1 00:00:00,080 --> 00:00:02,080 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,080 --> 00:00:04,960 Becker's Payer Issues podcast. Thrilled today to be 3 00:00:04,960 --> 00:00:07,599 joined by Alan Cohen, who's the cofounder and 4 00:00:07,599 --> 00:00:09,619 chief product officer at Sentivo. 5 00:00:09,919 --> 00:00:11,519 Alan, thanks so much for taking the time 6 00:00:11,519 --> 00:00:13,219 to be with me on the podcast today. 7 00:00:13,785 --> 00:00:15,544 Yeah. I'm happy to, Jake. I'm very happy 8 00:00:15,544 --> 00:00:17,464 to be here today. Yeah. And before we 9 00:00:17,464 --> 00:00:18,905 dive into everything we wanna talk with you 10 00:00:18,905 --> 00:00:21,065 about, actually, a pretty specific topic and everything 11 00:00:21,065 --> 00:00:22,505 going on there, can you tell us a 12 00:00:22,505 --> 00:00:24,664 little bit more about yourself, your background in 13 00:00:24,664 --> 00:00:26,265 health care, and what it is that you 14 00:00:26,265 --> 00:00:27,564 do today at Sentivo? 15 00:00:28,750 --> 00:00:29,149 Sure. 16 00:00:29,630 --> 00:00:31,630 So I've had a pretty long at this 17 00:00:31,630 --> 00:00:33,630 point, but varied career in kind of health 18 00:00:33,630 --> 00:00:34,929 coverage and health care. 19 00:00:35,390 --> 00:00:36,609 I started my career, 20 00:00:37,070 --> 00:00:38,909 in, you know, working for health plans. I 21 00:00:38,909 --> 00:00:40,909 worked for, you know, three different health plans, 22 00:00:40,909 --> 00:00:42,270 some of the major health plans in this 23 00:00:42,270 --> 00:00:44,065 country at the time, at least. You know, 24 00:00:44,065 --> 00:00:46,385 Prudential was the, was was the first one, 25 00:00:46,385 --> 00:00:48,325 also, Cigna and MassMutual. 26 00:00:49,185 --> 00:00:50,164 I then started, 27 00:00:50,625 --> 00:00:53,185 one of the first Internet based employee benefits 28 00:00:53,185 --> 00:00:54,565 companies called Online Benefits, 29 00:00:55,185 --> 00:00:57,344 where we were doing kinda, you know, something 30 00:00:57,344 --> 00:00:59,590 that's really common now, like doing enrollment and 31 00:00:59,590 --> 00:01:00,090 communication 32 00:01:00,549 --> 00:01:02,469 all online. And so people don't have to 33 00:01:02,469 --> 00:01:04,549 fill out paper forms. Well, actually, the company 34 00:01:04,549 --> 00:01:06,150 I started was one of the first companies 35 00:01:06,150 --> 00:01:08,229 doing that. I ran that company for about 36 00:01:08,229 --> 00:01:08,950 ten years. 37 00:01:09,349 --> 00:01:11,545 And then I sold we sold it to 38 00:01:11,545 --> 00:01:13,864 a public health care IT company named Adam, 39 00:01:13,864 --> 00:01:16,185 a d a m, a very well known 40 00:01:16,185 --> 00:01:18,204 company in kind of the health care information, 41 00:01:18,745 --> 00:01:19,245 space. 42 00:01:19,944 --> 00:01:21,325 And then I began, 43 00:01:22,025 --> 00:01:24,045 one of the first actually, the first, 44 00:01:24,520 --> 00:01:27,000 benefits exchange company. This idea of of of 45 00:01:27,000 --> 00:01:29,000 giving employees money and letting them shop for 46 00:01:29,000 --> 00:01:29,500 benefits, 47 00:01:29,799 --> 00:01:31,480 which was a, you know, kind of a 48 00:01:31,480 --> 00:01:33,400 hot idea for a while. That company is 49 00:01:33,400 --> 00:01:34,140 called Liaison. 50 00:01:34,439 --> 00:01:36,060 We were the first benefit exchange, 51 00:01:36,439 --> 00:01:38,200 you know, company that really trying to kind 52 00:01:38,200 --> 00:01:39,100 of create competition 53 00:01:39,584 --> 00:01:42,224 among among health plans competing competing for members. 54 00:01:42,224 --> 00:01:44,064 This is all pre ACA. So the idea 55 00:01:44,064 --> 00:01:46,385 of these health care exchanges in in part 56 00:01:46,385 --> 00:01:48,245 came from the the work that we did. 57 00:01:48,944 --> 00:01:50,625 I also spent some time at, 58 00:01:51,265 --> 00:01:53,685 Willis Towers Watson, you know, the, 59 00:01:54,099 --> 00:01:55,560 actuarial consulting firm. 60 00:01:56,099 --> 00:01:56,659 And then, 61 00:01:57,219 --> 00:01:59,619 now going back five years ago, I was 62 00:01:59,619 --> 00:02:01,539 one of the founders of Sentivo. We are 63 00:02:01,539 --> 00:02:04,439 a, a new health plan working exclusively 64 00:02:04,819 --> 00:02:08,340 with, high performing clinically integrated providers and accountable 65 00:02:08,340 --> 00:02:09,000 care organizations 66 00:02:09,625 --> 00:02:11,944 to really try to try to deliver cost 67 00:02:11,944 --> 00:02:13,724 effective, high quality health care, 68 00:02:14,185 --> 00:02:16,104 you know, to to employers and, you know, 69 00:02:16,104 --> 00:02:17,384 their employees and members. 70 00:02:17,944 --> 00:02:19,724 Also, by way of academic background, 71 00:02:20,104 --> 00:02:22,824 I have a, MBA from Columbia University in 72 00:02:22,824 --> 00:02:24,344 London Business School, and I also have an 73 00:02:24,344 --> 00:02:26,710 Miles per hour from Johns Hopkins. And so, 74 00:02:26,710 --> 00:02:28,169 you know, pretty varied career 75 00:02:28,469 --> 00:02:30,229 in different parts of kind of the health 76 00:02:30,229 --> 00:02:30,729 coverage, 77 00:02:31,669 --> 00:02:34,490 kind of world. But one thing that always 78 00:02:35,430 --> 00:02:37,189 seems to be a recurring theme is is 79 00:02:37,189 --> 00:02:39,590 health care inflation and trend. No matter where 80 00:02:39,590 --> 00:02:41,264 I go, it's it's something that that we're 81 00:02:41,264 --> 00:02:42,784 always trying to talk we're always talking about. 82 00:02:42,784 --> 00:02:44,305 We're always talking about trying to figure out 83 00:02:44,305 --> 00:02:45,985 ways to kind of bend the bend the 84 00:02:45,985 --> 00:02:46,805 trend curve, 85 00:02:47,504 --> 00:02:48,564 and, you know, simultaneously 86 00:02:49,504 --> 00:02:52,544 help, people get have access to high quality 87 00:02:52,544 --> 00:02:54,564 health care that's not frankly gonna 88 00:02:54,865 --> 00:02:57,680 gonna gonna, you know, financially, you know, harm 89 00:02:57,680 --> 00:03:00,159 them or financially harm their, you know, their 90 00:03:00,159 --> 00:03:00,659 employers. 91 00:03:01,120 --> 00:03:03,039 Sure. Absolutely. Well, appreciate you giving us that 92 00:03:03,039 --> 00:03:04,959 rundown, and let's dive right in and talk 93 00:03:04,959 --> 00:03:06,719 about some of the health care trends we're 94 00:03:06,719 --> 00:03:08,879 seeing right now. Certainly, as we go into 95 00:03:08,879 --> 00:03:11,299 next year, some pretty unprecedented changes, 96 00:03:12,055 --> 00:03:14,294 as we head into 2026 and what is 97 00:03:14,294 --> 00:03:16,294 looking like a pretty big increase for people 98 00:03:16,294 --> 00:03:18,155 all over the country when it comes to 99 00:03:18,455 --> 00:03:20,074 ACA coverage and and premiums. 