Latest / Becker’s Payer Issues Podcast / Eric C. Hunter, President and CEO of CareOregon

Transcript

Eric C. Hunter, President and CEO of CareOregon · 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 payer and health plan executives
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  and more than 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, and welcome to the Becker's Healthcare
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  podcast. I'm Scott King. Thrilled today to be
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  joined by a very special guest, Eric c
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  Hunter, president and chief executive officer over at
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  CareOregon.
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  Eric, how are you doing? Thanks so much
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  for joining us. Appreciate you. I'm doing great,
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  Scott. Thank you for having me on. Appreciate
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  it. Of course. And look. We have a
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  lot of big topics in in health care
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  and, you know, with health plans to get
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  to. But before I do that, I was
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  wondering if you could just please tell us
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  a little bit about your, your background and
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  your career journey. Sure. My, my career started
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  in an odd way as a petroleum engineering
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  major in Tulsa, Oklahoma back in the eighties.
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  Not the best career choice with what happened
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  to the industry. So and played with politics
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  for a while, ended up working for a
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  governor in or in Oklahoma,
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  and that governor implemented Medicaid managed care.
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  And so working with him on that and
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  then later the state agency that stood it
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  up is how I got into the health
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  care business from petroleum engineering.
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  I've done stints at
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  national entities, Shower Anderson. I was in multiple
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  states with Shower Anderson.
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  Aetna purchased them years ago,
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  did a stint at Centene for a couple
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  of years,
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  was a market leader,
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  for value options behavioral health care in Illinois
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  and in Texas.
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  Then before here, I was the chief operations
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  officer at Boston Medical Center Health Net Plan,
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  which is now Wellsys Health Plan.
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  And ten years ago, I was privileged to
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  be,
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  recruited and signed to come to CareOregon where
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  I where I am, and I'm loving loving
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  the work we do.
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  Yeah. Appreciate you sharing all that background info.
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  You certainly had a a lot of unique
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  experience that helps you give a a unique
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  perspective on everything going on. So the first
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  topic I wanna get to, Eric, is how
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  are your relationships with providers changing
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  as both sides face
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  cost pressure and workforce shortages?
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  I think for everyone, there are there are
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  new challenges. But for us, it's more acute
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  because
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  CareOregon was started thirty two years ago now
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  by provider organizations,
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  local safety net community organizations, FQHCs,
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  teaching hospital.
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  And so we've typically been provider centric in
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  everything we do.
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  But this this new reality
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  has forced us to have to make tough
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  choices. And you talk about changing that relationship
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  so that it it really is more
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  about,
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  enabling each other, empowering each other to do
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  more with less,
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  coordinating
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  care
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  more efficiently,
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  aligning payment methodologies with quality and performance, not
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  just widgets and moving revenue around,
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  to support the providers
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  in the core. So,
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  that's really been the big change is that
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  we've had to think
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  less about
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  codependency
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  and more about,
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  aligning better to get much greater quality and
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  and performance so that we can serve more
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  people.
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  Eric, does it also just kind of start
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  with, you know, in a general sense that
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  both
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  payers and providers are both up against so
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  much now and certainly in terms of,
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  of regulatory matters? Is it is it just
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  kind of understanding where each site is right
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  now and and the difficulties they're facing?
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  I think one of the challenges is finding
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  ways to
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  identify
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  where those barriers can be broken down. Because
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  even when we talk about regulatory matters,
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  there are a lot of things we have
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  in common
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  with the providers,
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  and how
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  states and the regulatory agencies deal with
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  matters
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  of merger and acquisition or ownership
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  or staffing.
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  You know, those kind of pressures,
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  hit us both
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  because they add sort of undue pressures on
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  the delivery of care
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  and then increase costs across the board, which
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  is then feed up into, ultimately, the Medicaid
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  business, greater state spending. And so how do
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  you manage all that and make sure that
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  everyone understands the implications of
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  right minded
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  thought processes, you know, protecting
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  the public dollar, protecting members. But at the
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  end of the day, everything has to fit
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  together so that it's all sustainable. And that's
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  the challenge we have when we have to
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  work together to solve some of that.
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  Where do you see the biggest gap today
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  between payer strategy and operational
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  execution?
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  For for plans particularly about the size of
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  CareOregon, we're not small by any means, but
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  we're not a big national either.
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  It's it's really that gap between the ambition
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  we have for what we wanna do to
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  transform the system fundamentally
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  and the infrastructure to do that, to pull
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  that off, whether it's,
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  the work we can do with with
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  AI, to reduce administrative burdens or the creativity
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  necessary to manage the data around
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  true total cost of care or value based
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  contract agreements
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  that take into consideration
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  not just the numbers of services provided, but,
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  the quality of those services, the outcomes of
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  those services, and tying all that in ways
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  that everyone can see it and believe the
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  numbers and coordinate on them. I think those
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  are those are the big gaps. So they're
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  really about the infrastructure being
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  designed and built
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  and pushed out so that everyone has visibility
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  into what's happening.
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  What's one investment or initiative you believe will
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  most reshape how health plans operate
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  over the next two to three years, you
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  think?
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  I think when talking about how the system
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  needs to manage, really, again, AI
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  comes into play. And not necessarily to replace
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  human beings, but to augment the work that
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  people are doing either at the payer or
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  at the provider.
