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This is Scott Becker with the Beckers HealthCare

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podcast.

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I'm thrilled today to be joined by two

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brilliant leaders.

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We're joined today by Brett Kaplan and Peter

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Winslow.

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Brett and Peter spent a ton of time

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in the managed care and payer space, and

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they talked to us about what they do.

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They're with BRG,

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Berkeley Research Group.

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Brett,

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Peter,

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can I ask you to take a second

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to introduce yourself

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and tell us a little bit about what

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you do and about BRG?

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Yeah. Sure. Great. Thanks, Scott, and and thanks

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for having us on that podcast. Really excited

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and and really appreciate it. So as you

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said, I'm I'm Brett Kaplan. I'm a director

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here at BRG.

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I have, over a decade of experience in

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management consulting in in the health care space,

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and I primarily spend my time in the

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in the managed care space or really revenue

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strategy, reimbursement strategy

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around managed care contracting, strategic pricing, and complex

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enterprises, such as multistate, multi hospital systems, academic

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medical centers, etcetera,

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and, comprehensive revenue analytics. So think benchmarking, macro,

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microeconomic

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review, and and things of that nature. And,

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really, all of that is to in in

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service of

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preparing for negotiations,

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which we'll we'll touch on a little bit

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later, but I'll hand it over to Peter.

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Thanks, Brett.

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Everybody, my name is Peter Winslow. I'm a

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managing consultant at Berkeley Research Group. I have

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about four years of experience in management consulting

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all within the health care sector. And

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my primary areas of focus are payer provider

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contract negotiations,

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revenue reimbursement strategy development and market trend analysis.

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And I also serve as the strategic communications

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and external affairs subject matter expert, within our

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managed care practice.

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So great to be here, Scott.

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No. Thank you so much. And and tell

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us maybe let's start with a second on

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payer provider relationships.

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We're also watch also watching so much fallout

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and changes in Medicare Advantage right now. Mhmm.

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Brett or Peter, can what do you take

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the lead in telling us what trends are

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you watching in payer provider relationships currently?

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What are you seeing?

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Yeah. So so thanks, Scott. I think it's

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really a perfect storm right now of pressures

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from an economic perspective, a regulatory perspective,

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thinking, you know, the uncertainty around Medicaid

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three forty b site neutrality,

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and site neutrality,

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any regulatory shifts stemming from the one big

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beautiful bill and price transparency that's coming through.

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And as you mentioned, the Medicare Advantage across

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that line of business, both from a provider

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and a payer side,

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there's rampant,

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you know, downgrades, denials, delays in payment, prioritization

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issues, really. So everything is is a an

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an afflection point from an economic perspective.

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And,

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really, that,

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that leads

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to tenuous

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relationships

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between the payer and provider because it comes

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down to margin. Right? It's really what we're

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watching most closely as hospital margins,

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being

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very uncertain today,

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being compressed today. And now more than ever

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is why our clients are dependent

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on the outcomes of these managed care contract

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negotiations

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to strengthen their source of the negotiated revenue

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that they have and try to protect that

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revenue through securing more favorable contract language.

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Yeah. And and what I'll add is

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is, Scott, that we're we're really seeing we're

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continuing to see an increasingly

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contentious negotiation landscape between

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providers and payers. And, I mean, it's not

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centered exclusively around reimbursement rates even though both

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sides are under

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tremendous

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financial pressure. I mean, on the provider side,

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hospitals,

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health systems alike continue to shoulder

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challenges associated with labor,

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supply chain, capital constraints. You know, these these

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are

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by no means new issues, right, all while

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trying to maintain,

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you know, quality and access for their patients.

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But on the payer side, there's a growing

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scrutiny

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from regulators and employers demanding cost containment, media

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and public skepticism, which has been skyrocketing over

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the last couple of years. And, you know,

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while inflationary pressures of aging population and and

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rising utilization

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compress their margins. So, I mean,

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what makes this

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moment particularly volatile? I'd I'd say that

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American health care is a hot button divisive

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topic at the center of discussions touching really

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our our broader economic and political climate. These

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these disputes within the health care sector

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are are no longer isolated events. I mean,

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they're really proliferating at a rapid speed

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with increasingly significant implications.