100 00:03:21,094 --> 00:03:22,694 Obviously, as as you know, there's there's a 101 00:03:22,694 --> 00:03:24,375 lot of limbo right now over the enhanced 102 00:03:24,375 --> 00:03:24,875 subsidies. 103 00:03:25,334 --> 00:03:28,510 There's worsening market morbidity that's really been dampening 104 00:03:28,510 --> 00:03:30,849 earnings for the big players in this market. 105 00:03:31,550 --> 00:03:33,310 And now we're seeing all over the country 106 00:03:33,310 --> 00:03:36,270 the proposed rate filings with premium hikes. We've 107 00:03:36,270 --> 00:03:38,270 seen as high as over 50% 108 00:03:38,270 --> 00:03:40,634 in in certain states, certain markets, but, 109 00:03:41,034 --> 00:03:43,034 it seems that the average proposed increase right 110 00:03:43,034 --> 00:03:44,655 now is around 18%. 111 00:03:45,674 --> 00:03:47,995 So give us your perspective on this, Alan. 112 00:03:47,995 --> 00:03:49,914 Given what you what you've seen, the history 113 00:03:49,914 --> 00:03:50,655 of this market, 114 00:03:51,514 --> 00:03:53,514 what's what's driving these increases, and what's how 115 00:03:53,514 --> 00:03:55,294 should we be thinking about this right now? 116 00:03:55,819 --> 00:03:57,580 Yeah. I think the first thing is look. 117 00:03:57,580 --> 00:03:59,979 These are shockingly high increases. And, you know, 118 00:03:59,979 --> 00:04:00,639 in this, 119 00:04:01,099 --> 00:04:02,939 you know, in this area, we've kind of, 120 00:04:02,939 --> 00:04:05,099 in some ways, gotten dull to the whip 121 00:04:05,099 --> 00:04:07,580 of of of rising inflation. But I think 122 00:04:07,580 --> 00:04:09,740 we have to realize that, you know, that 123 00:04:09,740 --> 00:04:10,719 the, you know, 124 00:04:11,325 --> 00:04:13,724 rises in health care costs, which then create 125 00:04:13,724 --> 00:04:16,764 rises in premium or changes in, you know, 126 00:04:16,764 --> 00:04:17,745 the the pool 127 00:04:18,125 --> 00:04:20,524 of of who is covered, which causes rise 128 00:04:20,524 --> 00:04:21,264 in premium. 129 00:04:21,805 --> 00:04:23,500 They they just have to stop. Right? I 130 00:04:23,500 --> 00:04:25,259 mean, we're we're you know, I I feel 131 00:04:25,259 --> 00:04:27,420 like we've been talking about this. It looks 132 00:04:27,420 --> 00:04:28,939 me. I've been talking about this since I 133 00:04:28,939 --> 00:04:31,100 entered this industry in 1989, which is quite 134 00:04:31,100 --> 00:04:32,779 a long time ago. But but I do 135 00:04:32,779 --> 00:04:34,459 think it has been a, you know, kind 136 00:04:34,459 --> 00:04:36,939 of long, long path going off a cliff. 137 00:04:36,939 --> 00:04:38,745 Right? So we we can't be kind of 138 00:04:38,745 --> 00:04:41,464 dull to these things. And and I think 139 00:04:41,464 --> 00:04:43,084 this is, you know, a reemergence 140 00:04:43,704 --> 00:04:47,004 of of health care and and health coverage 141 00:04:47,064 --> 00:04:47,805 or premium 142 00:04:48,504 --> 00:04:51,120 inflation. And it's not, you know, it's not, 143 00:04:51,120 --> 00:04:54,019 you know, solely, you know, you know, segmented 144 00:04:54,079 --> 00:04:56,319 into the ACA markets. I think ACA markets 145 00:04:56,319 --> 00:04:58,000 might be the kind of sharp end of 146 00:04:58,000 --> 00:04:58,660 the spear 147 00:04:59,120 --> 00:05:01,120 for a lot of reasons, but but we're 148 00:05:01,120 --> 00:05:03,600 seeing this in in the employer coverage as 149 00:05:03,600 --> 00:05:06,394 well for, you know, for insured employers. We're 150 00:05:06,394 --> 00:05:08,714 seeing it in in, in employer coverage for, 151 00:05:09,915 --> 00:05:11,535 you know, for self funded employers. 152 00:05:12,074 --> 00:05:15,214 And, really, it is a a broad phenomenon 153 00:05:15,754 --> 00:05:18,634 that is occurring in all different aspects of 154 00:05:18,634 --> 00:05:20,400 of health coverage, and it's one that we 155 00:05:20,400 --> 00:05:22,319 we must attack. I mean, we, you know, 156 00:05:22,319 --> 00:05:24,319 we we we can't go through kind of 157 00:05:24,319 --> 00:05:25,840 yet another, you know, 158 00:05:26,400 --> 00:05:28,900 cycle of of double digit inflation 159 00:05:29,360 --> 00:05:31,975 because we've gotten to the point in in 160 00:05:31,975 --> 00:05:34,154 our industry here that I mean, 161 00:05:34,694 --> 00:05:37,995 it has become unaffordable, unaffordable for companies, unaffordable 162 00:05:38,134 --> 00:05:39,975 for people. I mean, you know, you know, 163 00:05:39,975 --> 00:05:42,694 the the last the last cycle of of 164 00:05:42,694 --> 00:05:43,435 cost increases 165 00:05:43,735 --> 00:05:45,275 were mitigated by 166 00:05:45,620 --> 00:05:47,779 by raising deductibles. Right? I mean, you know, 167 00:05:47,779 --> 00:05:48,279 deductibles, 168 00:05:49,060 --> 00:05:51,220 we used to have $500 deductibles, dollars 1,000 169 00:05:51,220 --> 00:05:51,720 deductibles. 170 00:05:52,020 --> 00:05:54,100 They would only apply to to, you know, 171 00:05:54,100 --> 00:05:56,339 to hospitalization and surgery. And then, you know, 172 00:05:56,339 --> 00:05:58,259 now with with high deductible health plans that 173 00:05:58,259 --> 00:06:00,404 are HSA qualified, I mean, people have 2,000, 174 00:06:00,644 --> 00:06:04,644 3,000, 5,000, dollars 6,000 deductibles, 10,000, dollars 15,000 175 00:06:04,644 --> 00:06:06,564 are out of pocket maximums. I mean, these 176 00:06:06,564 --> 00:06:08,024 are individuals that have, 177 00:06:08,324 --> 00:06:10,165 you know, a few thousand dollars of, 178 00:06:10,564 --> 00:06:12,564 in the bank, and they have and what 179 00:06:12,564 --> 00:06:13,704 has happened is 180 00:06:14,084 --> 00:06:16,910 they have become, you know, functionally uninsured. 181 00:06:17,290 --> 00:06:18,830 I mean, you are functionally uninsured 182 00:06:19,290 --> 00:06:21,050 when you can't afford your deductible and you 183 00:06:21,050 --> 00:06:22,910 can't afford your out of pocket maximum. 