This is Scott Becker with the Beckers HealthCare
podcast.
I'm thrilled today to be joined by two
brilliant leaders.
We're joined today by Brett Kaplan and Peter
Winslow.
Brett and Peter spent a ton of time
in the managed care and payer space, and
they talked to us about what they do.
They're with BRG,
Berkeley Research Group.
Brett,
Peter,
can I ask you to take a second
to introduce yourself
and tell us a little bit about what
you do and about BRG?
Yeah. Sure. Great. Thanks, Scott, and and thanks
for having us on that podcast. Really excited
and and really appreciate it. So as you
said, I'm I'm Brett Kaplan. I'm a director
here at BRG.
I have, over a decade of experience in
management consulting in in the health care space,
and I primarily spend my time in the
in the managed care space or really revenue
strategy, reimbursement strategy
around managed care contracting, strategic pricing, and complex
enterprises, such as multistate, multi hospital systems, academic
medical centers, etcetera,
and, comprehensive revenue analytics. So think benchmarking, macro,
microeconomic
review, and and things of that nature. And,
really, all of that is to in in
service of
preparing for negotiations,
which we'll we'll touch on a little bit
later, but I'll hand it over to Peter.
Thanks, Brett.
Everybody, my name is Peter Winslow. I'm a
managing consultant at Berkeley Research Group. I have
about four years of experience in management consulting
all within the health care sector. And
my primary areas of focus are payer provider
contract negotiations,
revenue reimbursement strategy development and market trend analysis.
And I also serve as the strategic communications
and external affairs subject matter expert, within our
managed care practice.
So great to be here, Scott.
No. Thank you so much. And and tell
us maybe let's start with a second on
payer provider relationships.
We're also watch also watching so much fallout
and changes in Medicare Advantage right now. Mhmm.
Brett or Peter, can what do you take
the lead in telling us what trends are
you watching in payer provider relationships currently?
What are you seeing?
Yeah. So so thanks, Scott. I think it's
really a perfect storm right now of pressures
from an economic perspective, a regulatory perspective,
thinking, you know, the uncertainty around Medicaid
three forty b site neutrality,
and site neutrality,
any regulatory shifts stemming from the one big
beautiful bill and price transparency that's coming through.
And as you mentioned, the Medicare Advantage across
that line of business, both from a provider
and a payer side,
there's rampant,
you know, downgrades, denials, delays in payment, prioritization
issues, really. So everything is is a an
an afflection point from an economic perspective.
And,
really, that,
that leads
to tenuous
relationships
between the payer and provider because it comes
down to margin. Right? It's really what we're
watching most closely as hospital margins,
being
very uncertain today,
being compressed today. And now more than ever
is why our clients are dependent
on the outcomes of these managed care contract
negotiations
to strengthen their source of the negotiated revenue
that they have and try to protect that
revenue through securing more favorable contract language.
Yeah. And and what I'll add is
is, Scott, that we're we're really seeing we're
continuing to see an increasingly
contentious negotiation landscape between
providers and payers. And, I mean, it's not
centered exclusively around reimbursement rates even though both
sides are under
tremendous
financial pressure. I mean, on the provider side,
hospitals,
health systems alike continue to shoulder
challenges associated with labor,
supply chain, capital constraints. You know, these these
are
by no means new issues, right, all while
trying to maintain,
you know, quality and access for their patients.
But on the payer side, there's a growing
scrutiny
from regulators and employers demanding cost containment, media
and public skepticism, which has been skyrocketing over
the last couple of years. And, you know,
while inflationary pressures of aging population and and
rising utilization
compress their margins. So, I mean,
what makes this
moment particularly volatile? I'd I'd say that
American health care is a hot button divisive
topic at the center of discussions touching really
our our broader economic and political climate. These
these disputes within the health care sector
are are no longer isolated events. I mean,
they're really proliferating at a rapid speed
with increasingly significant implications.
