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, and welcome to the Becker's Healthcare
podcast. I'm Scott King. Thrilled today to be
joined by a very special guest, Eric c
Hunter, president and chief executive officer over at
CareOregon.
Eric, how are you doing? Thanks so much
for joining us. Appreciate you. I'm doing great,
Scott. Thank you for having me on. Appreciate
it. Of course. And look. We have a
lot of big topics in in health care
and, you know, with health plans to get
to. But before I do that, I was
wondering if you could just please tell us
a little bit about your, your background and
your career journey. Sure. My, my career started
in an odd way as a petroleum engineering
major in Tulsa, Oklahoma back in the eighties.
Not the best career choice with what happened
to the industry. So and played with politics
for a while, ended up working for a
governor in or in Oklahoma,
and that governor implemented Medicaid managed care.
And so working with him on that and
then later the state agency that stood it
up is how I got into the health
care business from petroleum engineering.
I've done stints at
national entities, Shower Anderson. I was in multiple
states with Shower Anderson.
Aetna purchased them years ago,
did a stint at Centene for a couple
of years,
was a market leader,
for value options behavioral health care in Illinois
and in Texas.
Then before here, I was the chief operations
officer at Boston Medical Center Health Net Plan,
which is now Wellsys Health Plan.
And ten years ago, I was privileged to
be,
recruited and signed to come to CareOregon where
I where I am, and I'm loving loving
the work we do.
Yeah. Appreciate you sharing all that background info.
You certainly had a a lot of unique
experience that helps you give a a unique
perspective on everything going on. So the first
topic I wanna get to, Eric, is how
are your relationships with providers changing
as both sides face
cost pressure and workforce shortages?
I think for everyone, there are there are
new challenges. But for us, it's more acute
because
CareOregon was started thirty two years ago now
by provider organizations,
local safety net community organizations, FQHCs,
teaching hospital.
And so we've typically been provider centric in
everything we do.
But this this new reality
has forced us to have to make tough
choices. And you talk about changing that relationship
so that it it really is more
about,
enabling each other, empowering each other to do
more with less,
coordinating
care
more efficiently,
aligning payment methodologies with quality and performance, not
just widgets and moving revenue around,
to support the providers
in the core. So,
that's really been the big change is that
we've had to think
less about
codependency
and more about,
aligning better to get much greater quality and
and performance so that we can serve more
people.
Eric, does it also just kind of start
with, you know, in a general sense that
both
payers and providers are both up against so
much now and certainly in terms of,
of regulatory matters? Is it is it just
kind of understanding where each site is right
now and and the difficulties they're facing?
I think one of the challenges is finding
ways to
identify
where those barriers can be broken down. Because
even when we talk about regulatory matters,
there are a lot of things we have
in common
with the providers,
and how
states and the regulatory agencies deal with
matters
of merger and acquisition or ownership
or staffing.
You know, those kind of pressures,
hit us both
because they add sort of undue pressures on
the delivery of care
and then increase costs across the board, which
is then feed up into, ultimately, the Medicaid
business, greater state spending. And so how do
you manage all that and make sure that
everyone understands the implications of
right minded
thought processes, you know, protecting
the public dollar, protecting members. But at the
end of the day, everything has to fit
together so that it's all sustainable. And that's
the challenge we have when we have to
work together to solve some of that.
Where do you see the biggest gap today
between payer strategy and operational
execution?
For for plans particularly about the size of
CareOregon, we're not small by any means, but
we're not a big national either.
It's it's really that gap between the ambition
we have for what we wanna do to
transform the system fundamentally
and the infrastructure to do that, to pull
that off, whether it's,
the work we can do with with
AI, to reduce administrative burdens or the creativity
necessary to manage the data around
true total cost of care or value based
contract agreements
that take into consideration
not just the numbers of services provided, but,
the quality of those services, the outcomes of
those services, and tying all that in ways
that everyone can see it and believe the
numbers and coordinate on them. I think those
are those are the big gaps. So they're
really about the infrastructure being
designed and built
and pushed out so that everyone has visibility
into what's happening.
What's one investment or initiative you believe will
most reshape how health plans operate
over the next two to three years, you
think?
I think when talking about how the system
needs to manage, really, again, AI
comes into play. And not necessarily to replace
human beings, but to augment the work that
people are doing either at the payer or
at the provider.
How do we leverage data and information
so that people are empowered to identify
ways to engage patients and members better to,
be more efficient in how we work with
them to get the information we need at
the right time to the right people.