184 00:06:23,850 --> 00:06:25,610 And so we have you know, in in 185 00:06:25,610 --> 00:06:27,529 kind of the last cycle of health care 186 00:06:27,529 --> 00:06:27,975 costs, 187 00:06:28,615 --> 00:06:30,955 increases, we were we, you know, we mitigated 188 00:06:31,014 --> 00:06:33,334 that in the industry by just jacking up 189 00:06:33,334 --> 00:06:35,975 deductibles to the moon. Right? And then hoping 190 00:06:35,975 --> 00:06:37,435 people would put money in HSAs, 191 00:06:38,134 --> 00:06:39,574 which, you know, some people did, but a 192 00:06:39,574 --> 00:06:40,774 lot of people you you can't put the 193 00:06:40,774 --> 00:06:42,134 money in HSA if you don't have the 194 00:06:42,134 --> 00:06:44,310 money. Right? And so we don't have that 195 00:06:44,310 --> 00:06:45,370 escape valve anymore, 196 00:06:45,990 --> 00:06:48,310 because our our the deductibles are as high 197 00:06:48,310 --> 00:06:50,310 as really they can be. They're they're they're 198 00:06:50,310 --> 00:06:51,990 they're getting close to, you know, a you 199 00:06:51,990 --> 00:06:53,050 know, ACA limits. 200 00:06:54,470 --> 00:06:56,470 And so, you know, it's really gonna be 201 00:06:56,470 --> 00:06:58,564 very difficult for the entire industry. When I 202 00:06:58,564 --> 00:07:00,724 say industry, I I mean I mean health 203 00:07:00,724 --> 00:07:01,544 care providers. 204 00:07:02,084 --> 00:07:05,044 I mean insurance companies. I mean health plan 205 00:07:05,044 --> 00:07:06,664 administrators. I mean employers. 206 00:07:07,524 --> 00:07:09,944 It's gonna be horrible for all of us 207 00:07:10,084 --> 00:07:12,350 if we don't find ways to mitigate, 208 00:07:13,050 --> 00:07:14,830 you know, these broad cost increases. 209 00:07:15,770 --> 00:07:17,689 And and, again, there's a a whole series 210 00:07:17,689 --> 00:07:19,530 of reasons why. And, Jacob, would you like 211 00:07:19,530 --> 00:07:21,490 me to go into some, you know, some 212 00:07:21,490 --> 00:07:24,250 some reasons on on why why I think 213 00:07:24,250 --> 00:07:26,830 we're seeing these cost increases like you mentioned? 214 00:07:26,944 --> 00:07:28,704 Yeah. Absolutely. I mean, give us some specifics 215 00:07:28,704 --> 00:07:30,724 on on exactly what is driving this 216 00:07:31,104 --> 00:07:33,425 industry wide. Yeah. No. So I I think 217 00:07:33,425 --> 00:07:35,664 they they fall into a few buckets. Right? 218 00:07:35,664 --> 00:07:38,384 I think one bucket is just rising health 219 00:07:38,384 --> 00:07:40,485 care costs and rising inflation. Right? 220 00:07:40,860 --> 00:07:43,040 I mean, we know that that health care 221 00:07:43,100 --> 00:07:43,600 costs, 222 00:07:44,300 --> 00:07:47,019 the health care inflation, you know, historically has 223 00:07:47,019 --> 00:07:49,600 has for decades and decades rose significantly 224 00:07:50,379 --> 00:07:53,235 above, you know, consumer price index. Right? 225 00:07:54,274 --> 00:07:56,034 But in, you know, in the last ten 226 00:07:56,034 --> 00:07:56,534 years, 227 00:07:56,834 --> 00:07:59,394 it had been closer to the consumer price 228 00:07:59,394 --> 00:08:01,555 index than it had been, you know, previous. 229 00:08:01,555 --> 00:08:03,875 I I but but we're going through another 230 00:08:03,875 --> 00:08:07,394 cycle now of of simply higher cost inflation. 231 00:08:07,394 --> 00:08:08,740 Right? And so so if you, you know, 232 00:08:08,740 --> 00:08:10,680 again, if we wanna use the number of 233 00:08:10,819 --> 00:08:11,699 15% 234 00:08:11,699 --> 00:08:12,839 or 18%, 235 00:08:12,980 --> 00:08:15,459 you know, for premium increases like you you 236 00:08:15,459 --> 00:08:17,699 mentioned, you know, the ACA, you know, going 237 00:08:17,699 --> 00:08:19,080 up 18%. Well, 238 00:08:19,699 --> 00:08:22,180 eight to 10% of that so eight to 239 00:08:22,180 --> 00:08:25,394 10 points of that is is really due 240 00:08:25,935 --> 00:08:27,935 to just inflation in health care costs. 241 00:08:29,615 --> 00:08:31,295 And so, you know, some some you know, 242 00:08:31,295 --> 00:08:33,535 there there you know, there's some culprits in 243 00:08:33,535 --> 00:08:34,274 there. Right? 244 00:08:35,134 --> 00:08:36,995 Drug costs are rising significantly, 245 00:08:38,059 --> 00:08:40,559 faster than, the medical expenses. 246 00:08:41,259 --> 00:08:43,200 You know, the advent of GLP ones, 247 00:08:43,740 --> 00:08:45,659 has been kind of, you know, certainly a 248 00:08:45,659 --> 00:08:46,159 boon 249 00:08:46,539 --> 00:08:46,940 to, 250 00:08:47,340 --> 00:08:49,899 to people who, who are who are overweight 251 00:08:49,899 --> 00:08:51,465 and have used them for weight loss and 252 00:08:51,465 --> 00:08:53,305 and lose them to control diabetes and use 253 00:08:53,305 --> 00:08:56,024 them, but they're also quite expensive. Right? And 254 00:08:56,024 --> 00:08:58,125 they have and they have and unlike 255 00:08:58,585 --> 00:09:01,085 many, in fact, unlike almost all 256 00:09:01,465 --> 00:09:04,345 very expensive drugs that are are segmented to 257 00:09:04,345 --> 00:09:05,805 a small part of the population, 258 00:09:06,379 --> 00:09:07,519 you know, GLP ones, 259 00:09:08,379 --> 00:09:10,959 thirty, forty, fifty percent of the American population 260 00:09:11,419 --> 00:09:13,519 could potentially be using GLP ones, 261 00:09:14,139 --> 00:09:15,839 if they chose, right, to, 262 00:09:16,620 --> 00:09:18,559 due to either diabetes or 263 00:09:19,754 --> 00:09:20,254 prediabetes 264 00:09:20,955 --> 00:09:22,654 or, or or obesity. 265 00:09:23,195 --> 00:09:26,095 And so that is certainly, you know, increasing, 266 00:09:27,035 --> 00:09:29,115 costs as well. And so we we so 267 00:09:29,115 --> 00:09:31,195 so we have at its base, at its 268 00:09:31,195 --> 00:09:31,695 foundation, 269 00:09:32,350 --> 00:09:34,289 just, you know, a an inflationary 270 00:09:34,830 --> 00:09:35,330 environment 271 00:09:35,870 --> 00:09:38,190 in, in health care costs. So health care 272 00:09:38,190 --> 00:09:40,929 costs, think about medical and prescription combined. Right? 273 00:09:41,470 --> 00:09:43,309 That that is higher than the past. Right? 274 00:09:43,309 --> 00:09:44,750 We we were we were kind of in 275 00:09:44,750 --> 00:09:46,049 a four to 6%, 276 00:09:47,225 --> 00:09:48,284 health care inflation 277 00:09:48,664 --> 00:09:50,184 range, and now we're at an 8% to 278 00:09:50,184 --> 00:09:52,904 10% health care inflation range. But but the 279 00:09:52,904 --> 00:09:55,065 premium cost increases that you talked about were 280 00:09:55,065 --> 00:09:56,825 significantly more than that because this is only 281 00:09:56,825 --> 00:09:57,565 one component 282 00:09:58,105 --> 00:10:00,590 of of what's called, you know, premium or 283 00:10:00,590 --> 00:10:02,750 even medical trend, what we call a trend, 284 00:10:02,750 --> 00:10:04,129 which is different than inflation. 