Providers can't afford
to adopt a passive stance or rely on
the prospect of resolution through pair negotiation,
you know, on its own. You know, what
we what we think about with clients is
establishing a comprehensive,
you know, out of network strategy. You know,
that's become imperative. It's and to serve as
a means to ensure, you know, equitable positioning
of that organization,
safeguarding their financial stability, and really preserving
the continuity of care when contract discussions
reach an impasse.
So that's that's kind of what we're seeing.
And and we see these tenuous negotiations,
you know, across the country. I mean, UMass
Memorial Hospital, Blue Cross Blue Shield of Massachusetts,
recently resolved one,
in North Carolina. Cigna and u a UNC
Health were were at bat with one another,
and UHC was was also kinda duking it
out with WakeMed and and Lehigh Valley Health
Network. So there are many, many others across
the country, but those are just a couple
that that pop in top of mind.
And is there gonna be more tension in
these payer provider negotiations? Seems like we go
through cycles the last ten, twenty years. With
some years, things seem pretty copacetic.
Other years, a lot of tension.
What's the temperature currently?
I think, to the points we were raising
earlier, just the economic realities.
I think there is some tension,
that's going to continue, but at what point
will it ultimately lead to more,
you know, more partnership related is what I'm
hoping for. And what we try to advise
our clients is let's try to find some
common ground. Let's find some win win scenarios
when possible,
but ultimately be ready for those 10 tenuous
kinda
conversations and tenuous negotiations moving forward.
Thank you. And and talk about as you
head into next year,
BRGs had this great growing practice,
brilliant management consulting and leadership.
When you look at this next year, what
are you most focused on and excited about
heading into 2026?
Yeah. Thanks, Scott. And I I think you
hit it right on the head with that
one really. It's we're we're in a growth
mode, from a firm perspective primarily or or
a lot in our health care space.
We're making some big investments, which I'm really
excited about, bringing
expertise from enterprise strategy, managed care contracting and
financial management,
clinical and operational
diligence, and and bringing all the pieces
of the health care industry together in an
integrated way. So and we just announced that
our our leader of Rich Bay Bainer coming
to to the firm. So really excited about
the investments and strategic investments from our firm
that we're making and what it's gonna do
from a professional standpoint, but more importantly, from
our clients and how we're gonna be driving
really great impact from a client perspective
in the marketplace. So, more to come from
a BRG in the market, and I'm excited
to to be a part of it.
Absolutely. And just and just to reiterate Brett's
points, I mean, we we were able to
join in in a group of
really intelligent and passionate
leaders. I mean, there there are people at
this firm that
are incredibly impressive and contribute so much to,
you know, developing health care solutions that benefit,
you know, not only our clients, but the
patients that they serve.
And and it's just
such a great opportunity to to be at
BRG and and to see
what we're we're actively building out and and,
you know, like Brett said, much more to
come, and and we're very excited for what's
coming down the road.
And and, Brett, I'll ask you this question.
You come from a brilliant family of physicians
and lawyers
and and, actually, athletes as well.
Do you ever feel like that you're on
the right side of history
by moving into consulting in health care versus
law or medicine
or or sports?
How do you look at that?
Thanks, Scott.
So I I like to think I take
the the good of both, my my paths
that I've seen,
ahead of me. I really appreciate in the
health care world of really having the altruistic
helping people aspect. But,
at the end of the day, the lawyer
in me in in brokering conversations, working with
people, and and the administrative side of the
health care industry to kinda move it forward,
my job is hopefully to make, the clinician's
job easier. So I'm trying to fuse the
two of them. And, you know, if you
think about it, everything's a little bit of
a sport, so that's, I think, part of
the negotiation in me too. So I do
my best to try to to blend all
of my background together and and take what
I think is is the good, and and
move it forward. So
You are a remarkable leader, and by chance,
I happen to know some of, Brett's family.
I'm gonna ask you one more question, and
you do not have to answer this.
Okay. Who is a better athlete, Mickey or
Gary?
