1 00:00:02,240 --> 00:00:04,980 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:13,044 payer and health plan executives and more than 5 00:00:13,044 --> 00:00:16,504 100 speakers to Chicago April. 6 00:00:16,885 --> 00:00:19,765 This year's event includes keynote conversations with the 7 00:00:19,765 --> 00:00:23,044 industry's top leaders and former president George w 8 00:00:23,044 --> 00:00:25,605 Bush. For the full agenda and event details, 9 00:00:25,605 --> 00:00:27,809 visit beckershospitalreview.com 10 00:00:27,890 --> 00:00:29,250 and click on the events tab in the 11 00:00:29,250 --> 00:00:31,489 upper right. We're looking forward to hosting you 12 00:00:31,489 --> 00:00:32,549 here in Chicago. 13 00:00:34,049 --> 00:00:36,850 This is Scott Becker with the Beckers Health 14 00:00:36,850 --> 00:00:37,590 Care Podcast. 15 00:00:38,129 --> 00:00:40,789 Thrilled to say to be visiting with brilliant 16 00:00:40,929 --> 00:00:42,629 journalist Jacob Emerson. 17 00:00:43,284 --> 00:00:45,685 Jacob follows the payer area and what's going 18 00:00:45,685 --> 00:00:47,064 on in the payer world. 19 00:00:47,445 --> 00:00:47,945 Jacob, 20 00:00:48,884 --> 00:00:50,804 tell us what's going on currently. What are 21 00:00:50,804 --> 00:00:52,564 the big stories you're watching in the payer 22 00:00:52,564 --> 00:00:53,625 universe currently? 23 00:00:54,325 --> 00:00:56,340 Yeah. Hey, Scott. Good to talk with you. 24 00:00:56,820 --> 00:00:58,340 So last night, we had the state of 25 00:00:58,340 --> 00:01:00,899 the union with president Donald Trump, the first 26 00:01:00,899 --> 00:01:02,600 one of his second administration. 27 00:01:03,539 --> 00:01:05,780 And health care was a topic during the 28 00:01:05,780 --> 00:01:06,280 speech. 29 00:01:06,579 --> 00:01:09,135 Longest speech in in history in terms of 30 00:01:09,135 --> 00:01:11,295 state of the unions, hundred and seven minutes, 31 00:01:11,295 --> 00:01:13,135 and health care got about four minutes of 32 00:01:13,135 --> 00:01:15,555 that. So, you know, I think that kind 33 00:01:15,694 --> 00:01:17,795 of speaks for itself in terms of where 34 00:01:17,935 --> 00:01:20,415 the policy focuses for for the administration in 35 00:01:20,415 --> 00:01:21,694 terms of health care right now. And I 36 00:01:21,694 --> 00:01:23,170 can I can dig into that a bit 37 00:01:23,170 --> 00:01:23,909 in terms of, 38 00:01:24,450 --> 00:01:25,890 some of the lack of details we have 39 00:01:25,890 --> 00:01:28,230 around specific things like ACA subsidies 40 00:01:28,609 --> 00:01:30,770 moving forward? We we would love you too. 41 00:01:30,770 --> 00:01:32,210 We we would love you too. Tell tell 42 00:01:32,210 --> 00:01:33,569 us what's going on there. I know that, 43 00:01:33,569 --> 00:01:34,125 like, I was on 44 00:01:35,084 --> 00:01:37,885 the on the podcast yesterday with leader of 45 00:01:37,885 --> 00:01:40,385 Banner Health, leader of of HonestHealth, 46 00:01:40,924 --> 00:01:42,924 and basically saying in terms of value based 47 00:01:42,924 --> 00:01:45,484 care, they're gonna have several 100,000 people in 48 00:01:45,484 --> 00:01:47,484 the city of Arizona coming off of health 49 00:01:47,484 --> 00:01:49,109 insurance. So we've gotta make sure they get 50 00:01:49,109 --> 00:01:51,370 to cure those people as well as possible. 51 00:01:51,989 --> 00:01:54,630 Yeah. And and as efficiently as possible because 52 00:01:54,630 --> 00:01:56,469 there'll be there'll be not only no margin, 53 00:01:56,469 --> 00:01:57,290 probably no 54 00:01:57,590 --> 00:01:59,030 reimbursement for a lot of those people as 55 00:01:59,030 --> 00:02:00,549 they gotta and and it it plays right 56 00:02:00,549 --> 00:02:02,650 into this discussion, but it's a brilliant discussion 57 00:02:02,709 --> 00:02:04,924 about value based care and how important it 58 00:02:04,924 --> 00:02:07,405 is. We're particularly in the areas we gotta 59 00:02:07,405 --> 00:02:08,865 take care of people who don't pay, 60 00:02:09,165 --> 00:02:10,365 and you have to make sure they're still 61 00:02:10,365 --> 00:02:12,284 taken care of really well but efficiently. But 62 00:02:12,365 --> 00:02:13,564 yeah. So tell us what what you heard 63 00:02:13,564 --> 00:02:14,944 coming out of the State of the Union. 