This is where health insurance leadership comes together.
Becker's fourth annual spring payer issues roundtable brings
together over 400
payer and health plan executives and more than
100 speakers to Chicago April.
This year's event includes keynote conversations with the
industry's top leaders and former president George W.
Bush. For the full agenda and event details,
visit beckershospitalreview.com
and click on the events tab in the
upper right. We're looking forward to hosting you
here in Chicago.
Hello, everyone. Welcome to Becker's Health Care Podcast.
I'm Scott King. Thrilled today to be joined
by a very special guest who's speaking with
us at our spring payer issues roundtable, and
that's Brandy Thompson, chief executive officer of Benefit
Bay. Brandy, how are you doing today? Thanks
so much for joining us.
I'm doing great, Scott. Thanks for having me.
Always a pleasure. Of course. And, you know,
we have a lot of big topics, to
dive into here with with health plans and
and health care. But before we do that,
I was wondering if you please just share
a little bit about your background and your
career journey.
Yeah. Absolutely.
I am the CEO and cofounder at Benefit
Bay, and my career journey was up through
operations and finance. I've got an undergrad in
accounting and a master's degree in business administration
with a major in finance there as well.
I was really motivated
to solve health care challenges from being in
that operations and finance seat,
knowing that your people are,
you know, tackling
their work life balance, their families, everything, that
they're tackling, but also tackling what the employer
and the business needs to tackle from, being
able to afford benefits
and then being able to control those outcomes.
And so health care really meets at the
intersection there, and that's what brings the passion
for Benefit Bay and what we do here
in trying to make an impact in defining
contribution for employers
and be the enabler for the broker consultant
to provide that consultant of value to their
client.
Thanks, Brandy. I appreciate you giving that background
info and and sharing the mission there of
Benefit Bay. And the first topic I wanted
to get to
is how are your relationships with providers changing,
you know, as both sides
face cost pressure and workforce shortages?
Yeah. I mean, that's been a real pivotal
change for the payer side. I think there's
two things that are crossing at this intersection,
which is that there is
wild adoption in individual coverage, health care reimbursement
arrangements out there in the market. So they've
got cost pressures to service individual policies for
employer groups.
And that side of the house may not
have had as much technology investment in the
past. So what we've seen is that
the relationships are really growing with the providers
because they are facing administrative cost pressures,
and they also have workforce shortages.
So they have to invest in the technology
outcomes to improve the member experience.
We've seen a lot more motivation from the
payer side to do that, and we've also
seen the payers motivated
to ensure that they're integrating direct so that
they're not driving up the cost of that
individual product or that plan
administration.
Yeah. You know, it's it's been an interesting
week. I've I've been speaking with some providers
and some payers, and it seems like just
with regulatory pressures on both sides,
people are just kind of both coming to
the table and then on both sides and
and being like, you know, like, we're going
through this pressure. I know you're under that,
and they're like, let's just try to get
something done. Is that kinda what you're seeing
too? Is, you know, maybe there is a
little more compromise right now just because everybody's
up against so much. Yeah. I just think
there's a motivation to solve the problem. I
think there hadn't always been a willingness to
face that
the legacy technology was causing a problem, that
the way we've always done health care was
causing a problem,
that all of the additional administrative barriers that
were created and pre auths and various processes
were causing provider and access to care challenges.
And I think there's enough of
just a momentum
overwhelming across all aisles, across all pieces to
say, we've gotta be able to do this
better. Come on. We're smart people. Let's solve
these problems.
Where do you see the biggest gap today
between payer strategy and operational execution?
So I think in that same
I think in that same breath, I've seen
a lot of momentum. I've seen a lot
of excitement.
But where the,
payer execution
is still
especially in our industry, in our side of
the aisle is
carriers, they'll they'll develop a strategy a couple
of years ahead. And so the execution just
isn't there where the market momentum is at
the time. So there's still a lot of
those pain points. So we know they have
the investment. We know they have the right
ideas. We know their executives are coming to
the table,
but they move like such slow cruise ships.