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Providers can't afford

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to adopt a passive stance or rely on

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the prospect of resolution through pair negotiation,

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you know, on its own. You know, what

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we what we think about with clients is

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establishing a comprehensive,

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you know, out of network strategy. You know,

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that's become imperative. It's and to serve as

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a means to ensure, you know, equitable positioning

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of that organization,

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safeguarding their financial stability, and really preserving

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the continuity of care when contract discussions

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reach an impasse.

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So that's that's kind of what we're seeing.

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And and we see these tenuous negotiations,

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you know, across the country. I mean, UMass

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Memorial Hospital, Blue Cross Blue Shield of Massachusetts,

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recently resolved one,

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in North Carolina. Cigna and u a UNC

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Health were were at bat with one another,

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and UHC was was also kinda duking it

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out with WakeMed and and Lehigh Valley Health

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Network. So there are many, many others across

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the country, but those are just a couple

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that that pop in top of mind.

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And is there gonna be more tension in

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these payer provider negotiations? Seems like we go

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through cycles the last ten, twenty years. With

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some years, things seem pretty copacetic.

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Other years, a lot of tension.

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What's the temperature currently?

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I think, to the points we were raising

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earlier, just the economic realities.

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I think there is some tension,

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that's going to continue, but at what point

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will it ultimately lead to more,

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you know, more partnership related is what I'm

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hoping for. And what we try to advise

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our clients is let's try to find some

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common ground. Let's find some win win scenarios

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when possible,

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but ultimately be ready for those 10 tenuous

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kinda

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conversations and tenuous negotiations moving forward.

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Thank you. And and talk about as you

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head into next year,

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BRGs had this great growing practice,

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brilliant management consulting and leadership.

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When you look at this next year, what

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are you most focused on and excited about

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heading into 2026?

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Yeah. Thanks, Scott. And I I think you

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hit it right on the head with that

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one really. It's we're we're in a growth

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mode, from a firm perspective primarily or or

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a lot in our health care space.

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We're making some big investments, which I'm really

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excited about, bringing

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expertise from enterprise strategy, managed care contracting and

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financial management,

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clinical and operational

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diligence, and and bringing all the pieces

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of the health care industry together in an

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integrated way. So and we just announced that

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our our leader of Rich Bay Bainer coming

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to to the firm. So really excited about

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the investments and strategic investments from our firm

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that we're making and what it's gonna do

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from a professional standpoint, but more importantly, from

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our clients and how we're gonna be driving

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really great impact from a client perspective

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in the marketplace. So, more to come from

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a BRG in the market, and I'm excited

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to to be a part of it.

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Absolutely. And just and just to reiterate Brett's

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points, I mean, we we were able to

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join in in a group of

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really intelligent and passionate

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leaders. I mean, there there are people at

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this firm that

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are incredibly impressive and contribute so much to,

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you know, developing health care solutions that benefit,

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you know, not only our clients, but the

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patients that they serve.

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And and it's just

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such a great opportunity to to be at

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BRG and and to see

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what we're we're actively building out and and,

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you know, like Brett said, much more to

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come, and and we're very excited for what's

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coming down the road.

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And and, Brett, I'll ask you this question.

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You come from a brilliant family of physicians

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and lawyers

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and and, actually, athletes as well.

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Do you ever feel like that you're on

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the right side of history

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by moving into consulting in health care versus

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law or medicine

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or or sports?

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How do you look at that?

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Thanks, Scott.

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So I I like to think I take

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the the good of both, my my paths

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that I've seen,

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ahead of me. I really appreciate in the

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health care world of really having the altruistic

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helping people aspect. But,

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at the end of the day, the lawyer

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in me in in brokering conversations, working with

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people, and and the administrative side of the

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health care industry to kinda move it forward,

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my job is hopefully to make, the clinician's

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job easier. So I'm trying to fuse the

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two of them. And, you know, if you

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think about it, everything's a little bit of

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a sport, so that's, I think, part of

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the negotiation in me too. So I do

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my best to try to to blend all

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of my background together and and take what

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I think is is the good, and and

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move it forward. So

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You are a remarkable leader, and by chance,

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I happen to know some of, Brett's family.

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I'm gonna ask you one more question, and

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you do not have to answer this.

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Okay. Who is a better athlete, Mickey or

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Gary?

