Carrier Networks Primer
[00:00:00] Stacey Richter: Today, Evan Anderson and I are talking about carrier networks, how they started, how it's going.
Because irrespective of whatever the plan was at the very beginning, any given network, especially talking about the big status quo networks, has evolved into what I'll call a three-headed monster. Probably there's many heads, but we'll limit ourselves to three right now
So in the conversation that follows, Evan Anderson and I, we first describe said monster, and then we get into the and so now what?
I'm gonna say this episode is a bit of a primer. It's a bit of a survey of the general map of the landscape, and it also gave me the opportunity to kind of stick on that map links to many other episodes for anybody looking to take a deep dive at any point along the journey. Just, yeah, making sure that we have laid down the breadcrumbs to additional information because it's really easy with some of these topics to go down some pretty deep, dark holes.
And when you do, just please know that there is a community around you, listeners of Relentless Health Value are the village in a lot of it-takes-a-village equations. So if you find yourself in need of a hand to lift you up, please do reach out to the guests who have been on Relentless Health Value or head over to LinkedIn, check out who is commenting on our posts, and find your tribe.
[00:02:17] Stacey Richter: All right. Let's take it from the top, shall we?
Three Headed Monster
[00:02:21] Stacey Richter: Evan Anderson and I are going to describe first the three-headed monster, as aforementioned, that your average big status quo network has grown into. These networks are, lest we forget, built on a fee-for-service model that structurally aligns incentives in ways that are a lot of times misaligned with members and plan sponsors.
The three heads of the aforementioned many-headed monster are the contractual illusion of discounts, that's the first head we discuss.
Second, payment integrity, meaning even if you can figure out what the contracted price should be, you can't usually see what was actually billed that aligns with that what it should be.
So there's almost no way to confirm that you are getting what you signed up for, at least without a lot of work. What complicates matters are old mainframe-based adjudication systems and high billing error rates that compound the problem.
The third head of the monster that we discuss are wild variations in site of care costs for the exact same drugs and/or services, like one site of care can cost literally hundreds of thousands or a million dollars more than somewhere else that you could walk into. Both may be in the same exact network.
Four Paths Forward
[00:03:48] Stacey Richter: After describing our monster, then we get into what are the solutions here. The discussed solutions are, first of all, change networks. And a little bit good luck with that working extremely well for a bunch of reasons that Evan Anderson and I talk about later on.
Second possible way forward here is direct contract. And there's a couple of different flavors of direct contracting, which comes up in every single show lately. Primary care is one of them, direct contracting for primary care. And then also Center of Excellence type specialty care. Listen for a bunch of nuances.
Third, steer and tier to the optimal site of care. And for reasons aforementioned, this is starting to exceed just, this is our preferred institution, and become site of care optimization for stuff like infusions where a member might go one place for the right diagnosis and treatment plan and maybe the first two infusions or something like this, but then go somewhere else for the continuing series of infusions.
And number four, last thing we talk about, is bundling. But more than that, it's the aggregation of bundles into alternative health plans basically, and the pushing of the market toward a care episode where the quality can be measured or the outcomes can be measured, the appropriateness can be measured.
Listen to the show with Dr. Ahilan Sivaganesan for a lot more on this. Link in the show notes. Or actually you could go back if you want kind of the primer on bundles and listen to episode 434 with Dr. Ben Schwartz
So yeah, how was all that for, like, the spoiler of the century? Sorry, not sorry.
Meet Evan Anderson
[00:05:32] Stacey Richter: My guest today is Evan Anderson.
Evan has spent a career in the healthcare industry, and today he works on product strategy, general strategy, and operations for Handl Health.
Speaking of Handl Health, big thanks and much appreciation for sponsoring today's episode and helping to offer up some of the financial assistance to keep the show on the air.
Also, thanks to our founding sponsor, Aventria Health Group, and the team that tirelessly, week after week for the past 12 years, does all that needs to be done for each episode to get recorded, scheduled, edited, produced, the graphics made, proofreading, links created, posts written, newsletter sent.
It's a lot, which is also why I appreciate the folks who have left a tip in the Tip Jar or do any kind of recurring donation. I see your names, and it is very restorative when my motivation starts to flag. You lot rock. Thank you, all.
