Rae Woods (00:00):
Hey, it's Rae. Today we're rerunning one of our most popular episodes. And we're adding on a little bit of bonus content. Frankly, we have been flooded with questions about the future of commercial risk. I was actually on a webinar with Claire and Alex a couple of weeks ago, and I'm not kidding here. The software almost shut down because so many people flooded the platform. So I thought we should include a little bit of an update on the work that Claire and Alex have been doing. If you've already heard this episode, go ahead and skip to about minute 19 to hear the latest from Claire and Alex.

Rae Woods (00:39):
From Advisory Board, we're bringing you a Radio Advisory. My name is Rachel Woods. You can call me Rae.

Rae Woods (00:48):
Medicare continues to push forward on risk, albeit slowly. Commercial risk, however, is a bit of a wild card. Yes, we have had fits and starts, but we haven't landed on a clear model for the commercial population. That's why Advisory Board has been researching whether commercial risk is actually possible. And spoiler alert, we believe that it is. We've been analyzing a national database of commercial claims. And today I've brought two experts to talk us through it. We've got Clare Wirth, who is our tried and true value-based care expert. And a new voice, Alex Tallian more quantitative insights team. Hey Claire. Hey Alex.

Clare Wirth (01:28):
Hey Rae.

Alex Tallian (01:30):
Hey Rae, how are you doing?

Rae Woods (01:31):
Doing well. I'm excited Alex, to have you on the podcast. You are our second true data nerd to be joining us. So no pressure, but it's kind of difficult to talk about numbers and analytics on an audio-based format. But I think, I think you're up to the task.

Alex Tallian (01:48):
I've been practicing, I think for 10 years, but we'll see how I do. Not too many numbers, hopefully, today.

Rae Woods (02:14):
Advisory Board has historically been pretty optimistic, maybe even too optimistic, about Medicare risk, but we've had a different tone on the commercial side. Maybe we've been too pessimistic. Why have we actually taken that stance historically?

Clare Wirth (02:30):
Well, Rae, there's good reason to have been pessimistic. And that's just because commercial risk has been harder in a number of ways. So for example, just look at who's in the commercial patient population. It's people younger than 65, so they're younger, they're healthier and there's just less avoidable cost. In addition to that, there's a shorter time window to reduce costs. So these patients are switching their employers because that's how they get their health insurance. And then employers are oftentimes switching between different health plan partners. And so there's a dual sense of churn there happening. So there's a short window of savings opportunity.

Rae Woods (03:05):
I'm not sure that there's just churn in the patient population, but I almost feel like there's this sense of churn or maybe it's more like fits and starts when it comes to the kinds of partnerships we've seen with commercial risk. There's not a single central body like Medicare that's trying to figure out what we do as an industry.

Clare Wirth (03:20):
Yeah. And I think that makes it harder to have that glide path that we see in Medicare, of and here's the step then moving on, we don't have one group defining the standard or even defining what the viable path forward should be.

Rae Woods (03:33):
Alex, from your perspective, are we right to be pessimistic or have we been right to be pessimistic in the past?

Alex Tallian (03:39):
I think it made sense in the past, especially if you think about where we were three to five years ago from a data and information perspective. For all of this, we need to have the building blocks to be able to have conversations with each other, to be looking at the same information and data, to be making decisions. And I think even three to five years ago, if you look at just the prevalence of commercial data, commercial information, wasn't very easy to get your hands on unless you were a payer or other organizations.

Rae Woods (04:06):
Everything you just said are huge barriers. And I'm not sure that all of them have necessarily gone away, but you two are here because our perspective has actually changed. Why has it changed?

Clare Wirth (04:19):
The barriers are still there, like you said. But there are a number of reasons that commercial risk is worth pursuing. The first is that all purchasers involved want lower costs. Patients want less costs out of their pocket, plans want to rein in costs, employers want to spend less on benefits. The list goes on and on. But essentially what I'm saying is there is some common ground. Our analysis gets into some of that. There are some obvious and non-obvious opportunities that could have a pretty tremendous impact.

Rae Woods (04:46):
Plus we can't ignore the fact that CMS is not backing down. And we do know that commercial payers tend to follow CMS's lead here.

