3,500
8:43
at one site,
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$7,500
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at another site, and $13,000
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at a third site.
8:50
Same same surgeon, same procedure.
8:53
Hospitals need to do a better job of
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eliminating the cross subsidy that raises prices.
9:00
Carriers need to do a better job
9:02
of not burdening
9:05
providers
9:06
with too much slow pay, which is like
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an interest free loan from the provider to
9:11
the carrier,
9:12
and then too much bureaucracy to determine,
9:16
you know, whether the procedure is approved. I
9:19
noticed today,
9:20
again, probably in one of your articles, that
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prior auth is down 11%
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versus before the
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before the commitment was made to reduce it.
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So, look, good compromises or good agreements are
9:33
made when both sides compromise,
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and we think those are compromises that both
9:37
carriers and and,
9:39
providers could make.
9:41
I was actually interviewing someone a few weeks
9:44
ago about,
9:46
a self funding
9:47
model that they were focused on and how
9:50
they're trying to shift a lot of people
9:52
or a lot of employers who work with
9:54
health systems normally
9:56
to independent
9:57
providers and communities.
10:00
How
10:01
feasible do you think that is,
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to execute something like that?
10:06
It's not easy to do, but it's worth
10:08
doing, and therefore, it is feasible if the
10:10
results are better.
10:15
The the again, I find that,
10:18
a lot of the health care debate is
10:19
whether Kmart is better than
10:22
Target.
10:24
The real question is, is Amazon better than
10:26
Kmart and Target?
10:29
Who's gonna build a system
10:31
that is consumer driven, consumer friendly, less expensive,
10:35
and more convenient?
10:37
And if it's in if it's an independent
10:39
player, I think that player is gonna win.
10:42
If it's a player that's embedded in big
10:44
providers or big carriers, I think that system
10:47
is gonna win. It's less about
10:50
what the ownership structure looks like and more
10:53
about what the objectives of the organization are.
10:56
And,
10:57
you know, we're looking for organizations that wanna
10:59
say,
11:01
we want consumers to feel a lot better
11:03
about their experience.
11:05
We want them healthier
11:06
as a result of the experience.
11:08
And we understand it will cost maybe a
11:11
little more at the beginning,
11:13
but it'll save a lot in the end.
11:14
I would use as an example,
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who really gets up every morning and worries
11:19
about medication adherence?
11:21
We it's it's a it's a fact of
11:23
life
11:24
like the sun rises in the East
11:26
that a diabetic who stays current with their
11:29
metformin is gonna have a better result than
11:30
one who doesn't.
11:32
Who's doing something about that?
11:35
And it doesn't really matter so much to
11:37
us
11:38
if the if the someone is owned by
11:40
private equity or is a five zero one
11:42
three owned by a hospital or whether it
11:45
is a carrier or a PBM.
11:47
Who's getting the job done?
11:50
And,
11:51
I think
11:52
the biggest disease in US health care is
11:55
the repetition disease.
11:59
Probably most of the problems I've mentioned here
12:01
in our discussion have been
12:03
around for thirty or forty years. There's nothing
12:06
new about any of these problems.
12:08
What I hope will be new is that
12:10
new players will come into the market or
12:12
old players
12:13
will solve these problems in the market.
12:17
In an economy where more and more consumers
12:19
are more and more result driven,
12:21
I want what I want delivered to my
12:23
doorstep at a price that I think is
12:26
right by this afternoon at 04:00.
12:28
That's the opposite of health care.
12:30
Whomever can make that happen for consumers in
12:33
health care is gonna be the winner,
12:35
And we think there should be a robust
12:37
competitive market to see who wins.
12:41
Are there any concerns you're hearing from employers
12:44
in your recent discussions with them that you
12:47
wanna bring up, whether it's about, you know,
12:48
kind of that consumer push for more direct
12:51
access?
12:52
Anything similar to that that has kind of
12:55
been dominating your conversations lately.
12:58
The great hockey player Wayne Gretzky
13:00
said infamously
13:02
that great players are not where the puck
13:04
is. They're where the puck's going.
13:07
Where we think the puck is going is
13:09
a tsunami
13:11
of gene therapy and cell therapy claims.
13:15
Today, gene therapy is for extremely rare and
13:19
exotic diseases like sickle cell anemia
13:22
or horrible respiratory diseases for infants.
13:26
Thank God there are solutions happening right now
13:29
saving people's lives.
13:30
We think there's gonna be an evolution of
13:33
gene therapy away from exotic to just exotic
13:36
diseases
13:37
to more common ones like type one diabetes
13:40
or skin cancer
13:42
or alcoholism.
13:44
When that occurs, and I think it's when,
13:46
not if,
13:48
we see a tsunami of high cost claims
13:50
that are gonna have to be paid by
13:52
someone
13:54
because I don't see a society I don't
13:56
wanna live in a society when someone says,
13:58
yeah, We could cure your son of type
14:00
one diabetes, but we're not covering it. I
14:03
don't think that should happen or is gonna
14:05
happen.
14:06
But the cost of these therapies is gonna
14:08
be monstrous compared to the present spend.
