1 00:00:02,240 --> 00:00:04,980 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 --> 00:00:10,500 together over 400 4 00:00:10,639 --> 00:00:13,039 payer and health plan executives and more than 5 00:00:13,039 --> 00:00:16,494 100 speakers to Chicago April. 6 00:00:16,875 --> 00:00:19,754 This year's event includes keynote conversations with the 7 00:00:19,754 --> 00:00:23,035 industry's top leaders and former president George W. 8 00:00:23,035 --> 00:00:25,675 Bush. For the full agenda and event details, 9 00:00:25,675 --> 00:00:27,754 visit beckershospitalreview.com 10 00:00:27,754 --> 00:00:29,195 and click on the events tab in the 11 00:00:29,195 --> 00:00:31,480 upper right. We're looking forward to hosting you 12 00:00:31,480 --> 00:00:32,539 here in Chicago. 13 00:00:33,879 --> 00:00:36,299 Hello, everyone. Welcome to Becker's Health Care Podcast. 14 00:00:36,359 --> 00:00:38,519 I'm Scott King. Thrilled today to be joined 15 00:00:38,519 --> 00:00:40,359 by a very special guest who's speaking with 16 00:00:40,359 --> 00:00:42,600 us at our spring payer issues roundtable, and 17 00:00:42,600 --> 00:00:45,895 that's Brandy Thompson, chief executive officer of Benefit 18 00:00:45,895 --> 00:00:47,335 Bay. Brandy, how are you doing today? Thanks 19 00:00:47,335 --> 00:00:48,475 so much for joining us. 20 00:00:48,854 --> 00:00:50,854 I'm doing great, Scott. Thanks for having me. 21 00:00:50,854 --> 00:00:52,695 Always a pleasure. Of course. And, you know, 22 00:00:52,695 --> 00:00:54,375 we have a lot of big topics, to 23 00:00:54,375 --> 00:00:56,695 dive into here with with health plans and 24 00:00:56,695 --> 00:00:58,135 and health care. But before we do that, 25 00:00:58,135 --> 00:00:59,575 I was wondering if you please just share 26 00:00:59,575 --> 00:01:01,710 a little bit about your background and your 27 00:01:01,710 --> 00:01:02,369 career journey. 28 00:01:02,909 --> 00:01:03,729 Yeah. Absolutely. 29 00:01:04,349 --> 00:01:06,590 I am the CEO and cofounder at Benefit 30 00:01:06,590 --> 00:01:08,989 Bay, and my career journey was up through 31 00:01:08,989 --> 00:01:11,890 operations and finance. I've got an undergrad in 32 00:01:12,109 --> 00:01:14,924 accounting and a master's degree in business administration 33 00:01:15,305 --> 00:01:17,724 with a major in finance there as well. 34 00:01:18,185 --> 00:01:19,405 I was really motivated 35 00:01:19,864 --> 00:01:22,744 to solve health care challenges from being in 36 00:01:22,744 --> 00:01:24,765 that operations and finance seat, 37 00:01:25,305 --> 00:01:27,325 knowing that your people are, 38 00:01:27,939 --> 00:01:28,680 you know, tackling 39 00:01:29,140 --> 00:01:32,260 their work life balance, their families, everything, that 40 00:01:32,260 --> 00:01:34,579 they're tackling, but also tackling what the employer 41 00:01:34,579 --> 00:01:36,979 and the business needs to tackle from, being 42 00:01:36,979 --> 00:01:38,200 able to afford benefits 43 00:01:38,579 --> 00:01:40,739 and then being able to control those outcomes. 44 00:01:40,739 --> 00:01:42,585 And so health care really meets at the 45 00:01:42,585 --> 00:01:44,825 intersection there, and that's what brings the passion 46 00:01:44,825 --> 00:01:46,685 for Benefit Bay and what we do here 47 00:01:46,745 --> 00:01:48,905 in trying to make an impact in defining 48 00:01:48,905 --> 00:01:50,125 contribution for employers 49 00:01:50,585 --> 00:01:52,765 and be the enabler for the broker consultant 50 00:01:52,825 --> 00:01:54,905 to provide that consultant of value to their 51 00:01:54,905 --> 00:01:55,405 client. 52 00:01:56,090 --> 00:01:58,430 Thanks, Brandy. I appreciate you giving that background 53 00:01:58,569 --> 00:02:00,909 info and and sharing the mission there of 54 00:02:00,969 --> 00:02:02,650 Benefit Bay. And the first topic I wanted 55 00:02:02,650 --> 00:02:03,630 to get to 56 00:02:04,090 --> 00:02:07,390 is how are your relationships with providers changing, 57 00:02:08,010 --> 00:02:09,550 you know, as both sides 58 00:02:09,865 --> 00:02:12,044 face cost pressure and workforce shortages? 