Clare Wirth (04:54):
Yes. And that's completely true. I want to take this as a moment to urge your audience what I've been saying to a lot of provider executives. And that is that Medicare has been dictating the story when it comes to risk for the last decade. And commercial risk is a place where providers and plans have more agency. It's a place to play. It's a place where you can control the future that you want in your market. And that's a pretty powerful statement that would have ripple effects for the entire industry, whether we all are able to realign around one reimbursement standard, or if the industry remains split in hybrid incentives forever.

Rae Woods (05:34):
That's actually a really interesting way to reframe a barrier we talked about earlier. We said it was a barrier, that there wasn't this single entity that is creating a glide path. What you're actually saying is the sense of agency that individual organizations and parts of the healthcare enterprise has, that's actually a benefit when it comes to commercial risk.

Clare Wirth (05:55):
Yes, exactly right, Rae.

Rae Woods (05:57):
So it's not just that we're less pessimistic. What I'm hearing is that there's actually a sense of hope for commercial risk in the healthcare industry. But let me take a step back for a second. To start with, how did the two of you even go about answering the question, is commercial risk possible?

Alex Tallian (06:14):
It was something that the Advisory Board, something that Claire and I were really excited to partner on with our research and data teams. We've gotten access to a really exciting new database of commercial claims that covers over 20 million covered lives. It's a really robust, national data set that covers the entire country. From there, what we wanted to do was dig into the data to surface key areas of opportunity for commercial risks. So what are the specific service lines or sub service lines that we can focus on or draw the conversation to that are going to be really rich starting points as different providers, payers, entities in this space enter into that conversation.

Rae Woods (06:52):
I don't want to hide the ball here. Is commercial risk actually possible?

Clare Wirth (06:56):
It's possible. It may just look different than the Medicare path, which is why I think we should get into the data first.

Rae Woods (07:02):
Okay. Let's do that. Alex, when it comes to the commercial population, what did you find were the top opportunities for savings?

Alex Tallian (07:10):
Just to ground us in the analysis, we dug into a robust series of professional claims, focusing on ambulatory costs and how those would present to the payer. And so what we found in our analysis is that there's a lot of things that you'd expect at the top. Outpatient E and M, flies in DME, but then also some really interesting secondary categories like chemotherapy, psychiatry, delivery. And so a lot of these are key sub-service lines and we can dig into them more in a second, but that we see changing how they might be managed or those associated costs as we enter into more risk based contracting or more of a value environment across the next year.

Clare Wirth (07:51):
As we talk with folks around the industry, we get some common questions around what's excluded from this data set. So Alex, can you comment on that?

Alex Tallian (07:59):
Yeah, absolutely. So since we're focusing on professional claims, a lot of the facility costs that you'd expect. So surgeries, some costs associated with delivery. We're also digging into DME or durable medical equipment, which is a whole different cost category and presents pretty differently in the data. But I think what we've surfaced is the key medical or surgical sub-service lines that may be early movers or lead indicators for us of what's possible. And so I think that's what's most exciting now that we have the data to double click on as we're going forward in our research.

Clare Wirth (08:31):
So to be really explicit on what Alex just said, what in this analysis is not included is things like surgeries and prescriptions. We understand those are big cost drivers. But that's not where this data set is going to point us toward.

Rae Woods (08:44):
But in the data set that we have, I'm not sure that I'm all that surprised in what we found. Maybe with the exception of labor and delivery, we would expect things like ED utilization to be a top opportunity in the Medicare population, like in the commercial population.

Clare Wirth (08:58):
Yeah. You know, Rae, I've been researching population health for a number of years now. And ED utilization is always a top priority in Medicare. The issue is in commercial that a lot of the ED utilization is simply not avoidable. It's accidents, it's injuries, and so those folks are in the ED because it's a true emergency.

Rae Woods (09:15):
So it's a top cost, but it's not actually an actionable cost. It's not something that we can really address.

Clare Wirth (09:21):
Right, not as such.

Rae Woods (09:22):
What were some of the emerging opportunities that you saw in the data?

Alex Tallian (09:26):
When looking at any source of data, the way that you identify opportunity to move is that you see variability, you see a change in trend, you see different people, different players doing different things. And so just taking chemotherapy as an example, we've seen almost a doubling of chemotherapy costs in the commercial population in the last five years. We have to dig into that more, but it's such an outlier compared to all these other sub service lines that we're seeing. It seems like there's a trend there. Just taking that as an example, those service lines that have seen disruption seen a lot of change or seen rising costs, I think are some of the first ones that we would want to look at.

