Rae Woods (00:02):
From Advisory Board, we are bringing you a Radio Advisory, your weekly download on how to untangle healthcare's most pressing challenges. My name is Rachel Woods. You can call me Rae. In American Healthcare, there is a spotlight on spending and frankly, that's for good reason. We spend a lot of money on healthcare. And look, the industry has experimented with a lot of things that can so-called bend the cost curve, but largely speaking, we're underperforming and not just on spend on plenty of other performance measures, including things like outcomes and quality and safety.

(00:39):
So headed into 2024, we're watching nearly every purchaser looking to turn the screws. And I want to talk about one of those purchasers today. Employers. We all know that healthcare costs have gone up enormously for employers. And while that's not necessarily a new story, today's landscape does feel particularly pressing, and it's no surprise then that 94% of us employers say that managing health benefit costs is their top priority over the next few years. But I kept thinking we've exhausted our legacy cost sharing strategies. So employers need a new plan to address healthcare costs both for themselves and for their employees. So to dig into this challenge, I brought on two special guests. We're going to do this in two parts.

(01:30):
First, Advisory Board's own payer expert, Max Hakanson is back on the pod to share an update on his latest research aimed at the perspective of the employer. Then I'll bring on Rivka Friedman, who leads innovation at JP Morgan's Morgan Health, a business unit that launched in 2021, specifically to improve equality, equity, and affordability of employer sponsored insurance. First, we'll go to Max. Hey, Max. Welcome back to Radio Advisory.

Max Hakanson (02:03):
Thanks, glad to be on again.

Rae Woods (02:06):
Let's be honest, because the last time you came on Radio Advisory, we spent a lot of time talking about problems and from our own research perspective, we just didn't have a lot of answers yet. So I really hope that we are now prepared with advice and guidance for the industry when it comes to this really complex problem of high and rising employer costs.

Max Hakanson (02:29):
Yeah. I'm excited to share some of our top research solutions that we've found. We talked with over 40 stakeholders for this research, which is really an exceptional number from health plans, brokers, employers, providers, really everyone in between. So we feel really confident in the work we've put in on this study and excited to share some of our thoughts.

Rae Woods (02:49):
And if I'm honest, our listeners understand this challenge deeply. We all know that the challenge of high costs, rising costs, this is not new in the employer space. And we also are very aware of the fact that this is a problem that's only going to get worse. I'm excited that we are going to be able to talk about solutions, but my first question is have any of the strategies in the old employer playbook, the things that we maybe said 3, 4, 5, 10 years ago about how to reign in costs? Have any of them actually worked?

Max Hakanson (03:24):
It depends who we're talking about. Who have they worked for? Employers, employees, and let me start with, for the employees, I would say largely, no. I think we've squeezed out a lot of the juice out of some of those strategies.

Rae Woods (03:40):
What kinds of strategies have we squeezed the juice out of already?

Max Hakanson (03:43):
One, let's start with high deductible health plans. I know everyone's favorite thing in the world. Probably over the last five years or so, we've really hit a plateau. We've only seen about a 1% increase in the number of employees on high deductible health plans over the last five years. Just a 1% increase. And in most of our conversations with health plans and employers, they think we've really hit a peak there. So that's one strategy I would say that we probably are not going to see increased utilization of.

Rae Woods (04:14):
And I think that there's probably also some question on whether or not that was a strategy that worked for the express purpose for employers of reducing costs. And like you said, there's just not much more cost we can offload to the employee and still call it a benefit.

Max Hakanson (04:31):
Yeah, no doubt. We've heard that same exact thinking of we can't really shift more costs to employees. We're already asking them to put in so much money into their plans. We've seen these super high deductibles that are leading to people even avoiding care. We saw data that showed last year, 38% of people in the US avoided care, and a huge piece of that was just the cost and the deductibles associated with it. So even if employers are saving some money upfront, they might be paying for that downstream if employees get sicker and sicker and need more expensive care.

Rae Woods (05:04):
Interesting. Which that actually brings me to a question that I think a lot of folks have when it comes to this particular problem. And the last time we spoke again, you said that focusing on reducing costs alone might not even be the right goal. It might not be realistic, and honestly it's also a bit narrow. So how do we want to shift employer thinking? If it's not just about reducing costs, what should it be about?