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  How do we leverage data and information
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  so that people are empowered to identify
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  ways to engage patients and members better to,
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  be more efficient in how we work with
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  them to get the information we need at
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  the right time to the right people.
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  It's not it's not cheap to develop those
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  systems.
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  There are a lot of vendors that they
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  can say they can do it easily,
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  but even those folks are gonna cost you
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  a pretty penny. And right now, the resources
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  are pretty scarce. So being able to make
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  the investment
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  to move forward on that front,
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  means we have to be that much more
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  efficient in the work we're doing now and
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  maybe even cut some cut some corners.
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  If you could change one regulatory or industry
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  practice
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  tomorrow to improve affordability and access,
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  what would it be and why?
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  I believe to improve,
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  affordable and access from a
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  from a rule standpoint, it really is about
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  how
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  how states again see
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  their role
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  as
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  the protector
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  of of
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  commerce, of industry, of of,
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  you know, public benefit
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  with the need to micromanage industries they don't
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  understand and put hurdles
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  in front of us that that makes it
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  more difficult to do the work, particularly in
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  tough times. For instance, you know, merger and
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  acquisition laws, certificates of need laws, staffing rules.
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  A lot of those things are are well
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  meaning and well intentioned,
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  but they they they reduce the ability of
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  the providers and the payers to actually do
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  the work they need to do to serve
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  the patients. And and being able to take
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  a step back from that,
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  collectively and working with the states,
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  would be really, really critical to being able
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  to make this work long term.
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  Yeah. That's interesting. So a lot of those
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  those rules in place actually kinda get in
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  the way of,
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  payers and providers reaching an agreement, and then
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  now you're you're kinda have to look for
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  certain workarounds. Is that basically what you're saying,
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  Eric?
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  That is. There there are times when,
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  you're required to make a certain payment level
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  or hire certain staffing levels at the provider
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  level.
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  That means they need more people. They need
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  more revenue from the payers to do that
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  work.
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  You know, where's the is there value in
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  that to the care the members receive, or
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  is it because someone feels better because those
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  positions exist or they think there's better work
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  when it could be about efficiencies and technology
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  and and policies that really drives the work
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  instead.
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  Some of the mergers and acquisition
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  rules, some of the corporate practices of medicine
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  rules that
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  can be overreaching
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  and impact abilities of providers and payers to
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  work together,
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  to find value based solutions.
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  But there's forced separation,
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  that that really is less about
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  the effect efficacy of doing the work
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  and and more about the appearance of impropriety.
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  You know, hold folks accountable, hammer them if
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  they do wrong, but but give the industry
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  the the flexibility
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  to do what we need to do to
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  make it work.
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  What issue is putting the most pressure on
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  health system margins right now,
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  and and how are you responding differently or
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  or going to respond differently in as 2026
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  plays out?
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  With the bulk of CareOregon's work being in
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  the Medicaid
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  space, it really is the
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  the clash of
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  intentional utilization increases for some areas,
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  particularly in behavioral health, substance use disorder treatment.
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  Those are those are critical crises in our
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  communities right now. We have to fund and
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  provide services for those services,
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  but the rates that we're paid
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  to manage them aren't keeping up.
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  The coordinated care model in Oregon,
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  received a pretty hefty
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  rate increase for 2026 that still doesn't necessarily
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  cover the costs of
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  implemented
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  rate increases and access and capacity increases
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  that have people actually getting in for care
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  they need,
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  but it's not sustainable
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  unless we find that right balance. And so
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  that's really,
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  for us, the greatest pressure on our margins
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  is there's only so much we can do
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  administratively
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  or operationally
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  if we're paying out a dollar and 10¢
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  for every dollar we get in in rates.
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  So that's really the the challenge we have
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  right now is the right sizing the rates
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  with the benefits provided so that we can
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  actually provide quality care.
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  And the last question I wanted to ask
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  you, Eric, you know, now certainly more than
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  ever,
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  the right kind of leadership, the strong leadership
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  is needed in health care. So I just
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  wanted to ask you, you know, the course
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  of your career and up to now, how
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  is how have you evolved as a leader?
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  You know, that that's a great question. I
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  believe that
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  coming from an engineering background, I was about
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  policy and procedure, nuts and bolts, blocking and
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  tackling as the the key to success.
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  Now there's there's much more nuance required.
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  There are much more
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  much more opportunity to trade off and to
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  bargain and to negotiate,
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  bringing the best people, the best minds into
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  the room, and finding solution that that truly
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  is a win win. It's not a competitive
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  business.
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  I don't know that
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  that Medicaid managed care in particular should be
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  a competitive or profit business anyway.
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  But, but looking at it as a partnership
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  with the provider systems and the states,
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  the hospitals and the nurses associations
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  to say, collectively, with find common ground and
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  build
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  sustainable
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  structures
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  that can weather these storms that are happening
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  now. And so a lot of my career
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  has been less about managing direct care and
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  more about
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  convening
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  folks together, creating entities and organizations and alliances
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  that are gonna move the needle. And that
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  that's where I spend a lot of my
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  time these days.
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  Well, Eric, thanks so much for sharing your
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  insight and perspectives
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  and and joining the podcast. We're really looking
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  forward to having you speak at the spring
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  payer issues roundtable. So, looking forward to that,
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  and and thanks so much. Thank you, Scott.
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  Looking forward to it.