285 00:10:04,990 --> 00:10:07,009 A number of other things that are happening 286 00:10:07,470 --> 00:10:07,950 that, 287 00:10:08,429 --> 00:10:10,990 that the insurance companies are are looking at 288 00:10:10,990 --> 00:10:13,070 and worried about are things like the enhanced, 289 00:10:13,070 --> 00:10:15,565 you know, the the expiration of the enhanced 290 00:10:15,565 --> 00:10:16,785 premium tax credits. 291 00:10:17,565 --> 00:10:20,125 So the expiration of the enhanced premium tax 292 00:10:20,125 --> 00:10:22,705 credits, which essentially is going to make, 293 00:10:23,965 --> 00:10:25,504 health insurance coverage 294 00:10:26,299 --> 00:10:27,120 less affordable, 295 00:10:27,500 --> 00:10:28,320 more expensive 296 00:10:28,860 --> 00:10:32,059 for a significant number of Americans. Right? Because 297 00:10:32,059 --> 00:10:34,139 they're not gonna get their enhanced premium tax 298 00:10:34,139 --> 00:10:36,940 credit anymore. And so so their costs are 299 00:10:36,940 --> 00:10:39,039 gonna go up. And we know what happens, 300 00:10:39,475 --> 00:10:42,115 especially in an environment where, remember, at the 301 00:10:42,115 --> 00:10:44,595 beginning of the ACA, there was man you 302 00:10:44,595 --> 00:10:46,595 know, it was mandatory health coverage. Well, the 303 00:10:46,595 --> 00:10:49,394 mandatory health coverage has now been repealed. Right? 304 00:10:49,394 --> 00:10:51,554 We don't have we don't have to have 305 00:10:51,554 --> 00:10:54,570 insurance in this country. Right? Right. And so 306 00:10:54,570 --> 00:10:56,250 if health care if health care, 307 00:10:57,049 --> 00:10:58,830 you know, if if the effective 308 00:10:59,850 --> 00:11:00,350 cost 309 00:11:00,970 --> 00:11:03,230 for health insurance goes up, right, 310 00:11:03,929 --> 00:11:06,509 then you're gonna have more people who opt 311 00:11:06,570 --> 00:11:09,524 not to have health insurance on the particularly 312 00:11:09,524 --> 00:11:11,845 on the individual market. And those people who 313 00:11:11,845 --> 00:11:13,605 opt to have not had health insurance, you 314 00:11:13,605 --> 00:11:15,225 know, we know, we've seen it historically, 315 00:11:15,924 --> 00:11:18,084 are gonna be those people who are healthier 316 00:11:18,084 --> 00:11:20,485 and have less health care expenses. And so 317 00:11:20,485 --> 00:11:22,164 what that is gonna do is it's going 318 00:11:22,164 --> 00:11:24,299 to worsen the risk pool. And so the 319 00:11:24,299 --> 00:11:26,480 risk pool will will get worse, 320 00:11:27,019 --> 00:11:27,920 because the 321 00:11:28,299 --> 00:11:30,220 the people who are you know, who have 322 00:11:30,220 --> 00:11:33,019 lower health care expenses will will opt out 323 00:11:33,019 --> 00:11:34,799 of the pool because there's no longer 324 00:11:35,100 --> 00:11:35,679 a mandatory 325 00:11:36,139 --> 00:11:37,840 requirement to have health insurance. 326 00:11:38,585 --> 00:11:40,845 And that is going to kind of increase, 327 00:11:42,105 --> 00:11:44,745 increase costs for everyone who's remaining. And I 328 00:11:44,745 --> 00:11:47,225 I saw the Keisei Family Foundation estimate that 329 00:11:47,225 --> 00:11:49,004 that, you know, they think about four points 330 00:11:49,384 --> 00:11:51,545 of the, of of this, you know, let's 331 00:11:51,545 --> 00:11:52,679 call it 18% 332 00:11:53,080 --> 00:11:55,480 is is likely due to, due to just 333 00:11:55,480 --> 00:11:56,919 that due to the worsening of the health 334 00:11:56,919 --> 00:11:57,419 pool, 335 00:11:57,799 --> 00:11:59,080 you know, due to the, 336 00:11:59,639 --> 00:12:01,720 expiration of premium tax credits. And then we 337 00:12:01,720 --> 00:12:03,480 have a number of other things that are 338 00:12:03,480 --> 00:12:04,200 going to, 339 00:12:04,759 --> 00:12:08,004 make health care costs for, again, the commercially 340 00:12:08,065 --> 00:12:10,785 insured. So people who get their get coverage 341 00:12:10,785 --> 00:12:11,285 through, 342 00:12:11,985 --> 00:12:15,184 their employer or get coverage individually. It'll it'll 343 00:12:15,184 --> 00:12:16,725 make their cost more expensive. 344 00:12:17,264 --> 00:12:19,264 The most recent budget bill that was passed 345 00:12:19,264 --> 00:12:20,325 is gonna reduce, 346 00:12:21,279 --> 00:12:23,279 reduce the number of people on Medicaid. Right? 347 00:12:23,279 --> 00:12:25,519 And and people who are who currently are 348 00:12:25,519 --> 00:12:28,480 on Medicaid, it's gonna substantially reduce them according 349 00:12:28,480 --> 00:12:31,139 to the, the congressional budget office of CPO. 350 00:12:31,360 --> 00:12:33,519 Those people are gonna gonna no longer have 351 00:12:33,519 --> 00:12:36,644 coverage. That's gonna create on more uncompensated care 352 00:12:36,644 --> 00:12:38,725 for health care providers. And when health care 353 00:12:38,725 --> 00:12:41,845 providers have a greater level of uncompensated care, 354 00:12:41,845 --> 00:12:43,125 well, they still have to keep the lights 355 00:12:43,125 --> 00:12:45,524 on. Right? They still have to pay for, 356 00:12:45,845 --> 00:12:47,784 you know, for all of their inputs, 357 00:12:48,950 --> 00:12:50,389 in health care. They have to pay the 358 00:12:50,389 --> 00:12:52,710 salaries of all their health care providers to 359 00:12:52,710 --> 00:12:54,549 deliver that great health care that they do. 360 00:12:54,549 --> 00:12:57,110 And so they have to then shift the 361 00:12:57,110 --> 00:12:58,330 costs from, 362 00:12:58,870 --> 00:13:01,350 from this case, kind of uncompensated care into 363 00:13:01,350 --> 00:13:03,105 the only place they can shift cost to, 364 00:13:03,105 --> 00:13:04,704 which is the commercial market. Right? You can't 365 00:13:04,704 --> 00:13:07,024 shift costs in the Medicaid. Those rates are 366 00:13:07,024 --> 00:13:08,625 pretty much what they are. You can't shift 367 00:13:08,625 --> 00:13:11,024 costs to Medicare. CMS determines what those costs 368 00:13:11,024 --> 00:13:13,184 are, what those rates are. So you shift 369 00:13:13,184 --> 00:13:15,125 the cost to the commercially insured. 