Max Hakanson (05:30):
Cost savings is obviously very important. Basically every employer survey out there, every employer we talk to says cost is one of their top priorities, if not their top priority. But what we really found through this research is that cost savings is only half the equation. The other half of that equation is avoiding disruption. And when I say avoiding disruption specifically, what I mean is this combination of employee palatability and administrative ease for the employer.

Rae Woods (06:03):
Okay. So it has to be easy for the employer to actually do, and it can't mess too much with employee benefits, otherwise they're going to say, "This is too much disruption, this is too much change. This isn't actually working for me." And if I imagine the Venn diagram of those two things, something that actually helps curb costs and something that is palatable for the employee and the employer, how much is actually in that middle ground? What's actually in that overlap?

Max Hakanson (06:26):
This is really the sweet spot for care navigation strategies, directing members to the right care at the right time, going to the right providers. We think this is an area that has, A, large cost savings potential, but, B, is fairly palatable to employees and doesn't cause too much administrative disruption.

Rae Woods (06:46):
So what are some examples of care navigation strategies that we think employers should be focused on?

Max Hakanson (06:50):
We dove deeper into five different ones for this study. Advanced primary care, virtual first health plans, near site onsite clinics, centers of excellence, digital navigation. That's just a sampling of the many strategies out there. But these are some of the ones we think have strong potential and they don't necessarily need to be used alone. They can be used in conjunction with each other, but we think these are areas of promise. Some of them are older ones. Centers of excellence have certainly been around for a while. Same with near site onsite, but virtual first health plans, advanced primary care, those are some newer areas that we're looking into.

Rae Woods (07:27):
Yeah. Those also feel novel to me. I was nodding my head going, "Yeah, we've seen the center of Excellence programs. We all know the story of sending your spine patients to the Cleveland Clinic because it's ultimately going to save money." I think mostly because they're sending patients back and saying do physical therapy instead of actually have surgery. But that's a story that I know I've personally told health leaders for a very long time. Tell me more about some of these more novel approaches. The advanced primary care, the virtual first, how do they work and what makes them different?

Max Hakanson (07:59):
Yeah. Let's start with advanced primary care because it's been getting a lot of buzz over the last few years and it is really a newer strategy. I want to start off by saying that advanced primary care is very loosely defined in the market with many different definitions depending on who you're talking to.

Rae Woods (08:15):
Yeah. And I think a lot of folks tend to think about it as something that is ultra consumeristic. I want to get people to pay more because I have come up with this more niche, specialized, souped up primary care. Is that what we're talking about?

Max Hakanson (08:30):
I would say that's one way to think about it. The consumer definitely is top of mind. You want to make it as easy for them. You want everything to be integrated into somewhat of a one-stop shop. But the way we were defining it, because we know we needed to put pen to paper and really define what we're talking about here, and what we've said is advanced primary care is a care model with increased availability for patients, longer visit times with doctors, some value-based payment system in place, a team of providers offering really whole person care, certainly including behavioral health and then high quality referrals to specialists if they need them.

Rae Woods (09:11):
So let me think about your two characteristics. Characteristic number one was actually being able to reduce costs. Everything that you just said are examples that we already know that work to reduce the total cost of care, especially in the value-based care business model that you just described. More holistic care team, more hours, more availability. That's all important. The right financial model, that's all important. And you also said it's this consumeristic view of it's something that patients or in this case, employees might actually want and that's why it fits into that sweet spot.

Max Hakanson (09:42):
Yeah, exactly. Has that potential to save costs, but also is not going to upset employees and won't have too much disruption for the employer. So that is why we think of it as that sweet spot.

Rae Woods (09:54):
But is this something that every employer can do? You mentioned value-based care, and so I'm reminded of a different episode that we did where we talked about employer's role in value-based care, and one of our explicit insights was, hey, not every employer can do every strategy. I have to assume that there is a similar set of guidance when it comes to these kinds of strategies.

Max Hakanson (10:17):
There is certainly no one best strategy for everyone, and not every employer is going to be able to do every strategy. Some of the key factors to think through are size of the employer, how many employees do you have? What's the geographic location of employees? So are they spread out all throughout the country or are they in one geographic area? For example, if you want to do near site onsite clinics, it's not going to make sense if all of your employees are spread out throughout the country, you do need some geographic concentration. But that's also only one piece of it. It's does the provider side, are they enabled to do this? So one challenge with advanced primary care is just finding enough provider groups throughout the country that are able to actually perform the duties we just talked through and have those features, and that has certainly been a challenge.