My name is Stacey Richter, and here is my conversation with Evan Anderson.
Evan Anderson, welcome to Relentless Health Value.
[00:06:38] Evan Anderson: Thanks for having me, Stacey.
What Is a Network
[00:06:40] Stacey Richter: So if we are talking about networks, maybe we just start at the very, very beginning. What is a network?
And I'm gonna kick us off here, because I did just read an article written by Katy Talento entitled "I Dream of... a Post-Network World", where she defined a network. She says, at its simplest level, a network is “simply a set of contracts between… carriers and providers."
[00:07:05] Evan Anderson: Yeah, so in summary, I think a network is a set of contracts, and there is a mechanism for making sure that those contracts are fulfilled between the owner of those networks as well as who's buying them.
[00:07:17] Stacey Richter: And I'm sure we're gonna dig into what those words mean because I think depending on who you ask, they may have a different definition.
Just talked to Kimberly Carleson about the vast number of times where what is written on the contract is a little unclear, and therefore it is quite unclear whether the price that is being billed, like the number that is being billed, actually does in fact match whatever the contractual obligation or contractual agreement is, which is kind of unclear, but that's probably way too much foreshadowing.
The Network Myth
[00:07:51] Stacey Richter: So if we talk about then what is the network myth, which is a term that you have used, if you were gonna just kind of like summarize what people believe about what we just said that may technically, accurately, IRL (in reality) not actually be the case.
[00:08:14] Evan Anderson: Yeah. I mean, I think that we have these contracts, and generally speaking, a contract can be fairly simple, but the reality is much different than that.
The way that things have been going, we have these extremely complicated contracts, and there is a certain level of value that the plan administrators place on these carrier networks. And I think that, you know, over the years, there's been a lot of work to make those as powerful as possible, and it's not clear to me that they have to be as complex as they are.
Several people have pushed back that there might be some standardizations possible, including Mark Cuban [LinkedIn Post]. And I think that, the main thing that these networks are doing is they're trying to obfuscate the actual costs of care. And then also trying to make it a little more complex to figure out if what those costs, if they actually been paid the way they should be.
The winners in these cases are the administrators who, you know, have these carrier networks because they're able to drive costs and increases and be able to market their products as significant benefit to their clients.
[00:09:34] Stacey Richter: So, like, the marketing copy, there's something like, you know, marketing is theater. The data is the source of truth.
And unless you have... You can subtract X from Y to get Z. It's exactly like you just said, like, how much are we actually saving here? Are we paying what was contracted?
But then also, I think, kinda underlying a point that you just made is that it would be one thing if it was just I, carrier, have a contract with this one provider organization. But that's not what's happening now. There's all these dependencies where the contract depends on somebody else's contract, right?
So then you wind up with weird cross-plan offsetting. You wind up with anticompetitive stuff. You wind up with weird shared savings stuff that is a giant question mark, right?
Like, there's just so much in that complexity is buried so many money traps, so many honeypots, and not for the plan sponsor. Let's just be clear.
[00:10:41] Evan Anderson: To cut through the chaff here, I mean, if you only know the discounts, you're looking at an optical illusion. You're negotiating, you know, a discount off a price that basically nobody can defend.
It's off of a chargemaster. And that's sort of the way that the industry has built their marketing. And it's really not an effective way to understand whether or not you're getting value for the money that you're spending.
Why Networks Persist
[00:11:08] Stacey Richter: At the same time, though, you try to get rid of a network and because having a network is the status quo, it's not like you can just be like, Okay, be gone, network.
I see what you're doing there. I see how it may have started out as a good idea, for sure, right? And then has kind of morphed into this other thing, with perverse incentives and etc. But if you get rid of it, Hello, disruption.
[00:11:43] Evan Anderson: Yeah. We need networks, we need coverage, we need to minimize disruption.
And I think that in the short term, we are stuck with networks, but I do think there's a number of things that we can do around the edges to push towards improving what services are provided at what price, and allowing for employers to one, understand that, and then make decisions based off of real data as we move towards different types of plans and different types of contracts that build these networks.
