1 00:00:02,240 --> 00:00:05,059 This is where health insurance leadership comes together. 2 00:00:05,279 --> 00:00:08,960 Becker's fourth annual spring payer issues roundtable brings 3 00:00:08,960 --> 00:00:12,259 together over 400 payer and health plan executives 4 00:00:12,400 --> 00:00:16,524 and more than 100 speakers to Chicago April. 5 00:00:16,904 --> 00:00:19,785 This year's event includes keynote conversations with the 6 00:00:19,785 --> 00:00:23,064 industry's top leaders and former president George W. 7 00:00:23,064 --> 00:00:25,704 Bush. For the full agenda and event details, 8 00:00:25,704 --> 00:00:27,785 visit beckershospitalreview.com 9 00:00:27,785 --> 00:00:29,224 and click on the events tab in the 10 00:00:29,224 --> 00:00:31,519 upper right. We're looking forward to hosting you 11 00:00:31,519 --> 00:00:32,659 here in Chicago. 12 00:00:34,000 --> 00:00:35,920 Hello, everyone, and welcome to Becker's Health Care 13 00:00:35,920 --> 00:00:38,399 Podcast. I'm Scott King, thrilled today to be 14 00:00:38,399 --> 00:00:41,219 joined by Rob Hitchcock, president and chief executive 15 00:00:41,439 --> 00:00:43,840 officer of SelectHealth. Rob, how are you? Thanks 16 00:00:43,840 --> 00:00:45,059 so much for joining us. 17 00:00:45,524 --> 00:00:46,965 I'm good. Thank you very much. It's a 18 00:00:46,965 --> 00:00:48,965 pleasure to be here. Of course. Yeah. I 19 00:00:48,965 --> 00:00:50,344 know I know we have a lot of 20 00:00:50,405 --> 00:00:51,304 of big topics, 21 00:00:51,924 --> 00:00:54,164 in health care, especially with health plans to 22 00:00:54,164 --> 00:00:55,684 get to. But before we jump into the 23 00:00:55,684 --> 00:00:57,204 the topic, can you please just kinda tell 24 00:00:57,204 --> 00:00:59,045 us a little bit about your your background 25 00:00:59,045 --> 00:01:00,104 and your career journey? 26 00:01:00,840 --> 00:01:01,340 Sure. 27 00:01:01,879 --> 00:01:03,799 I, I'm currently the president and CEO of 28 00:01:03,799 --> 00:01:06,359 SelectHealth as you as you said. I've been 29 00:01:06,359 --> 00:01:08,780 a a health insurance executive for, 30 00:01:09,879 --> 00:01:12,599 many years. Been with companies like Humana and 31 00:01:12,599 --> 00:01:14,859 Centene and some of the Blues plants. 32 00:01:15,424 --> 00:01:17,025 Moved out to Salt Lake about three and 33 00:01:17,025 --> 00:01:18,385 a half years ago and have been the 34 00:01:18,385 --> 00:01:21,605 CEO of SelectHealth for about three years now. 35 00:01:22,064 --> 00:01:24,625 And, what's interesting about SelectHealth is it's it's 36 00:01:24,625 --> 00:01:26,704 a little different than the the national players 37 00:01:26,704 --> 00:01:29,765 in that it's owned by Intermountain Health. So 38 00:01:29,905 --> 00:01:31,609 SelectHealth is a wholly owned 39 00:01:32,229 --> 00:01:33,609 subsidiary of Intermountain Health, 40 00:01:33,989 --> 00:01:36,149 and, so we're what's known as a community 41 00:01:36,149 --> 00:01:38,789 health plan or a provider owned health plan, 42 00:01:38,789 --> 00:01:40,329 which which makes us unique 43 00:01:40,709 --> 00:01:43,030 in the ecosystem of health insurers. And, 44 00:01:43,590 --> 00:01:45,094 I can say it's just been a pleasure 45 00:01:45,094 --> 00:01:47,515 to be part of an organization like that. 46 00:01:48,534 --> 00:01:50,055 Thanks thanks a lot for the background and 47 00:01:50,055 --> 00:01:52,134 further, Rob. Yeah. Certainly a a unique position 48 00:01:52,134 --> 00:01:52,875 to be in 49 00:01:53,254 --> 00:01:55,015 in this space. And let me ask you, 50 00:01:55,015 --> 00:01:56,774 getting on the first topic, how are your 51 00:01:56,774 --> 00:02:00,549 relationships with providers changing as both sides face 52 00:02:00,770 --> 00:02:02,790 cost pressure and workforce shortages? 