59 00:02:13,145 --> 00:02:15,085 Yeah. I mean, that's been a real pivotal 60 00:02:15,145 --> 00:02:17,384 change for the payer side. I think there's 61 00:02:17,384 --> 00:02:19,245 two things that are crossing at this intersection, 62 00:02:19,305 --> 00:02:21,004 which is that there is 63 00:02:21,625 --> 00:02:25,159 wild adoption in individual coverage, health care reimbursement 64 00:02:25,859 --> 00:02:28,659 arrangements out there in the market. So they've 65 00:02:28,659 --> 00:02:32,340 got cost pressures to service individual policies for 66 00:02:32,340 --> 00:02:33,400 employer groups. 67 00:02:33,780 --> 00:02:35,219 And that side of the house may not 68 00:02:35,219 --> 00:02:37,299 have had as much technology investment in the 69 00:02:37,299 --> 00:02:40,004 past. So what we've seen is that 70 00:02:40,625 --> 00:02:43,444 the relationships are really growing with the providers 71 00:02:43,584 --> 00:02:46,724 because they are facing administrative cost pressures, 72 00:02:47,264 --> 00:02:49,525 and they also have workforce shortages. 73 00:02:49,919 --> 00:02:51,859 So they have to invest in the technology 74 00:02:51,919 --> 00:02:54,099 outcomes to improve the member experience. 75 00:02:54,400 --> 00:02:56,159 We've seen a lot more motivation from the 76 00:02:56,159 --> 00:02:57,919 payer side to do that, and we've also 77 00:02:57,919 --> 00:02:59,139 seen the payers motivated 78 00:02:59,599 --> 00:03:01,680 to ensure that they're integrating direct so that 79 00:03:01,680 --> 00:03:03,519 they're not driving up the cost of that 80 00:03:03,519 --> 00:03:05,379 individual product or that plan 81 00:03:05,685 --> 00:03:06,185 administration. 82 00:03:07,365 --> 00:03:08,805 Yeah. You know, it's it's been an interesting 83 00:03:08,805 --> 00:03:10,905 week. I've I've been speaking with some providers 84 00:03:10,965 --> 00:03:12,965 and some payers, and it seems like just 85 00:03:12,965 --> 00:03:15,465 with regulatory pressures on both sides, 86 00:03:15,844 --> 00:03:17,605 people are just kind of both coming to 87 00:03:17,605 --> 00:03:19,830 the table and then on both sides and 88 00:03:19,830 --> 00:03:21,189 and being like, you know, like, we're going 89 00:03:21,189 --> 00:03:23,189 through this pressure. I know you're under that, 90 00:03:23,189 --> 00:03:24,550 and they're like, let's just try to get 91 00:03:24,550 --> 00:03:26,230 something done. Is that kinda what you're seeing 92 00:03:26,230 --> 00:03:27,830 too? Is, you know, maybe there is a 93 00:03:27,830 --> 00:03:29,909 little more compromise right now just because everybody's 94 00:03:29,909 --> 00:03:31,854 up against so much. Yeah. I just think 95 00:03:31,854 --> 00:03:34,175 there's a motivation to solve the problem. I 96 00:03:34,175 --> 00:03:36,814 think there hadn't always been a willingness to 97 00:03:36,814 --> 00:03:37,715 face that 98 00:03:38,254 --> 00:03:41,055 the legacy technology was causing a problem, that 99 00:03:41,055 --> 00:03:42,894 the way we've always done health care was 100 00:03:42,894 --> 00:03:43,875 causing a problem, 101 00:03:44,330 --> 00:03:47,289 that all of the additional administrative barriers that 102 00:03:47,289 --> 00:03:49,949 were created and pre auths and various processes 103 00:03:50,090 --> 00:03:52,430 were causing provider and access to care challenges. 104 00:03:52,489 --> 00:03:54,750 And I think there's enough of 105 00:03:55,610 --> 00:03:56,509 just a momentum 106 00:03:57,944 --> 00:04:01,544 overwhelming across all aisles, across all pieces to 107 00:04:01,544 --> 00:04:03,305 say, we've gotta be able to do this 108 00:04:03,305 --> 00:04:05,544 better. Come on. We're smart people. Let's solve 109 00:04:05,544 --> 00:04:06,205 these problems. 110 00:04:06,985 --> 00:04:08,425 Where do you see the biggest gap today 111 00:04:08,425 --> 00:04:11,085 between payer strategy and operational execution? 