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Hello, and welcome to the Becker Payers Issues
podcast
recorded live at the third annual spring payer
issues roundtable here in Chicago.
I'm joined today by Mark Rich, until recently
the president and current board member of Stewart
Healthcare System.
Mark, thank you so much for joining us
today. Thank you. I appreciate the opportunity.
Well, the pleasure is all ours. Would you
please take a moment to introduce yourself and
tell us a little bit about, what you
do? Sure.
Sure. So I'm a a health care executive
with forty years of experience,
thirty of it in c suites,
but I'm from the provider side and the
ACO side. So a little bit different view
than some of the people you may have
been talking to from the plan side. You
know, I've served as a a part a
partner in a firm and as the CFO,
the chief administrative officer, the president of a
of a number of providers,
and, I'm kind of a turnaround crisis guy
these days.
Okay. So balancing affordability and quality is a
constant challenge for health plans. How is your
organization innovating to manage the cost of care
while maintaining or improving member outcomes?
That's a great question. I really appreciate it.
And, you know, I could share from the
provider side, the ACO side, what I think
the the solution is.
And I think we've heard about it at
the conference today here and in the other
side.
So
I think you have to define affordability
and quality.
I'm not sure we always do that. And
and if does affordability mean,
cheaper
premium for the patient
or the customer?
And quality, as you know, is all performance
metrics. It's rearview stuff. It's did you give
a glucose test. It's not really outcome based,
and that's because that's very difficult to do.
I'm not it's what we've got, and we're
working with it. But, if you could define
those two and just put that aside,
I'm a big
believer in ACOs
and,
having come from just one of the biggest
in the country.
And
I think that you have to
answer this question in context of the overall
strategy.
And for me, our strategy has been value
based care and embracing value based care. I've
given it a big bear hug. I'm bullish
on it.
It it works. You know, it's gonna do
$3,600,000,000,000
over ten years in the total commercial space.
It's a,
3.1
to 5,000,000,000 in '23 just for Medicare,
and that's the MSSP program, which is the
hardest kind of of managed care in that
bit in that side of the business, because
you you it works on attribution and not
as and not directly chosen PCP.
So I think you have to embrace that.
And then
if you do that, then you need to
think about the core things you need, and
and ACOs are really simple. Once you have
the physicians,
you it's really IT,
then it's data management,
because you want to you wanna be able
to use the data for predictive outcomes and
everything that we're trying to do these days.
So big data warehouse.
And the thing you need for,
an ACO
or forming an ACO, value based care company's
money. Mhmm. Mhmm. All those things cost a
lot of money. We need to have reserves.
I think there's plenty of money in the
system right now. I just don't think it's
evenly distributed. We could talk about that if
we want. Mhmm. Yeah. Mhmm. So in an
ever evolving regulatory
landscape,
what best practices or tools does your organization
rely on to keep the quality of care
at the forefront?
Well,
again, you know, I think quality metrics are
performance metrics,
so we measure those.
We give feedback. We try to keep it
simple.
When we measure data,
I'm a big believer that the only data
that should be supplied to anybody in the
organization
is is actionable immediately actionable
data that they could turn into information and
move. And that could be because I'm from
a crisis centered chaos centered world. Mhmm. But
clouding everybody's inbox with a bunch of random
data
basically just gives people the
opportunity to admire the problem. Mhmm. They're not
really working. Right. So we wanna get the
right data in the right hands. And so
we measure all that. We measure quality. We
measure performance up to that. We have, pharmacists
that go to go to the home to
make sure that the patients are taking their
drugs, and they're not, you know, after the
shoulder surgery, not up swinging a golf club
two days later. Right. Right. So you try
to get a lot of that in. And
then,
I think value based care becomes a big
big way to do this. Mhmm. It it
it clearly saves money. It clearly works.
And the beauty of it is better for
the patient. Mhmm. I mean, if you think
about it,
value based care, we make a big deal
about it. But if you think about it,
it's what the patient thinks is happening anyway.
Right? They think that you're the PCP. Right.
You're talking to me, this surgeon, and giving
me notes because Right. I'm getting personalized care.
And we know that that is difficult to
do, and it doesn't really happen
until you're able to,
get a standard EMR and bring people under
the umbrella. Mhmm. And you have to you
have to line the economics or they won't
come under the umbrella, and that's really the
key. Right. Well, looking ahead, what do you
see as the biggest opportunity for payers to
lead the charge in transforming health care delivery
and driving better outcomes, for all stakeholders?
And how can leaders take a step in
this direction right now? I think I think
commercial insurers,
can play a big part, in two ways.
One, they need they need to take a
look at their systems, and they need to
embrace value based care a little bit. We've
run into problems as Stewart went across the
country
with with the value based care that that
we were ready. We had the infrastructure and
the ACO in place, but we didn't have
an insurance partner who had the IT infrastructure
to handle that. And it's unique, and you
gotta you're gonna have to make the the,
you know, the investment, and it's a big
number. But I think, that's where we're going.
There's 608,000
clinicians in value based care right now,
and it's growing at an 8% CAGR over
the next ten years. So Mhmm. It's gonna
be big, and it's gonna be here.
But,
the cash is out there. I think we
need to look at relook at risk based
capital, which I know is the rail the
rail.
But when you have 800%
of the minimum required
minimum required risk based capital
and you're a nonprofit plan, like a Blue
Cross plan, it's not tax paying, I mean,
isn't that just isn't that just excess premium
that people have paid to you over the
years that you maybe could have lowered the
rate if you invested that capital?
So there's plenty of cash there. There's a
trillion dollars sitting in private equity on the
sideline. Now not all that's for health care,
but that's a big pretty big pool to
choose up to pull pull from. And the
government is gonna continue to make investments in
value based care. Medicare is is all of
this. I think the I think the new
secretary,
even had meeting special meetings on value based
care, like, last week as soon as it
works out again.
Well, Mark, I really appreciate you, taking the
time to join us today on the Becker's
Perry issue podcast.
Before I let you go, do you have
any final thoughts you'd like to leave with
our listeners? I think that
if I had a final thought, it would
be the solution to this problem and really
bending the cost curve is having to work
together. Mhmm. Payer and provider. That's been a
very big success for Stewart with Blue Cross
of Mass. Started that in 02/2010.
That's where the money's gonna come from. That's
where we can think about capital. We can
think about new capital structure.
And I don't I'm not a big provider
insurer kind of base guy. I think providers
do what they do, and insurers do what
they do. And never the twain shall meet,
but Mhmm. There is a good opportunity to,
work together. Right. Right. Well, Mark, thank you
again for joining us today, and I hope
you have a lovely rest of your day.
Thank you. I appreciate it. My pleasure.