370 00:13:15,440 --> 00:13:17,700 Those are people who are insured through employers 371 00:13:17,759 --> 00:13:20,339 or insured through their own their own, individual 372 00:13:20,399 --> 00:13:22,500 insurance. And so that cost shifting 373 00:13:22,879 --> 00:13:23,940 is gonna increase, 374 00:13:24,559 --> 00:13:26,480 increased costs as well. And that's the thing 375 00:13:26,480 --> 00:13:28,639 that, you know, the insurance companies are trying 376 00:13:28,639 --> 00:13:30,945 to predict what you know, how much cost 377 00:13:30,945 --> 00:13:33,424 shifting is gonna occur over the next, you 378 00:13:33,424 --> 00:13:34,644 know, year or so, 379 00:13:35,264 --> 00:13:36,545 you know, due to due to that. And 380 00:13:36,545 --> 00:13:38,545 then then I think another you know? And 381 00:13:38,545 --> 00:13:41,184 then there's, you know, even even maybe little 382 00:13:41,184 --> 00:13:43,799 in quotes things like like tariffs are gonna 383 00:13:43,799 --> 00:13:45,879 increase input cost. Right? I mean, you know, 384 00:13:45,879 --> 00:13:48,040 the tariffs that are starting to come in 385 00:13:48,040 --> 00:13:50,519 now are gonna increase the input costs for 386 00:13:50,519 --> 00:13:53,019 health care providers in a variety of ways, 387 00:13:53,240 --> 00:13:55,240 and then they, in turn, have to increase 388 00:13:55,240 --> 00:13:58,519 their costs above, let's say, a regular inflation 389 00:13:58,519 --> 00:13:59,019 rate, 390 00:13:59,825 --> 00:14:02,865 in order to, you know, financially survive. So 391 00:14:02,865 --> 00:14:03,684 we have, like, 392 00:14:04,065 --> 00:14:05,904 four or five things all hitting us at 393 00:14:05,904 --> 00:14:08,144 the same time, which is the which is 394 00:14:08,144 --> 00:14:10,065 resulting in that, you know, like you said, 395 00:14:10,065 --> 00:14:12,884 maybe 15 to 20% increase Yeah. In premium, 396 00:14:13,299 --> 00:14:15,220 which is a combination of all these different 397 00:14:15,220 --> 00:14:17,379 things. But is it is it a foregone 398 00:14:17,379 --> 00:14:19,620 conclusion at this point, Alan, that the enhanced 399 00:14:19,620 --> 00:14:21,700 subsidies will not be extended? I mean, what 400 00:14:21,700 --> 00:14:24,580 are you hearing both within the industry among 401 00:14:24,580 --> 00:14:25,080 lawmakers? 402 00:14:25,940 --> 00:14:28,019 Is this where we should be operating from 403 00:14:28,019 --> 00:14:28,840 at this point? 404 00:14:29,245 --> 00:14:31,024 Yeah. I I think the general consensus 405 00:14:31,485 --> 00:14:33,884 is that they will not be extended because 406 00:14:33,884 --> 00:14:36,605 the extension is just too expensive. Yeah. I 407 00:14:36,605 --> 00:14:38,285 mean, look. We we we just passed a 408 00:14:38,285 --> 00:14:40,625 budget bill that radically increases 409 00:14:41,004 --> 00:14:41,504 our 410 00:14:41,909 --> 00:14:44,470 our deficit. Right? According again, not to me. 411 00:14:44,470 --> 00:14:46,070 It's not a political statement at all. Kind 412 00:14:46,070 --> 00:14:48,709 of the congressional budget bills, the CBO. The 413 00:14:48,709 --> 00:14:49,209 CBO 414 00:14:49,669 --> 00:14:52,230 scores all these things in a very, you 415 00:14:52,230 --> 00:14:53,289 know, nonpartisan, 416 00:14:53,990 --> 00:14:54,549 you know, 417 00:14:55,110 --> 00:14:56,970 mathematical way. Right? 418 00:14:57,345 --> 00:14:58,544 We are going to, 419 00:14:59,345 --> 00:14:59,845 increase 420 00:15:00,225 --> 00:15:02,324 our deficit. And so I think anything 421 00:15:02,704 --> 00:15:05,105 you know, after kind of the passing of 422 00:15:05,105 --> 00:15:07,264 the most recent budget bill, anything that's gonna 423 00:15:07,264 --> 00:15:07,764 increase 424 00:15:08,065 --> 00:15:10,670 cost to to our government, which doesn't have 425 00:15:10,670 --> 00:15:12,930 the money to pay it. Right? Increasing deficits 426 00:15:12,990 --> 00:15:15,470 mean very simply. Right? We don't have the 427 00:15:15,470 --> 00:15:17,230 money to pay for these things, so we're 428 00:15:17,230 --> 00:15:19,149 gonna take out more debt. Right? Yeah. I 429 00:15:19,149 --> 00:15:20,769 think it's gonna be very hard, 430 00:15:21,790 --> 00:15:24,235 you know, to to get anything passed that 431 00:15:24,235 --> 00:15:25,115 is going to, 432 00:15:25,915 --> 00:15:26,415 significantly 433 00:15:26,795 --> 00:15:27,295 increase, 434 00:15:27,754 --> 00:15:30,554 our federal deficit. Yeah. So I would not 435 00:15:30,554 --> 00:15:34,154 bet that the enhanced premium tax credits will 436 00:15:34,154 --> 00:15:36,394 will be extended Sure. Because we're just not 437 00:15:36,394 --> 00:15:38,875 in a place right now in this country 438 00:15:38,875 --> 00:15:42,070 where it's gonna be easy to increase government 439 00:15:42,070 --> 00:15:44,549 spending. Yeah. 100%. And, you know, it's interesting. 440 00:15:44,549 --> 00:15:45,690 We've been seeing some, 441 00:15:46,230 --> 00:15:49,190 industry analysis online from executives at health plans 442 00:15:49,190 --> 00:15:51,509 saying that just this year alone, these subsidies 443 00:15:51,509 --> 00:15:53,990 have cost over a $130,000,000,000 444 00:15:53,990 --> 00:15:55,694 in one year. And that's that is way 445 00:15:55,694 --> 00:15:58,095 over what the CBO had previously estimated, which 446 00:15:58,095 --> 00:15:59,774 is around 330,000,000,000 447 00:15:59,774 --> 00:16:02,595 in a decade. So to your point, just 448 00:16:02,654 --> 00:16:04,894 an extreme amount of money that these subsidies 449 00:16:04,894 --> 00:16:05,554 are costing. 450 00:16:06,894 --> 00:16:09,074 So, okay, the subsidies aren't extended. 451 00:16:09,419 --> 00:16:11,259 Ultimately, what does that mean for the stability 452 00:16:11,259 --> 00:16:13,039 of the ACA market? What happens 453 00:16:13,419 --> 00:16:15,679 to to this segment moving forward? 454 00:16:16,460 --> 00:16:18,620 Well, you know, unfortunately, you you we we 455 00:16:18,620 --> 00:16:20,940 could see the ACA market get into, you 456 00:16:20,940 --> 00:16:23,384 know, real a real death spiral. Right? Which 457 00:16:23,384 --> 00:16:23,865 is, 458 00:16:24,264 --> 00:16:25,644 so, again, the elimination 459 00:16:26,185 --> 00:16:27,165 of the PTCs, 460 00:16:28,264 --> 00:16:30,125 again, increases the effective. 461 00:16:30,425 --> 00:16:32,665 Right? Not the the gross premium is 462 00:16:33,545 --> 00:16:35,865 let's say let's just use simple numbers. Let's 463 00:16:35,865 --> 00:16:38,049 say an insurance company is charging $600 a 464 00:16:38,049 --> 00:16:39,190 month. That's gross premium. 465 00:16:39,889 --> 00:16:42,309 But now let let's imagine that an individual 466 00:16:42,370 --> 00:16:43,889 is getting a $200, 467 00:16:44,290 --> 00:16:47,009 you know, credit. Right? So the effective premium 468 00:16:47,009 --> 00:16:49,205 for that individual is $400. 469 00:16:49,665 --> 00:16:51,985 But if that credit goes away, now the 470 00:16:51,985 --> 00:16:54,625 effective premium of that individual is $600. 471 00:16:54,625 --> 00:16:56,884 Well, this individual made a buying decision 472 00:16:57,264 --> 00:16:59,904 with four with a $400 cost. Is that 473 00:16:59,904 --> 00:17:01,825 insurance worth the $400 474 00:17:01,825 --> 00:17:02,870 cost? Right? 