64 00:02:15,259 --> 00:02:17,099 Yeah. And and it's interesting you talk about 65 00:02:17,099 --> 00:02:19,579 what Banner told you, Scott, because we heard, 66 00:02:19,579 --> 00:02:21,340 I believe it was last week from Tenet 67 00:02:21,340 --> 00:02:21,840 Healthcare 68 00:02:22,299 --> 00:02:25,519 executives projecting a 20% drop in exchange enrollment 69 00:02:25,739 --> 00:02:26,239 nationally. 70 00:02:26,699 --> 00:02:28,699 And last year, there's about 24,000,000 71 00:02:28,699 --> 00:02:30,775 people, a little more than that, enrolled in 72 00:02:30,775 --> 00:02:31,995 in the exchange plans. 73 00:02:32,375 --> 00:02:34,935 So a 20% drop. That's, you know, that's 74 00:02:34,935 --> 00:02:35,594 a huge, 75 00:02:36,135 --> 00:02:37,034 patient population 76 00:02:37,655 --> 00:02:40,155 coverage shift for or a payer mix shift. 77 00:02:40,215 --> 00:02:41,895 For for health systems all over the country, 78 00:02:41,895 --> 00:02:43,574 a volume shift, more people going to the 79 00:02:43,574 --> 00:02:45,115 ED for for basic care. 80 00:02:46,080 --> 00:02:48,080 So huge on that front alone. But in 81 00:02:48,080 --> 00:02:49,459 terms of the president's speech, 82 00:02:50,000 --> 00:02:52,000 he he definitely used the address to criticize 83 00:02:52,000 --> 00:02:52,659 the ACA. 84 00:02:53,280 --> 00:02:54,739 Nothing new for the president, 85 00:02:55,120 --> 00:02:57,884 but calling it the unaffordable care act and 86 00:02:57,884 --> 00:02:59,104 basically reiterating 87 00:02:59,485 --> 00:03:00,384 some of the, 88 00:03:01,564 --> 00:03:03,164 I don't know if I wanna say their 89 00:03:03,164 --> 00:03:05,664 policy proposals, but some of the ideas that 90 00:03:05,805 --> 00:03:08,525 he and and some Republicans have been, pushing 91 00:03:08,525 --> 00:03:09,025 forward 92 00:03:09,405 --> 00:03:11,004 last year, a little bit early this year 93 00:03:11,004 --> 00:03:12,580 as some of the talks over the enhanced 94 00:03:12,580 --> 00:03:14,840 subsidies continued, which is basically, 95 00:03:15,139 --> 00:03:18,260 you know, going against the insurers completely, really 96 00:03:18,260 --> 00:03:18,760 just 97 00:03:19,139 --> 00:03:21,080 talking trash about the insurance companies 98 00:03:21,460 --> 00:03:23,479 and proposing having funds, 99 00:03:23,780 --> 00:03:26,419 instead of subsidies, having funds go straight to 100 00:03:26,419 --> 00:03:26,919 Americans. 101 00:03:27,294 --> 00:03:29,055 A lot of Republicans supporting the idea of 102 00:03:29,055 --> 00:03:31,694 that being through HSAs, which as we know, 103 00:03:31,694 --> 00:03:34,275 you know, it's not really a replacement for 104 00:03:34,414 --> 00:03:35,715 a health insurance plan, 105 00:03:36,094 --> 00:03:37,794 funding an HSA just because, 106 00:03:38,174 --> 00:03:40,194 HSA funds can't be used to, 107 00:03:40,574 --> 00:03:41,715 pay insurance premiums. 108 00:03:42,240 --> 00:03:44,080 And, you know, funding HSA of, let's say, 109 00:03:44,080 --> 00:03:45,199 like, $2,000, 110 00:03:45,199 --> 00:03:46,800 that doesn't really get you anywhere in terms 111 00:03:46,800 --> 00:03:49,120 of premiums that can cost you 20 plus 112 00:03:49,120 --> 00:03:52,080 thousand dollars annually every year. So that's kind 113 00:03:52,080 --> 00:03:54,080 of where things are at with that. But 114 00:03:54,080 --> 00:03:56,794 I think overall, it's we're operating in a 115 00:03:56,794 --> 00:03:58,334 space now where the the marketplace 116 00:03:58,875 --> 00:04:01,114 now that these these talks around the subsidies 117 00:04:01,114 --> 00:04:02,495 have completely fallen apart, 118 00:04:02,794 --> 00:04:04,634 there is no where to go really with 119 00:04:04,634 --> 00:04:06,174 them at this point, it seems like. 120 00:04:06,634 --> 00:04:08,794 The marketplace is operating without any clear federal 121 00:04:08,794 --> 