53 00:02:04,049 --> 00:02:06,930 That's a great question. I you know, being 54 00:02:06,930 --> 00:02:09,569 a provider owned health plan has put us 55 00:02:09,569 --> 00:02:12,389 in a unique situation where our default 56 00:02:12,849 --> 00:02:15,074 as a health plan at SelectHealth is to 57 00:02:15,074 --> 00:02:17,814 work very closely with providers. And so, 58 00:02:18,915 --> 00:02:20,835 we were founded in 1983, 59 00:02:20,835 --> 00:02:23,155 so we've been operational now for about forty 60 00:02:23,155 --> 00:02:24,915 three years and in our forty three year 61 00:02:24,915 --> 00:02:25,415 journey, 62 00:02:26,354 --> 00:02:28,490 our first thought is how do we work 63 00:02:28,490 --> 00:02:30,349 very closely with our providers 64 00:02:30,889 --> 00:02:32,170 and how do we take care of our 65 00:02:32,170 --> 00:02:33,950 providers and how do we work collaboratively 66 00:02:34,409 --> 00:02:35,550 with them. And so, 67 00:02:35,930 --> 00:02:38,409 from that perspective, I do appreciate that there's 68 00:02:38,409 --> 00:02:39,849 a lot of cost pressures, not only for 69 00:02:39,849 --> 00:02:42,270 health plans but for our physician and hospital 70 00:02:42,715 --> 00:02:44,715 providers as well. And I have a great 71 00:02:44,715 --> 00:02:46,734 amount of appreciation for that. But 72 00:02:47,514 --> 00:02:49,194 I also think that the way that we 73 00:02:49,194 --> 00:02:49,694 work 74 00:02:50,074 --> 00:02:53,215 together with providers and with hospitals is together 75 00:02:54,314 --> 00:02:55,594 rather than as, 76 00:02:56,155 --> 00:02:58,014 I call it the enmity model 77 00:03:00,500 --> 00:03:02,259 where each side is just trying to protect 78 00:03:02,259 --> 00:03:03,400 their own interests. 79 00:03:03,699 --> 00:03:05,379 And so we kind of default to that. 80 00:03:05,379 --> 00:03:07,460 I think a great example of that is 81 00:03:07,460 --> 00:03:09,060 something that we all had to live through, 82 00:03:09,060 --> 00:03:10,120 especially providers, 83 00:03:10,775 --> 00:03:12,075 was the change healthcare, 84 00:03:13,094 --> 00:03:15,254 incident that happened a little over a year 85 00:03:15,254 --> 00:03:15,754 ago. 86 00:03:16,215 --> 00:03:18,314 And the way we handled that was we 87 00:03:18,775 --> 00:03:20,694 were getting a lot of outreach from our 88 00:03:20,694 --> 00:03:22,855 provider partners saying, hey, look, I'm in danger 89 00:03:22,855 --> 00:03:24,635 of not being able to make payroll 90 00:03:25,290 --> 00:03:27,550 because I'm not I'm not getting my claims 91 00:03:27,610 --> 00:03:30,090 paid due to this this issue with Change 92 00:03:30,090 --> 00:03:31,689 Healthcare. And so what we did is we 93 00:03:31,689 --> 00:03:32,189 advanced 94 00:03:32,810 --> 00:03:35,050 money to our provider partners so that they 95 00:03:35,050 --> 00:03:36,990 can make payroll, keep the doors open, 96 00:03:37,610 --> 00:03:38,110 and 97 00:03:39,034 --> 00:03:40,875 we were a little nervous about that. We 98 00:03:40,875 --> 00:03:42,074 felt it was the right thing to do, 99 00:03:42,074 --> 00:03:43,835 but we're a little nervous because we weren't 100 00:03:43,835 --> 00:03:44,335 sure 101 00:03:45,275 --> 00:03:47,034 that that money was gonna be paid back. 102 00:03:47,034 --> 00:03:49,115 And in reality, what happened was all that 103 00:03:49,115 --> 00:03:50,254 money was paid back. 104 00:03:50,715 --> 00:03:51,215 And 105 00:03:51,580 --> 00:03:54,060 our our relationships with the providers, although I 106 00:03:54,060 --> 00:03:56,139 I would like to think was good before 107 00:03:56,139 --> 00:03:58,560 that, was even better after that. 108 00:03:58,860 --> 00:03:59,919 And so I think 109 00:04:00,620 --> 00:04:03,340 I think we've always defaulted to that. But 110 00:04:03,340 --> 00:04:05,039 the other thing I would say is 111 00:04:06,235 --> 00:04:08,655 the way we get through these cost pressures 112 00:04:09,275 --> 00:04:11,134 that we're that everybody's facing 113 00:04:11,834 --> 00:04:13,995 is is, again, we have to do that 114 00:04:13,995 --> 00:04:16,314 together. And I think that's gonna require a 115 00:04:16,314 --> 00:04:17,294 lot of operational 116 00:04:17,595 --> 00:04:18,095 changes. 117 00:04:19,430 --> 00:04:20,949 And the only way that that can be 118 00:04:20,949 --> 00:04:23,509 done, I think, is working together and being 119 00:04:23,509 --> 00:04:24,810 collaborative and 120 00:04:25,509 --> 00:04:27,430 just being open and honest with each other, 121 00:04:27,430 --> 00:04:28,490 which I think 122 00:04:29,270 --> 00:04:30,970 in a lot of ways in the industry 123 00:04:31,270 --> 00:04:32,810 doesn't happen very often. 