[[00:12:18] Stacey Richter: For some nuances on this, read posts by Craig Gottwals. I will link to one of them where he says that for the right plan sponsor, not all, but for some, not having a network, even today, will work, and it can make care more affordable for members. But it does depend, again, on the plan and the demographics of the members that the plan has and their willingness to not have a logo on their members' cards.
It also will require a plan who is on board with the level of engagement and communication that is required and be willing and have the staff or the outsourced vendors to deal with definitely some inevitable disruption.]]
So if we're just gonna... and I'm, I'm on the edge of my seat. Maybe I'm creating suspense right now.
Head One Discount Illusion
[00:13:19] Stacey Richter: Before we get to your recommendations relative to what you can do around the edges, I do just wanna make sure that we're kind of clarifying, I'm gonna call it the, three-headed monster of status quo networks.
One of the things that you mentioned is the contractual illusion of discounts, right?
[00:13:29] Evan Anderson: Yeah. And I think there was a Health Affairs article by Jiang in 2023 that, that spoke about, you know, at roughly half the hospitals, the discounted cash rate is lower than the insurer negotiated rate. I think that's a really powerful statement right there if you look at what, what are we actually buying if it's not a better price than what you could pay by just walking into a clinic or a hospital.
And I think that there's a strong incentive for these care networks to keep the prices higher, and that there is an option to be able to see, you know, what that data is. But if we're just looking at what the discount is and we don't know what the denominator is, then we're walking in blind in terms of negotiating and understanding how we can save money.
[00:14:15] Stacey Richter: Yeah, absolutely. And you said there, there is kind of a structural incentive for prices to be high. There's been a number of shows where this has come up, I think most recently with Preston Alexander. [Episode 482] If you're making a percentage of the premiums, now you make more money the higher the costs are in this kind of weird, perverse way.
[00:14:36] Evan Anderson: Correct. Yeah.
Head Two Payment Integrity
Evan Anderson: And I think that, you know, a lot of these systems for adjudication are built off of really old mainframes that have a... There's... We've experienced it ourself that it's difficult to get these things updated. And so there's certain, like, rigidity in how these claims are adjudicated. And the contracts are complicated and over years these things have gotten to be basically obtuse. It's almost impossible to go through them and understand it.
The reality though is that, you know, it doesn't have to be that way. The logic is bad and right now it's grown over 25 years, and it's a problem. So, you know, nobody with skin in the game is, allowed to check the output, and that's a business model.
[00:15:24] Stacey Richter: Where there's mystery, there's margin, as I've said 900,000 times. It's also absolutely crazy when you start looking at the number of bills that have, the percentage of bills that have errors.
Going back to the, the Kimberly Carleson episode [Episode 480] where she just goes through, it's some crazy double-digit percentage of bills where if you actually look at them, there's a, a billing problem.
[00:15:49] Evan Anderson: Yeah, I was gonna say, I think, is it episode 521 with Tsang. It's a $200 billion industry playing hot potato with these dollars, right?
So the weakest party, patients, independent practices, or employers, those are the ones who are absorbing the cost when accuracy isn't determined upfront.
[00:16:08] Stacey Richter: Definitely go back and listen to that episode with Andrew Tsang about revenue cycle management if anyone hasn't, because a lot of these things become crystal, crystal clear.
Head Three Site of Care
[00:16:16] Stacey Richter: The other issue, and I'm gonna call this the third head of our three-headed monster, and there's probably people listening who can think of six more heads, but we're gonna stop with three, is this idea of structural, like, site of care flaws. You know, for example, Jim Jusko wrote an article two or three years ago. I think the article was entitled Networks: An Idea That Has Come and Gone.
Just about how crazy it is that you could have the same doctor in the same place doing the exact same service, and depending on what, which network contracted the service, you could pay wildly different prices, which is just the definition of a dysfunctional market honestly.
[00:17:00] Evan Anderson: Yeah, exactly. I mean, we're looking at, you know, every time you go into a hospital as opposed to outpatient, it's a multiplier. You know, sometimes as high as 13X. So, there is a huge differential based upon where you're seeing a provider on what those costs are actually gonna be.
