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Welcome everyone to the Becker's Healthcare podcast series.
I'm Mohammed, writer and moderator with Becker's Healthcare.
I'm thrilled to have with me today Boyd
Faust, chief strategy officer at GoHealth Urgent Care
and a newly elected member of the board
of directors for the Urgent Care Association. Boyd,
welcome to the Becker's Healthcare podcast. We're very
excited to have to have you today. To
get us started, would you mind please introducing
yourself and telling us a bit about your
background?
You bet. My name is Boyd Faust, and
I'm the strategy officer at GoHealth Urgent Care.
GoHealth is a provider of on demand care.
We operate about
280 urgent care centers nationwide with health systems,
and we also provide telehealth.
We partner with major health systems to kinda
tackle
long standing issues in health care, especially
access, cost, and quality.
I've been with GoHealth for 11 years and
actually part of the initial operating team. I've
served in various roles there, CFO, COO, and
compliance officer.
And my current position focuses on working with
health system partners to develop
sustainable relationships with national and local payers
that bring value and promote the use of
urgent care for low and moderate acuity illnesses
and injuries when and where patients need it.
Stepping back a bit, I've I've worked in
health care for over 35 years.
I've been on the hospital health system side,
freestanding ambulatory
care side, and on the consulting side of
health care with,
I think, a focus
mostly in the last half of my career
on patient access to care settings that truly
optimize
affordable quality of care.
And my first introduction to urgent care was
actually back in the nineties helping develop and
manage an urgent care center.
Board of directors of the urgent care association
where I will work with my fellow board
members to even be more involved than I
currently am in advocating for urgent care providers
to the payers of health care services.
We we want payers to recognize the differentiated
role and value that urgent care brings to
the health care continuum.
Being in health care services for for all
my career and currently in urgent care,
I understand some of the challenges that many
participants in health care are facing, and I'm
putting my energy into improving the relationship
with commercial insurance payers, which I consider to
be the most critical
factor in the future
success of urgent care and the broader health
care industry as a whole.
Specifically, I'm working to promote and expand urgent
care provider payer arrangements by creating value based
care models
that demonstrate the benefit that urgent care brings
to health insurance plans and especially
to to the members and employers, the ones
who actually pay for most of the health
care in the United States.
Wonderful. Thank you so much for giving us
that overview about your background. It's definitely helpful,
especially to know a bit more about you,
with this conversation that we're having. So the
next question I really wanted to ask you
is with all your experience,
and your busyness, I'm sure, what are some
of the biggest issues you're following in health
care this year,
and head into the next year?
You know, it's it's interesting. I think every
time this this time of year in late
July,
I think about the both 2 things, the
benefit design changes that are gonna happen with
commercial health insurance plans
and Medicare rate changes. And both those,
you know, change and start
new January 1st each year.
Most of the countries commercially insured and and
small changes to member benefits
impact their decisions when faced with unexpected health
care needs.
I specifically
watch for changes in health insurance members' cost
share responsibility
for the benefit design. Not only just for
urgent care benefits, but also
urgent care urgent care's cost share relative to,
like, emergency room and primary care settings.
Cost share includes, of course, the normal items
of co pays, coinsurance, and deductibles.
And when patients make decisions about which setting
to use for an episodic need for care,
they make a choice between 1 or all
all these three settings
and thus going to their pre CP or
the closest emergency room is a consideration that
I watch in these design changes for benefit
design.
We find that this benefit design of patients'
cost share can significantly
make a difference in how patients choose their
setting of health care.
Because patients may have trouble discerning the quality
of their care, but they have no problem
in understanding a dollar amount assigned to a
decision on the setting of care.
As part of the benefit design, we look
at also the benefit tiers,
which have tier 1 providers
favored with a lower cost share than, say,
tier 2 and tier 3 providers.
Thus, I'm looking to see at the see
who's in tier 1 and whether we, GoHealth,
is actually grouped in that tier whenever possible.
And this
these tier 1 providers are often narrower networks
that focus on on name brand providers with
a reputation for quality and cost effective care.
If you as a provider
are included in those preferred brands as a
tier one provider, then great. But if you're
not, the patient must pay more for the
use of of a of a provider services,
and patients often choose not to go to
these more costly providers.