Clare Wirth (10:01):
Alex, I'm glad you hit on chemotherapy, because it's a complicated one. It is sensitive. It is something that employers may or may not want to get involved in. We have already identified, especially collaborating with our researchers who study oncology in and out, some clear opportunities there like site-of-care shift. Chemotherapy is a tricky one, but an emerging opportunity nonetheless.

Rae Woods (10:23):
I'm glad you bring up sensitivities. Are there any areas that leaders should avoid that should be maybe at the bottom of the to-do list?

Clare Wirth (10:31):
So it's a big counterintuitive, Rae, because some of these areas are places where we'd see costs decrease. We mentioned ED utilization, for example, but some of these are places we'd expect costs to increase when you better manage this patient population. So for example, immunizations is in the top 20 list. We'd expect those to increase in a better managed population or just preventive care. So outpatient utilization also something we'd want to see increase.

Rae Woods (10:56):
And this is why I really value your partnership as a data and analytics team, but also as a healthcare business research team, because it's not enough to just look at the top 20 numbers. There are nuances where are there sensitivities like chemotherapy, where are there not actionable opportunities like ED utilization, and where might you actually want to see costs go up instead of go down?

Alex Tallian (11:20):
Yeah, really excited about this partnership with Claire. I think combining the skills that our data team has with the terrain and expertise that she has in the value-based care area. We have a second set of analyses that we would like to pursue in the back half of this year. The first I think that we're going to look at is if you think about value-based care, the entire concept is delivering value on some sort of time horizon. So across a one, two or three year period that you have either with a beneficiary or pool, what are all the levers that you can pull to drive value and lower cost for them will be using the data that we have to build those sorts of analyses and look longitudinally across those years and see some of the trends that we can service.

Clare Wirth (12:01):
Alex, do you want to give the Radio Advisory audience a sense of what we're working on this week?

Alex Tallian (12:05):
Yeah. We're digging into enrollment data for the commercial population and looking at beneficiary falloff rates. How many people stay on the plan? How long do they stay with the payer? And what we're finding is that actually it's about, roughly this is early, but maybe one and three quarters years to two and a half, two and three quarters years. So not a lot of time, but still a meaningful period, but you have to be specific about maybe the services or interventions that you choose, because of that limited time with the population.

Rae Woods (13:20):
I want to come back to the initial question that you all looked at. There's clearly a lot more optimism around commercial risk than I thought, but what you're talking about are that some of the specific steps that industry players need to take are just going to look different in the commercial population than the Medicare population. Is that the takeaway, that the directions of commercial risk and Medicare risk are just going to follow different paths?

Clare Wirth (14:04):
Yes and no, that's a potential direction that this could go in. I want to be clear though, that I don't think that this is a world where there's no commercial risk whatsoever. And there is a potential that we could see commercial risk following Medicare, mainly because if everyone's following that same model, we by definition are making it more feasible day to day from an administrative perspective. Something I hear from provider executives all the time is that we're managing relationships with a bunch of different payers. We have a bunch of different quality metrics that we have to track and report on and it's just not workable, so that would be a big benefit to following the Medicare glide path.

Alex Tallian (14:43):
Another way that the conversation around value-based care and commercial value-based care might have to evolve too, is have the data and information sharing situation look a little bit more like it does with Medicare. Medicare claims are available to so many people who want to analyze them, surface trends, things like that. And that hasn't been the case historically with commercial data. I think now that's changing, but we need to keep that ball rolling down the hill, settling on metrics, definitions, and as an industry to facilitate this conversation to keep moving it forward.

Rae Woods (15:15):
What other option do we have for the future of commercial risk? There's the Medicare path. And then there's something else.

Clare Wirth (15:23):
Something else that would look kind of like three to five core bundles that would be focused around some of those top cost opportunities that we were talking about. So for example, a labor and delivery type of bundle that would extend throughout the pregnancy and immediately postpartum. The thing is with that is that those bundles would have to be manageable to avoid some of that administrative complexity of I'm managing this big population based payment in Medicare, and yet certain slices in commercial. The other issue with that is at a certain point, you run out of places to go. You run out of savings to obtain. And so you may ultimately just end up back in the population-based payment camp.

Rae Woods (16:04):
I want to channel the mindset of a very tired, very overworked, very frustrated provider leader who's been saying for years that they're frustrated with the fact that their business model feels like they have a foot in two boats. Frankly, this isn't just provider leaders. This is healthcare leaders everywhere. How is what you're describing, Claire, different from that feeling of a foot in two boats?