[[00:17:20] Stacey Richter: Do go back from a couple of weeks ago and listen to episode 529 with Dr. Eric Bricker, where site un-neutral payments comes up, and just how high facility fees are in comparison with physician professional fees. And if you did not understand what I just said, no worries. Again, episode 529.
I know a lot of episodes are getting name-dropped. All links, as always, are in the show notes. But as I said in the introduction, this conversation I would consider sort of a primer, kind of a survey, rolling up a bunch of specific examples where our industry has lost itself.]]
[00:18:03] Evan Anderson: I think a lot of people know about that, but there's a lot of lack of information about when you're booking an appointment, where you're actually gonna see a provider, and what those costs are gonna be at the end of the day.
And I think that in episode 501 with Ivana Krajcinovic, this is the poster child for the, you know, on this show, $135 versus $13,560 for the exact same infusion drug. Same drip, different tax ID.
[00:18:28] Stacey Richter: Both of which were in-network, which was the crazy thing.
Like, you had two in-network providers. One of them was charging $135, and the other one was charging $13,000 for the exact same thing.
I mean, like question mark? I do feel like there's this three-headed monster that exists now, but I also just wouldn't want anyone to overlook the downstream or the underlying kind of foundational consequences of us having these three-headed monster networks as our status quo.
And those are, and Dr. Eric Bricker talked about this in one of his episodes [Episode 472] that I thought was really interesting, that I had never really thought about. Because the networks exist, what that means is if you're trying to not have a network, it's really hard. Because, you know, one of the things that the networks do is they reprice and dah, dah, dah, and nobody knows what the cost is.
It's like this mysterious sorting hat, like, that, that you throw charges and tells you like, what the cost is supposed to be. But then if you don't have a network, then no one knows what the cost is supposed to be, right? So it makes it really hard.
[00:19:48] Evan Anderson: You cut one head off and the body grows it back.
The body is, you know, it's, it's two things. It's opacity, for decades, sponsors contractually couldn't see their claims or rates. Gag clauses were only banned by CAA in 2021.
And then you have misaligned agents. Every intermediary between the sponsor and the price gets paid in a way, in ways indifferent or positively correlated to higher spend.
[00:20:13] Stacey Richter: There's this kinda like two things here. Number 1, this is such a well-funded industry, that there's so much money that everyone has an incentive. Exactly, like, if you, if you, there's some policy or anything, you know, a plan manages to get creative and figure out how to cut one of those heads off, then you're right. Like, the industry's gonna regenerate.
But then Number 2, there's a lot of barriers to entry that this creates, which I think is kinda the point that I'm making. Like, if you walk in trying to pay cash, they're like, "Well, then you just, you can't get an appointment, I guess."
What Good Solutions Need
[00:20:43] Stacey Richter: So I think now, Evan, is probably the time, since we've disheartened all listeners, where we start talking about what we potentially can do.
You said there's things that you can do around the edges even now. And I'm assuming that you're saying around the edges because you want to move forward in such a way that isn't so disruptive that patients wind up getting caught unable to get care, or they have to work really hard. How do you conceive of what a good solution looks like right now?
[00:21:22] Evan Anderson: Yeah, it, great question.
Switching Networks With Data
[00:21:32] Evan Anderson: So first to evaluate, you know, a network switching, I mean, you need actual prices. Let's, just start there, okay? We're four years into hospital and plan transparency regulation, and the data's still messy, and hard to interpret without significant cleanup.
[00:21:39] Stacey Richter: Even with the data, switching networks can be disruptive. So what you need to do is run an analysis with your own claims file. Like you know, you need to have actual data on what the networks cost, and you need to have your own claims files to start with.
[00:21:56] Evan Anderson: So how does each network stack up for your people, your provider, and your providers in your geography? So sometimes, you know, switching network then can be justified, but you need that data first to do that analysis.
So we're seeing employers, you know, facing extreme, increases, and I think that that's causing them to evaluate whether network changes can make some improvements if they have the right data to do the analysis.
[00:22:26] Stacey Richter: So thing one, and kinda what you're saying, is just like, let's just say, table stakes or whatever the right terminology is.