And when these providers are moved from, say,
tier 1 to to tier 2 or 2
3 at the beginning of the year, those
providers experience an overnight drop in utilization, which
significantly affects their bottom line. So, fortunately,
collaborating with payers and our health system partners
on value based care has allowed GoHealth to
predominantly become a tier one provider and remain
viable in that health care continuum with patients.
Like Like I mentioned earlier, there's a there's
a second item that I look at, which
is Medicare rates. And and as usual, in
July of each year, CMS publishes the the
proposed rate changes for the next calendar year,
including the Medicare physician fee schedule changes.
And those impact nonfacility providers like physician practices
and urgent care like us.
Commercial payers watch and closely follow these these
CMS proposals and the resulting final final decision
because certain health insurance reimbursement for physicians and
urgent cares
are tied to the CMS rates.
And even if the insurance plan reimbursement is
not directly tied to CMS, the rest of
the payer reimbursement arrangements at least consider them
or recalibrate to them. With inflation running high,
especially in health care industry, these annual rate
changes to reimbursement
determine whether profit margins will, you know, erode,
stay the same, or actually improve for providers.
And this commercial insurance ripple effect by CMS
thus determines the financial viability or or the
fate of urgent care centers and physician practices.
I guess my last note of this is
that the the payer rate changes have not
kept pace with inflation
so far with CMS. The annual CMS rate,
also known as the conversion factor, has hovered
around the same for the last few years
and actually
decreased in 2024.
And then 2025 was just announced like clockwork,
a couple weeks ago and is no exception
to this negative trend.
The the CMS proposed conversion factor dropped 2.8%,
which is another challenge to the to the
health care industry and the leaders that that
have to run it.
Yeah. Yeah. Thank you so much for sharing
all that important information. It definitely seems like
a lot is at stake. Is there anything
that you are most excited about or anything
that's making you nervous, whether it's anything you're
dealing with, Echol Health or anything else that
you're seeing in the news?
You know, it's it's it's interesting. I think
the the thing I'm most excited about is
also the same same thing that makes me
nervous. You know, for the first time,
providers can actually see reimbursement
rates paid to other providers by health insurance
companies
under the new transparency rules,
which went into effect a couple years ago.
And that makes me both excited and nervous.
You know, even though it was mandated a
couple years ago, this transparency
has been pretty cloudy and blurred up until
recently, and it still needs some improvement.
But but it's it's it's been improved as
payers, and and the new price transparency companies
have gone through a process of trying to
fix data gaps and organizing this data to
make it a little more user friendly.
You know, I'm excited because this is an
opportunity to understand where our reimbursement stands in
comparison to other providers for urgent care services
in the various markets that we serve.
But I'm also nervous
to see the results and to know how
we compare
because understanding these results presents challenges and risks
whether we're at the top or at the
bottom of the range.
Knowing that the payers and competitors also have
access to this
information
creates more a more competitive rate environment,
which impacts negotiations and discussions with payers and
potentially
risks a degree of commoditization
of rate.
The result of this transparency is causing and
and will cause and should cause a shift
and an emphasis more on the value that
health care providers actually offer.
So if if we're closer to the higher
end of the range or desire to be,
we must demonstrate,
in my mind, why our services are worth
that higher value.
Fortunately for us,
for the last 7 years, GoHealth's been involved
in programs that create value for the patients
as well as payers.
We see this new price transparency as an
opportunity to show payers how we're different and
the value we and our health system partners
bring.
We call this value based care,
but but these value based care programs range
from
proactively engaging with patients to educate them about
more affordable and convenient
options other than the ED
to practicing antibiotic stewardship.
Most of our value based care programs focus
on shifting patient behavior
to embrace a lower cost, high quality alternative
offered by urgent care.
In addition, our programs in chronic disease identification
and monitoring in cooperation with PCPs create preventative
health value recognized by the payers.
The the value based care programs create not
only immediate savings for that episode that the
patient comes in for,
but long term benefits for that insured member
and their health health care payer.
And then I think I'd be remiss to
say that not that
to say that everyone
in health care leadership
is justifiably nervous and concerned about the inflationary
cost overall of health care. And and this
really deals with the 2 big operating cost
categories of payroll and supplies.
It'll be interesting to see where this cost
trend goes
because I don't see any end in sight
with the with the limited number of providers
and clinical staff,
in this country not able to meet patient
demand currently,
and the shrinking workforce as burnout continues to
weigh on those more senior clinicians.