Rae Woods (11:08):
So if only certain kinds of employers can deploy certain kinds of solutions, like you said, only certain kinds of organizations can do a near-site clinic or onsite clinic. Does that mean that of the five examples you shared, there's really only one that works for every employer? Is that the right way I should be thinking about this?

Max Hakanson (11:26):
No, that is not really the way I see it. We think that these strategies can really work together to create synergistic effects. Let me give you an example. Virtual first health plans, advanced primary care, onsite near site clinics, or really all under that primary care bucket. They're just different entry points into the healthcare system. But from there, they can all work synergistically with centers of excellence. They could be that jumping off point for those high value specialty referrals. So you don't necessarily need to choose one or the other. It can be one and the other.

Rae Woods (12:03):
So you've done all these interviews. You've spent a ton of time doing this research. My question is, I guess potentially my last question for you is, who's doing this well that we should be paying attention to?

Max Hakanson (12:15):
There are certainly some mega sized employers out there that are able to be more innovative. They have the resources behind to fund these type of initiatives, but we've also seen some interesting groups pop up some collaboratives. One, I want to specifically call out is a pilot in California. The Purchaser Group on Health and the Integrated Healthcare Association are working with seven different payers across California. And I'm talking about big guys, Aetna, Blue Shield of California, Anthem, United Healthcare to try and move more provider practices into downside risk and really enable advanced primary care. This is huge because historically we don't see health plans work together.

(12:57):
They have a very antagonistic relationship, but from the provider perspective, practices wouldn't historically want to change all of their payment models for just a small sliver of a patient population if only one or two payers is doing this. But with seven large payers now working together to coordinate this, there is a large enough patient panel to motivate them to make a switch. We also know that another innovative party here is Morgan Health. I know you're going to be talking to them later. They've invested a lot in this, and I'm excited to hear more about what they're doing in this space.

Rae Woods (13:31):
And yeah, I'm interested in speaking about Morgan Health because they are technically a new entity, only as of 2021. But they represent a large employer, JP Morgan, that is trying and maybe failing and trying again at not only reducing costs for themselves, but thinking about their role in assisting other employers and frankly, employees in general. So Max, thank you for sharing your research. And now I'm going to go talk to the folks at Morgan Health.

Max Hakanson (14:05):
Thanks, Rae.

Rae Woods (14:51):
Max just talked about our latest research. Now I want to explore what that looks like in practice. So again, I've invited Rivka Friedman who leads Morgan Health's healthcare innovation team. That means she oversees all of Morgan Health's pilots, their data, their research work, and I wanted to talk to her about what makes Morgan Health's approach a little bit different than others in the employer space. Rivka, welcome to Radio Advisory.

Rivka Friedman (15:18):
I'm honored to be here. What a blast.

Rae Woods (15:21):
How does it feel seriously, not just to be on Radio Advisory, but to be acknowledged and named for your work in healthcare?

Rivka Friedman (15:26):
It feels exciting. I'm mostly excited about the work and about what it means for Morgan Health and our potential to affect care for employer sponsored insurance.

Rae Woods (15:34):
And I should acknowledge at the start that I am not sure that our listeners fully understand what Morgan Health is and the role that you play in the healthcare space. In fact, I think most folks may not even realize that Morgan Health is part of JP Morgan and that this is not JP Morgan's first attempt to enter the healthcare space. So tell me what Morgan Health is and what's different about your organization's role.

Rivka Friedman (15:59):
So Morgan Health is, as you said, a part of JP Morgan Chase. And we were founded in the wake of Haven, which was JP Morgan Chase and Amazon and Berkshire Hathaway's joint venture focused on reducing employers healthcare expenses. We were founded in the wake of Haven winding down, really focused on the employee side of employer sponsored insurance. So our mission is to improve the quality, equity and affordability of employer sponsored healthcare, but from the employee's perspective, we want to make care better and cheaper and higher quality.

Rae Woods (16:32):
And I actually think that shift is really, really interesting because we're having this conversation in a moment in time in which every employer is saying, and frankly has been saying that their costs are unsustainable. They've been able to sustain their costs up until now, but there's some signals of why we're seeing employers and we're going to mess the employer and employee word up several times in this conversation. There's some signals of why employers are getting a little bit more active. It's interesting to me that in this public shift away from Haven, restarting again, that you've moved from focusing on employer costs and saying, "Actually we need to focus on the employee." Tell me about why that shift was so important.