Oh, that's that's a tough one. I think
it depends on the sport, but I'd be
remiss to say,
that my uncle did play Michael Jordan back
in in high school days. So that'd be
a tough one. That'd be a tough one.
That's a very well well way of stating
it without offending your father. I think that
was really well put. I I have to
tell you, it's it's a pleasure to visit
with the two of you. Aside from knowing
a little bit of Brett's family, brilliant, brilliant
people,
Peter and Brett are brilliant,
leaders and management consultants at BRG.
Brett or Peter, take the lead on the
next question.
Advice to emerging leaders, emerging careerists,
what what advice would you give to emerging
leaders, emerging professionals?
Yeah. I think, really, there's two that I
would like to to voice. First is be
curious. Right? We're in such a a complex
world of that's ever changing. So being a
lifelong learner, and I think that's why I
I chose consulting, it's all about lifelong learning
and just driving personal growth through learning a
new skill, deeper understanding of anything in your
area of expertise or not in your area
of expertise too. Trying to keep pace with
all the change that's happening in in not
just the health care industry, but but industries
writ large around AI, etcetera. So I think
just being curious is something that never stopped
learning,
is is something I definitely,
continue to to tell people as as whoever
listens to me, and and Peter probably is
is, rolling his eyes as I say that
because I've definitely told him to him too.
But the other one I think is is
about being a kind of a self starter
and looking for ways to make
somebody else's life a little easier.
Again, whether that's
your boss or your manager, a client, a
colleague, or even a friend, by lending a
hand or or stretching your role, you will
advance to wherever that next step may be
professionally and personally. If you just think about
how can I make that that person's life
a little bit better, a little bit easier,
a little bit more manageable?
But but I think that's that last point
is so well taken and so well stated.
People often don't realize in a professional organization
or any business, whatever you're doing, so much
of what you do
is about trying to help whoever you're working
with make things a little bit easier, a
little more concise, a little bit better,
and and and to solve problems rather than
to create more problems. I just I just
love that actually.
Peter, let me turn it to you. Any
piece of advice you could give to emerging
leaders?
Yeah. Absolutely.
And and I really kinda draw on
some of my past experiences.
You know, before I I put the consulting
hat on, I was an investigative reporter based
in Chicago. And,
you know, one of the things that has
done me personally very well and that that
I see really effective leaders doing is is
is networking and just being open to connections.
I mean, Scott, you're one of the best
to do it yourself. I mean, you know,
the way that we are able to to
get connected and just build these bridges and
start forming a relationship has, you know,
been invaluable, and it's something that, you know,
I'm looking forward to going into the future.
But, I mean,
effective leaders really recognize that networking isn't just
about, you know, collecting contacts or filling the
Rolodex. Right? It's about cultivating meaningful relationships. So
they invest time in the individuals. They they
listen. They and and they build this trust
and and and curate a broad and diverse
contact list. So, you know, these connections
benefit both their personal growth and their organization's
success. I mean, they open doors to collaboration,
innovation,
problem solving,
and and it makes
networking
a a strategic leadership skill rather than seeming
like a transactional activity.
And I think that point of developing real
relationships
versus a transactional
activity is is right on. I mean, the
more that long term people are available to
each other, it it's not so much you
do this, I gotta get that, or vice
versa. It's more, you know, over time, you
figure out where there's synergistic opportunities for people
and that work for everybody. And and I
think that's right on. I think that's just
a very I think that's a great perspective
on networking and relationship building
versus the alternative, which is everything's good, bro,
quorum, transactional, which is very short lived and
and leads to very flawed relationships, quite frankly.
Right. Brett and Peter, I I wanna thank
you both for taking the time to join
us today on the Becker's Healthcare podcast.
For me, this is a tremendous pleasure to
visit with the both of you. Thank you
so much for taking the time and joining
us. Thank you. Thank you, Scott. The pleasure
is ours. Thanks, Scott.