I'm I'm nervous about this because it impacts
margins and profitability both in our company and
the overall health care industry. And this puts
a a further strain on existing providers such
as such as, you know, such as us.
And because if others are not able to
stay in business,
that that business and that access to care
gets even tougher.
Yeah. Yeah. That completely makes sense. And and,
Boyd, before I let you go, the last
thing I wanted to ask you, and you
might have touched on in a bit already.
But what would the most effective health care
leaders need in order to be successful in
the next 2 to 3 years, do you
think?
You know, when I think about this, I
I think there's there's probably foundational items and
there's, like, that are required, and then there's
probably other items. But I think of I
think of 3 areas. 1 is attracting and
retaining providers.
The other is, like I mentioned earlier, collaborating
with payers, and then finally, attracting patients.
And so if I hit all 3 of
these, attracting and retaining providers, I mean,
this is foundational because you've gotta be able
to provide the health care service. So leaders
must attract and
retain retain providers and the support personnel that
go with them. So when I say providers,
I I mean, not only physicians, but advanced
practitioners like PAs and NPs
who are essential to delivering care these days.
And without them, we would be actually in
much worse shape as as an industry.
So, you know, fun fundamentally, we're in the
service business, not the product business. So thus,
we deliver all of our services through these
people that we're talking about.
With current foreseeable few and future type pool
type pools of providers and supporting clinicians, a
leader must be able to show why their
company, in my mind, is is a preferred
place to work and why working there is
a better experience compared to their competitors.
And and and you have to do something
that sets you apart from just the your
competitors above and beyond just paying, like, an
extra dollar or 2 in compensation
hourly or whatever.
So so these kind of items are are
things like higher quality of care that your
company provides or a better environment to work
in or,
say, in a more enriched experience the employee
has through
the technology and support tools that you give
that person.
But the what I see is the workforce
is looking for meaning in their role at
work and chooses health care companies that meet
or exceed that standard.
And and we found at GoHealth that that
providing value based care is one of the
differentiators
since this demonstrates that our company looks beyond
just the patient's current
episodic care need and thinks to the whole
patient's quality of quality of health and their
financial stability, frankly.
And then the the second thing I mentioned
was collaborate with payers. I mentioned it a
little earlier,
but those companies that succeed will have, like,
savvy and creative leaders who'll develop partnerships with
payers that are known as value based care.
They'll look beyond the routine
transactional delivery of fee schedules between the the
the the payer and the provider each year
and actually develop meaningful delve into and develop
meaningful,
drivers to increase quality and reduce unnecessary cost.
This will allow for more meaningful collaborations with
payers to to share in the value created
in order to receive better reimbursement than the
average provider company. And this will allow those
collaborative providers
to actually keep up with the challenge of
rising payroll costs referred to earlier and still
make a profit.
And then finally, you know, attracting the patient,
because if you can if you have the
other 2 and you don't have patients, you
really don't have a business.
And with consumers having health insurance, most consumers
having health insurance,
patients have a wide variety of options when
choosing health care providers, in our case, urgent
care providers.
So it's important for leaders to differentiate their
company's service from its competitors in order to
help attract patients
to the point of selecting them as a
preferred
provider for their health care needs.
You know, at Giddle Health, we've not only
applied the the value based cost and quality
programs to attract the patient that I mentioned
earlier, but we've also joined with our health
system partners to invest in patient engagement tools
that make the make the create a more
seamless experience for our patients to come in.
While patients may switch payers every couple years,
health care providers have the ability every day
to actually create trust with patients for a
lifetime
relationship of caring for them and their family
members.
And so I I really consider all 3
of those focus areas to be essential, not
only to keeping them keeping the lights on,
but to thrive profitably. And those profits
allow leaders the funding to invest in technology
and also serve the evolving services model that's
surely to be demanded by the empowered patient
in the future.
And, overall, I just say health care is
complex,
but we must strive to do whatever we
can
in our individual parts of the continuum
to to to make it as sustainable
as possible and focus on these three areas
to be successful.
In in in my case, that part of
the health care continuum for GoHealth is serving
patients for on demand care.
Wow. What amazing advice for these organizations to
take. Thank you so much for giving us
those final thoughts. This has definitely been an
informative discussion for me and I'm sure the
people that are listening. So, again, I wanna
thank you so much for coming on Becker's
HealthCare. We really do appreciate it. And I
look forward to connecting, with you again soon.
Well, thank you for having me. I really
appreciate it.