00:04:10,800 policy direction for the first time in a 122 00:04:10,800 --> 00:04:11,539 long time. 123 00:04:12,319 --> 00:04:14,240 So no no real plan right now from 124 00:04:14,240 --> 00:04:16,899 either side. Ideas, like I just mentioned, but 125 00:04:17,040 --> 00:04:20,019 no votes, no details, no implementation path. 126 00:04:20,879 --> 00:04:22,639 So, you know, for for the for the 127 00:04:22,639 --> 00:04:24,595 hospital systems, let's say that it's it's a 128 00:04:24,595 --> 00:04:26,214 scary time because you've got, 129 00:04:26,514 --> 00:04:29,975 like, according to tenant, 20% less exchange enrollees 130 00:04:30,035 --> 00:04:31,235 and, you know, a lot of change to 131 00:04:31,235 --> 00:04:32,995 your payer mix. And then on the insurer 132 00:04:32,995 --> 00:04:34,214 side, a lot less members, 133 00:04:34,514 --> 00:04:37,714 and overall, just a a directionless marketplace as 134 00:04:37,714 --> 00:04:39,014 things currently stand. 135 00:04:39,529 --> 00:04:40,889 Right. And you and you do see some 136 00:04:40,889 --> 00:04:41,949 of the big insurers 137 00:04:42,730 --> 00:04:46,189 peering down their Medicare Advantage marketing and populations 138 00:04:46,569 --> 00:04:47,470 in in 139 00:04:47,770 --> 00:04:49,529 in areas that they're serving. Is that is 140 00:04:49,529 --> 00:04:50,750 that is that right? 141 00:04:51,210 --> 00:04:53,094 It is it is correct. And a lot 142 00:04:53,094 --> 00:04:54,794 of it was very deliberate. 143 00:04:55,495 --> 00:04:55,995 Basically, 144 00:04:56,375 --> 00:04:58,134 they got too big, and we're really talking 145 00:04:58,134 --> 00:04:59,435 about the national carriers. 146 00:04:59,974 --> 00:05:01,495 And and I put an asterisk there because 147 00:05:01,495 --> 00:05:03,495 there were some exceptions that we saw in 148 00:05:03,495 --> 00:05:05,574 some of the most recent enrollment data during 149 00:05:05,574 --> 00:05:08,069 the annual enrollment period that just wrapped up 150 00:05:08,069 --> 00:05:08,870 last fall. 151 00:05:09,269 --> 00:05:10,009 But, yes, 152 00:05:10,550 --> 00:05:11,050 United, 153 00:05:11,589 --> 00:05:12,569 Aetna, CVS, 154 00:05:13,910 --> 00:05:15,430 Elevants, and then some of the big Blue 155 00:05:15,430 --> 00:05:17,289 Cross conglomerates besides Elevants, 156 00:05:17,910 --> 00:05:20,949 all seen really big reductions in in disenroll 157 00:05:21,269 --> 00:05:21,850 NA disenrollments. 158 00:05:22,605 --> 00:05:24,524 And, again, a lot of that was very 159 00:05:24,524 --> 00:05:27,105 deliberate. But I thought what was really interesting 160 00:05:27,324 --> 00:05:27,824 is, 161 00:05:28,605 --> 00:05:31,805 Humana actually enrolled over a million people just 162 00:05:31,805 --> 00:05:34,204 this past fall. So Humana kind of bucking 163 00:05:34,204 --> 00:05:36,285 the trend of of the national publicly traded 164 00:05:36,285 --> 00:05:36,785 insurers. 165 00:05:37,110 --> 00:05:39,029 And then what we really saw, in the 166 00:05:39,029 --> 00:05:41,750 enrollment data was the the start up, the 167 00:05:41,750 --> 00:05:44,310 smaller insurers, the nonprofits, some of the Blue 168 00:05:44,310 --> 00:05:45,129 Cross plans, 169 00:05:45,910 --> 00:05:47,589 plans that, you know, have a very special 170 00:05:47,589 --> 00:05:49,589 focus. They they focus in one region or 171 00:05:49,589 --> 00:05:52,105 they focus on a specific population for Medicare. 172 00:05:52,404 --> 00:05:54,584 They they boomed. We saw plans 173 00:05:54,884 --> 00:05:56,024 double their enrollment, 174 00:05:56,485 --> 00:05:57,705 in in in already 175 00:05:58,084 --> 00:06:00,264 having in the hundreds of thousands of members. 176 00:06:00,805 --> 00:06:01,285 So, 177 00:06:01,605 --> 00:06:03,629 so we're actually speaking with insurance about that 178 00:06:03,709 --> 00:06:05,389 this week, but it it was a definitely 179 00:06:05,389 --> 00:06:07,470 noticeable trend that the small guys, some of 180 00:06:07,470 --> 00:06:09,490 the hospital and insurers did fantastic. 