112 00:04:11,840 --> 00:04:13,060 So I think in that same 113 00:04:13,360 --> 00:04:14,920 I think in that same breath, I've seen 114 00:04:14,920 --> 00:04:16,560 a lot of momentum. I've seen a lot 115 00:04:16,560 --> 00:04:17,220 of excitement. 116 00:04:17,759 --> 00:04:19,300 But where the, 117 00:04:19,839 --> 00:04:20,740 payer execution 118 00:04:21,040 --> 00:04:21,680 is still 119 00:04:22,160 --> 00:04:24,639 especially in our industry, in our side of 120 00:04:24,639 --> 00:04:25,699 the aisle is 121 00:04:26,144 --> 00:04:28,305 carriers, they'll they'll develop a strategy a couple 122 00:04:28,305 --> 00:04:31,425 of years ahead. And so the execution just 123 00:04:31,425 --> 00:04:33,504 isn't there where the market momentum is at 124 00:04:33,504 --> 00:04:35,105 the time. So there's still a lot of 125 00:04:35,105 --> 00:04:36,865 those pain points. So we know they have 126 00:04:36,865 --> 00:04:38,464 the investment. We know they have the right 127 00:04:38,464 --> 00:04:40,944 ideas. We know their executives are coming to 128 00:04:40,944 --> 00:04:41,524 the table, 129 00:04:41,879 --> 00:04:44,839 but they move like such slow cruise ships. 130 00:04:44,839 --> 00:04:46,779 So so to turn and move the iceberg 131 00:04:47,240 --> 00:04:48,680 is not something that they can do. And 132 00:04:48,680 --> 00:04:50,759 so we're we're constantly taking on ice and 133 00:04:50,759 --> 00:04:53,639 taking on water, right, due to the, speed 134 00:04:53,639 --> 00:04:56,060 at which these payers can move. I think 135 00:04:56,199 --> 00:04:56,699 operational 136 00:04:57,044 --> 00:04:59,125 execution, I think they're they're dealing with, 137 00:04:59,764 --> 00:05:02,245 you know, it's it's tough recruiting environment to 138 00:05:02,245 --> 00:05:04,824 recruit talent into health insurance or 139 00:05:05,365 --> 00:05:08,324 into any of the, payer side or provider 140 00:05:08,324 --> 00:05:10,620 sides of health care due to all of 141 00:05:10,620 --> 00:05:12,779 the things that are they're facing. So being 142 00:05:12,779 --> 00:05:14,379 able to have the right resources to solve 143 00:05:14,379 --> 00:05:15,919 the problem and to do it quickly 144 00:05:16,220 --> 00:05:17,979 is, I think, two of the things that 145 00:05:17,979 --> 00:05:20,459 are not aligned. The strategy is starting to 146 00:05:20,459 --> 00:05:23,100 get there. The ability to execute the the 147 00:05:23,100 --> 00:05:25,545 operational strategy on time where the market's 148 00:05:28,105 --> 00:05:30,025 Absolutely. You don't just need the right strategy 149 00:05:30,025 --> 00:05:32,585 or solution. You need that that quick execution 150 00:05:32,585 --> 00:05:33,324 these days. 151 00:05:33,705 --> 00:05:35,785 Yeah. Something else something else I wanna ask, 152 00:05:35,785 --> 00:05:37,705 Brandy, is what's one investment or initiative you 153 00:05:37,705 --> 00:05:40,764 believe will most reshape how health plans operate 154 00:05:41,290 --> 00:05:42,910 over the next two to three years? 155 00:05:43,610 --> 00:05:45,310 Yeah. I think I I think an investment 156 00:05:45,689 --> 00:05:48,189 in, one, taking a look at their compliance, 157 00:05:50,089 --> 00:05:50,589 narratives. 158 00:05:51,449 --> 00:05:53,144 I I believe there's still a lot of 159 00:05:53,464 --> 00:05:55,724 administrative mindset or long tenured 160 00:05:56,264 --> 00:05:58,824 individuals inside the payer systems that believe they 161 00:05:58,824 --> 00:06:01,564 have to receive a fax. Right? And so 162 00:06:01,784 --> 00:06:03,305 taking a look at some of that older 163 00:06:03,305 --> 00:06:06,379 mindset, looking at where is the compliance, where 164 00:06:06,379 --> 00:06:07,899 does it really sit, is there a way 165 00:06:07,899 --> 00:06:09,259 that we can do this in a more 166 00:06:09,259 --> 00:06:11,279 effective manner that's less administrative 167 00:06:11,980 --> 00:06:13,579 lift on all parties and that can be 168 00:06:13,579 --> 00:06:14,079 executed, 169 00:06:14,860 --> 00:06:16,000 operationally efficient. 