It's not it's not cheap to develop those
systems.
There are a lot of vendors that they
can say they can do it easily,
but even those folks are gonna cost you
a pretty penny. And right now, the resources
are pretty scarce. So being able to make
the investment
to move forward on that front,
means we have to be that much more
efficient in the work we're doing now and
maybe even cut some cut some corners.
If you could change one regulatory or industry
practice
tomorrow to improve affordability and access,
what would it be and why?
I believe to improve,
affordable and access from a
from a rule standpoint, it really is about
how
how states again see
their role
as
the protector
of of
commerce, of industry, of of,
you know, public benefit
with the need to micromanage industries they don't
understand and put hurdles
in front of us that that makes it
more difficult to do the work, particularly in
tough times. For instance, you know, merger and
acquisition laws, certificates of need laws, staffing rules.
A lot of those things are are well
meaning and well intentioned,
but they they they reduce the ability of
the providers and the payers to actually do
the work they need to do to serve
the patients. And and being able to take
a step back from that,
collectively and working with the states,
would be really, really critical to being able
to make this work long term.
Yeah. That's interesting. So a lot of those
those rules in place actually kinda get in
the way of,
payers and providers reaching an agreement, and then
now you're you're kinda have to look for
certain workarounds. Is that basically what you're saying,
Eric?
That is. There there are times when,
you're required to make a certain payment level
or hire certain staffing levels at the provider
level.
That means they need more people. They need
more revenue from the payers to do that
work.
You know, where's the is there value in
that to the care the members receive, or
is it because someone feels better because those
positions exist or they think there's better work
when it could be about efficiencies and technology
and and policies that really drives the work
instead.
Some of the mergers and acquisition
rules, some of the corporate practices of medicine
rules that
can be overreaching
and impact abilities of providers and payers to
work together,
to find value based solutions.
But there's forced separation,
that that really is less about
the effect efficacy of doing the work
and and more about the appearance of impropriety.
You know, hold folks accountable, hammer them if
they do wrong, but but give the industry
the the flexibility
to do what we need to do to
make it work.
What issue is putting the most pressure on
health system margins right now,
and and how are you responding differently or
or going to respond differently in as 2026
plays out?
With the bulk of CareOregon's work being in
the Medicaid
space, it really is the
the clash of
intentional utilization increases for some areas,
particularly in behavioral health, substance use disorder treatment.
Those are those are critical crises in our
communities right now. We have to fund and
provide services for those services,
but the rates that we're paid
to manage them aren't keeping up.
The coordinated care model in Oregon,
received a pretty hefty
rate increase for 2026 that still doesn't necessarily
cover the costs of
implemented
rate increases and access and capacity increases
that have people actually getting in for care
they need,
but it's not sustainable
unless we find that right balance. And so
that's really,
for us, the greatest pressure on our margins
is there's only so much we can do
administratively
or operationally
if we're paying out a dollar and 10¢
for every dollar we get in in rates.
So that's really the the challenge we have
right now is the right sizing the rates
with the benefits provided so that we can
actually provide quality care.
And the last question I wanted to ask
you, Eric, you know, now certainly more than
ever,
the right kind of leadership, the strong leadership
is needed in health care. So I just
wanted to ask you, you know, the course
of your career and up to now, how
is how have you evolved as a leader?
You know, that that's a great question. I
believe that
coming from an engineering background, I was about
policy and procedure, nuts and bolts, blocking and
tackling as the the key to success.
Now there's there's much more nuance required.
There are much more
much more opportunity to trade off and to
bargain and to negotiate,
bringing the best people, the best minds into
the room, and finding solution that that truly
is a win win. It's not a competitive
business.
I don't know that
that Medicaid managed care in particular should be
a competitive or profit business anyway.
But, but looking at it as a partnership
with the provider systems and the states,
the hospitals and the nurses associations
to say, collectively, with find common ground and
build
sustainable
structures
that can weather these storms that are happening
now. And so a lot of my career
has been less about managing direct care and
more about
convening
folks together, creating entities and organizations and alliances
that are gonna move the needle. And that
that's where I spend a lot of my
time these days.
Well, Eric, thanks so much for sharing your
insight and perspectives
and and joining the podcast. We're really looking
forward to having you speak at the spring
payer issues roundtable. So, looking forward to that,
and and thanks so much. Thank you, Scott.
Looking forward to it.