181 00:06:10,029 --> 00:06:12,029 And then deliberately, a lot of the big 182 00:06:12,029 --> 00:06:13,389 publicly traded guys, 183 00:06:13,790 --> 00:06:16,350 lost a a lot of members for United 184 00:06:16,350 --> 00:06:16,964 up to, 185 00:06:17,444 --> 00:06:19,685 a million just, because of the the rising 186 00:06:19,685 --> 00:06:21,605 utilization costs and trying to shed some of 187 00:06:21,605 --> 00:06:22,345 those unprofitable, 188 00:06:23,125 --> 00:06:23,625 plans. 189 00:06:25,044 --> 00:06:26,725 Right. I mean, they truly tried to move 190 00:06:26,725 --> 00:06:28,245 out of those markets because they're they're not 191 00:06:28,245 --> 00:06:30,324 making money in those markets, and and they'd 192 00:06:30,324 --> 00:06:31,740 rather not do it. It. Where does that 193 00:06:31,740 --> 00:06:33,579 leave us in terms of Medicare Advantage? Is 194 00:06:33,579 --> 00:06:35,019 it still last year, I think it ended 195 00:06:35,019 --> 00:06:36,139 up up 54% 196 00:06:36,139 --> 00:06:36,879 of Medicare. 197 00:06:37,259 --> 00:06:38,939 Where where is that currently at? Do we 198 00:06:38,939 --> 00:06:40,220 have a sense of that or not not 199 00:06:40,220 --> 00:06:40,720 exactly? 200 00:06:41,259 --> 00:06:43,579 As as it stands now, it's at, over 201 00:06:43,579 --> 00:06:44,459 55%. 202 00:06:44,459 --> 00:06:46,889 It it slowed. The, the 203 00:06:48,194 --> 00:06:50,354 enrollment rate itself actually slowed during this past 204 00:06:50,354 --> 00:06:52,535 annual enrollment. We're we're in open enrollment. 205 00:06:53,475 --> 00:06:55,894 So people, you know, there's still people enrolling, 206 00:06:56,115 --> 00:06:58,194 but for new enrollees, that was happening this 207 00:06:58,194 --> 00:07:00,055 past fall, and the rate did slow. 208 00:07:01,154 --> 00:07:03,379 I I think, though, Scott, one one story 209 00:07:03,379 --> 00:07:05,539 I did wanna mention that contextually is a 210 00:07:05,539 --> 00:07:06,740 part of all of this, and it's just 211 00:07:06,899 --> 00:07:09,779 it it it's massive. It's, it's the largest 212 00:07:09,779 --> 00:07:12,039 Medicare Advantage fraud settlement to date, 213 00:07:12,419 --> 00:07:14,039 with Kaiser Permanente. 214 00:07:14,579 --> 00:07:16,419 And that happened in January between them and 215 00:07:16,419 --> 00:07:19,535 the DOJ. $556,000,000, 216 00:07:19,935 --> 00:07:20,915 settlement to resolve 217 00:07:21,375 --> 00:07:23,455 allegations from the government that basically the health 218 00:07:23,455 --> 00:07:23,955 system, 219 00:07:24,814 --> 00:07:27,694 gained the the MA payment system by doing 220 00:07:27,694 --> 00:07:29,295 the upcoding that we've heard about in the 221 00:07:29,295 --> 00:07:31,639 headlines for over a decade now, but basically 222 00:07:31,639 --> 00:07:35,160 inflating patient diagnosis codes to get higher, higher 223 00:07:35,160 --> 00:07:37,000 payments from the government. And this is all 224 00:07:37,000 --> 00:07:37,500 alleged, 225 00:07:38,439 --> 00:07:39,959 but it's a it's a big scheme, a 226 00:07:39,959 --> 00:07:42,360 lot of details that the DOJ alleged in 227 00:07:42,360 --> 00:07:44,360 in their release about this. And, again, it's 228 00:07:44,360 --> 00:07:45,819 a record fraud settlement, 229 00:07:46,595 --> 00:07:48,595 which I just think is interesting even just 230 00:07:48,595 --> 00:07:51,394 from the fact that Kaiser often has some 231 00:07:51,394 --> 00:07:53,955 of the highest quality rated Medicare Advantage Plans 232 00:07:53,955 --> 00:07:55,795 in the country. In some of their markets, 233 00:07:55,795 --> 00:07:57,235 they get five out of five stars in 234 00:07:57,235 --> 00:07:58,615 some of their markets with CMS. 235 00:07:58,995 --> 00:08:02,709 So CMS's highest quality Medicare Advantage Plans arguably 236 00:08:03,490 --> 00:08:03,990 now 237 00:08:04,529 --> 00:08:07,029 having the largest Medicare Advantage fraud settlement. 238 00:08:07,810 --> 00:08:09,569 So, you know, I I I would let 239 00:08:09,569 --> 00:08:11,329 the the listeners, you know, come to their 240 00:08:11,329 --> 00:08:12,689 own conclusions about that, but I just think 241 00:08:12,689 --> 00:08:13,910 it's a very interesting 242 00:08:14,610 --> 00:08:15,110 contrast, 243 00:08:15,435 --> 00:08:16,814 in terms of recent developments. 