170 00:06:16,620 --> 00:06:18,860 The other thing I think is is gonna 171 00:06:18,860 --> 00:06:21,404 make a difference is an ability to recruit 172 00:06:21,404 --> 00:06:23,485 top talent into this space that wanna solve 173 00:06:23,485 --> 00:06:24,944 this problem with the right motivators. 174 00:06:25,724 --> 00:06:26,224 And 175 00:06:26,604 --> 00:06:27,745 I think that will 176 00:06:28,204 --> 00:06:31,404 overwhelmingly reduce the cost of delivering health care 177 00:06:31,404 --> 00:06:33,664 or at administrating at the payer side. 178 00:06:34,279 --> 00:06:36,279 If you could change to one regulatory or 179 00:06:36,279 --> 00:06:39,560 industry practice tomorrow, so very, very quickly, very 180 00:06:39,560 --> 00:06:42,519 soon, to improve, affordability and access, what would 181 00:06:42,519 --> 00:06:43,500 it be and why? 182 00:06:44,439 --> 00:06:46,040 It this is gonna be a little self 183 00:06:46,040 --> 00:06:49,615 serving, but I would correct the lowest cost 184 00:06:49,615 --> 00:06:52,414 silver affordability guidelines. Do not be on the 185 00:06:52,414 --> 00:06:55,475 on exchange product that could be heavily regulatory, 186 00:06:57,294 --> 00:06:58,115 and changed, 187 00:06:58,574 --> 00:07:00,654 which is what we experienced recently, and have 188 00:07:00,654 --> 00:07:01,794 that be on 189 00:07:02,389 --> 00:07:04,550 in a way that it could be charged. 190 00:07:04,550 --> 00:07:06,710 The affordability could be calculated on the off 191 00:07:06,710 --> 00:07:09,830 exchange silver product for the employer that would 192 00:07:09,830 --> 00:07:11,910 move speed to quote in this environment. It 193 00:07:11,910 --> 00:07:12,569 would also 194 00:07:13,189 --> 00:07:15,189 accelerate a pace for employers to be able 195 00:07:15,189 --> 00:07:16,089 to make decisions 196 00:07:16,694 --> 00:07:19,095 and make choice available to their employees and 197 00:07:19,095 --> 00:07:22,074 drive consumer accountability and health care decisions 198 00:07:22,534 --> 00:07:24,694 with those employer dollars and with their own 199 00:07:24,694 --> 00:07:26,394 dollars that are coming out of their paycheck. 200 00:07:27,094 --> 00:07:28,214 And the last thing I want to ask 201 00:07:28,214 --> 00:07:30,420 you, Brandy, what issue is putting the most 202 00:07:30,420 --> 00:07:33,220 pressure on health plan margins right now, and 203 00:07:33,220 --> 00:07:35,379 how are you responding differently to that, this 204 00:07:35,379 --> 00:07:36,759 year in 2026? 205 00:07:37,060 --> 00:07:39,220 Yeah. I think for health plans, overwhelmingly, there's 206 00:07:39,220 --> 00:07:42,040 just there's 10 people in the food chain 207 00:07:42,524 --> 00:07:45,324 before access to care is even there. So 208 00:07:45,404 --> 00:07:47,805 Yeah. The the provider of the care, so 209 00:07:47,805 --> 00:07:49,644 the physician, you know, they've done years of 210 00:07:49,644 --> 00:07:51,084 medical school, and they wanna be able to 211 00:07:51,084 --> 00:07:52,144 provide the right 212 00:07:52,444 --> 00:07:54,365 outcome for their patients, and they're driven by 213 00:07:54,365 --> 00:07:55,185 the right motivators. 214 00:07:55,610 --> 00:07:57,610 However, they have to see a huge number 215 00:07:57,610 --> 00:07:59,129 of patients. They have to follow a set 216 00:07:59,129 --> 00:08:00,670 of rules to even be, 217 00:08:01,290 --> 00:08:03,449 getting that pre authorization to be able to 218 00:08:03,449 --> 00:08:06,029 provide that care to their individual patient. So 219 00:08:06,330 --> 00:08:07,149 those providers 220 00:08:07,529 --> 00:08:08,589 or those payers 221 00:08:09,254 --> 00:08:11,975 need to be able to deliver those answers 222 00:08:11,975 --> 00:08:13,574 quicker. And I don't think AI is the 223 00:08:13,574 --> 00:08:15,834 answer. We've seen a lot of incorrect denial 224 00:08:15,894 --> 00:08:18,535 rates and and and a lot of, items 225 00:08:18,535 --> 00:08:20,774 