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Hello, Hello, everyone. This is Jacob Emerson with
the Becker's Payer Issues podcast.
Thrilled today to be joined by Alan Silver,
who's the president of Centene's Ambetter Health Solutions
business. That's the part of the company that
focuses on ICRA.
Alan, thank you so much for taking the
time to be with me on the podcast
today.
Appreciate it, Jacob. I I really appreciate the
time. Yeah. And we're glad you're here with
us. Before we dive into everything we wanna
talk with you about, can you tell us
a little bit more about yourself, your background
in health care, and what it is that
you're doing today at Centene?
Yeah. Jacob, thank you so much for the
time today as I mentioned. As you stated,
my name is Alan Silver. I'm the president
of Ambetter Health Solutions,
which is the brand of Centene Corporation that's
focused on ICRA.
I'm sure most of your audience knows, but
for those that don't, ICRA stands for individual
coverage health reimbursement arrangement,
which is a new type of employer sponsored
health benefits plan with a focus on flexibility
customization
using the individual market.
Prior to, joining this role, I spent
more than twenty years at, consultant brokerage house
called, Willis Towers Watson, where I led retiree
and ICRA initiatives. And I'm just really excited
to be in this role. I I think
that the reality is I spent a lot
of time working with employers and and many,
many employers at the current moment in time
are seeing the status quo of their group
health plan hasn't been working well for them
and and
really wanna focus on the innovation that ICRA
provides as an alternative to that status quo
approach.
Absolutely. And, you know, Alan, we're hearing so
much about ICRA more and more as time
goes on both in the private sector and
and at the government level. So
talk to us about why did Centene wanna
create this position? Why are you the first
president of ICRA at the company?
Yeah. I I think,
it's some of it is based in the
kind of tradition of what Ambetter Health is.
Ambetter Health is the largest individual market,
carrier in the market. It's been
creating
tailored health care plans to millions over the
past decade, and
there's an understanding
that we have a responsibility
if there is an individual market solution
such as ICRA that we need to be
championing and championing and leading that effort,
to keep pace with an evolving landscape and
bringing in somebody
that has the experience
of traditional group health plans and trying to
understand
how we might innovate in the individual market
realm to meet the needs of employers. So
I think it's been
really important for Centene to have somebody
at the head of this strategy, which represents
a great opportunity
for Centene in particular and the market as
at large.
Absolutely. It makes complete sense. So there's market
demand for this. Employers are asking for this
kind of new model, Alan. Yeah.
If we're backing up for a second for
our audience, just to level set here,
what does the ICRA landscape look like right
now? How many enrollees are out there, and
and who are some of the employers that
are actually interested in this model?
Yeah. I think it's a fair question, Jacob.
I think that the
the current environment
is is one of constant evolution.
From the HRA council data that we have
and some other data points that we have
out there, we right now can see somewhere
between 500,000
and a million people eligible for an ICRA
and some 250,000
to 750,000
people actually enrolling.
The
the point in time nature of those estimates
makes it a very wide range, but it
started to become a a significant
kind of portion of the employer sponsored landscape.
The leaders in this space have been small
group employers, and the reason why is because
the direct comparison
between small group rates on insurance and individual
market rates has been something that, a lot
of small group employers have have taken the
opportunity to seize
the the more efficient way of providing benefits.
Interestingly enough, though, 83%
of them
hadn't provided insurance before. So this provides a
significant opportunity for them to provide a benefit
that they haven't provided in the past.
The last thing that I'll say about the
the number of lives and and the growth
that's out there is just this concept of
the greatest growth sector segment of the market
is actually in employers with 200 and more
lives.
So larger midsize midsize and larger employers are
really coming into this space because they understand
the promise of what ICRA can do for
them
and understand there may be a different way
given the population that they're covering.
Sure. That's a really interesting last point that
you just made there, Alan, that you are
seeing a lot of large employers
interested in this. But at the same time,
you're also seeing a lot of, small employers
offering this kind of model, offering insurance for
the first time to their employees through this.
So it's that's a really interesting, dichotomy there.
But
I wonder you know, we're hearing so much
now about,
ICRA changes at the federal level.
How how do you see this market continuing
to evolve, let's say, over the next five
years or so?
Yeah. So I think the next eighteen to
twenty four months are crucial to the growth
of ICRA.
It's growing year over year. But the reality
of the situation is,
I wanna take a little bit of a
a a look at what employer group sponsored
coverage is is doing these days. And the
the issue that we have is a multigenerational
workforce, four generations of people working within
the workforce today, and that can include the
young professional that's relatively healthy, the family of
four with, two kids under three,
somebody managing a chronic condition,
people on benefits to kind of bridge the
gap in their retirement to Medicare.
