Hello, everyone, and thank you for tuning in
to the Becker's Healthcare podcast.
We're thrilled to be joined today by Brett
Spark, cofounder and president of Auroras Health, to
discuss enhancing payer contracts. Brett, thank you so
much for joining us. Yeah. Thanks for having
me. So so to to get things going
here, lay the groundwork for the conversation, can
you just share a bit more about your
background and and sort of the gen genesis
for for starting Auroras?
Sure. Full health care background for me. I
I started my career in a large
health system in the Minneapolis region,
had a wonderful
experience with them,
was there for, I think, 12 years,
if I remember right, in a number of
different positions on the care delivery side for
them. And then I transitioned into privately owned
medical practices still in in Minneapolis. I was
actually you could call it headhunted, but I'd
I'd formed some good relationships with with good
people
within a lot of different consulting firms in
Minneapolis. And and when positions opened up in
the private practice lane, they reached out and
said that might be a good next step
for me. So I transitioned into
a privately owned medical practice and then actually
bounced around to a few different organizations as
CEOadministrator before starting to do some consulting work
in
Aurora's
after that.
And next question is, what have you learned,
you know, as a founder really since jumping
into to Auroras and and really working to
help support providers' financial viability,
which we, of course, know how challenging that
can be?
Yeah. I'll say I I didn't
start my career thinking I would be a
founder, thinking I'd be an entrepreneur in any
way like that. It somewhat evolved from my
experiences that I had, not only, you know,
with a large health system that I worked
for, but then
very specifically in the private practice space, I
I really understood that there was a lack
of resources available
to privately owned medical organizations from large to
small,
specifically around their relationship with the payers and
the complexity that exists
not only today, but that that ever changing
landscape that exists
between payers and providers is is really what
evolved
the theory behind Auroras. And
I felt it when I was running these
these medical practices, and then
as as growing Auroras, we we feel like
we can support them with some of the
background that that I've had in my experiences
as well. Yeah. And that complexity, it's it's
not going the other direction, is it? It's
not getting simpler out there at the You
know, it it's one of the things that
I thought about it in advance of having
a talk today at at Becker's was that
the complexity is growing, and that's great for
our business. It's scary to think about the
challenges that exist for not only medical practices,
but the consumers
as well. It is growing
and it will only get more and more
challenging.
And
that might tie into sort of where
you I know you strongly believe that payer
contracts should be digitized to aid providers
in being able to be more successful with
those contract negotiations. I think that ties into
to what we're talking about with the complexity
here. Can you just expand on that perspective
for us and and and talk about why
that's so important?
Yeah. You know, we started Auroras as a
service first business. We built a team
and really boots on the ground, we felt
that we could apply those resources
to multiple practices across the United States. So
service first, not really tech enabled.
Very quickly, we realized we were going to
need some support within our organization to be
able to scale it beyond
just a few practices. We wanted to go
nationwide
with what we were doing. And to be
able to do that, we were gonna have
to have some tech enabled service
that helped align
what we were doing with negotiations
with the complexities that exist in the payer
provider relationship. So
we built our tech internal.
There's a lot of options out there for
medical practices. But to the question, I believe
heavily that you have to create a digital
footprint for your relationship between
your practice and all of the payers that
you work with because the the challenges exist
are individual to every payer that you're working
with. You need something that can support that
and give you
a lane directly into what each of those
relationships look like. And that's where the digital
footprint and creating that is a strong foundation
for leading to success and negotiations long term.
Yeah. And that
that every challenge, every provider has separate challenges.
Every payer has different issues. It speaks to
that growing complexity as well.
And I guess I wanna hear too sort
of some firsthand examples, I'm sure listeners would
too, about how payers
respond to your engagement,
to to negotiate contract terms with them and
and really point to the value of of
having a partner like Aurora's
negotiate with payers versus the provider trying to
do that work themselves.
Yeah. I think, you know, to the the
first point,
we have different relationships with every payer that
that we're engaged with and so do our
clients. You know, providers,
it's not a stagnant environment. There's not one
contract that exists between payers and providers. They're
all individual. They're all unique, and they each
have their own challenges, but they also each
have their own opportunities as well. And I
think that's where it you know, the the
question that I get from every client is,
well, how do you find success? I've already
tried to do it. And
the the challenge in answering it is it
might be different for every one of your
every one of your payers. It might be
different for every one of the clients that
we have. There's different ways of finding opportunity,
and we're not going to know what they
are until we've already formed that relationship with
our clients.
But our organization
comes at the approach with the payer,
always data
and foundational
in what we can find in market. We're
not price gouging. We're not trying
to ask above and beyond what we think
is fair and equitable for our clients.
So what we try and approach each of
the conversations with is here's what we see
in the market.
Here's what we see for this specific organization
as a gap between what what might be
market and and what might be opportunity.
And we try and foundationally
approach it like that and are open to
kind of every different way that the payer
might wanna negotiate that. Yeah. And and I
imagine too for for providers out there,
you know, finding some of those opportunities for
success isn't the easiest thing to do when
you've got a bunch of other work on
your plate already. Right? Yep. Like like sitting
down, getting your arms around the data for
individual payers, that's that's not simple or easy
work. The largest barriers to success
are time and data. Yep. Yeah. And our
client base usually has neither of those. There's
more data available now than ever before in
the in the health care reimbursement lane,
But having that available and actually applying it
to your specific situation and using it as
a knowledge base to gain success in negotiations
are are really two different things. And the
commitment is is heavy and the resource need
is heavy. And yes, our our client base
has a lot of other fires that they
usually need to put out. Certainly.