Clare Wirth (16:31):
To some extent, we're always going to have our feet in multiple boats and that's because you can't take a one size fits all approach. The benefit here at least is that you'd be aligned around some of the core goals that we have in Medicare, as we do in commercial rather than growing and increasing utilization like we do today.

Rae Woods (16:47):
Who are the most important stakeholders when it actually comes to succeeding here?

Alex Tallian (16:51):
To me, it's the payers. Just the information that they have in this space, they are the true source of the information that the rest of the industry needs to make these decisions and move things along. I don't expect them to throw their proprietary claims datasets over the fence or, or publish them publicly. But I think even providing leadership and guidance on what we should be measuring, what we should be paying attention with and then providing at least some of the data for the conversation, they're the only option. So I think it has to start with them.

Clare Wirth (17:21):
Yeah. I think payers have to give up some of their fear of the secret sauce, so to speak. The other constituency that comes to mind is employers here. So employers could make a pretty big impact if they were willing to drive true transformation. I would say that healthcare spending has become less of a top priority for them like it once was, particularly as the job market is so hot, they are trying to retain folks and attract talent. They don't want to jeopardize that with changing benefits drastically.

Rae Woods (17:51):
Well Alex, Claire want to give you a moment to speak directly to our audience. What advice do you have for leaders that are actually embarking on commercial risk?

Clare Wirth (18:00):
You can't pursue commercial risk without partners. So Alex mentioned that really short time horizon challenge, then commit to a long term partnership with whichever plan or providers in your market, and like any good partnership there has to be some give and take. One of my favorite insights from a colleague who has studied partnerships has said, if your partnership strategy is about winning, you've already lost. Can I cheat and do a second?

Rae Woods (18:26):
Oh, of course.

Clare Wirth (18:28):
I would just reiterate what I said before, which is that commercial risk is the place where you can lead with your partners rather than following Medicare and value-based care, which is what we've been doing for years now.

Alex Tallian (18:38):
And I think I would just echo the partnership piece; information sharing, data sharing, just again, facilitating the conversation. I think it will need to come from people on multiple sides coming together to speak a common language and deciding to measure, analyze, and then make decisions on the same things. It doesn't have to start with the health plans necessarily, but they will be integral to that and the foundation for the information on which all these decisions are made.

Rae Woods (19:11):
Claire, Alex. Long time no talk. Welcome back to Radio Advisory.

Clare Wirth (19:16):
Thank you. Happy to be back.

Alex Tallian (19:18):
Hi Rae. So nice to be back.

Rae Woods (19:20):
What have you two been hearing since we released our last episode on commercial risk?

Clare Wirth (19:25):
I think we really hit the nail on the head in terms of the research question this year, in all honesty. We had hundreds of people join our webinar. We've gotten monster of questions come in about this. But I think the resounding response has been commercial risk is the animating ingredient when we talk about the future of value-based care. Medicare is going towards risk. Commercial is muddier. It's more complicated.

Rae Woods (19:50):
I agree with you, Claire. In fact, I've had a couple of conversations with executives where when I start talking to them about the state of the industry and I get to this moment of value-based care, they go, "We've been talking about this for a long time," and I go, "But what are you doing in commercial risk?" And I kid you not, Claire, they stop talking and they go, "Wow, we do need to learn more here. We haven't done enough in commercial risk."

Alex Tallian (20:14):
Yeah, and I completely agree. If my LinkedIn profile is any anecdotal evidence that value-based care is a topic is a winner, because I think I'm up 10 to 15 times the number of hits that I had this time last year. So definitely buzzing.

Rae Woods (20:28):
Clearly, a lot of buzz. But I imagine you've also gotten a lot of questions, especially given the number of people who've been engaging in this conversation. What kinds of questions have you gotten? And what can we answer for our audience, now that we're coming back to this conversation?

Clare Wirth (20:42):
One big question we've been getting is around what kinds of providers are leading the market and taking the lead when it comes to commercial risk. And one group that's pretty obvious to us is independent medical groups. When we've had conversations with them, they seem to be ones who are focusing in this area and they are really emphasizing two distinct strategies. First is focusing on site of care shifts. So when these patients do have a care need, it's at the right site of care at the lowest cost with the lowest cost provider.