Those are just four examples
of people that need very different things from
their health care.
So
the growth in ICRA is going to come
from this concept of kind of a direct
to consumer
type of approach to health care. We
anticipate this model becoming more and more streamlined
in the next few years,
but we absolutely
need, some some technology enhancements, some some education,
some decision support tools to come out to
make that view and vision of that multigeneration
generational
use,
workforce
become a reality in the ICRA space.
Sure. No. That makes complete sense. And it
really sounds like, at the end of the
day, what this what this model offers is
flexibility
to employers.
I wonder then what what you would say
are some of the biggest challenges you're seeing
facing AMCA. And when you're when you're talking
about to employers, when you're promoting this new
model, what are some of the top challenges
you're hearing hearing there?
Yeah. I I think it's it's
basically mostly about education. If if I had
to drive one point home, it's education, and
it's education for
employers themselves. It's education
for,
brokers, both on a group and the individual
basis. But it's also education for health systems
and education,
for payers
just to get to a place where we
all understand
what the future of this could look like.
It's a new category
growing at speed, and it's gonna face some
challenges. I think beyond the education,
two or one or two other things could
be just the concept of
the technology
really needing to embrace
the world of, you know, frankly, consumers making
their own choice on health insurance.
So we need to get to a place
of decision support where pipes are connected between
carrier and broker and employer
and ICRA administrator altogether to make this a
fundamentally
good experience.
And then we bear responsibility at places like
Ambetter for us to meet the needs for
individuals and what they want for their health
insurance.
That talks about us building networks,
building,
designs, having good relationships at the local level
with health systems, with providers
to ensure that people actually want to produce
want to purchase
our health insurance coverage that we are providing
to them.
Absolutely. So really just getting more information about
this new model out there sounds very key,
to more growth in this market. What do
you what do you think other insurers should
know, Alan? I mean, should most insurers be
considering entering this market at this point?
Jacob, the the words I wanna use here
are I think other insurers will need to
have a very intentional strategy
around
entering the ICRA space. It's kind of an
obvious play for us at Ambetter because we
don't have
a group business for us to sit there
and say, oh my gosh. We're taking things
from the group business to the individual. For
us, we are pushing an individual solution, and
that's why we see ourselves
as a leader in this space. For other
carriers, that may not be the case, but
I think they're going to wanna either make
a determination that they are in with us
in this kind of building of a direct
to consumer world or maybe it's just not
for them. It's going to be very important
for us to all understand
that you can't really do this off the
side of your desk. You actually need to
commit to meet the needs of the employee
population.
Absolutely. So a strong strategy here. It's it's
gonna be different for every company. That makes
sense.
Before we go, Alan, you've got the ears
of a lot of other health plan leaders
from all over the country right now. What
else do you wanna tell them about this
market?
Anything else we we really need to hit
home on today? Yeah. Jacob, I think you
could hear it in my voice. I am
very, very passionate about this. I am very
much looking forward to the challenge of building
ICRA
in this country. It comes from a couple
different places, but the biggest place that it
comes from is I think, that employer sponsored
insurance was built for a different time,
a time when
everybody came into the office or the store
or the factory, and employers only had to
worry about people that lived close to where
they worked. So it's really easy for employers
to understand
what the health kind of construct was in
the markets where they had people.
Well, as I mentioned earlier, with a multigenerational
workforce, if we add on
the concept of remote and hybrid work,
all of a sudden, you have employees that
are working
nowhere close
to an office or, in some cases, very
far away from the people that they're associated
with. And as a result of that, employers
have to make a choice. And the choice
is, do I now go out and try
to learn
what's different about the health systems where all
of my people are,
or do I rely on someone
to help deliver deliver a solution at the
local level
through ICRA? I I think that's a fair
choice, and employers need to be intentional about
that choice. What I'll just say coming out
of that conversation is, at Ambetter,
our focus is improving the lives of the
people we serve
at the local level in the communities we
serve them.
So we are well positioned and you will
see us commit to the ICRA strategy at
a very local level, which will be a
great option for many, many employers.
Fantastic. Well, I think that's a great place
to leave things. Alan, I wanna thank you
for taking the time to sit down with
us and for sharing your insights with our
listeners. We really appreciate it. Jacob, appreciate the
time. Thank you so much. And to our
listeners, if you'd like to listen to more
podcasts from Becker's Healthcare, you can visit beckershospitalreview.com.