124 00:04:33,375 --> 00:04:35,055 And so that's what we're focused on is 125 00:04:35,055 --> 00:04:37,134 really how do we how do we be 126 00:04:37,134 --> 00:04:39,634 open? How do we be have authentic conversations 127 00:04:39,694 --> 00:04:41,875 with our provider partners? And how do we 128 00:04:42,014 --> 00:04:44,514 work through these challenges together rather than 129 00:04:45,055 --> 00:04:46,194 rather than independently? 130 00:04:47,860 --> 00:04:49,540 Yeah. You know, it doesn't happen very often, 131 00:04:49,540 --> 00:04:51,460 Rob, and and hopefully, you'll start to see 132 00:04:51,460 --> 00:04:52,500 more. But I I think that was a 133 00:04:52,500 --> 00:04:54,660 great example of, you know, reaching across the 134 00:04:54,660 --> 00:04:57,139 aisle, so to speak, and advancing those funds. 135 00:04:57,139 --> 00:04:58,980 And I'm glad to see they Yeah. Got 136 00:04:58,980 --> 00:05:00,900 paid back. But, yeah, just a great example 137 00:05:00,900 --> 00:05:02,564 of kinda going out of your way to 138 00:05:02,644 --> 00:05:05,305 make sure everyone can can work together effectively. 139 00:05:06,245 --> 00:05:07,444 What do you what do you see the 140 00:05:07,444 --> 00:05:08,745 biggest gap today? 141 00:05:09,045 --> 00:05:10,404 Excuse me. Where do you see the biggest 142 00:05:10,404 --> 00:05:11,384 gap today between 143 00:05:11,845 --> 00:05:12,745 payer strategy 144 00:05:13,125 --> 00:05:14,985 and operational execution? 145 00:05:15,699 --> 00:05:17,300 Well, I think I think there's a few 146 00:05:17,300 --> 00:05:18,360 things. One is, 147 00:05:19,139 --> 00:05:21,060 oh, there's a lot of external pressures, I 148 00:05:21,060 --> 00:05:23,800 think, on health plans today. And 149 00:05:25,379 --> 00:05:26,279 the one example 150 00:05:26,580 --> 00:05:28,100 I'll I'll give you on that is some 151 00:05:28,180 --> 00:05:29,399 there's a lot of regulatory 152 00:05:30,014 --> 00:05:31,854 pressures that are that are put on us, 153 00:05:31,854 --> 00:05:33,235 and I think regulatory 154 00:05:33,535 --> 00:05:34,735 changes and and, 155 00:05:35,935 --> 00:05:36,514 are always 156 00:05:36,975 --> 00:05:38,995 have positive intent behind them, 157 00:05:39,854 --> 00:05:41,694 but it it does put some pressure. The 158 00:05:41,694 --> 00:05:44,115 greatest example is on our individual product. 159 00:05:44,629 --> 00:05:45,449 The federal government through 160 00:05:45,909 --> 00:05:48,550 the one big beautiful bill actually increased premium 161 00:05:48,550 --> 00:05:51,589 taxes. So for SelectHealth, that impact was about 162 00:05:51,589 --> 00:05:52,709 $14,000,000 163 00:05:52,709 --> 00:05:53,370 a year. 164 00:05:54,949 --> 00:05:57,370 And that puts enormous pressure on us 165 00:05:58,295 --> 00:05:59,915 to keep premiums low 166 00:06:00,535 --> 00:06:03,675 and to benefit our communities that we serve. 167 00:06:03,814 --> 00:06:06,235 So that's that's something that we're always cognizant 168 00:06:06,295 --> 00:06:08,214 of of the regulatory changes that are that 169 00:06:08,214 --> 00:06:08,875 are happening. 170 00:06:09,334 --> 00:06:10,875 I think also our 171 00:06:12,370 --> 00:06:15,569 our ability to change and to adapt, and 172 00:06:15,569 --> 00:06:17,250 and let's face it, with the the changes 173 00:06:17,250 --> 00:06:18,850 in the in the one big beautiful bill 174 00:06:18,850 --> 00:06:20,850 or HR one, I'm not sure what people 175 00:06:20,850 --> 00:06:21,649 are calling it, but, 176 00:06:23,649 --> 00:06:25,189 that I think has changed 177 00:06:25,615 --> 00:06:27,615 a lot of realities for people, not just 178 00:06:27,615 --> 00:06:29,154 on the health plan side, but 179 00:06:29,535 --> 00:06:31,294 for providers as well. I mean, when you 180 00:06:31,294 --> 00:06:33,954 take a trillion dollars out of the healthcare 181 00:06:34,415 --> 00:06:37,555 industry through specifically on the Medicaid side, 182 00:06:38,699 --> 00:06:41,579 that changes things. And and I think from 183 00:06:41,579 --> 00:06:42,959 an operational perspective, 184 00:06:43,899 --> 00:06:45,420 what we're gonna have to become very good 185 00:06:45,420 --> 00:06:46,939 at, and again, I think this goes back 186 00:06:46,939 --> 00:06:49,180 to working with our our hospital partners and 187 00:06:49,180 --> 00:06:51,854 our physician partners is, okay. Well, when you 188 00:06:51,854 --> 00:06:53,454 when you take a trillion dollars out of 189 00:06:53,454 --> 00:06:54,035 the ecosystem, 190 00:06:55,294 --> 00:06:56,834 what do we have to do differently? 