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Oh, that's that's a tough one. I think

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it depends on the sport, but I'd be

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remiss to say,

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that my uncle did play Michael Jordan back

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in in high school days. So that'd be

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a tough one. That'd be a tough one.

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That's a very well well way of stating

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it without offending your father. I think that

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was really well put. I I have to

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tell you, it's it's a pleasure to visit

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with the two of you. Aside from knowing

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a little bit of Brett's family, brilliant, brilliant

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people,

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Peter and Brett are brilliant,

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leaders and management consultants at BRG.

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Brett or Peter, take the lead on the

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next question.

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Advice to emerging leaders, emerging careerists,

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what what advice would you give to emerging

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leaders, emerging professionals?

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Yeah. I think, really, there's two that I

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would like to to voice. First is be

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curious. Right? We're in such a a complex

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world of that's ever changing. So being a

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lifelong learner, and I think that's why I

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I chose consulting, it's all about lifelong learning

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and just driving personal growth through learning a

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new skill, deeper understanding of anything in your

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area of expertise or not in your area

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of expertise too. Trying to keep pace with

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all the change that's happening in in not

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just the health care industry, but but industries

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writ large around AI, etcetera. So I think

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just being curious is something that never stopped

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learning,

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is is something I definitely,

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continue to to tell people as as whoever

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listens to me, and and Peter probably is

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is, rolling his eyes as I say that

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because I've definitely told him to him too.

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But the other one I think is is

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about being a kind of a self starter

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and looking for ways to make

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somebody else's life a little easier.

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Again, whether that's

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your boss or your manager, a client, a

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colleague, or even a friend, by lending a

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hand or or stretching your role, you will

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advance to wherever that next step may be

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professionally and personally. If you just think about

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how can I make that that person's life

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a little bit better, a little bit easier,

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a little bit more manageable?

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But but I think that's that last point

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is so well taken and so well stated.

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People often don't realize in a professional organization

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or any business, whatever you're doing, so much

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of what you do

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is about trying to help whoever you're working

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with make things a little bit easier, a

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little more concise, a little bit better,

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and and and to solve problems rather than

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to create more problems. I just I just

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love that actually.

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Peter, let me turn it to you. Any

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piece of advice you could give to emerging

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leaders?

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Yeah. Absolutely.

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And and I really kinda draw on

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some of my past experiences.

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You know, before I I put the consulting

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hat on, I was an investigative reporter based

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in Chicago. And,

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you know, one of the things that has

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done me personally very well and that that

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I see really effective leaders doing is is

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is networking and just being open to connections.

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I mean, Scott, you're one of the best

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to do it yourself. I mean, you know,

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the way that we are able to to

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get connected and just build these bridges and

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start forming a relationship has, you know,

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been invaluable, and it's something that, you know,

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I'm looking forward to going into the future.

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But, I mean,

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effective leaders really recognize that networking isn't just

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about, you know, collecting contacts or filling the

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Rolodex. Right? It's about cultivating meaningful relationships. So

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they invest time in the individuals. They they

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listen. They and and they build this trust

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and and and curate a broad and diverse

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contact list. So, you know, these connections

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benefit both their personal growth and their organization's

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success. I mean, they open doors to collaboration,

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innovation,

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problem solving,

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and and it makes

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networking

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a a strategic leadership skill rather than seeming

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like a transactional activity.

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And I think that point of developing real

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relationships

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versus a transactional

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activity is is right on. I mean, the

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more that long term people are available to

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each other, it it's not so much you

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do this, I gotta get that, or vice

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versa. It's more, you know, over time, you

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figure out where there's synergistic opportunities for people

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and that work for everybody. And and I

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think that's right on. I think that's just

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a very I think that's a great perspective

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on networking and relationship building

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versus the alternative, which is everything's good, bro,

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quorum, transactional, which is very short lived and

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and leads to very flawed relationships, quite frankly.

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Right. Brett and Peter, I I wanna thank

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you both for taking the time to join

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us today on the Becker's Healthcare podcast.

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For me, this is a tremendous pleasure to

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visit with the both of you. Thank you

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so much for taking the time and joining

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us. Thank you. Thank you, Scott. The pleasure

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is ours. Thanks, Scott.