You get your claims data, but then once you get those claims files, what you're doing is you're running simulations and saying, "Okay, if we had this network, what it would be? If we had this network carrier, what would it be?"
Right? Like you're doing that math. And you might actually find that for whatever reason, one of them is superior to your current network. So, like, you might as well just try.
[00:22:54] Evan Anderson: Yeah. It's possible. I think that's the starting point. I think over time what we're gonna see is that the transparency arms race is gonna regress prices towards a mean.
And so I think we're already seeing some of that in the market right now. So that's not gonna be a long-term solution for decreasing these in-price increases year over year.
[00:23:16] Stacey Richter: Yeah, and Jacob Asher, Dr. Jacob Asher was on the podcast [Episode 398] a year or two ago who basically said the same thing. And that was even before price transparency, that like changing, because it's the same providers.
I mean, like most every network, it's not like they have all different provider organizations. Like, it's the same providers. So if you're trying to get much higher quality out of the same provider network or you're trying to get much lower prices out of the same provider network, like it's kinda rough.
[00:23:42] Evan Anderson: Yeah, I think that, you know, we need to keep pushing, but longer term, I think that there needs to be other solutions that we're investigating that will help, and I think there are options out there.
[00:23:53] Stacey Richter: You talked earlier about things you can do around the edges of that, and I'm extremely interested in what those things are.
Direct Contracting Options
[00:24:01] Evan Anderson: Yeah, I think some of them can be really powerful depending on the size of the employer. So direct contracting, talked about on the show many times. I think that that, especially for direct primary care or advanced primary care, especially if it's tied into value-based incentives, can be super powerful for organizations and there’s for employers.
And there's a number of companies that are providing direct contracting. But there's nothing stopping an employer from directly contracting themselves with a primary care practice in their local geography.
So I think that that alone can make a big difference because if you're incentivizing the primary care provider, maybe you have some kind of capitated model with value-based incentives, there's a lot that you can do to prevent people from getting more sick.
And the providers are incentivized to do that. When you're working with a network, the primary care providers are not really incentivized to do a lot of that preventative care because large hospital systems do make a lot of money off of specialty care.
[[00:25:04] Stacey Richter: I'm gonna link to a great post by Mike Hopkins in response to a recent show on private equity getting into primary care, which is the episode [Episode 528] with Yashaswini Singh, PhD.
I really think that this post summarizes so concisely the considerations here. And there were some great comments on that post by Lori Smith Guiliano [Comment] and also Patrick Nelli, [Comment] who was a guest on an earlier show, [Episode 509] so go back and listen to that one too.
And yeah, all of these links are in the show notes to the earlier show and also the post by Mike Hopkins for further reading and listening on the topic of not buying primary care through a status quo carrier network.]]
[00:25:47] Evan Anderson: And I think that also, like, you know, contracting with Centers of Excellence for things like MSK can be a huge value savings. And I think there is options to do that also, you know, locally. It can be a little bit more challenging, but there's a lot of great solutions around, you know, GI, cancer, MSK for Centers of Excellence.
And that's a proven model. It's been around for a while. Not all employers are taking advantage of it, but direct contracting around primary care and some specialty care can be a significant savings.
[[00:26:18] Stacey Richter: So the ideas that came up so far, find a better network. This is increasingly not a great solution as prices regress to the mean across the board, but yeah, give it a go.
Second, direct contract with primary care or with specialty care.]]
You certainly have advanced primary care or direct primary care. Listen to the show [Episode 509] with Patrick Nelli. Listen to the show [Episode 504] again with Ryan Jacobs for kind of a deep dive into what's going on and the advantages and the importance.
Then the second one is Center of Excellence contracting.
And I think, you know, for specialty, for example, oncology care; or for example, with, MSK—musculoskeletal care.
Talk about then what else.
Steer and Tier Smarter
[00:26:58] Evan Anderson: Well, I think that, you know, steerage architectures have been around for a while. I do think that there are some newer ones, relatively new ones that are becoming more powerful.
So I think that network tiering been around for a long time, but I think the thing that's really important and hard to get to is including site of care tiers, not just provider tiers. That's critical, like we talked about earlier, because depending on where you're seeing a provider, you could have a massive difference in what you're paying.