191 00:06:57,375 --> 00:06:59,454 And and I think we are all going 192 00:06:59,454 --> 00:07:01,794 to be doing things differently. And I think 193 00:07:01,935 --> 00:07:03,935 I think some of the different changes that 194 00:07:03,935 --> 00:07:04,834 are gonna happen 195 00:07:05,350 --> 00:07:07,350 from the hospitals, from the physicians, and even 196 00:07:07,350 --> 00:07:08,170 the health plans 197 00:07:08,790 --> 00:07:09,670 is gonna be, 198 00:07:10,949 --> 00:07:12,490 I think it's gonna be significant. 199 00:07:13,110 --> 00:07:14,790 And so how do you how do you 200 00:07:14,790 --> 00:07:16,629 do that? How do you change that? How 201 00:07:16,629 --> 00:07:18,310 do you change your mindset? How do you 202 00:07:18,310 --> 00:07:20,009 change the culture of 203 00:07:20,645 --> 00:07:21,145 American, 204 00:07:21,764 --> 00:07:23,944 the way health care is delivered in America? 205 00:07:24,645 --> 00:07:26,725 And and to me, that's that's the biggest 206 00:07:26,725 --> 00:07:28,564 challenge we got coming up in the next, 207 00:07:28,564 --> 00:07:30,345 I would say, three to five years, 208 00:07:30,725 --> 00:07:32,404 is how do you change the mindset of 209 00:07:32,404 --> 00:07:33,625 how health care is delivered? 210 00:07:34,279 --> 00:07:37,000 How do you how do you operate in 211 00:07:37,000 --> 00:07:39,080 a in a in an environment where where 212 00:07:39,080 --> 00:07:41,660 revenue has been decreased by such a significant 213 00:07:41,879 --> 00:07:42,379 amount? 214 00:07:43,560 --> 00:07:45,180 Those are really difficult challenges. 215 00:07:46,555 --> 00:07:48,875 Well, that that's incredibly interesting thoughts there, Rob. 216 00:07:48,875 --> 00:07:50,154 Let me let me ask you about that. 217 00:07:50,154 --> 00:07:51,774 What do you think the first step is 218 00:07:52,314 --> 00:07:54,074 towards changing that mindset? What do you think 219 00:07:54,074 --> 00:07:54,814 that would be? 220 00:07:55,194 --> 00:07:56,634 Well, if you think if you think about 221 00:07:56,634 --> 00:07:59,354 the I I reference culture of of how 222 00:07:59,354 --> 00:08:01,639 health care is delivered in America. The the 223 00:08:01,639 --> 00:08:03,480 culture is and and this is a bit 224 00:08:03,480 --> 00:08:05,480 of a history lesson, so, you know, forgive 225 00:08:05,480 --> 00:08:07,639 me. This is not my personal opinions. This 226 00:08:07,639 --> 00:08:08,939 is kinda just reality. 227 00:08:09,720 --> 00:08:10,220 But 228 00:08:10,840 --> 00:08:11,340 America, 229 00:08:11,764 --> 00:08:13,845 back in the early foundations of the country, 230 00:08:13,845 --> 00:08:17,464 decided that healthcare was a purchased service. 231 00:08:18,564 --> 00:08:20,404 That the only way that an American can 232 00:08:20,404 --> 00:08:22,745 get healthcare is if you purchase that service, 233 00:08:23,125 --> 00:08:24,024 right or wrong. 234 00:08:24,399 --> 00:08:26,660 And so I think the mentality 235 00:08:27,120 --> 00:08:29,779 of of hospitals with physicians 236 00:08:30,879 --> 00:08:33,379 and even health plans is that, okay. Well, 237 00:08:33,759 --> 00:08:36,159 that we're gonna do this pay for services 238 00:08:36,159 --> 00:08:38,159 or fee for service environment. You know? You 239 00:08:38,159 --> 00:08:38,684 you get a 240 00:08:40,205 --> 00:08:42,524 a procedure done or or a visit to 241 00:08:42,524 --> 00:08:43,965 the physician that you have to you have 242 00:08:43,965 --> 00:08:45,004 to pay for that, and you pay for 243 00:08:45,004 --> 00:08:47,664 that on a on a on a on 244 00:08:47,965 --> 00:08:50,205 a, you know, as incurred basis, so to 245 00:08:50,205 --> 00:08:50,705 speak. 