Rivka Friedman (17:14):
It is a bit of a misstatement on my part to say that we're not focused on the employer piece of this because so much of the transformation has to happen with employers really taking the reins of their healthcare expenditures and also just their healthcare choices that they're making for their employees. But I think some of this came out of a recognition that employer healthcare costs have been growing for as long as I can remember, and they're unlikely to stop. So if we said that we were focused on reducing employers healthcare spend, our CEO, Jamie Diamond would probably say, "Don't break my heart twice." So that's some of it.

(17:45):
The other piece of it is we so often ignore or overlook the employee as key stakeholder that we're serving. And I experienced this when I was at CMS and we were focused on trying to improve Medicare and Medicaid, and often would have somebody in the room say, "But what about the beneficiary?" So we are really trying to take a patient-centered approach to this work.

Rae Woods (18:05):
And I think it's right to remind our audience, remind me, that we can't really untangle these two pieces, and I want to do something maybe dangerous with you, Rivka. I want to actually gut check with you the way that our research team is currently thinking about the employer side.

Rivka Friedman (18:24):
I would love that. Can't wait.

Rae Woods (18:26):
So we're thinking about what should the employer's role be in this world and where costs are unsustainable? And let's be honest, our playbook hasn't really worked up to this point. So we're thinking about this in two ways. We're thinking that solutions for employers need to first have some cost savings potential for the employer. That's their goal. But the second part of the equation, and this is really important, is that tools aren't going to work if they're really disruptive for employees or if they're really disruptive for the employer to actually resonate. How do those two criteria resonate with you when you think about your work at Morgan Health?

Rivka Friedman (19:07):
I think the research team crushed it. I'm proud of my former colleagues. I think those two things are both right. So we absolutely need to be thinking about the employer's spend, even if we aren't promising them that it's going to go down based on last year's spend. Because as you noted, spend is getting unsustainable. And I've been saying that myself in my career for at least a decade, but we've gone through waves with the recession and then the bounce back from the recession and more recently with inflation. And I think this has been a trend that has ebbed and flowed, but is likely to continue. In particular with inflation often affecting staffing and then healthcare on the lag, we are likely to see huge cost growth in employers healthcare burden from this year to next year. So that has to be a piece of the equation.

(19:53):
And to your other point in my conversations with benefits professionals, I am constantly hearing, but we can't because that causes disruption, and I don't want to minimize that as a consideration. It's incredibly important for employees to feel a measure of predictability in what their healthcare will look like. And that's not just how much it'll cost, it's which providers they have in their network, what's covered, et cetera.

Rae Woods (20:15):
And again, probably something that you felt in your time at CMS that sure, we can tell people that they have a closed, very, very, very ultra narrow network that they can only go to for their care, and that's not palatable for most people. From the employer's perspective, they're also thinking about how do I keep these people loyal to me, engaged with me as their employer, which is why that is so important.

Rivka Friedman (20:38):
I would challenge the notion that we can't try things like narrower networks, even in an environment where we're trying to make sure that employees feel minimal friction. And I say this in part because of the conversations we've been having about this with Santivo, which is a company in which we've invested, and also with employers who are increasingly asking, is there interest in narrowing a network which would enable us to offer high quality care at a lower cost for our employees? In the time that you and I have been working in this field, we have tried everything and it turns out costs keep growing. So I am seeing more interest from employers and saying, "What maybe haven't we tried in a while because it was unpopular that we might consider trying now?"

Rae Woods (21:24):
And there's two things that I think I'm hearing from you. One is that it's not so black and white. We absolutely cannot think of narrow networks and open networks and just say there's two options and there's nothing in between. The other maybe bigger and more important lesson that I'm hearing from you is we have to keep experimenting because what we have tried has not worked very well thus far. The tools in our toolbox have run out when it comes to things like high deductible health plans. So we need to keep innovating and figuring out what the next steps are. And that I think is a particular mindset that Morgan Health has just run at that perhaps others have not. So tell me more about your approach to testing, maybe failing and testing again.

Rivka Friedman (22:10):
I think you hit it. So we are in many ways learning from the work of the Center for Medicare and Medicaid Innovation where I worked previously where some of my other colleagues have worked previously. And the ethos of CMMI is and has been let's test things. And when things don't work, we will learn from them. And when things do work, we will then figure out how to bring them to scale. So that's the mindset that we have for our work here at Morgan Health. We are testing a range of things. We are testing them internally with JP Morgan employees, and we are testing them externally with our portfolio companies, but in other employers. And our mindset is some of these things will fail, and we hope very much that we will see some of them fail and then learn from those failures. But some of them will succeed.