244 00:08:17,995 --> 00:08:20,074 No. It's it's, you're fascinated. You've got some 245 00:08:20,074 --> 00:08:21,835 actually moving in the right direction, some moving 246 00:08:21,835 --> 00:08:23,435 in the wrong direction. Even though the growth 247 00:08:23,435 --> 00:08:25,035 is slow to Medicare Advantage, it's still up 248 00:08:25,035 --> 00:08:26,095 to 55% 249 00:08:26,154 --> 00:08:28,555 as opposed to retrenching. That's fascinating too, isn't 250 00:08:28,555 --> 00:08:32,379 it? Yeah. Definitely. And where we saw most 251 00:08:32,379 --> 00:08:34,620 of the growth, majority of the growth, was 252 00:08:34,620 --> 00:08:37,519 not in traditional Medicare Advantage with healthy seniors. 253 00:08:37,740 --> 00:08:40,620 It was in, dual special needs plan special 254 00:08:40,620 --> 00:08:43,419 special Medicare Advantage Plans that take care of 255 00:08:43,419 --> 00:08:47,445 very sick chronic chronically sick, populations or people 256 00:08:47,445 --> 00:08:50,404 who are dually eligible for Medicaid and Medicare. 257 00:08:50,404 --> 00:08:52,105 So really, really low income seniors. 258 00:08:52,565 --> 00:08:54,904 That is where that is the fastest growing 259 00:08:55,125 --> 00:08:58,529 portion of Medicare Advantage now across the country 260 00:08:58,529 --> 00:09:00,710 for the entire program, and that's what drove 261 00:09:00,769 --> 00:09:02,210 most of the growth this last fall as 262 00:09:02,210 --> 00:09:04,149 well. So not normal MA anymore. 263 00:09:04,529 --> 00:09:06,690 And who are the payers that specialize in 264 00:09:06,690 --> 00:09:08,769 that market? Are there peers that really specialize 265 00:09:08,769 --> 00:09:11,805 there? Honestly, they they all they all, they 266 00:09:11,805 --> 00:09:12,305 all, 267 00:09:12,925 --> 00:09:15,325 have have, business lines in this market because 268 00:09:15,325 --> 00:09:17,565 it's growing so fast. They and it's really 269 00:09:17,644 --> 00:09:19,404 Scott, it's grown. I'd say in the last 270 00:09:19,404 --> 00:09:22,045 two, three, four years is where we've really 271 00:09:22,045 --> 00:09:23,024 started to see, 272 00:09:23,644 --> 00:09:25,019 resources invested in this 273 00:09:25,660 --> 00:09:27,840 this space and and then the the corresponding 274 00:09:27,899 --> 00:09:28,399 enrollment. 275 00:09:29,580 --> 00:09:31,279 A lot a lot of the reasons because 276 00:09:31,340 --> 00:09:33,500 you get higher reimbursements for taking care of, 277 00:09:33,740 --> 00:09:36,620 sicker populations, especially when they're dually eligible for 278 00:09:36,620 --> 00:09:37,120 Medicaid. 279 00:09:37,445 --> 00:09:38,565 Right. And that was that was the next 280 00:09:38,565 --> 00:09:40,485 one I was gonna ask you. Is is 281 00:09:40,485 --> 00:09:42,985 there higher reimbursement because they're 282 00:09:43,524 --> 00:09:45,845 more more sick, and those payers are still 283 00:09:45,845 --> 00:09:47,524 making money off it so that part of 284 00:09:47,524 --> 00:09:49,605 the market grows. I mean, it's fascinating how 285 00:09:49,605 --> 00:09:51,509 it works, how things really do follow the 286 00:09:51,509 --> 00:09:52,710 money. And I don't mean in a bad 287 00:09:52,710 --> 00:09:54,809 way or good way, just an observational way. 288 00:09:54,950 --> 00:09:57,110 Yeah. Definitely. But I think some would argue 289 00:09:57,110 --> 00:09:58,570 that now these individuals, 290 00:09:59,110 --> 00:10:00,490 pretty vulnerable populations, 291 00:10:01,429 --> 00:10:02,410 are now getting 292 00:10:03,254 --> 00:10:05,914 health benefits that are a lot more comprehensive 293 00:10:05,975 --> 00:10:08,534 than just traditional Medicaid, traditional Medicare, which, you 294 00:10:08,534 --> 00:10:09,995 know, doesn't really cover much, 295 00:10:10,534 --> 00:10:12,134 on the Medicare side, much of anything beyond 296 00:10:12,134 --> 00:10:13,654 