246 00:08:51,529 --> 00:08:53,529 I think when you take a trillion dollars 247 00:08:53,529 --> 00:08:54,350 out of Medicaid, 248 00:08:54,970 --> 00:08:56,589 that mindset has to change. 249 00:08:57,449 --> 00:08:59,470 And that means that you have to start 250 00:09:00,089 --> 00:09:01,389 the way you treat 251 00:09:01,769 --> 00:09:04,169 a Medicaid patient or a Medicare patient or 252 00:09:04,169 --> 00:09:06,784 a commercial patient may may change. 253 00:09:07,325 --> 00:09:09,004 So if if I'm a physician and you 254 00:09:09,004 --> 00:09:10,845 think about physicians and how they think, they're 255 00:09:10,845 --> 00:09:12,764 they're like, well, I'm gonna treat every patient 256 00:09:12,764 --> 00:09:13,424 the same. 257 00:09:13,804 --> 00:09:15,664 Well, that may not be 258 00:09:16,764 --> 00:09:18,445 that may you may not be able to 259 00:09:18,445 --> 00:09:19,105 do that 260 00:09:19,480 --> 00:09:21,720 going forward. Right? You you may have to 261 00:09:21,720 --> 00:09:22,220 change 262 00:09:23,639 --> 00:09:25,799 how you treat a Medicaid patient, how you 263 00:09:25,799 --> 00:09:27,160 treat a Medicare patient, how you treat a 264 00:09:27,160 --> 00:09:29,580 commercial payment, and even the site of care. 265 00:09:30,200 --> 00:09:31,100 So perhaps 266 00:09:31,480 --> 00:09:34,039 a Medicaid patient is is not treated in 267 00:09:34,039 --> 00:09:36,504 a hospital. Perhaps there's an alternative site where 268 00:09:36,504 --> 00:09:38,205 a Medicaid patient receives care. 269 00:09:38,825 --> 00:09:40,184 And and by the way, I know I'm 270 00:09:40,184 --> 00:09:43,164 I'm saying some things that might, be disagreeable 271 00:09:43,225 --> 00:09:44,745 to some folks, but I think that is 272 00:09:44,745 --> 00:09:45,325 the reality. 273 00:09:46,105 --> 00:09:47,940 And I think that is what providers are 274 00:09:47,940 --> 00:09:50,019 struggling with and even what health plans are 275 00:09:50,019 --> 00:09:52,440 are struggling with. It's like, if my reimbursement 276 00:09:52,660 --> 00:09:55,000 on Medicaid is going down so dramatically, 277 00:09:55,860 --> 00:09:58,500 how then do I change the delivery of 278 00:09:58,500 --> 00:09:59,240 health care 279 00:09:59,894 --> 00:10:02,535 to that population so that they still are 280 00:10:02,535 --> 00:10:04,855 able to get the services they need, that 281 00:10:04,855 --> 00:10:07,355 they're still able to live a healthy lifestyle, 282 00:10:07,815 --> 00:10:09,415 but I do it in a way that 283 00:10:09,415 --> 00:10:10,695 is 50% 284 00:10:10,695 --> 00:10:11,195 less 285 00:10:11,654 --> 00:10:13,274 expensive than it is today? 286 00:10:14,000 --> 00:10:15,200 And and by the way, I don't have 287 00:10:15,200 --> 00:10:17,360 the answers to that, which I think the 288 00:10:17,360 --> 00:10:19,200 important thing is is that health plans and 289 00:10:19,200 --> 00:10:20,899 providers, physicians and hospitals 290 00:10:21,519 --> 00:10:23,860 have to work together to redefine that. 291 00:10:24,320 --> 00:10:26,720 And I think even government is gonna have 292 00:10:26,720 --> 00:10:28,339 to be involved in this. Because, 293 00:10:28,835 --> 00:10:31,735 for example, if I'm successful at really reducing, 294 00:10:32,914 --> 00:10:35,495 the cost of delivering care to a Medicaid 295 00:10:35,794 --> 00:10:36,294 recipient, 296 00:10:37,315 --> 00:10:40,514 either through reducing utilization or through working very 297 00:10:40,514 --> 00:10:41,014 collaboratively 298 00:10:41,875 --> 00:10:42,375 with 299 00:10:43,340 --> 00:10:45,440 a provider partner, the government 300 00:10:46,540 --> 00:10:47,360 should not, 301 00:10:48,059 --> 00:10:48,960 punish me 302 00:10:49,340 --> 00:10:51,420 for doing the right thing. So in other 303 00:10:51,420 --> 00:10:53,740 words, if I really do that and I 304 00:10:53,740 --> 00:10:55,120 really reduce the cost, 305 00:10:55,964 --> 00:10:57,565 government is gonna have the tendency to come 306 00:10:57,565 --> 00:10:59,004 and say, well, okay. Well, you've reduced that 307 00:10:59,004 --> 00:11:00,944 cost, so I'm gonna reduce your re reimbursement 308 00:11:01,084 --> 00:11:01,904 even more. 309 00:11:02,524 --> 00:11:03,584 That can't happen. 