Encore! EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews
11/14/24 • 39 min
In this episode, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former Congressman, about the strategic steps jumbo employers can take to achieve improved health outcomes while reducing cost. They delve into the importance of using data to discern effective practices, negotiate contracts, and hold intermediaries accountable.
To Read The Show Notes With All Mentioned Links, Visit the Episode Page.
If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.
The discussion highlights maternal health as a critical area of focus, with successful interventions shown to reduce NICU admissions and overall healthcare costs. Andrews emphasizes the role of self-insured employers in driving systemic changes that align financial incentives with health outcomes.
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.
07:34 How did Rob get to his current role?
09:08 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this.
10:27 Why economic consequences move the needle, and why sometimes they don’t.
12:26 Why the best way to address costs isn’t to re-shift costs but to address them directly.
13:22 Why compensation that isn’t dependent on outcomes is a problem.
16:23 “Strategy’s not what people say; it’s what they do.”
18:21 How do you operationalize saving money with better outcomes?
26:26 How do employers turn conflict into collaboration?
28:20 What is the win-win-win structure among employers, payers, and providers in Rob’s eyes?
30:53 To whom should the task of risk adjustment fall?
34:43 “Better contracts do improve outcomes.”
In this episode, Stacey Richter speaks with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former Congressman, about the strategic steps jumbo employers can take to achieve improved health outcomes while reducing cost. They delve into the importance of using data to discern effective practices, negotiate contracts, and hold intermediaries accountable.
To Read The Show Notes With All Mentioned Links, Visit the Episode Page.
If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.
The discussion highlights maternal health as a critical area of focus, with successful interventions shown to reduce NICU admissions and overall healthcare costs. Andrews emphasizes the role of self-insured employers in driving systemic changes that align financial incentives with health outcomes.
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.
07:34 How did Rob get to his current role?
09:08 The problem of maternal health and mortality rate, and how self-insured employers wind up directly and indirectly paying for this.
10:27 Why economic consequences move the needle, and why sometimes they don’t.
12:26 Why the best way to address costs isn’t to re-shift costs but to address them directly.
13:22 Why compensation that isn’t dependent on outcomes is a problem.
16:23 “Strategy’s not what people say; it’s what they do.”
18:21 How do you operationalize saving money with better outcomes?
26:26 How do employers turn conflict into collaboration?
28:20 What is the win-win-win structure among employers, payers, and providers in Rob’s eyes?
30:53 To whom should the task of risk adjustment fall?
34:43 “Better contracts do improve outcomes.”
Previous Episode
EP456: Advice to Pharma at the Intersection of Product Value, Reputation, and Patient Affordability, With Brian Reid
In this comprehensive episode host Stacey Richter sits down with Brian Reid to discuss pivotal aspects for the pharmaceutical industry. Key topics include understanding product value from the perspectives of plan sponsors, patients, and society, and the significance of benefit design in improving patient affordability.
For the show notes with all links mentinoed, visit the episode page.
If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.
The discussion delves into the complexities of drug pricing, the roles of Pharmacy Benefit Managers (PBMs) and brokers, and the impact of healthcare consolidation on costs. Reid emphasizes the importance of transparent communication among stakeholders, the detrimental effects of cost containment strategies, and the necessity of considering policy and reputational impacts.
Throughout the conversation, examples such as the Hepatitis C drug illustrate the broader implications on drug access and affordability. Listeners are provided with critical insights into how pharmaceutical companies can better engage with ultimate purchasers to ensure patients receive necessary, cost-effective medications while navigating a changing healthcare landscape.
For the show notes with all links mentinoed, visit the episode page.
08:29 Why is it important to understand the term “value” in respect to medicine?
10:07 Why is it important to consider all the players affected by the idea of this “value”?
11:06 Who are the ultimate purchasers in Pharma?
12:23 Findings of the Kaiser Employer Health Benefits Survey.
14:52 Why does it matter that we consider what value looks like to all players affected by Pharma?
16:46 EP300 with Bruce Rector, MD.
18:38 EP448 (Part 1) with Shawn Gremminger.