(22:52):
And when I say some of them, we could be talking about something as big as a whole pilot, improving quality and lowering costs, which would be a thrill. Or we could talk about a specific element of a pilot working. So for example, we have piloted primary care onsite in Columbus for all of JP Morgan Chase employees in Columbus with a company called Vera Whole Health. A new part of that pilot is thinking about other needs that people have that aren't solely clinical like food needs or transportation needs. And we are starting to think with Vera about how to address those needs. So we could see successes in a narrow way with specific elements of a pilot that we implement working for people. And again, that would be as much of a thrill.

Rae Woods (23:37):
This is the point in the podcast where I need to remind our audience that I'm proudly from Ohio. I'm from Columbus, Ohio actually. So I paid a lot of attention when I saw the announcement about Vera Whole Health and the partnership with Central Ohio Primary Care and started watching that particularly closely. But I'm intrigued by this idea of the metric of success might look different or we need to interrogate what success looks like. I want to ask the opposite question. How do you know when a pilot does not work? What are the ways, or a program. What are the things that you need to say, you know what, that either was very clearly a failure or it wasn't good enough because we didn't get these metrics for success?

Rivka Friedman (24:19):
It's a great question, and it's something we've been thinking about really actively over the past couple of months. So first I would say we take a data-driven approach to all of this. We launched pilots where we've launched them in part because our data analysis suggested that those products were needed in those places. So we're starting a pilot with data in mind already. But something else that we're doing that will inform both our successes and our failures is that we've developed a set of leading indicators for these pilots that we will be tracking internally at Morgan Health that our colleagues in the benefits organization will be tracking and that our partners at Vera will be tracking. And these are meant to be early suggestions of how things are faring across different domains of success. I put that in quotes.

(25:00):
So everything from a patient's experience of care in Vera to whether certain kinds of appointments are leading to other kinds of appointments, are we seeing people start to stick for primary care when maybe previously they've come for an acute visit? Are we seeing also downstream effects around quality of care for specific conditions, different kinds of utilization, especially inappropriate utilization going down? So we're tracking all of these. We're going to track them of course on the year and do a formal evaluation, but in advance of that, we have some domains where we can say, green, yellow, red, how are things tracking so that if something is "failing," we'll know early and can make changes.

Rae Woods (25:37):
So what I'm hearing you say is there's a lot more than just, did we save money or did we reduce spend so much more but what I-

Rivka Friedman (25:42):
Always that's a secondary question.

Rae Woods (25:44):
Really?

Rivka Friedman (25:45):
It's not important. It would be amazing to save money. I think all of us have our eyes wide open that saving money in healthcare is very hard, that trends are going in the opposite direction. And I guess I would say our first priority would be making care higher quality and more affordable for our employees.

Rae Woods (26:01):
Can I name something that you didn't say that I think will be interesting for the listeners of this podcast who are deeply aware of the employer space? I didn't hear you specifically name or stop at employee satisfaction as being the metric of success. Why is that important?

Rivka Friedman (26:18):
So experience is on the list. So our leading indicators include an employee experience, metric first and foremost, 100% important. And I think in many ways, employee satisfaction gets more attention in the ESI space than maybe it does in public payers, and there's probably a lot behind that that we can all unpack in our therapy. But I think realistically, people get to choose what job they have in most circumstances, and we tend to think of our employees as free agents who could go somewhere else if they aren't satisfied. Some of the package of their satisfaction is do they like the healthcare they have? So employee satisfaction is a critical metric for us.

Rae Woods (26:56):
In addition to hoping to actually influence quality, hoping to actually influence outcomes, hoping to actually influence the cost of care that the employee bears, let alone this secondary piece that you're naming, which is the employer.

Rivka Friedman (27:09):
Yes. And when I look at what I see in ESI with other colleagues and counterparts who are working in this space, I actually think employee satisfaction gets a lot of attention. I think that quality gets less attention because first of all, everybody assumes they have a high quality doctor. This is well-documented in the evidence. People tend to think their doctors are good, and that's good in some ways. We don't want mass distress of our providers, but there is evidence that some doctors are better than others, some providers are better than others. It would be, from my perspective, wonderful, if every employer had the tools to help their employees figure out which providers in these very broad networks that everybody has access to are actually producing high quality care. And then to pick those providers with that information in mind.