475 00:17:03,330 --> 00:17:05,089 Now now this individual is gonna have to 476 00:17:05,089 --> 00:17:07,089 buy make a buying decision. Is that insurance 477 00:17:07,089 --> 00:17:09,410 worth the $600 cost? And and we know. 478 00:17:09,410 --> 00:17:10,549 You know? Look. Look. 479 00:17:11,329 --> 00:17:13,349 This is you know, there's there's real elasticity 480 00:17:13,970 --> 00:17:16,710 in this market. As costs go up, 481 00:17:17,164 --> 00:17:19,644 less there's less people who purchase it. Right? 482 00:17:19,644 --> 00:17:21,565 More people make the decision to say, you 483 00:17:21,565 --> 00:17:22,144 know what? 484 00:17:22,605 --> 00:17:24,525 I'm I'm not gonna buy health insurance. Again, 485 00:17:24,525 --> 00:17:26,605 you know, this this all would be very 486 00:17:26,605 --> 00:17:28,544 different if we were still in a mandatory 487 00:17:28,765 --> 00:17:29,825 insurance environment, 488 00:17:30,605 --> 00:17:32,570 you know you know, right after the passing 489 00:17:32,570 --> 00:17:34,650 of the ACA. But since that has been 490 00:17:34,650 --> 00:17:35,150 repealed, 491 00:17:35,850 --> 00:17:37,690 we we now it is not a law 492 00:17:37,690 --> 00:17:39,950 that you need to have insurance. And so 493 00:17:40,090 --> 00:17:42,029 you'll have a segment of the population 494 00:17:42,410 --> 00:17:44,674 who opts not to have insurance. And it 495 00:17:44,755 --> 00:17:45,955 and, you know, I think, you know, there's 496 00:17:45,955 --> 00:17:47,095 good industry analysis 497 00:17:47,474 --> 00:17:49,474 on on, you know, on on projections on 498 00:17:49,474 --> 00:17:51,474 what that segment of the population is, and 499 00:17:51,474 --> 00:17:53,875 it's significant. Right? There's a significant number of 500 00:17:53,875 --> 00:17:56,355 people who opt not to have insurance, and 501 00:17:56,355 --> 00:17:58,035 what that will do is that will worsen 502 00:17:58,035 --> 00:18:00,730 the pool. And so what the insurance company 503 00:18:00,730 --> 00:18:02,509 is trying to do now is predict 504 00:18:03,049 --> 00:18:05,369 what that kind of what that pool what 505 00:18:05,369 --> 00:18:07,690 that pool is gonna worsen to. Right? Because 506 00:18:07,690 --> 00:18:09,690 what you have again, let's just use, you 507 00:18:09,690 --> 00:18:12,265 know, simple numbers. I don't I'm not I'm 508 00:18:12,265 --> 00:18:14,224 not claiming that these were these is what 509 00:18:14,345 --> 00:18:15,945 this is exactly what's gonna happen. But let's 510 00:18:15,945 --> 00:18:18,184 say 10% of the people who are buying 511 00:18:18,184 --> 00:18:20,265 individual insurance now opt to not to have 512 00:18:20,265 --> 00:18:22,744 individual insurance because of the of the, 513 00:18:23,865 --> 00:18:25,404 because of the lack of the PTCs. 514 00:18:26,019 --> 00:18:27,240 We know that 515 00:18:27,700 --> 00:18:29,859 that that that on average, those people who 516 00:18:29,859 --> 00:18:31,079 opt out of insurance, 517 00:18:31,940 --> 00:18:35,380 coverage are a significantly healthier population than the 518 00:18:35,380 --> 00:18:36,279 me. Right? 519 00:18:36,660 --> 00:18:39,220 And so what you've done now is the 520 00:18:39,220 --> 00:18:41,559 remaining, in this case, 90%, 521 00:18:42,394 --> 00:18:43,534 have higher 522 00:18:43,994 --> 00:18:46,474 average health care expenses. You you essentially worsen 523 00:18:46,474 --> 00:18:48,575 that pool. Right? And so now, 524 00:18:49,194 --> 00:18:51,375 the premium need to cover those expenses 525 00:18:52,075 --> 00:18:54,794 is higher. Right? And what that'll create is 526 00:18:54,794 --> 00:18:56,919 another cycle of people who say, well, now 527 00:18:56,919 --> 00:18:58,759 that the price goes from $600 528 00:18:58,759 --> 00:18:59,259 to 529 00:18:59,960 --> 00:19:00,919 $700 530 00:19:00,919 --> 00:19:02,519 because it's a worse pool, well, that's a 531 00:19:02,519 --> 00:19:04,700 whole another segment of people who will decide, 532 00:19:04,759 --> 00:19:06,539 I don't need to have coverage. Right? 533 00:19:07,000 --> 00:19:08,919 And you can get into, again, what's called 534 00:19:08,919 --> 00:19:09,740 death spiral, 535 00:19:10,144 --> 00:19:13,024 where as the costs keep going up, you 536 00:19:13,024 --> 00:19:15,845 have less and less people opting for coverage. 537 00:19:15,984 --> 00:19:18,704 And every time you lose people, in this 538 00:19:18,704 --> 00:19:21,184 case, you're losing people who are on the 539 00:19:21,585 --> 00:19:23,264 on on average. Again, not every one of 540 00:19:23,264 --> 00:19:24,865 them. There's always gonna be someone you lose 541 00:19:24,865 --> 00:19:27,190 that all of a sudden has a medical 542 00:19:27,190 --> 00:19:29,827 expense. But on average, you're lose you're losing 543 00:19:29,827 --> 00:19:32,171 people who have lower health care expenses, which 544 00:19:32,171 --> 00:19:34,514 again worsens your pool, which cause you to 545 00:19:34,514 --> 00:19:36,858 increase your rates again. Right. So it could 546 00:19:36,858 --> 00:19:39,201 get into a death spiral where we're really 547 00:19:39,201 --> 00:19:41,914 seeing a smaller and smaller pool of people 548 00:19:41,974 --> 00:19:42,795 buying coverage 549 00:19:43,255 --> 00:19:45,894 that that is essentially a riskier and riskier 550 00:19:45,894 --> 00:19:49,174 pool with higher and higher premium rates. Absolutely. 551 00:19:49,174 --> 00:19:51,335 So you've got this smaller pool. You've got 552 00:19:51,335 --> 00:19:53,974 millions peep of people uninsured that were previously 553 00:19:53,974 --> 00:19:56,190 not. What does that mean for a company 554 00:19:56,190 --> 00:19:57,490 like Scentivo, Alan? 555 00:19:58,430 --> 00:20:00,589 So so, again, at Scentivo, I and I 556 00:20:00,589 --> 00:20:01,150 I think that 557 00:20:01,950 --> 00:20:04,109 and what we do is really try to 558 00:20:04,109 --> 00:20:06,109 take a a kind of different a different 559 00:20:06,109 --> 00:20:08,065 path to say that if we can just 560 00:20:08,065 --> 00:20:10,384 keep doing the same things that we're doing 561 00:20:10,384 --> 00:20:11,605 in kind of health coverage, 562 00:20:12,225 --> 00:20:14,225 we're just gonna be all running off this 563 00:20:14,225 --> 00:20:16,384 cliff. Right? And so what I think that 564 00:20:16,384 --> 00:20:18,305 every, you know, company has to think about, 565 00:20:18,305 --> 00:20:20,144 what every individual has to think about if 566 00:20:20,144 --> 00:20:22,404 they're