So those, that tiering needs to include that, and you can see some real savings from that. Now, that does create some disruption.
And so, you know, the members need to engage and look at those network tiers, and you need to have the actual data. You have to have a pipeline to get that data in to understand what those costs actually are based on the site of care.
Bundling Episodes of Care
[00:27:48] Evan Anderson: You know, the other thing that you could think about is, and I'm excited about is bundling episodes of care. I mean, you, you sort of, we've talked about that with regard to Centers of Excellence for specialty care. You, you know, you're typically, you know, bundling a MSK solution for a certain price.
But you can do much more than that through, you know, dynamic copay plans, as an example, like bundling up to a 150 different episodes of care that can be included in that.
And paying a single price to see a provider or, or a health system for that whole episode. And if you look at the value that that's driven by, you know, with the quality as well as the cost, then you can start to tier based on episodes of care.
Call it an alternative health plan. Something like a surest, but maybe, you know, not dependent on a specific network.
[00:28:40] Stacey Richter: So I, I heard you say two things there. (1) is steer and tier. Again, talking about the Ivana Krajcinovic show [Episode 501] where there's just... It's not like it's 10 bucks. She gives one example in that episode about how two members went... Again, all on the same network, by the way. If two members had gone down the street to get an infusion, the exact same infusion. So we're talking about a drug now, right? So it's not like the quality is any. It's the same drug. It would've been a million dollars less. $1 million. Like, this is, this is big money here.
So the making sure that you're steering to certain sites of care.
[[And look, this is not as easy as just moving around, I don't know, Lego pieces. Listen to the episode from a week or so ago with Jake Velie and Keith Hartman, who emphasize the clinical expertise needed to figure out how to get the right patient to the right place.
Also listen to the show [Episode 523] with Dr. Suhas Gondi, who really emphasizes the importance of communication in these moments, because moving patients around also can mean patients not getting care in a timely fashion while multiple parties who aren't talking to each other blindly kind of play a very unwelcome high-stakes squid guessing game about where the patient needs to go and whose form or what form needs to be filled in and faxed where (ie., there's fragmenting of an already fragmented system).
The episode also with Adam Stavisky, Dr. Leo Spector, and Ryan Wells from Health Here is also enlightening if you are looking to learn more about just, like, how this whole thing works for musculoskeletal MSK bundles.]]
So the steering and tiering is certainly there. And then you mentioned bundling.
[00:30:28] Evan Anderson: There are a number of companies that are trying to develop these bundles and package them in certain ways, providing infrastructure or providing plans themselves.
[00:30:37] Stacey Richter: What you're saying is there's growing aggregators of bundles right? They'll go around, they'll do all the negotiation. They'll figure out what the beginning and end of the bundle is or the episode. That's an idea that has been around for a while.
There is certainly some best practices relative to paying for an episode with a certain quality and certain time parameters and guarantees, etc. But what you're saying is new, is that the entities that are going around doing all of the direct contracts with various provider organizations, you can leverage all of the contracts that they've negotiated.
[00:31:14] Evan Anderson: Yeah, you can negotiate those contracts. And I think that one of the things that it does, which I don't think we should underestimate, is chipping away at that fee-for-service model that providers have gotten used to.
If you are starting to push for more bundling, you'll see providers think about the care that they're providing differently.
There's a lot of different ways to do this bundling. I think that, you know, doing the contracting can be slow and arduous, but if you're looking at just bundling claims and having a single copay, I mean, that in and of itself can change the dynamic of how members decide on what kind of care to get, and you can push people towards providers that are higher value within that, that either provide both higher quality outcomes and lower costs or some mix of the two that equal higher value.
So there's, there's multiple ways to do it, and if you're, if you're pushing this in multiple levels, I think we can change some of the status quo around fee-for-service.
[00:32:16] Stacey Richter: You're also kind of implying people are gonna build what the market wants. So if enough people, enough plan sponsors, enough companies are going around saying, "Give me your bundle price for X," then provider organizations are gonna rise to the market.
