• Encore! EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews

  • 2024/11/14
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Encore! EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews

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  • This encore is very relevant after the shows with Cora Opsahl (EP452), Claire Brockbank (EP453), and Marilyn Bartlett (EP450). Getting better health for the 160 million Americans covered by commercial insurance is all about rates, rights, and power. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. So, for sure, go back and listen to those shows if you haven’t already. They are very revealing. And if you listened to this particular episode, 415, last year when it first came out, you might want to listen to it again because in the context of those earlier shows, there’s points of contemplation that might become clear. By the way, also, the show with Ann Kempski (EP444) is relevant to this end (ie, sometimes government intervention doesn’t achieve the stated goal). This is a very nuanced world that we live in, and those nuances impact Americans both clinically and also very much financially. I’m saying this partially because maternal and newborn outcomes and costs are part of this conversation. Now, in this conversation, maternity care and outcomes gets brought up mainly because a lot of employers, for a lot of them, maternity constitutes one of the highest areas of spend for both the employer and then also employees. It costs a lot to have a baby in this country. Strategy 101 does, in fact, suggest that if you look at your data and you discover outsized problems and costs in any one area, fixing those problems and costs is going to have an outsized impact on employee health and plan spend. And this is even more of a strategic consideration just given everything going on with maternal health and rising infant and mom death rates in this country. So, with that, here’s Rob Andrews, who is the CEO of the HTA, the Health Transformation Alliance, which is a group made up of jumbo employers. I had wanted to get Rob on the show ever since I heard him say at the thINc360 conference in DC. He said, “Morally abhorrent doesn’t move the needle. What moves the needle is financial implications.” This interview was my chance to ask Rob Andrews, what are these financial implications of which you speak that move needles? What kinds of financial implications are we talking about? And when that needle moves, what happens? In the show that follows, Rob says that when you improve the health of employees and dependents and actually just the health of the community, you as an employer improve your financials directly and also indirectly. But let me focus on the direct bucks out of pocket right now because … yeah, study after study shows that, for self-insured employers, if you pay for the right things and you steer to the right providers in the right care settings, a self-insured employer and the member do a whole lot better than if the employer kind of laissez-faire pays for any manner of things provided by anybody who can manage to submit a billing code—even if that billing code comes with a too-good-to-be-true discount. Rob talks about how the HTA has data to suggest that if you, as a self-insured employer, lean in on paying for the right things, readmissions go down 29%. Total cost of care is 15% lower. Drugs cost 25% less. So, none of this is theoretical, as we talk about how employers can create a win-win—better health, lower costs. There are jumbo employers in the HTA right now who are doing this. I love how Will Shrank, MD, has put it; and I’m paraphrasing, but it’s a point that keeps getting reiterated in episode after episode here on Relentless Health Value: There’s a difference between paying for what you want and just negotiating allegedly cheaper prices. Buying things is not a strategy. And that is true no matter what price you think you’re paying. Also not a strategy is buying things and then cost shifting to plan members, by the way. Strategy means addressing root causes. It’s a considered plan of action to achieve an optimized ambition. Here is the strategic stepwise that Rob offers on this: 1. Discern the difference between rumor and data. Get your data and get it objectively analyzed by an objective third party, self-insured employers. Then you have what you need to figure out the delta between the worst performers and the best performers on a risk-adjusted basis. 2. Now that you know what normal is and what good looks like, gang up and negotiate contracts that hold intermediaries accountable for outcomes and with performance guarantees. Address root causes and the excess and wasteful spend, in other words. Listen to the show with Dr. Will Shrank (EP413) for more on wasteful spend. 3. Be transparent with consumers/employers about relative quality. Educate them. You may also want to reward members who go to see those high-quality docs and/or make it expensive for them to go to the worst performers. There are lots of win-win case studies here on how well this ...
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あらすじ・解説

This encore is very relevant after the shows with Cora Opsahl (EP452), Claire Brockbank (EP453), and Marilyn Bartlett (EP450). Getting better health for the 160 million Americans covered by commercial insurance is all about rates, rights, and power. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. So, for sure, go back and listen to those shows if you haven’t already. They are very revealing. And if you listened to this particular episode, 415, last year when it first came out, you might want to listen to it again because in the context of those earlier shows, there’s points of contemplation that might become clear. By the way, also, the show with Ann Kempski (EP444) is relevant to this end (ie, sometimes government intervention doesn’t achieve the stated goal). This is a very nuanced world that we live in, and those nuances impact Americans both clinically and also very much financially. I’m saying this partially because maternal and newborn outcomes and costs are part of this conversation. Now, in this conversation, maternity care and outcomes gets brought up mainly because a lot of employers, for a lot of them, maternity constitutes one of the highest areas of spend for both the employer and then also employees. It costs a lot to have a baby in this country. Strategy 101 does, in fact, suggest that if you look at your data and you discover outsized problems and costs in any one area, fixing those problems and costs is going to have an outsized impact on employee health and plan spend. And this is even more of a strategic consideration just given everything going on with maternal health and rising infant and mom death rates in this country. So, with that, here’s Rob Andrews, who is the CEO of the HTA, the Health Transformation Alliance, which is a group made up of jumbo employers. I had wanted to get Rob on the show ever since I heard him say at the thINc360 conference in DC. He said, “Morally abhorrent doesn’t move the needle. What moves the needle is financial implications.” This interview was my chance to ask Rob Andrews, what are these financial implications of which you speak that move needles? What kinds of financial implications are we talking about? And when that needle moves, what happens? In the show that follows, Rob says that when you improve the health of employees and dependents and actually just the health of the community, you as an employer improve your financials directly and also indirectly. But let me focus on the direct bucks out of pocket right now because … yeah, study after study shows that, for self-insured employers, if you pay for the right things and you steer to the right providers in the right care settings, a self-insured employer and the member do a whole lot better than if the employer kind of laissez-faire pays for any manner of things provided by anybody who can manage to submit a billing code—even if that billing code comes with a too-good-to-be-true discount. Rob talks about how the HTA has data to suggest that if you, as a self-insured employer, lean in on paying for the right things, readmissions go down 29%. Total cost of care is 15% lower. Drugs cost 25% less. So, none of this is theoretical, as we talk about how employers can create a win-win—better health, lower costs. There are jumbo employers in the HTA right now who are doing this. I love how Will Shrank, MD, has put it; and I’m paraphrasing, but it’s a point that keeps getting reiterated in episode after episode here on Relentless Health Value: There’s a difference between paying for what you want and just negotiating allegedly cheaper prices. Buying things is not a strategy. And that is true no matter what price you think you’re paying. Also not a strategy is buying things and then cost shifting to plan members, by the way. Strategy means addressing root causes. It’s a considered plan of action to achieve an optimized ambition. Here is the strategic stepwise that Rob offers on this: 1. Discern the difference between rumor and data. Get your data and get it objectively analyzed by an objective third party, self-insured employers. Then you have what you need to figure out the delta between the worst performers and the best performers on a risk-adjusted basis. 2. Now that you know what normal is and what good looks like, gang up and negotiate contracts that hold intermediaries accountable for outcomes and with performance guarantees. Address root causes and the excess and wasteful spend, in other words. Listen to the show with Dr. Will Shrank (EP413) for more on wasteful spend. 3. Be transparent with consumers/employers about relative quality. Educate them. You may also want to reward members who go to see those high-quality docs and/or make it expensive for them to go to the worst performers. There are lots of win-win case studies here on how well this ...
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Encore! EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrewsに寄せられたリスナーの声

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