Rae Woods (27:56):
You're getting at the perhaps much harder part of what you're doing. So the first step that Morgan Health is doing is just taking this innovator's mindset. We're going to learn from CMMIs approach and we are going to test and fail and try to figure out pockets of what works. The perhaps harder step is then figuring out how to scale that. And your position in the market is not just figuring out how to scale that potentially to JP Morgan's employee base, which is vast, but also thinking about how to support other employers. This is a massive challenge. How are you thinking about scaling the innovations at work?

Rivka Friedman (28:36):
It's the hardest part of our work for sure, and I don't know that we realize that upfront, but it's definitely the biggest challenge. I was talking about this with my team yesterday in context of something specific we're trying to do around helping employers get better tools for measuring and then acting on quality of care. And I said, it's like the Steve Jobs idea of making people love a product that they don't know they need [inaudible 00:28:58] of this that we're in. When you talk to employers in benefits, they have 101 problems, and for many of them, probably quality isn't one of those 100 problems because they have so many other things going on, especially in this moment where inflation is high and they're really thinking about premiums for next year, and the list goes on.

(29:18):
Our job is to make the employer community realize that quality is, A, important, B, noticeable, that people care. The same way they care about their experience, that people care if you get them high quality doctors and C, measurable and improvable, that they actually could have the tools to make changes here. And that's a tall order. The national carriers tend to determine who is a network. There tends to be very high, like 95% overlap from one carrier's network to the next. So there's not a lot of differentiation in this marketplace. So our job is to try to tackle that from all angles. So one, how do we get products into the marketplace that actually look different so that employers have a real choice? Two, how do we educate employers that quality matters and that they can make a difference on it.

Rae Woods (30:05):
Or that it's potentially not actually that disconnected from the same efforts to reduce costs. I'm thinking about Central Ohio Primary Care as being a leading medical group for a very long time in trying to move into meaningful downside risk and trying to do all of the population health measures that come with succeeding in an alternative payment model. And those things both reduce cost and at least uphold, if not improve quality. So if we can think about those things together when we start doing some of these kinds of experiments, and to your point, learning from what the industry has already tested in writ large, if I think about value-based care.

Rivka Friedman (30:40):
Totally. I think one of the exciting things about the Vera COPC partnership is that COPC is the teacher for a lot of these value-based care pieces of what Vera is trying to do. And Vera has incredible doctors, incredible provider team that is focused on this but didn't have the experience operating at risk. So I think it's a really interesting model that we are thinking about how to replicate, where you take organizations that are focused on, for example, offering primary care to employers and have employers priorities in minds. How do you pair them with provider organizations that have experience operating in a risk-based model?

Rae Woods (31:19):
Can I reveal to you the other thing that makes me nervous about this?

Rivka Friedman (31:22):
Yes, please. Share your fears.

Rae Woods (31:24):
We know that scale is going to be hard. That was a given. But I think what makes scale even harder is if I look at the variation in employers across the country in terms of their size, in terms of their geographic spread, in terms of their capital, in terms of their ability to take on this change management that folks are going to need to be successful, and that that's happening at the same time where the threats for increasing spend are looming and bigger than ever before, especially if I think about some of these high cost and ultra high cost drugs that we've talked about on the podcast before. So my fear, the thing that makes me nervous is how do we actually prop up the mid-size, the small employers, the ones that would be struggling with this anyways, even if the environment wasn't going to get more difficult very soon.

Rivka Friedman (32:17):
So this is an area where I see tremendous opportunity. This is actually not a fear of mine. It is a place where I am really, really excited about the potential for our work to make an impact. So two things I would say. The first is jumbo employers of which we are of course, one, have lots of tools and resources. They have relatively robust benefits organizations. They can do this analytics on their own. Small and medium sized businesses cannot and will not, which means our job isn't just to convince jumbo employers that they indeed could be doing this analysis. Our job is to do these analysis and make them available to all businesses, and that is how we're thinking about our analytics work.

(32:54):
How do we publish information on, for example, health equity and racial disparities in access and outcomes to care, which we have now published on a national level and are going to be publishing again within the next couple of months. We're going to do this on an annual basis. How do we publish information on what works? So when we have a Vera evaluation, what of it will we be able to share with other employers who can then say, "This could work for us," without having to run the full analytics on their population. So that's one opportunity is can we get this information into small and medium-sized business' hands?

