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Evernorth brings the power of wonder and relentless

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innovation to create world class pharmacy, care, and

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benefit solutions.

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Barriers to care can lead to gaps in

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care, which can drive up the total cost

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of care. Our capabilities work seamlessly together to

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create innovative pharmacy care and benefit solutions for

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today and tomorrow.

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Our connected health services make the treatment, prediction,

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and prevention of health care's most complex conditions

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easier and more accessible as we drive organizations

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and people forward.

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Hello, and welcome to the Becker Payers Issues

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podcast

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recorded live at the third annual spring payer

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issues roundtable here in Chicago.

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I'm joined today by Mark Rich, until recently

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the president and current board member of Stewart

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Healthcare System.

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Mark, thank you so much for joining us

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today. Thank you. I appreciate the opportunity.

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Well, the pleasure is all ours. Would you

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please take a moment to introduce yourself and

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tell us a little bit about, what you

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do? Sure.

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Sure. So I'm a a health care executive

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with forty years of experience,

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thirty of it in c suites,

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but I'm from the provider side and the

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ACO side. So a little bit different view

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than some of the people you may have

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been talking to from the plan side. You

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know, I've served as a a part a

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partner in a firm and as the CFO,

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the chief administrative officer, the president of a

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of a number of providers,

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and, I'm kind of a turnaround crisis guy

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these days.

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Okay. So balancing affordability and quality is a

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constant challenge for health plans. How is your

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organization innovating to manage the cost of care

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while maintaining or improving member outcomes?

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That's a great question. I really appreciate it.

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And, you know, I could share from the

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provider side, the ACO side, what I think

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the the solution is.

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And I think we've heard about it at

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the conference today here and in the other

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side.

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So

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I think you have to define affordability

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and quality.

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I'm not sure we always do that. And

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and if does affordability mean,

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cheaper

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premium for the patient

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or the customer?

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And quality, as you know, is all performance

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metrics. It's rearview stuff. It's did you give

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a glucose test. It's not really outcome based,

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and that's because that's very difficult to do.

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I'm not it's what we've got, and we're

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working with it. But, if you could define

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those two and just put that aside,

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I'm a big

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believer in ACOs

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and,

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having come from just one of the biggest

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in the country.

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And

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I think that you have to

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answer this question in context of the overall

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strategy.

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And for me, our strategy has been value

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based care and embracing value based care. I've

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given it a big bear hug. I'm bullish

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on it.

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It it works. You know, it's gonna do

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$3,600,000,000,000

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over ten years in the total commercial space.

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It's a,

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3.1

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to 5,000,000,000 in '23 just for Medicare,

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and that's the MSSP program, which is the

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hardest kind of of managed care in that

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bit in that side of the business, because

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you you it works on attribution and not

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as and not directly chosen PCP.

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So I think you have to embrace that.

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And then

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if you do that, then you need to

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think about the core things you need, and

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and ACOs are really simple. Once you have

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the physicians,

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you it's really IT,

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then it's data management,

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because you want to you wanna be able

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to use the data for predictive outcomes and

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everything that we're trying to do these days.

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So big data warehouse.

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And the thing you need for,

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an ACO

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or forming an ACO, value based care company's

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money. Mhmm. Mhmm. All those things cost a

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lot of money. We need to have reserves.

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I think there's plenty of money in the

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system right now. I just don't think it's

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evenly distributed. We could talk about that if

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we want. Mhmm. Yeah. Mhmm. So in an

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ever evolving regulatory

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landscape,

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what best practices or tools does your organization

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rely on to keep the quality of care

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at the forefront?

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Well,

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again, you know, I think quality metrics are

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performance metrics,

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so we measure those.

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We give feedback. We try to keep it

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simple.