20:04 What does Pharma need to do to showcase their value when PBMs are often “locked in” at the moment?
23:11 Why Brian is celebrating companies that put their prices in their press releases.
32:31 Why does Pharma have an obligation to explain their value?
33:16 EP426 with Nina Lathia, RPh, MSc, PhD.
33:39 Why is it important for Pharma to keep an eye on hospital monopoly behavior?
35:55 EP370 with Erik Davis and Autumn Yongchu.
37:44 Why Pharma needs to capitalize on alignment.
Next Episode
Encore! EP418: Mark Cuban With a PSA for CEOs and CFOs of Self-insured Employers, With Mark Cuban and Ferrin Williams, PharmD, MBA, From Scripta
In this encore episode, Mark Cuban discusses his insights and experiences on disrupting the healthcare and pharmacy benefits landscape with Stacey Richter. This show from last year was one of the most popular episodes of the past year. And it’s also extremely relevant right now, given all of the PBM (pharmacy benefit manager) goings-on, as well as ongoing litigation like the J&J lawsuit, etc. Listen to the show with Julie Selesnick (EP428) for more on that one.
You can find the show notes with all links mentioned and a transcript on our episode page.
If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.
Joined by Ferrin Williams from Scripta, Cuban stresses the importance for CEOs and CFOs of self-insured companies to get actively involved in their healthcare plans to avoid overpaying. The conversation tackles the opaque practices of PBMs, the financialized nature of the healthcare industry, and introduces Mark Cuban's Cost Plus Drugs model which aims for transparency and cost reduction.
Key topics also include the potential legal implications for employers, the importance of trust in healthcare transactions, and the real-world savings and benefits achievable with greater involvement and transparency in healthcare management.
What do all of these numbers have in common: $140,000, $3 million, $35 million, and $3 billion?
These are all actual examples of how much employers, unions, and some public entities saved on healthcare benefits for themselves and their employees. The roadmap to saving 25% on pharmacy spend and/or 15% on total cost of care in ways that improve employee health and satisfaction always begins when one thing happens. There’s one vital first step.
That first step is CEOs and/or CFOs or their equivalents roll up their sleeves and get involved in healthcare benefits.
Read the full article/show notes with all the mentioned links here: https://cc-lnk.com/Encore418
06:29 What was Mark Cuban’s own journey as a self-insured employer with Cost Plus Drug Company?
07:44 What did Mark find when he decided to go through and look through his company’s benefit program?
09:12 “When you think it through, you start to realize that money is being spent primarily by your sickest employees.” —Mark
10:02 How do you get CEOs and CFOs of self-insured employers to realize that their sickest employees are the ones subsidizing their checks?
13:00 What is the role of insurance in healthcare?
14:30 “If you can’t convince them, confuse them and hide it.” —Mark
15:24 The reality behind getting a rebate check.
16:21 Why are rebates going away, and why isn’t that changing PBM earnings?
19:05 How do you get CEOs and CFOs to dig into their benefits plan?
20:59 Does morally abhorrent move the needle?
21:33 “What we’re trying to do is just simplify the [healthcare] industry.” —Mark
24:19 What’s been changing in consumer behavior?
25:04 “Transparency is a huge part of building that trust.” —Ferrin
25:19 Why CEOs and CFOs really have the power to change healthcare.
32:29 What are Cost Plus Drugs’ plans to expand?
39:21 Where is the future of the prescription drug market going?
42:09 What will happen to the prescription drug market in 10 to 20 years?
48:40 The wake-up call self-insured employers should be acknowledging now.
52:02 Where is the real change in the healthcare industry going to come from?
Relentless Health Value - Encore! EP415: Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15% on Total Cost of Care, With Rob Andrews
Transcript
Encore episode. "Some Jumbo Employers Buying Better Healthcare Outcomes While Saving 15 Percent on Total Cost of Care". Today, I speak with Rob Andrews.
America Healthcare Entrepreneurs and Executives You Want to Know, Talking.
Relentlessly Seeking Value. This encore is very relevant after the shows with Cora Opsahl, Claire Brockbank, and Marilyn Bartlett. Getting better health
If you like this episode you’ll love
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