just, you know, the hospital stays and and 297 00:10:13,654 --> 00:10:15,254 stuff like that. You know? Now they're getting 298 00:10:15,254 --> 00:10:17,470 at least dental benefits, hearing benefits, 299 00:10:17,850 --> 00:10:19,690 things like that. So some could argue, you 300 00:10:19,690 --> 00:10:21,129 know, the growth here is a good thing 301 00:10:21,129 --> 00:10:23,129 because it's it's getting better benefits for some 302 00:10:23,129 --> 00:10:25,769 of these more vulnerable populations. A 100%. I 303 00:10:25,769 --> 00:10:27,129 mean, those are the people that need it 304 00:10:27,129 --> 00:10:28,409 the most. And if you could manage it 305 00:10:28,409 --> 00:10:30,909 efficiently, get them some extra benefits, god bless. 306 00:10:31,424 --> 00:10:32,945 What what a fascinating thing to watch. I 307 00:10:32,945 --> 00:10:34,225 mean, well, you sort of have a little 308 00:10:34,225 --> 00:10:35,904 bit of a government policy that's all over 309 00:10:35,904 --> 00:10:38,144 the board, not very clear. You do have 310 00:10:38,144 --> 00:10:41,285 Medicare advantage. Man, it's growing in certain segments 311 00:10:41,345 --> 00:10:43,504 even though the big traditional MA is slowing 312 00:10:43,504 --> 00:10:44,865 down some and some of the big payers 313 00:10:44,865 --> 00:10:46,320 have moved out of it. It's a lot 314 00:10:46,320 --> 00:10:48,639 to digest there, isn't it? It is. And 315 00:10:48,639 --> 00:10:51,120 and, like, connected to, you know, some of 316 00:10:51,120 --> 00:10:52,879 the tensions we've seen with the health systems 317 00:10:52,879 --> 00:10:55,120 and and MA, they use that as kind 318 00:10:55,120 --> 00:10:56,879 of a marketing piece to tell people, well, 319 00:10:56,879 --> 00:10:58,735 if you come into our MA plan that 320 00:10:58,735 --> 00:11:00,174 we own, you're not gonna go out of 321 00:11:00,174 --> 00:11:01,855 network like you would with some of the 322 00:11:01,855 --> 00:11:03,134 big guys who are always in danger of 323 00:11:03,134 --> 00:11:05,695 that. So it kind of all works together 324 00:11:05,695 --> 00:11:07,214 what we saw, but but like I said, 325 00:11:07,214 --> 00:11:10,014 the smaller guys, the hospital owned insurers with 326 00:11:10,014 --> 00:11:11,820 MA, they they did really well this past 327 00:11:11,820 --> 00:11:13,259 year, and that's what they told us they 328 00:11:13,259 --> 00:11:14,559 were they were hoping to do. 329 00:11:15,019 --> 00:11:16,000 Absolutely fascinating. 330 00:11:16,779 --> 00:11:19,200 Jacob, anything else you want to share today? 331 00:11:20,059 --> 00:11:21,259 No. I don't I don't think so. I 332 00:11:21,259 --> 00:11:22,860 mean, the president's speech also touched a little 333 00:11:22,860 --> 00:11:25,100 bit on Trump RX. We've covered that pretty, 334 00:11:25,340 --> 00:11:25,840 extensively 335 00:11:26,424 --> 00:11:27,245 on the websites, 336 00:11:27,785 --> 00:11:29,465 with Becker's. And then, you know, I think 337 00:11:29,465 --> 00:11:30,285 just overall, 338 00:11:30,825 --> 00:11:32,184 insurers don't have a lot of friends in 339 00:11:32,184 --> 00:11:34,904 Washington right now. Yeah. Tell us. And that's 340 00:11:34,904 --> 00:11:37,404 unusual because for thirty, forty years, 341 00:11:38,105 --> 00:11:39,865 they've had an insane amount of friends in 342 00:11:39,865 --> 00:11:40,365 Washington 343 00:11:40,980 --> 00:11:43,480 partly because of so much lobbying in Washington 344 00:11:44,019 --> 00:11:46,500 and a general bent to turn over a 345 00:11:46,500 --> 00:11:48,200 lot of government health care 346 00:11:48,899 --> 00:11:50,679 to have it managed for the payers. 347 00:11:51,059 --> 00:11:52,659 And that seems like it's not going as 348 00:11:52,659 --> 00:11:55,779 well as people expected. Certainly, it's become very 349 00:11:55,779 --> 00:11:56,279 expensive. 