purchasing individual insurance is 567 00:20:22,869 --> 00:20:25,690 how is your health coverage provider 568 00:20:25,990 --> 00:20:27,210 thinking about controlling 569 00:20:27,509 --> 00:20:28,009 costs 570 00:20:29,029 --> 00:20:31,990 this year, but also five years, ten years 571 00:20:31,990 --> 00:20:33,829 down the line? And so what we do 572 00:20:33,829 --> 00:20:34,490 at Sentivo 573 00:20:35,284 --> 00:20:36,744 is we we build, 574 00:20:37,605 --> 00:20:40,884 plans that are called high performing. They're plans 575 00:20:40,884 --> 00:20:41,625 that will 576 00:20:42,005 --> 00:20:43,464 increase at a 577 00:20:43,765 --> 00:20:46,244 significantly lower first of all, they save money 578 00:20:46,244 --> 00:20:48,325 right away, and then they increase at a 579 00:20:48,325 --> 00:20:50,440 significantly lower rate than, 580 00:20:50,740 --> 00:20:52,579 you know, than kind of, let's say, general 581 00:20:52,579 --> 00:20:53,079 regular 582 00:20:53,380 --> 00:20:56,099 insurance coverage. Right? Well, why? Because we work 583 00:20:56,099 --> 00:20:59,539 with providers who themselves are high performing. These 584 00:20:59,539 --> 00:21:02,845 accountable care organizations or clinically integrated networks who've 585 00:21:02,845 --> 00:21:03,585 been designed 586 00:21:04,284 --> 00:21:06,284 to really kind of meet the aims of 587 00:21:06,284 --> 00:21:07,964 health care. You know, they they they're designed 588 00:21:07,964 --> 00:21:10,605 to improve the patient experience, to improve the 589 00:21:10,605 --> 00:21:12,464 health of the population, to reduce 590 00:21:13,005 --> 00:21:15,005 the total cost of care health care in 591 00:21:15,005 --> 00:21:16,924 the future and to reduce inequities of health 592 00:21:16,924 --> 00:21:20,589 care. And so we build our networks around 593 00:21:20,809 --> 00:21:24,009 high performing providers, organizations like, you know, like 594 00:21:24,009 --> 00:21:26,349 Mount Sinai here in New York, like Orlando 595 00:21:26,490 --> 00:21:29,929 Health in in, in in, in Florida, like 596 00:21:29,929 --> 00:21:31,549 Bowers, Scott and White in Texas, 597 00:21:32,255 --> 00:21:35,054 like MoroCare in California. These are organizations that 598 00:21:35,054 --> 00:21:38,174 are delivering high quality, cost effective healthcare. And 599 00:21:38,174 --> 00:21:40,894 we build our networks exclusively around them, really 600 00:21:40,894 --> 00:21:42,355 allowing them to be accountable 601 00:21:42,815 --> 00:21:44,730 for all the care in their 602 00:21:45,130 --> 00:21:47,869 geographic footprint. And then what we also do 603 00:21:47,929 --> 00:21:50,329 is we make sure that people, that members, 604 00:21:50,329 --> 00:21:51,929 you know, that you know, think about you 605 00:21:51,929 --> 00:21:54,169 know, we work with employers. So an employer 606 00:21:54,169 --> 00:21:56,809 has employees that become our members, that become 607 00:21:56,809 --> 00:21:58,845 our health care partners' patients, but they're the 608 00:21:58,845 --> 00:22:00,924 same person. Right? Here's an employee or a 609 00:22:00,924 --> 00:22:02,625 member and a patient. Well, 610 00:22:03,085 --> 00:22:05,984 what these, what these members do is they 611 00:22:06,045 --> 00:22:07,565 align themselves with, 612 00:22:07,884 --> 00:22:10,625 with high quality advanced primary care providers, 613 00:22:11,390 --> 00:22:13,789 like patient centered medical homes that are part 614 00:22:13,789 --> 00:22:16,210 of these clinically integrated networks and ACOs 615 00:22:16,509 --> 00:22:17,809 that really can organize 616 00:22:18,429 --> 00:22:21,950 and coordinate their care throughout their their kind 617 00:22:21,950 --> 00:22:24,444 of health care journey. And really have have 618 00:22:24,444 --> 00:22:27,085 the organization. Again, this this these are teams 619 00:22:27,085 --> 00:22:29,164 of people, you know, health you know, primary 620 00:22:29,164 --> 00:22:31,484 care teams who are really thinking about the 621 00:22:31,484 --> 00:22:33,804 health of the population that they're managing, thinking 622 00:22:33,804 --> 00:22:36,544 about their each of their patients journey, providing 623 00:22:36,684 --> 00:22:37,664 patient centered, 624 00:22:38,400 --> 00:22:41,119 high quality cost effective care. And they're going 625 00:22:41,119 --> 00:22:42,900 to help manage that health care, 626 00:22:43,320 --> 00:22:44,900 you know, through the person's lifetime. 627 00:22:45,200 --> 00:22:47,279 And we firmly believe and we've seen now 628 00:22:47,279 --> 00:22:49,059 for over five years of experience 629 00:22:50,565 --> 00:22:53,444 that building building networks with these great health 630 00:22:53,444 --> 00:22:56,345 care providers and making sure that every member 631 00:22:56,565 --> 00:22:59,284 has a, you know, patient centered medical home 632 00:22:59,284 --> 00:22:59,784 level, 633 00:23:00,085 --> 00:23:02,105 advanced primary care team 634 00:23:02,419 --> 00:23:05,220 that is patient centered and really kind of 635 00:23:05,220 --> 00:23:08,339 quarterbacking and coordinating their care, not only does 636 00:23:08,339 --> 00:23:10,980 that significantly reduce cost right away, like, right 637 00:23:10,980 --> 00:23:13,460 away, like, next, you know, next year, but 638 00:23:13,460 --> 00:23:14,119 more importantly, 639 00:23:14,515 --> 00:23:15,335 it also 640 00:23:15,634 --> 00:23:17,335 improves the health of the population, 641 00:23:17,954 --> 00:23:18,454 which 642 00:23:18,755 --> 00:23:20,595 reduces costs in the future. And, again, we 643 00:23:20,595 --> 00:23:21,815 work with with employers, 644 00:23:22,355 --> 00:23:24,595 and so it is, you know, it is, 645 00:23:24,595 --> 00:23:26,434 you know, it is people work for companies 646 00:23:26,434 --> 00:23:28,535 and their family members. We've seen, 647 00:23:30,519 --> 00:23:33,799 you'll see hypertensive control go up significantly, diabetic 648 00:23:33,799 --> 00:23:35,180 control go up significantly, 649 00:23:35,720 --> 00:23:38,759 early cancer detection significantly increase. And all these 650 00:23:38,759 --> 00:23:41,480 things, you know, they bend the curve. Right? 