Clare Wirth (21:09):
Then the other is pursuing different direct to employer opportunities, which I think they're still in early stages of. The other question that we've been getting is around specialists' role in value-based care. In value-based care, we focus a lot in primary care and we've been getting more questions of well, specialists could make a huge difference when it comes to costs in value-based care. So what could they start on? And we actually have some great research on that we can add to the show notes. Alex, because you've been in all the data conversations with me, I know we've gotten a lot. Is there any clarifications you want to make?

Alex Tallian (21:42):
Yeah, definitely. I think that the analysis people have really engaged with it. It's proven that people are really paying attention, because they've been asking a lot of questions on what is and isn't included and how are we counting things in our methodology. So just to remind everyone, the analysis that we did was looking at a really large sample of professional claims that covered almost 20 million beneficiaries each year. Within that, because we're focusing on professional claims, we didn't include things like inpatient or facility surgeries. A lot of prescription data isn't counted in there and then facility claims specifically. So anything taking place in the hospital or at a health system, things like delivery or things like that might have some undercounted costs.

Alex Tallian (22:18):
What was interesting, even with all of that missing, is that the list of sub-service lines that we returned with were the largest commercial opportunity, the largest spend for the payer in that ambulatory space. All of those sub-service lines that I just mentioned, like delivery surgery, et cetera, were still on the list, just maybe lower than they would be otherwise. And I think that's where we'll be turning next to more holistically capture those costs. But we've established the floor. I think they're important for us to pay attention to, and they'll just be risers, would be my expectation as we move forward.

Rae Woods (22:50):
And that's exactly why I wanted to come back to this conversation because you two have continued to partner together. Really the last conversation we had was just the beginning. What have the two of you been up to since the last time we talked?

Clare Wirth (23:03):
So one of the big challenges with the commercial patient population is the churn. People get their insurance through their employer. People change employers and employers change the health plans that they partner with for insurance coverage. And so that means we're getting dual churn.

Rae Woods (23:17):
Which is the biggest pushback that at least I've heard from payers when it comes to investing in some of the things that we do for government payers, when it comes to population health management, et cetera, is not only are these people younger, they tend to be healthier, but they're probably going to leave.

Clare Wirth (23:32):
Right, and so you have a shorter time horizon for savings. And so what we wanted to do with the data was understand how long do you really have, and is there a potential for people to come back? And so Alex, do you want to get into how we tackled that?

Alex Tallian (23:44):
Absolutely. There's a two phase approach to the analysis or two things that we wanted to look at. First is looking at just what are the general trends in commercial enrollment, commercial insurance across the last 10 years. And then, as Claire mentioned, within that, how have enrollment patterns, churn patterns specifically, changed across the last decade? And then the pandemic, as we know has been a big disruptor. So what has the impact been of that? Grounding us, trends we've seen in commercial enrollment in the last 10 years.

Alex Tallian (24:11):
Since about 2008, 2009, we've seen a huge increase actually in the number of 2 to 17 year olds, so that the children of new parents, been a big growth in that population and how long they stay with the plan. Similarly, on that same timeframe, 18 to 39 year olds, as Claire mentioned, that high churn young population, they've been very stable, but exhibiting a very consistent high rate of churn. And that population was actually very insulated from the pandemic. It didn't see the same enrollment follow up that we saw in every other demographic group.

Clare Wirth (24:44):
And by stable, Alex, you mean a stable level of churn, right?

Alex Tallian (24:49):
Stable level of enrollment and stable level of churn. So as an example, 2 to 17 year olds, 40 to 64 year olds, every other group, you saw an enrollment decline, a pretty sharp one with the onset of the pandemic. 18 to 39 year olds were the one group exempt from that, so stable in their instability is maybe one way I'd put it.

Rae Woods (25:07):
But we're not talking about their stability in terms of their health. We're not talking about unstable uncontrolled chronic conditions.

Alex Tallian (25:14):
No, just stable in their use of commercial insurance.

Rae Woods (25:18):
Got it.

Clare Wirth (25:18):
Well, the same commercial insurance.

Alex Tallian (25:21):
Exactly, exactly. And then a noticeable decline in 40 to 64 year olds, not in the overall number in the sample, but just in their share of the insured population. And so the overall trend that we're seeing is that the non-Medicare Advantage commercial pool is getting younger. So overall, younger patients in commercial plans across the last 10 years.

Rae Woods (25:41):
Help me make sense of this data, because Claire has two really interesting questions. The first is how long do people stay in their particular plan? And could they come back and on what timeline maybe would they come back?