350 00:11:57,024 --> 00:11:59,424 Lots of concerns about denials and pre auths, 351 00:11:59,424 --> 00:12:01,504 all the things that you needed the payers 352 00:12:01,504 --> 00:12:03,664 to do to try and manage cost, but 353 00:12:03,664 --> 00:12:06,304 aren't that the population actually just hates. And 354 00:12:06,304 --> 00:12:08,865 so what a fascinating what a fascinating situation 355 00:12:08,865 --> 00:12:10,485 where that's gone sort of, you 356 00:12:10,930 --> 00:12:13,730 you know, for so long, AHIP was so 357 00:12:13,730 --> 00:12:14,230 strong, 358 00:12:15,330 --> 00:12:16,690 you know, in in in a in a 359 00:12:16,690 --> 00:12:19,009 great job advocating for their members, the big 360 00:12:19,009 --> 00:12:20,769 payers. They were so strong in Washington, both 361 00:12:20,769 --> 00:12:21,810 sides of the island. Now you see a 362 00:12:21,810 --> 00:12:23,269 little bit of there's just a populist 363 00:12:23,730 --> 00:12:27,004 pushback against it. It's fascinating to watch. Yeah. 364 00:12:27,004 --> 00:12:28,365 And I I think it's also it's just 365 00:12:28,365 --> 00:12:30,044 a perfect storm right now, Scott, in terms 366 00:12:30,044 --> 00:12:32,044 of the the economics of all this with 367 00:12:32,044 --> 00:12:33,965 the Medicaid cuts coming down the line, the 368 00:12:33,965 --> 00:12:36,445 fact that employers are facing just huge costs 369 00:12:36,445 --> 00:12:38,820 right now, with self insured plans because of 370 00:12:38,980 --> 00:12:40,899 just rising costs overall with with health care, 371 00:12:40,899 --> 00:12:43,240 but also the GLP one factor that's rising, 372 00:12:44,019 --> 00:12:45,240 care costs with everybody. 373 00:12:45,620 --> 00:12:48,259 ACA falling apart, Medicare Advantage costs going up, 374 00:12:48,259 --> 00:12:49,940 all the tensions with providers and going out 375 00:12:49,940 --> 00:12:52,225 of the network. So I think everybody is 376 00:12:52,225 --> 00:12:54,304 affected by all these insurance issues now, whereas 377 00:12:54,304 --> 00:12:55,904 maybe in the past, it was just certain 378 00:12:55,904 --> 00:12:57,365 segments, certain populations. 379 00:12:57,745 --> 00:12:59,584 And then during these hearings with the insurance 380 00:12:59,584 --> 00:13:02,784 CEOs last month, you had congressmen complaining to 381 00:13:02,784 --> 00:13:05,009 the CEOs talking about, I couldn't get this 382 00:13:05,169 --> 00:13:07,090 prescription of mine covered by by my health 383 00:13:07,090 --> 00:13:09,090 plan through you. I couldn't get this prior 384 00:13:09,090 --> 00:13:12,309 authorization approved. The congressmen are are are complaining 385 00:13:12,370 --> 00:13:13,970 about health insurance at this point in term 386 00:13:14,049 --> 00:13:17,024 and and care delays. It's affecting everyone. It's 387 00:13:17,264 --> 00:13:19,125 it's impossible to ignore 388 00:13:19,425 --> 00:13:21,745 anymore, and I think that's why we're seeing 389 00:13:21,745 --> 00:13:23,205 there there's very little friends. 390 00:13:23,904 --> 00:13:25,585 But I think that's fascinating because at the 391 00:13:25,585 --> 00:13:26,565 end of the day, 392 00:13:26,945 --> 00:13:28,625 there's two different things here that that I 393 00:13:28,705 --> 00:13:30,669 that you mentioned right there. One is we 394 00:13:30,669 --> 00:13:32,350 always thought congress was somewhat immune to this 395 00:13:32,350 --> 00:13:33,790 because the rest of us see this as 396 00:13:33,790 --> 00:13:34,290 consumers, 397 00:13:34,669 --> 00:13:36,990 the challenge getting the access we need. But 398 00:13:36,990 --> 00:13:38,690 even those with better access 399 00:13:39,309 --> 00:13:40,290 that know everybody, 400 00:13:40,669 --> 00:13:42,929 there's just a shortage of physicians and caregivers. 401 00:13:43,070 --> 00:13:44,865 So as much as you know you know 402 00:13:44,865 --> 00:13:46,225 the CEO of this, you know the CEO 403 00:13:46,225 --> 00:13:47,504 of this, it's still hard to get the 404 00:13:47,504 --> 00:13:48,785 right on college when you're the right on 405 00:13:48,785 --> 00:13:49,904 college, just the right whoever, when you need 406 00:13:49,904 --> 00:13:51,585 the right whoever. It's just just it's just 407 00:13:51,585 --> 00:13:53,424 getting more challenging. I mean, the flip side 408 00:13:53,424 --> 00:13:53,924 is 409 00:13:54,225 --> 00:13:56,085 you could point the fingers at the insurers, 410 00:13:56,690 --> 00:13:59,110 but this is completely a problem that DC 411 00:13:59,169 --> 00:13:59,669 created 412 00:14:00,049 --> 00:14:01,649 by turning over so much of the federal 413 00:14:01,649 --> 00:14:04,789 government spend and Medicaid spend through the payers. 