that have caused risk there. I think what 226 00:08:20,774 --> 00:08:22,615 we need to do is get out of 227 00:08:22,615 --> 00:08:24,539 our own way in some of those routine 228 00:08:24,539 --> 00:08:25,039 care 229 00:08:25,579 --> 00:08:28,959 access challenges. I think the health plan margins 230 00:08:29,500 --> 00:08:31,819 are for any health plan to grow. They 231 00:08:32,059 --> 00:08:33,740 I I heard the stat at Becker's Healthcare, 232 00:08:33,740 --> 00:08:35,100 and I I would misquote it if I 233 00:08:35,100 --> 00:08:36,865 tried to quote it right now. But it's 234 00:08:36,865 --> 00:08:39,264 it's basically they've gotta grow by three admins 235 00:08:39,264 --> 00:08:41,665 for every x, you know, percentage of the 236 00:08:41,665 --> 00:08:44,305 health plan growth, and that's because of the 237 00:08:44,305 --> 00:08:47,184 lack of efficiency and operational efficiencies in the 238 00:08:47,184 --> 00:08:49,024 system. I think the other thing we've gotta 239 00:08:49,024 --> 00:08:51,665 stop doing is inserting middlemen into all of 240 00:08:51,665 --> 00:08:52,325 the processes. 241 00:08:52,840 --> 00:08:54,679 So one of the things that we we 242 00:08:54,679 --> 00:08:57,159 do here to remove that pressure is make 243 00:08:57,159 --> 00:08:58,840 sure that we're going direct to the health 244 00:08:58,840 --> 00:09:01,720 plan. So the techno our technology connects direct 245 00:09:01,720 --> 00:09:02,860 to that health plan, 246 00:09:03,320 --> 00:09:04,940 and we are remitting 247 00:09:05,365 --> 00:09:07,785 directly to that health plan. And so reconciliation 248 00:09:08,004 --> 00:09:09,845 can help in between those same two parties 249 00:09:09,845 --> 00:09:10,585 who are accountable. 250 00:09:10,965 --> 00:09:13,845 When you insert multiple people into the food 251 00:09:13,845 --> 00:09:16,085 chain or into the cost of service, you 252 00:09:16,085 --> 00:09:18,769 have multiple break points. You also have a 253 00:09:18,769 --> 00:09:20,709 cost for each one of those solutions, 254 00:09:21,009 --> 00:09:22,850 and so that drives up the cost. In 255 00:09:22,850 --> 00:09:25,250 most instances, it's ten to fifteen percent in 256 00:09:25,250 --> 00:09:27,490 all of the people that are receiving some 257 00:09:27,490 --> 00:09:27,990 portion 258 00:09:28,450 --> 00:09:30,450 out of that health care plan that hasn't 259 00:09:30,610 --> 00:09:33,134 doesn't have anything to do with the access 260 00:09:33,134 --> 00:09:35,055 to care for the member. And so I 261 00:09:35,055 --> 00:09:36,495 think that those are the those are the 262 00:09:36,495 --> 00:09:37,634 pressures they're receiving. 263 00:09:38,095 --> 00:09:41,075 That's what's affecting the margins and their ability 264 00:09:41,134 --> 00:09:41,875 to respond 265 00:09:42,654 --> 00:09:44,894 and respond quickly and have the talent at 266 00:09:44,894 --> 00:09:47,855 the table to deliver a less administrative outcome 267 00:09:47,855 --> 00:09:49,429 that is still meeting compliance 268 00:09:50,050 --> 00:09:52,290 and think outside of the thirty year box 269 00:09:52,290 --> 00:09:54,610 that that has been built around the payer 270 00:09:54,610 --> 00:09:57,090 system is gonna be how we improve those 271 00:09:57,090 --> 00:09:58,790 margins and we improve access. 272 00:09:59,490 --> 00:10:01,330 Well, Brandy, thanks so much for sharing your 273 00:10:01,330 --> 00:10:03,009 great and and unique perspective with us. It 274 00:10:03,009 --> 00:10:04,424 was awesome to have you on the podcast. 275 00:10:04,424 --> 00:10:06,585 It was a wonderful conversation. Look forward to 276 00:10:06,585 --> 00:10:08,684 you speaking with Becker's, in April. 277 00:10:09,065 --> 00:10:10,345 Yeah. I'm looking forward to it, and I 278 00:10:10,345 --> 00:10:12,424 can't wait to hear from, more health plans 279 00:10:12,424 --> 00:10:14,184 that are looking to solve the problem. Thought 280 00:10:14,184 --> 00:10:15,965 sharing is how we're gonna solve this problem.