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When we measure data,

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I'm a big believer that the only data

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that should be supplied to anybody in the

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organization

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is is actionable immediately actionable

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data that they could turn into information and

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move. And that could be because I'm from

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a crisis centered chaos centered world. Mhmm. But

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clouding everybody's inbox with a bunch of random

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data

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basically just gives people the

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opportunity to admire the problem. Mhmm. They're not

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really working. Right. So we wanna get the

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right data in the right hands. And so

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we measure all that. We measure quality. We

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measure performance up to that. We have, pharmacists

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that go to go to the home to

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make sure that the patients are taking their

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drugs, and they're not, you know, after the

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shoulder surgery, not up swinging a golf club

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two days later. Right. Right. So you try

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to get a lot of that in. And

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then,

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I think value based care becomes a big

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big way to do this. Mhmm. It it

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it clearly saves money. It clearly works.

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And the beauty of it is better for

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the patient. Mhmm. I mean, if you think

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about it,

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value based care, we make a big deal

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about it. But if you think about it,

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it's what the patient thinks is happening anyway.

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Right? They think that you're the PCP. Right.

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You're talking to me, this surgeon, and giving

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me notes because Right. I'm getting personalized care.

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And we know that that is difficult to

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do, and it doesn't really happen

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until you're able to,

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get a standard EMR and bring people under

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the umbrella. Mhmm. And you have to you

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have to line the economics or they won't

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come under the umbrella, and that's really the

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key. Right. Well, looking ahead, what do you

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see as the biggest opportunity for payers to

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lead the charge in transforming health care delivery

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and driving better outcomes, for all stakeholders?

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And how can leaders take a step in

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this direction right now? I think I think

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commercial insurers,

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can play a big part, in two ways.

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One, they need they need to take a

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look at their systems, and they need to

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embrace value based care a little bit. We've

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run into problems as Stewart went across the

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country

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with with the value based care that that

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we were ready. We had the infrastructure and

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the ACO in place, but we didn't have

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an insurance partner who had the IT infrastructure

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to handle that. And it's unique, and you

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gotta you're gonna have to make the the,

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you know, the investment, and it's a big

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number. But I think, that's where we're going.

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There's 608,000

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clinicians in value based care right now,

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and it's growing at an 8% CAGR over

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the next ten years. So Mhmm. It's gonna

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be big, and it's gonna be here.

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But,

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the cash is out there. I think we

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need to look at relook at risk based

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capital, which I know is the rail the

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rail.

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But when you have 800%

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of the minimum required

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minimum required risk based capital

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and you're a nonprofit plan, like a Blue

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Cross plan, it's not tax paying, I mean,

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isn't that just isn't that just excess premium

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that people have paid to you over the

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years that you maybe could have lowered the

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rate if you invested that capital?

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So there's plenty of cash there. There's a

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trillion dollars sitting in private equity on the

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sideline. Now not all that's for health care,

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but that's a big pretty big pool to

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choose up to pull pull from. And the

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government is gonna continue to make investments in

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value based care. Medicare is is all of

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this. I think the I think the new

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secretary,

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even had meeting special meetings on value based

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care, like, last week as soon as it

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works out again.

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Well, Mark, I really appreciate you, taking the

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time to join us today on the Becker's

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Perry issue podcast.

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Before I let you go, do you have

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any final thoughts you'd like to leave with

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our listeners? I think that

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if I had a final thought, it would

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be the solution to this problem and really

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bending the cost curve is having to work

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together. Mhmm. Payer and provider. That's been a

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very big success for Stewart with Blue Cross

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of Mass. Started that in 02/2010.

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That's where the money's gonna come from. That's

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where we can think about capital. We can

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think about new capital structure.

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And I don't I'm not a big provider

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insurer kind of base guy. I think providers

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do what they do, and insurers do what

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they do. And never the twain shall meet,

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but Mhmm. There is a good opportunity to,

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work together. Right. Right. Well, Mark, thank you

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again for joining us today, and I hope

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you have a lovely rest of your day.

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Thank you. I appreciate it. My pleasure.