414 00:14:05,169 --> 00:14:07,409 And it's it it it it's arguably cost 415 00:14:07,409 --> 00:14:09,429 a lot of hyperinflation in health care, 416 00:14:09,809 --> 00:14:11,595 and no one at least none of them 417 00:14:11,595 --> 00:14:13,674 are focused on the real issue. The congressman 418 00:14:13,674 --> 00:14:14,495 yelling at 419 00:14:15,115 --> 00:14:17,355 at AHIP members. Well, AHIP members have funded 420 00:14:17,355 --> 00:14:19,434 the congressman, and they've had this mutual sort 421 00:14:19,434 --> 00:14:21,754 of love for each other is literally the 422 00:14:21,754 --> 00:14:24,154 height of political theater in some ways. And 423 00:14:24,154 --> 00:14:26,429 instead of complaining about the insurance companies, it's 424 00:14:26,509 --> 00:14:27,870 trying to solve problems. Like, how do we 425 00:14:27,870 --> 00:14:29,789 end up with more specialists, more doctors, more 426 00:14:29,789 --> 00:14:31,309 primary care? How do we end up actually 427 00:14:31,309 --> 00:14:32,690 fill solving the problem 428 00:14:33,389 --> 00:14:35,789 versus just political theater, which is yelling at 429 00:14:35,789 --> 00:14:37,309 the payers? You you you say it right. 430 00:14:37,309 --> 00:14:38,589 The payers know a lot of friends in 431 00:14:38,589 --> 00:14:39,089 Washington, 432 00:14:39,514 --> 00:14:41,355 but but even the Washingtonians don't seem to 433 00:14:41,355 --> 00:14:43,355 be really focused on solving the problem. They're 434 00:14:43,355 --> 00:14:45,995 just they're just they're just grandstanding from what 435 00:14:45,995 --> 00:14:47,434 I could tell, and and it is what 436 00:14:47,434 --> 00:14:49,274 it is. Yeah. I think I mean, I 437 00:14:49,274 --> 00:14:51,274 think you talk to any of our our 438 00:14:51,274 --> 00:14:53,339 audience, the people we interview. It's a mess, 439 00:14:53,339 --> 00:14:55,259 and nobody really seems to know how to 440 00:14:55,259 --> 00:14:57,019 solve the problem. Nobody knows what to tackle 441 00:14:57,019 --> 00:14:57,519 first. 442 00:14:57,820 --> 00:15:00,480 Yeah. Because it's just this giant messy web. 443 00:15:00,940 --> 00:15:01,440 So 444 00:15:01,899 --> 00:15:04,059 yeah. Yeah. It is what it is, but 445 00:15:04,059 --> 00:15:05,980 we but we we, we need more doctors 446 00:15:05,980 --> 00:15:08,504 and nurses particularly and more specialists and everything. 447 00:15:08,504 --> 00:15:10,024 I mean, you look at the benches for 448 00:15:10,024 --> 00:15:11,945 oncology. The benches for some of these specialties, 449 00:15:11,945 --> 00:15:13,164 these are really important. 450 00:15:13,625 --> 00:15:15,144 Once you get past the the the front 451 00:15:15,144 --> 00:15:16,985 lines, there's just a real shortage and lots 452 00:15:16,985 --> 00:15:18,664 of specialties, and it's gonna get a lot 453 00:15:18,664 --> 00:15:20,293 worse for the next ten years. Yeah. So 454 00:15:20,346 --> 00:15:21,839 no. I I agree with you. People don't 455 00:15:21,839 --> 00:15:23,200 know where to start, but we could tell 456 00:15:23,200 --> 00:15:24,639 them where we think they should start. But, 457 00:15:25,279 --> 00:15:27,440 it is what it is. Jacob, as always, 458 00:15:27,440 --> 00:15:29,200 fantastic to visit with you. I always learn 459 00:15:29,200 --> 00:15:31,120 something. It's my favorite podcast of the week, 460 00:15:31,120 --> 00:15:32,799 Greg, to visit with you and learn something. 461 00:15:32,799 --> 00:15:34,240 Thank you for joining us on the Becker's 462 00:15:34,240 --> 00:15:34,966 Healthcare Podcast. 463 00:15:35,525 --> 00:15:36,806 I appreciate that. It's good to talk with 464 00:15:36,806 --> 00:15:37,466 you, Scott.