310 00:11:04,204 --> 00:11:06,125 You have to be able to reward health 311 00:11:06,125 --> 00:11:09,164 plans and providers and hospitals for for doing 312 00:11:09,164 --> 00:11:10,065 the right thing, 313 00:11:10,720 --> 00:11:13,539 for reducing the cost, for keeping people healthy, 314 00:11:14,399 --> 00:11:15,220 and not 315 00:11:15,519 --> 00:11:18,000 strip them of their ability to to make 316 00:11:18,000 --> 00:11:18,580 a living. 317 00:11:19,600 --> 00:11:21,360 And I think that's gonna be very tempting 318 00:11:21,360 --> 00:11:23,299 for government to do. And so I think 319 00:11:23,784 --> 00:11:25,465 I think we're gonna have to work very 320 00:11:25,465 --> 00:11:28,024 collaboratively, not just with our provider partners, and 321 00:11:28,024 --> 00:11:30,745 I I say that term generically, but our 322 00:11:30,745 --> 00:11:32,825 physician partners and our hospital partners, but also 323 00:11:32,825 --> 00:11:33,965 with government agencies 324 00:11:34,585 --> 00:11:36,445 and entities to say, hey, look, 325 00:11:37,009 --> 00:11:38,450 We're we're gonna try to do the right 326 00:11:38,450 --> 00:11:40,129 thing here, but you can't punish us for 327 00:11:40,129 --> 00:11:40,950 doing that. 328 00:11:41,730 --> 00:11:43,090 No. Absolutely. I think a lot of people 329 00:11:43,090 --> 00:11:45,250 would certainly agree with that, Rob. And let 330 00:11:45,250 --> 00:11:47,990 me ask you, what's one investment or initiative 331 00:11:48,210 --> 00:11:50,850 you believe will most reshape how health plans 332 00:11:50,850 --> 00:11:52,954 operate over the next two to three years? 333 00:11:54,615 --> 00:11:56,214 I I think I think it is this 334 00:11:56,214 --> 00:11:56,714 concept 335 00:11:57,095 --> 00:11:57,414 of, 336 00:11:58,694 --> 00:11:59,514 of culture. 337 00:12:00,294 --> 00:12:01,815 And and I I use that term a 338 00:12:01,815 --> 00:12:03,735 little bit loosely. But the culture of of 339 00:12:03,735 --> 00:12:06,235 the way medicine is delivered in America is 340 00:12:06,649 --> 00:12:08,970 is this concept of if I provide more 341 00:12:08,970 --> 00:12:10,910 services, then I get paid more. 342 00:12:12,490 --> 00:12:14,410 And that just that just has to change. 343 00:12:14,410 --> 00:12:16,090 And what what's interesting about it is I 344 00:12:16,169 --> 00:12:17,450 you know, I've been in this business for 345 00:12:17,450 --> 00:12:18,730 a long time, and I I would say 346 00:12:18,730 --> 00:12:20,730 that I've been I've been working on you 347 00:12:20,730 --> 00:12:23,035 know, at Intermountain and SelectHealth, we call it 348 00:12:23,035 --> 00:12:25,115 proactive care, but the industry calls it value 349 00:12:25,115 --> 00:12:26,794 based care. So so I'll just use the 350 00:12:26,794 --> 00:12:28,014 term proactive care. 351 00:12:29,434 --> 00:12:31,274 I've been working on this for twenty five 352 00:12:31,274 --> 00:12:33,195 years of my career. Kid you not. So 353 00:12:33,514 --> 00:12:36,470 but I think now it it it there 354 00:12:36,470 --> 00:12:38,629 is no other option. We have to figure 355 00:12:38,629 --> 00:12:39,529 out a way 356 00:12:41,429 --> 00:12:43,750 where you change the culture of of the 357 00:12:43,750 --> 00:12:46,389 American the way America delivers health care to 358 00:12:46,389 --> 00:12:46,889 say 359 00:12:48,245 --> 00:12:51,065 that less is more, not more is more. 360 00:12:51,605 --> 00:12:53,524 So how do we keep people healthy? How 361 00:12:53,524 --> 00:12:55,205 do we keep them out of the hospital? 362 00:12:55,205 --> 00:12:56,105 How do we 363 00:12:56,644 --> 00:12:58,504 deliver services, health care services, 364 00:12:59,125 --> 00:13:01,524 culture to home rather than in a bricks 365 00:13:01,524 --> 00:13:02,585 and mortar setting? 