14:12
Where we think the market will eventually go
14:15
is a hybrid model
14:17
where very high cost claimants are dealt within
14:20
a fully insured product
14:22
that is capped by a premium,
14:25
where the risk bearing entity has both the
14:27
expertise and the incentive to get a great
14:29
outcome for the patient,
14:31
and where the sprained ankles and normal pregnancies
14:34
and knee operations are left in the
14:39
are the normal knee operations are left in
14:42
the the fully the self insured model. That
14:45
company doesn't exist yet. I bet it does
14:47
in five years or less. And, it it
14:50
could be the big three. It it, it
14:53
could be the buccas. It could be a
14:56
new player. It could be someone not in
14:58
health care right now.
15:00
But you you would have,
15:02
I'm I this is literally true, I think,
15:04
that,
15:05
people came into Blockbuster Video in the eighties.
15:09
And so now we really ought to think
15:11
about
15:12
a product where people can watch movies on
15:15
their home computer.
15:17
And they said, that's a really stupid idea.
15:19
We're not gonna do that.
15:21
Well, hello, Netflix.
15:23
I'm sure it seemed bizarre the first time
15:27
the creators of Uber got together and said,
15:29
you know, if ordinary citizens just made themselves
15:32
available as temporary drivers and
15:35
picked people up at their house and dropped
15:36
them off where they wanna go and have
15:39
their credit card information on file. And
15:43
that seems like a really bizarre thought that
15:45
who would really do that? Hello, Uber.
15:48
That health care is going there.
15:51
And the reason it's going there is, I
15:53
think, closely tied to the tsunami
15:56
of gene and cell, gene and cell, therapies
15:59
that are coming in the very near future.
16:03
How do you recommend these new entrants or
16:06
even, you know, current players that are going
16:08
into that space with the more segmented pharmacy
16:11
approach?
16:12
How do you recommend they build trust with
16:14
employers as employers are used to more traditional
16:16
models?
16:18
Step one is know your customer.
16:20
It's not the CEO of the company.
16:23
It's probably not the CHRO or the CFO.
16:26
It is a benefit lead who is three
16:29
or four steps down the ladder from the
16:31
very top of the company,
16:33
but whose job it is to make the
16:34
plan work every day.
16:36
And she or he, it's usually a she.
16:40
You have to earn that trust.
16:42
She's heard a million times that all I
16:44
can save you 15% on your medical spend.
16:47
Some of our members whimsically say to me,
16:49
you know, tomorrow I'm gonna have six meetings
16:51
with Point Solutions,
16:53
and I'm gonna hire them all, and I'll
16:55
save 90% of my medical spend, six times
16:58
15. I mean, they they know that that's
17:00
not true.
17:01
The way that you earn their trust is
17:03
to show them the data,
17:06
give them references of people you've done good
17:09
work for,
17:10
tell them the truth. Your product isn't always
17:13
perfect. It's not always gonna work. It's not
17:15
easy to implement.
17:17
And let them know that when all hell
17:18
is breaking loose, she'll be there as their
17:20
partner.
17:21
I mean, this is the person who
17:23
if 90 people show up at a radiology
17:26
lab today and all of them get their
17:28
appointments canceled
17:29
because there's some administrative glitch, it's that problem
17:33
lands in their lap.
17:35
That's what they're worried about today.
17:37
If you help them solve that problem, you
17:39
earn their trust.
17:41
If you tell them that, no. No. They
17:42
need to take an hour and read your
17:44
pitch deck about how they're gonna say 15%,
17:48
you're slamming the door in their fingers.
17:52
Do you have any final thoughts or advice
17:54
for industry leaders as we wrap up our
17:56
conversation today?
17:58
Be proud of the industry that you are
17:59
in.
18:01
Naturally, people in health care gravitate to what's
18:03
wrong and how to fix it. That's our
18:05
job.
18:06
But what isn't wrong, what's right, and how
18:09
to sustain it is
18:11
this is an amazing place to get care.
18:15
Sovereign potentates come here to get their care
18:18
for a reason.
18:20
Because there are heart transplants happening today in
18:23
small hospitals that would have been unimaginable
18:26
forty years ago.
18:28
There are children who will be born today
18:30
who weigh a pound and a half,
18:32
who will survive to be full, thriving, healthy
18:35
adults.
18:36
There are cancer survivors who would have never
18:39
survived,
18:41
ten years ago, fifteen years ago because the
18:43
advances that have been made in detection and
18:46
surgery and chemotherapy.
18:48
We should be proud of this system.
18:51
We should be concerned about its inequities,
18:54
its inefficiencies,
18:55
its shortcomings,
18:57
but let's not throw the baby out with
18:59
the bathwater.
19:01
Now I
19:03
in our own families, we can I can?
19:05
I think we all can point to some
19:08
story that is miraculous about something that was
19:11
done to help someone we love.
19:13
That didn't happen by accident. It happened because
19:16
we have
19:17
a lot of good people in the health
19:19
care system who can do great things.
19:21
Let's try to unleash their talents so they
19:23
could do more. I guess I'd put it
19:25
to you this way.
19:26
I would hope that the most valuable player
19:29
in the health care system would be
19:32
a maternity
19:33
health nurse who helps convince, a mom to
19:36
take better care of herself
19:38
so the baby's healthier than she is, not
19:40
someone who's great at upcoding
19:42
so the hospital can collect more revenue. That's
19:45
what we need to do is fix a
19:47
system where that maternal nose nurse is the
19:50
rock star, and the upcoder
19:52
is shows some value, but is not the
19:55
rock star of the team.
19:57
Well, Rob, thank you so much for joining
19:59
us today, and I'm looking forward to continuing
20:01
this conversation going forward.