So so to turn and move the iceberg
is not something that they can do. And
so we're we're constantly taking on ice and
taking on water, right, due to the, speed
at which these payers can move. I think
operational
execution, I think they're they're dealing with,
you know, it's it's tough recruiting environment to
recruit talent into health insurance or
into any of the, payer side or provider
sides of health care due to all of
the things that are they're facing. So being
able to have the right resources to solve
the problem and to do it quickly
is, I think, two of the things that
are not aligned. The strategy is starting to
get there. The ability to execute the the
operational strategy on time where the market's
Absolutely. You don't just need the right strategy
or solution. You need that that quick execution
these days.
Yeah. Something else something else I wanna ask,
Brandy, is what's one investment or initiative you
believe will most reshape how health plans operate
over the next two to three years?
Yeah. I think I I think an investment
in, one, taking a look at their compliance,
narratives.
I I believe there's still a lot of
administrative mindset or long tenured
individuals inside the payer systems that believe they
have to receive a fax. Right? And so
taking a look at some of that older
mindset, looking at where is the compliance, where
does it really sit, is there a way
that we can do this in a more
effective manner that's less administrative
lift on all parties and that can be
executed,
operationally efficient.
The other thing I think is is gonna
make a difference is an ability to recruit
top talent into this space that wanna solve
this problem with the right motivators.
And
I think that will
overwhelmingly reduce the cost of delivering health care
or at administrating at the payer side.
If you could change to one regulatory or
industry practice tomorrow, so very, very quickly, very
soon, to improve, affordability and access, what would
it be and why?
It this is gonna be a little self
serving, but I would correct the lowest cost
silver affordability guidelines. Do not be on the
on exchange product that could be heavily regulatory,
and changed,
which is what we experienced recently, and have
that be on
in a way that it could be charged.
The affordability could be calculated on the off
exchange silver product for the employer that would
move speed to quote in this environment. It
would also
accelerate a pace for employers to be able
to make decisions
and make choice available to their employees and
drive consumer accountability and health care decisions
with those employer dollars and with their own
dollars that are coming out of their paycheck.
And the last thing I want to ask
you, Brandy, what issue is putting the most
pressure on health plan margins right now, and
how are you responding differently to that, this
year in 2026?
Yeah. I think for health plans, overwhelmingly, there's
just there's 10 people in the food chain
before access to care is even there. So
Yeah. The the provider of the care, so
the physician, you know, they've done years of
medical school, and they wanna be able to
provide the right
outcome for their patients, and they're driven by
the right motivators.
However, they have to see a huge number
of patients. They have to follow a set
of rules to even be,
getting that pre authorization to be able to
provide that care to their individual patient. So
those providers
or those payers
need to be able to deliver those answers
quicker. And I don't think AI is the
answer. We've seen a lot of incorrect denial
rates and and and a lot of, items
that have caused risk there. I think what
we need to do is get out of
our own way in some of those routine
care
access challenges. I think the health plan margins
are for any health plan to grow. They
I I heard the stat at Becker's Healthcare,
and I I would misquote it if I
tried to quote it right now. But it's
it's basically they've gotta grow by three admins
for every x, you know, percentage of the
health plan growth, and that's because of the
lack of efficiency and operational efficiencies in the
system. I think the other thing we've gotta
stop doing is inserting middlemen into all of
the processes.
So one of the things that we we
do here to remove that pressure is make
sure that we're going direct to the health
plan. So the techno our technology connects direct
to that health plan,
and we are remitting
directly to that health plan. And so reconciliation
can help in between those same two parties
who are accountable.
When you insert multiple people into the food
chain or into the cost of service, you
have multiple break points. You also have a
cost for each one of those solutions,
and so that drives up the cost. In
most instances, it's ten to fifteen percent in
all of the people that are receiving some
portion
out of that health care plan that hasn't
doesn't have anything to do with the access
to care for the member. And so I
think that those are the those are the
pressures they're receiving.
That's what's affecting the margins and their ability
to respond
and respond quickly and have the talent at
the table to deliver a less administrative outcome
that is still meeting compliance
and think outside of the thirty year box
that that has been built around the payer
system is gonna be how we improve those
margins and we improve access.
Well, Brandy, thanks so much for sharing your
great and and unique perspective with us. It
was awesome to have you on the podcast.
It was a wonderful conversation. Look forward to
you speaking with Becker's, in April.
Yeah. I'm looking forward to it, and I
can't wait to hear from, more health plans
that are looking to solve the problem. Thought
sharing is how we're gonna solve this problem.