366 00:13:03,910 --> 00:13:05,210 And how do we do that in 367 00:13:05,670 --> 00:13:06,250 a way 368 00:13:06,950 --> 00:13:07,769 that's effectual, 369 00:13:09,029 --> 00:13:10,250 maintains quality, 370 00:13:10,550 --> 00:13:12,410 and improves the health 371 00:13:12,950 --> 00:13:14,970 of the members and patients that we serve. 372 00:13:15,430 --> 00:13:17,050 I think that is the biggest 373 00:13:18,134 --> 00:13:20,295 challenge that we're gonna have as as an 374 00:13:20,295 --> 00:13:20,795 industry. 375 00:13:21,894 --> 00:13:23,894 And there's no way we get through that 376 00:13:23,894 --> 00:13:25,915 unless we we figure that out 377 00:13:26,615 --> 00:13:27,115 together. 378 00:13:28,295 --> 00:13:30,375 Along the lines of changing the culture, if 379 00:13:30,375 --> 00:13:31,675 you could change one 380 00:13:32,159 --> 00:13:35,539 regulatory or industry practice tomorrow to improve affordability 381 00:13:35,600 --> 00:13:36,179 and access, 382 00:13:36,559 --> 00:13:37,860 what would it be and why? 383 00:13:38,639 --> 00:13:40,259 Well, to me, you know, 384 00:13:41,279 --> 00:13:42,927 not Medicaid is not only under the on 385 00:13:42,927 --> 00:13:43,709 the the spot 386 00:13:44,475 --> 00:13:46,875 light, but Medicare and Medicare Advantage is under 387 00:13:46,875 --> 00:13:48,095 the spotlight. And 388 00:13:49,115 --> 00:13:50,634 to me, the way the way health plans 389 00:13:50,634 --> 00:13:53,115 are reimbursed on risk on this risk adjustment 390 00:13:53,115 --> 00:13:55,834 basis is is just a fascinating thing. I 391 00:13:55,834 --> 00:13:57,294 think initially when 392 00:13:58,019 --> 00:14:00,180 when CMS came out with a risk adjustment 393 00:14:00,180 --> 00:14:01,300 model, I I can't remember when I was 394 00:14:01,379 --> 00:14:03,060 I think it was, like, 02/1934, 395 00:14:03,060 --> 00:14:05,080 somewhere around there. Is there early two thousands 396 00:14:05,220 --> 00:14:06,600 where they changed that? 397 00:14:07,060 --> 00:14:09,139 Again, I think the intent was very positive. 398 00:14:09,139 --> 00:14:10,440 I think it's become this 399 00:14:11,220 --> 00:14:12,279 this this 400 00:14:12,995 --> 00:14:13,975 process whereby 401 00:14:14,834 --> 00:14:17,394 health plans are encouraged to to make sure 402 00:14:17,394 --> 00:14:19,634 they capture all these codes, and there's really 403 00:14:19,634 --> 00:14:22,214 not a quality or a outcome, 404 00:14:23,714 --> 00:14:26,779 measure that's tied to that. And so I 405 00:14:26,779 --> 00:14:29,179 think risk adjustment has has gotten to a 406 00:14:29,179 --> 00:14:31,120 point where it was never the intent. 407 00:14:31,980 --> 00:14:33,820 The the way it's operating now was never 408 00:14:33,820 --> 00:14:35,820 the intent of how it should operate. And 409 00:14:35,820 --> 00:14:36,320 so 410 00:14:37,100 --> 00:14:38,620 what what we're trying to do is we're 411 00:14:38,620 --> 00:14:40,460 trying to work with CMS and and some 412 00:14:40,460 --> 00:14:42,674 really thoughtful people to say, how how can 413 00:14:42,674 --> 00:14:43,654 our risk adjustment 414 00:14:44,115 --> 00:14:46,034 the way we get paid for Medicare Advantage, 415 00:14:46,034 --> 00:14:46,855 how can that 416 00:14:47,714 --> 00:14:49,954 how can that be changed so that that 417 00:14:49,954 --> 00:14:51,894 that we are we are paid 418 00:14:52,274 --> 00:14:53,095 in a way 419 00:14:54,389 --> 00:14:55,370 that encourages, 420 00:14:56,149 --> 00:14:58,329 us to make sure that members and patients 421 00:14:58,470 --> 00:14:59,289 are healthier, 422 00:15:00,949 --> 00:15:03,190 not paid on a on a basis of 423 00:15:03,190 --> 00:15:06,149 how many services that they get. Because, again, 424 00:15:06,149 --> 00:15:08,329 I think it's this culture of America where 425 00:15:09,245 --> 00:15:11,504 less is more rather than more is more. 426 00:15:11,725 --> 00:15:13,485 And then and so so then how do 427 00:15:13,485 --> 00:15:15,985 we work with a government entity like CMS 428 00:15:16,044 --> 00:15:18,144 to say, how do we get paid 429 00:15:18,764 --> 00:15:22,240 for making sure that that that that patients 430 00:15:22,240 --> 00:15:24,720 and citizens of this country actually get the 431 00:15:24,720 --> 00:15:28,079 