651 00:23:41,480 --> 00:23:44,244 And so these you know, by by making 652 00:23:44,244 --> 00:23:46,404 sure that the population is you know, the 653 00:23:46,404 --> 00:23:48,404 population of people are as healthy as they 654 00:23:48,404 --> 00:23:50,724 can be and really, you know, watching out 655 00:23:50,724 --> 00:23:52,964 for them, we can reduce the long term 656 00:23:52,964 --> 00:23:54,964 cost of health care by working with these 657 00:23:54,964 --> 00:23:57,269 wonderful health care providers that we partnered with. 658 00:23:57,269 --> 00:23:58,630 And what we do is we do we 659 00:23:58,630 --> 00:24:00,390 do what's called a value based contract with 660 00:24:00,390 --> 00:24:02,470 them, where instead instead of getting paid for 661 00:24:02,470 --> 00:24:04,549 every little teeny unit of care, you know, 662 00:24:04,549 --> 00:24:07,269 we really work a, a value based arrangement 663 00:24:07,269 --> 00:24:09,670 with them, which is as they deliver greater 664 00:24:09,670 --> 00:24:10,170 value, 665 00:24:10,734 --> 00:24:12,575 they they earn they earn great rewards for 666 00:24:12,575 --> 00:24:14,335 that. And so it's it's really you know, 667 00:24:14,335 --> 00:24:16,894 because, like, health care transformation can't happen without 668 00:24:16,894 --> 00:24:19,694 health without payment reform. And we're trying to, 669 00:24:19,694 --> 00:24:21,934 you know, with our health care partners, kind 670 00:24:21,934 --> 00:24:23,934 of lead that payment reform to a pay 671 00:24:23,934 --> 00:24:25,855 for value approach as a pay for, like, 672 00:24:25,855 --> 00:24:27,640 each unit of of care. But that only 673 00:24:27,640 --> 00:24:29,960 works if you're really working with these types 674 00:24:29,960 --> 00:24:32,299 of health care providers that have organized themselves 675 00:24:32,440 --> 00:24:34,359 in a way that they can deliver high 676 00:24:34,359 --> 00:24:37,160 value care and also really giving them that 677 00:24:37,160 --> 00:24:37,980 kind of control 678 00:24:38,279 --> 00:24:40,759 like we do by building our networks really 679 00:24:40,759 --> 00:24:43,105 exclusively around that. And so and so that's 680 00:24:43,105 --> 00:24:44,724 the way, you know, our approach 681 00:24:45,105 --> 00:24:47,025 to, you know, to fighting this problem with 682 00:24:47,025 --> 00:24:48,625 rising health care costs. And what I would 683 00:24:48,625 --> 00:24:49,365 say to, 684 00:24:49,825 --> 00:24:52,144 you know, to to health care providers out 685 00:24:52,144 --> 00:24:53,605 there is to find organizations 686 00:24:53,904 --> 00:24:56,190 kind of like us that are that are 687 00:24:56,190 --> 00:24:58,670 really trying to work with the health care 688 00:24:58,670 --> 00:24:59,170 providers 689 00:24:59,789 --> 00:25:01,329 to really, yeah, to 690 00:25:01,950 --> 00:25:03,390 to meet those aims that we all have 691 00:25:03,390 --> 00:25:05,869 the same aims. Right? We improve the patient 692 00:25:05,869 --> 00:25:06,369 experience, 693 00:25:06,670 --> 00:25:07,809 improve the population, 694 00:25:08,215 --> 00:25:10,475 the the health the health of the population, 695 00:25:10,535 --> 00:25:12,795 reduce the total cost of care, reduce inequities. 696 00:25:12,855 --> 00:25:14,695 We we're all on the same side. So 697 00:25:14,695 --> 00:25:15,674 health care providers 698 00:25:15,975 --> 00:25:18,555 should find organizations like us to work with, 699 00:25:18,855 --> 00:25:20,634 and employers should demand 700 00:25:21,160 --> 00:25:23,319 for for their providers of health coverage that 701 00:25:23,319 --> 00:25:26,380 they have a real viable long term strategy 702 00:25:27,079 --> 00:25:30,119 to to make sure that their employees and 703 00:25:30,119 --> 00:25:32,599 their family members are gonna have have access 704 00:25:32,599 --> 00:25:34,575 to high quality health care that is gonna 705 00:25:34,575 --> 00:25:37,534 be affordable now and affordable in five years, 706 00:25:37,534 --> 00:25:38,755 ten years, and forever. 707 00:25:39,214 --> 00:25:42,275 Fantastic. Well, Alan, take one minute. 708 00:25:42,894 --> 00:25:44,654 Talk to our audience. Give us your last 709 00:25:44,654 --> 00:25:46,734 bits of advice, all the health plan leadership 710 00:25:46,734 --> 00:25:48,595 listening in from all over the country. 711 00:25:49,210 --> 00:25:51,150 Last parting words you wanna share with them? 712 00:25:51,850 --> 00:25:53,309 I'd say we gotta change. 713 00:25:53,850 --> 00:25:55,470 I mean, you know, it's 714 00:25:56,090 --> 00:25:58,009 we are and I know it it it 715 00:25:58,009 --> 00:26:00,090 kind of becomes an old saw. It's like, 716 00:26:00,090 --> 00:26:02,009 well, you know, health care costs are going 717 00:26:02,009 --> 00:26:03,930 up so much. At some point, it's gonna 718 00:26:03,930 --> 00:26:04,430 break. 719 00:26:04,855 --> 00:26:07,575 It's going to break. And so we need 720 00:26:07,575 --> 00:26:10,054 to change. You know, we if if we 721 00:26:10,054 --> 00:26:10,714 are unhappy 722 00:26:11,335 --> 00:26:11,835 with, 723 00:26:12,375 --> 00:26:14,855 with with the cost of health care and 724 00:26:14,855 --> 00:26:17,575 maybe the unequal delivery of health care in 725 00:26:17,575 --> 00:26:18,315 this country, 726 00:26:18,649 --> 00:26:19,929 we need to look at ourselves in the 727 00:26:19,929 --> 00:26:21,769 mirror. And we're the ones in the industry, 728 00:26:21,769 --> 00:26:23,369 and we're the ones who've created this. And 729 00:26:23,369 --> 00:26:24,809 so we're the ones who need to change 730 00:26:24,809 --> 00:26:27,069 it. And so, you know, challenge 731 00:26:27,690 --> 00:26:28,750 the status quo, 732 00:26:29,130 --> 00:26:31,690 you know, work with health care per health 733 00:26:31,690 --> 00:26:32,349 care providers 734 00:26:32,974 --> 00:26:36,035 and and and, you know, health insurance companies 735 00:26:36,095 --> 00:26:38,674 or health plan administrators need to work together 736 00:26:38,815 --> 00:26:41,055 to solve this problem. And we cannot accept 737 00:26:41,055 --> 00:26:42,974 the status quo because the status quo has 738 00:26:42,974 --> 00:26:44,434 taken us right off a cliff. 739 00:26:45,070 --> 00:26:47,390 Alrighty. Good stuff. Alan, thank you very much 740 00:26:47,390 --> 00:26:48,830 for taking the time to be with me 741 00:26:48,830 --> 00:26:50,750 on the podcast, for sharing your insights with 742 00:26:50,750 --> 00:26:52,529 our audience. We really appreciate it. 743 00:26:52,990 --> 00:26:54,670 Thank you very much, Jacob. This was this 744 00:26:54,670 --> 00:26:56,350 was really fun for me too, and and, 745 00:26:56,830 --> 00:26:59,070 and hopefully, it was, it it'll be very 746 00:26:59,070 --> 00:27:01,224 useful for all the listeners. Yeah. I definitely 747 00:27:01,224 --> 00:27:03,065 think so. To our listeners, if you wanna 748 00:27:03,065 --> 00:27:05,304 listen to more podcasts from Becker's Healthcare, you 749 00:27:05,304 --> 00:27:07,964 can visit beckershospitalreview.com.