(33:25):
The second reason why this area excites me is because to your point, small and medium-sized businesses don't have the luxury of a massive organization that can weather this storm in some ways. Necessity is the mother of invention here. I was in Wisconsin last year talking to a set of employers that have made incredible systems change there, leveraging the power of Santivo and its analytics, but also leveraging local lobbying organizations and others to really say, "We don't accept low quality care. The worst providers in this network are going to be exposed. There's going to be more transparency." And when I had these conversations with employers, I realized the ones driving this the most are smaller businesses because they don't have the luxury of an alternative.

Rae Woods (34:07):
Wow. Gosh, that definitely makes me feel better. And I'll tell you, this is a similar sentiment that I'm hearing a lot, which is that we have to think about the positive role that the fast follower can have or even the laggard follower can have in not having to reinvent the wheel or being propped up by some of these other kinds of institutions, larger systems, third parties, that can help support these folks going forward. And frankly, I think that what makes me excited is that so many people like you see this as an opportunity and not as a foregone conclusion.

(34:42):
Here's the thing, you personally and Morgan Health as an organization is still early in their journey. We have admitted that Morgan Health is testing, figuring out what works, figuring out what fail points they have, testing what scale looks like, and thinking differently about how you scale to a larger employer versus a smaller one. With all of that in mind, what do you want our listeners to know and to take away and to act on when it comes to employer costs and the very, very essential role that we cannot forget employee costs or employee outcomes? What's your big takeaway for them?

Rivka Friedman (35:20):
I think probably one is just be aware that there are actual alternatives in the marketplace. That the marketplace is more diverse than we might assume. I often fell into this trap at CMMI and in my early days at Morgan Health of thinking everything was the same. You go to edit, you go to sign, you go to united, you get the same network, you got the same people. What's the difference? Or you go to K Street, you go to L Street for your doctor, I live in DC, it's all the same. The truth is, it's not the same. So that's the first thing is just awareness that there is a breadth of options.

(35:48):
The second is, especially for people listening to this podcast who have the opportunity to make change within an employer, within a carrier, within a provider, knowing that people are listening and that if you make change, they will come, is something that I would like people to know and also something that I'm focused on making true. We have a lot of work to do in order to make that the reality. Just like employers have 100 things going on and can't focus on everything at once, employees are people. They're people with jobs, they're people with families, responsibilities. They're not spending their whole day trying to figure out which doctor to see for whatever it is they need, and we shouldn't assume they are or that they can. So it's our job to put this information into their hands.

Rae Woods (36:30):
I love that. I am excited to see what Morgan Health does next. I'm excited to see what you do next, Rivka. So thank you so much for coming on Radio Advisory.

Rivka Friedman (36:39):
This is such a blast. Rae, you've done an incredible job with this podcast. It's so fun to talk to you.

Rae Woods (36:44):
Thank you. I appreciate that. We'll talk soon.

Rivka Friedman (36:47):
Bye.

Rae Woods (36:53):
Look, I don't want you to leave this episode thinking, "Yeah, we've been down this employer space before and nothing's really worked," because as Max shared, there's a lot of reasons for employers to get more active when it comes to controlling their costs. And there are organizations like Morgan Health who are challenging the way that we've done things before and trying to prop up other employers as they work to find their own solutions. We expect a lot of change to come here, but remember, as always, we're here to help. If you like Radio Advisory, please share it with your networks, subscribe wherever you get your podcasts, and leave a rating and a review.

(37:35):
And if you want to see me in another format, I am excited to share that I'm going to be hosting a webinar to the Health Community on Monday, September 18th. It's going to be at 2:00 PM Eastern Time. This is your opportunity to get Advisory Board's exclusive edition of the State of the industry, where we'll talk specifically about the rise of artificial intelligence. My goal in that webinar is to help you understand some of the seismic changes happening below the surface, but to also rightsize your feelings, your thoughts, maybe even your fears on AI. It's free to join. So register today. I've added a little bit of information in the show notes, or you can hop over to my LinkedIn page, find me at Rae M Woods.

(38:19):
Radio Advisory is a production of Advisory Board. This episode was produced by me, Rae Woods, as well as Katy Anderson, Kristin Myers, and Atticus Raasch. This episode was edited by Josh Rogers, with technical support provided by Chris Phelps, Joe Shrum, and Dan Tayag. Additional support was provided by Carson Sisk, Leanne Elston, and Erin Collins. Thanks for listening.