appropriate service at the appropriate setting. And that 432 00:15:28,079 --> 00:15:30,399 mean may mean that they get they get 433 00:15:30,399 --> 00:15:32,879 less services, but it's it's more effectual and 434 00:15:32,879 --> 00:15:34,799 it's more, timely. And it's 435 00:15:36,324 --> 00:15:37,065 the outcomes 436 00:15:37,924 --> 00:15:38,985 are better rather 437 00:15:39,365 --> 00:15:41,304 than this kind of focus on 438 00:15:42,884 --> 00:15:44,424 generating more services, 439 00:15:44,884 --> 00:15:47,524 if that makes sense. So I think if 440 00:15:47,524 --> 00:15:49,204 there's one thing I could change, and we're 441 00:15:49,204 --> 00:15:51,065 trying to change that, is how 442 00:15:51,570 --> 00:15:52,549 how do we make sure 443 00:15:53,169 --> 00:15:55,509 we're we're paid in a more efficient, more 444 00:15:56,129 --> 00:15:58,549 effective way than what the current risk adjustment 445 00:15:58,850 --> 00:15:59,830 process is, 446 00:16:00,289 --> 00:16:01,029 with Medicare. 447 00:16:01,889 --> 00:16:03,250 And the last question I have for you, 448 00:16:03,250 --> 00:16:05,975 Rob, what issue is putting the most pressure 449 00:16:06,034 --> 00:16:08,054 on health plan margins right now, 450 00:16:08,434 --> 00:16:10,595 and how are you gonna respond differently in 451 00:16:10,595 --> 00:16:11,654 2026? 452 00:16:12,274 --> 00:16:14,195 I I I'm gonna say three. One is 453 00:16:14,195 --> 00:16:17,120 is the regulatory pressures are real. They've always 454 00:16:17,120 --> 00:16:17,860 been real. 455 00:16:18,320 --> 00:16:20,500 So that's one. And I use one example 456 00:16:20,559 --> 00:16:22,980 on the premium tax going up. 457 00:16:23,680 --> 00:16:24,660 I think our 458 00:16:25,360 --> 00:16:27,700 pharmacy spend is just out of control. 459 00:16:28,514 --> 00:16:30,035 I think we're the only country in the 460 00:16:30,035 --> 00:16:31,254 world or one of 461 00:16:31,875 --> 00:16:33,555 one or two countries in the world that 462 00:16:33,555 --> 00:16:35,654 do direct to consumer marketing, 463 00:16:36,274 --> 00:16:39,815 and that just creates this perverse incentive. So 464 00:16:40,195 --> 00:16:42,500 even though that you know, CMS today has 465 00:16:42,500 --> 00:16:45,539 done some wonderful things on negotiating drug prices, 466 00:16:45,539 --> 00:16:47,240 drug prices are still going up. 467 00:16:47,620 --> 00:16:48,980 And not just going up, but going up 468 00:16:48,980 --> 00:16:50,500 in a dramatic way. We got to get 469 00:16:50,500 --> 00:16:52,579 control of that. We got to figure that 470 00:16:52,579 --> 00:16:54,039 out. It's just unsustainable. 471 00:16:54,945 --> 00:16:56,705 And then I think the other thing is 472 00:16:56,705 --> 00:16:57,764 behavioral health. 473 00:16:59,105 --> 00:17:00,164 On the one hand, 474 00:17:01,024 --> 00:17:03,504 the pandemic was wonderful because I think it 475 00:17:03,504 --> 00:17:04,005 destigmatized 476 00:17:05,105 --> 00:17:07,184 mental health. And I think that's a wonderful 477 00:17:07,184 --> 00:17:07,684 thing. 478 00:17:08,019 --> 00:17:09,640 But behavioral health spend 479 00:17:11,460 --> 00:17:12,440 and is really, 480 00:17:13,220 --> 00:17:15,380 is really out of control as well. And 481 00:17:15,380 --> 00:17:16,980 so we have to figure out how do 482 00:17:16,980 --> 00:17:18,759 we get people the help that they need 483 00:17:19,619 --> 00:17:21,640 because mental health is just so important. 484 00:17:22,065 --> 00:17:23,424 But how do we do that in a 485 00:17:23,424 --> 00:17:25,345 in an affordable way and in a way 486 00:17:25,345 --> 00:17:27,664 that, again, that gets the patients and the 487 00:17:27,664 --> 00:17:29,984 members the the help that they need, but 488 00:17:29,984 --> 00:17:31,444 in a more affordable way? 489 00:17:32,413 --> 00:17:33,773 Rob, thanks so much for joining us on 490 00:17:33,773 --> 00:17:35,773 the podcast and for a great conversation. Look 491 00:17:35,773 --> 00:17:36,973 forward to you speaking with us at the 492 00:17:36,973 --> 00:17:39,533 April event. Yeah. Thank you so much. Appreciate 493 00:17:39,533 --> 00:17:40,033 it.