Alex Tallian (25:55):
Yeah. Two really interesting questions that I think we are finally able to answer. What we see in the data is that about 60% of beneficiaries keep their coverage for over a year. So there's a really steep follow up. There's going to be 30, 40% of people, you're not going to keep them, they're going to fall up in the first year no matter what.

Rae Woods (26:13):
Again, that's in line with the kind of pushback we hear when it comes to addressing the commercial population.

Alex Tallian (26:18):
Absolutely. But what we see is that more than half the population keeps their coverage for over a year and then about a third keep their coverage for three or four years or longer. So there are certainly populations, certain groups with a larger window of opportunity.

Clare Wirth (26:34):
And so Alex called that out, and I was curious. Who are the populations who stay longer because that's who you'd want to target your interventions for, because you could reap the benefits and the ROI of investing up front.

Alex Tallian (26:47):
Exactly. And as we mentioned before that, the two groups that we see staying longer with the plan are 2 to 17 year olds. So I think we'd infer that's their parents and the children staying with the plan. That has actually increased over the last 10 years. So people with children are more likely to keep insurance longer now than they were in 2010. On the flip side to that, as we mentioned, beneficiaries age 18 to 39, still exhibit that huge amount of insurance, so maybe not a group to target or a group to focus on.

Alex Tallian (27:14):
To answer your question, Rae, on who comes back, what we saw is that year over year, it's actually pretty stable on a two year window. So beneficiaries and their coverage in year one, by the end of year three, about 10% come back, about six or 7% in year two, three or 4% in year three. So it's not a huge number, but I think as we dig more into that population, maybe they have certain characteristics or certain specific things about them. So could potentially be a group to be targeted.

Clare Wirth (27:43):
What I take away from this data, it seems like parents and children are the ones who are staying for multiple years in a single commercial health plan. And so they are the patient population that you can focus efforts on. And funny enough, they align pretty well with some of the top cost opportunities that we talked about earlier in the episode, our top 20 analysis. So things like chemotherapy affect that population in their forties and their fifties. We also talk about pregnancy and delivery that's of course, right for this patient population as well.

Rae Woods (28:12):
So in the first half of this episode, we talked about the fact that commercial risk is possible and gave some guidance on how to actually do it. Now this churn analysis is basically telling us it's actually worth it much more so than we originally thought.

Clare Wirth (28:27):
Yes, if you were to just focus on those top cost opportunity areas like pregnancy and chemotherapy, and others that we mentioned, but there's still a larger question here, which is one path or two? Do we have the entire industry go to risk in both commercial and Medicare or does commercial look different? And you'd focus on those top cost areas.

Rae Woods (28:47):
Is that your next research project?

Clare Wirth (28:49):
So earlier we talked about independent medical groups teaming up directly with employers and leaving health plans out. And that got us to thinking, what are all the different paths that the industry could pursue that would circumvent another major player? And so that's the thing that we're looking at is how could different partners who have deep pockets or have a lot of influence on the industry team up and leave another out to make this easier to happen.

Rae Woods (29:12):
Which I'm guessing is important because both of you independently said that partnership was the biggest thing you wanted our listeners to focus on in the end of our last conversation.

Clare Wirth (29:21):
Yeah, but partnership is hard. Partnership is so hard to do. And so what if different players in the industry said, buck partnership, I'm just going to pick somebody who I can really work with and flip the entire industry into some form of risk. And so that's what the team is looking at, is who could be the winners, who could be the losers. And most importantly, what would you want to influence in today's world based on what that future could look like? Do you want to tip the scale towards that future? Or do you want to try something more defensively to make sure it doesn't happen to you?

Rae Woods (29:52):
Well, maybe this is a risk for me to say, but I think you're both going to have to come back on the podcast, because you clearly have more to say.

Clare Wirth (29:58):
I think that's a sure bet, Rae.

Alex Tallian (30:00):
There's only more data to dig into for sure.

Rae Woods (30:03):
Thanks for coming back on Radio Advisory.

Clare Wirth (30:05):
Anytime.

Alex Tallian (30:05):
Thanks, Rae.

Rae Woods (30:11):
The industry's path towards risk was never necessarily a foregone conclusion. Frankly, that's one of the reasons why we're still talking about risk-based payment 10 plus years on. The future of commercial risk is unclear, but I am confident that the outlook looks better than we initially thought. There's some links in the show notes that give the update to Claire and Alex's analysis. Because remember as always, we're here to help.