And it it sounds like your approach to
sitting down with payers is you're you're coming
with data. It also seems like you're you're
open to exploring avenues. So you're coming from
a place of good faith and trying to
establish that.
Can you sort of describe maybe some of
the results you've seen,
for for providers after after you've sat down
and and really
hashed out this these negotiations with payers? Yeah.
I'll I'll say to to the first comment,
the one thing that that I can get
on board with and agree with a lot
of payers as I've sat on panels, as
I've I've been at different conferences, is fee
for service
needs to evolve.
We need to look at the reimbursement market
as a whole
and look at where there might be opportunities
to evolve the fee for service market, which
still is 75 to 80% of the contracts
that are out there today. And we need
to change that. And and value based care
has been one that's been around for a
long time. Mhmm.
And we've tried to implement that whenever possible.
But in a lot of cases, it is
very payer driven. You know, even the success
or
the value that they're measuring is is internal
to what's valuable to them. So
we we try and engage
in a way that we can look at
terms, we can look at at opportunities
that are valuable to both sides.
I realize that there's a lot of restrictions
that exist on the payer side of the
world as well. Our clients, which are mainly
physician based, are also beholden to to this
reimbursement model that's existed, you know, since the
beginning of healthcare. And if there's a way
for us to evolve that into a different
method of reimbursement, whether that's value based care,
whether it's gainshare, whether it's
providing reimbursement based on quality, we are open
to that. And
hopefully, we can be another resource to help
support an evolution in the reimbursement lane. Yep.
And and feel free to not answer this
next question or or and I'm certainly not
asking you to to name names, so to
speak. Yeah. But just curious if you've ever
sat down with an an organization, a payer,
and encountered hesitancy and overcome it, and what
that looked like and how you got there.
Yes. And that is pretty much every single
one of the the situations that we run
into.
You know, it just depends on what the
the opportunity is and and really what we're
both trying to overcome
in this situation. But no is something that
our organization has had to get comfortable with
since day 1. And that's just that's part
of the landscape that we live in. We
realize that there's there's a different lane that
the payers might be trying to go down
to find success than what we're trying to
go to.
The financials might look different. The outcomes that
they want might be different than what we're
looking for.
But what we try and do is we
we try and bring in as much of
a visual landscape to them as well and
share that information.
When we're having conversations with them, we're very
open to here's what what we would like
to see to be able to have a
successful relationship. And in some occasions,
it doesn't work. It doesn't make sense to
continue with the relationship.
But bar none majority of the time when
we are working with decision makers within the
payers, we can usually get to a productive
outcome.
The challenge is there might be several layers
that we need to go through before we're
actually working with the decision makers within the
payers. And the one thing I again, I
I realize that resources are a restraint
and are challenging within a lot of the
payer landscape as well.
What we do is we take a lot
of time to get and and weed through
some of the minutiae before we we actually
get to the outcomes we want. Yeah.
And and looking ahead here, I think based
on our conversation so far, it's safe to
say when we're pointing to sort of the
complexity here,
that there's a lot of change in this
space. A lot a lot is happening and
it it can be a challenge just to
predict what's going to happen 5 months from
now, let alone what I'm going to ask
you, which is what's going to happen in
the next 12 to 24 months?
But curious to get your thoughts on what
challenges and opportunities you foresee emerging in the
next year or 2. What are you keeping
your eyes on? What should our listeners
be looking out for? Yep. I mean, inevitably,
the complexity is going to increase. We talked
about that earlier as well. And that's why
I think it's such an important position right
now for medical practices,
large and small. Health systems,
all the way down to your solo practitioners,
they need to create some level of a
digital footprint for their relationship with the payers.
If they don't, the complexities that continue to
evolve and it's not just in the commercial
space. The complexity around Medicare Advantage, the complexity
with managed Medicaid products that are out there
now and the payers that are administering those
continues to grow. And if you don't understand
the position that you're currently in, it's going
to be very easy for that complexity to
take over the organization and will inevitably lead
to to lower reimbursements if you're not watching
it. So what's gonna happen over the next,
you know, several years?
I think the evolution of of the reimbursement
model will continue to be there, and I
think you need to understand where your opportunities
are specific to your subspecialties,
specific to your geographic region,
specific to your relationship with the payers. If
you don't understand that, if you don't understand
what's important to the payer landscape, it's gonna
be challenging for you to to make any
adjustments to current state.
And then and then I think on the
government side,
we need to kinda watch and see where
CMS continues to evolve, specifically with the Medicare
Advantage Plans. The star ratings have been a
hot topic
of recent. You know, CMS is dealing with
lawsuits from several of the payers
and that based on the star ratings that
that they were given and the outcomes of
that could change kind of the the position
that some of these payers have into the
future with Medicare Advantage products. So we need
to watch that and kinda let that fight
happen. But from a clinical perspective, from a
care delivery side,
what happens in those lanes could impact how
the reimbursement is dispersed in with some of
those government products.
Well, Brett, I think that's a good place
for us to sort of land the plane,
so to speak. I think I think it's
a good good closing thought. Brett, thank you
so much for for coming on the podcast.
Appreciate it. Thanks for having me. And thank
you as well to Aurora's Health for sponsoring
today's content. To our listeners, thank you for
joining us, and please be sure to check
out other Becker's podcasts. Have a wonderful rest
of your day.