And maybe vice versa. We had Steve Schutzer, Dr. Steve Schutzer, on the podcast [Episode 294] many years ago who built a huge Center of Excellence. He had all these bundled prices, etc, and couldn't find anyone to purchase the bundle. So it's definitely a two-sided market here also.
[00:32:52] Evan Anderson: Yes. I think that, you know, none of this is exotic anymore, but the way that we're approaching it, there are some innovative solutions to making it happen and, again, chipping around the edges.
I think that essentially, you know, if we're looking for a, at a fee-for-service model, it's very hard to measure the quality of a single procedure or single service. But if we're bundling it, those metrics become much more powerful around an episode of care that we can measure. And I think that there's not that much headwinds to prevent us from doing some of that.
As we look at the contracting to pay certain rates for higher quality care and higher volumes to certain providers and systems, that can be done as well. But I'm saying that there's, you know, it's all of the above.
[00:33:43] Stacey Richter: Which also sort of negates some of the three-headed monster issues that we were talking about with the network, because if you're negotiating these contracts around the edges, you know the price, you know the quality that you're looking for and you know how much you were charged, so you can compare the two.
Broker Role Is Changing
[00:34:02] Stacey Richter: You know, one of the things that's occurring to me as you're talking here, Evan, is the different role that the benefit consultant or the broker plays in this model.
Because in the past, maybe the main role of a broker was, like, being a good shopper. You know, like helping the employer, You know, like I'm gonna shop for a network, and I'm shopping for stop loss, right? Etc, right? Like, I'm minimizing here, I am aware.
But if we're thinking about the role of the broker/EBC in this new world, it's very much like an orchestration type affair.
[00:34:41] Evan Anderson: The role is changing. You know, the brokers and benefit consultants need to know the actual costs of things, and they need to be able to analyze that data, understand what the priorities are for their employers, and find solutions for them that exist out in the marketplace, and play the consulted role in helping get those employers onto the solutions that they need.
[00:35:03] Stacey Richter: Like, coming in and saying, "Oh, this network, offers a bigger discount." Like, that ship is starting to sail. Like, maybe not for the top of the bell curve, but it's, that's where this, this world is headed.
But then, you know, you can't, like, what's the broker gonna do at that juncture? Like, good luck.
So the other kind of orchestration that's falling on the EBC broker, or the ones that are leading the charge here, is, like, okay, how do I actually orchestrate a full plan here to address if I know that something is super high cost, overly expensive or lower quality, then how am I actually doing the steering and tiering, and to whom?
[00:35:44] Evan Anderson: I think that what we focus on here at Handl is not just presenting data for data's sake. The data has to be actionable. We talk about that all the time. We need to be able to connect the dots between what the data states that you should do and how you're actually gonna do it.
What Handl Health Does
[00:35:59] Stacey Richter: Talk to me about Handl Health.
[00:36:01] Evan Anderson: Handl Health is essentially a data infrastructure company. We provide self-funded employers and brokers with the information that allows them to get insights into how they can save money. And what they can do then with those insights is actually take them to a TPA or an ASO, and we provide the infrastructure for those TPAs and ASOs to implement those plans.
[00:36:23] Stacey Richter: So your customers are EBCs, brokers, TPAs?
[00:36:29] Evan Anderson: Yes, that's right. Yeah, we have some employers with payment integrity that bought direct as well, but yeah, it depends on is it just data for analytics, or is it data to provide infrastructure to allow for new designs?
[00:36:42] Stacey Richter: So if I am an EBC, broker, a sophisticated employer, or a TPA, and I'm like, Hmm, I wanna put in place some of the things that we're talking about today, but I'm not exactly sure whether I have the technology and the data ingestion pipes, whatever you wanna call it, in order to do that, like, that's who should call you.
[00:37:01] Evan Anderson: Exactly.
[00:37:02] Stacey Richter: Got it.
How to Reach Evan
[00:37:03] Stacey Richter: Where, if they are looking at calling you, Evan Anderson, should they get ahold of you?
[00:37:08] Evan Anderson: So, you can go to our LinkedIn website. It's Handl without an E, Handl Health. Our website's the same, Handlhealth.com without an E.
[00:37:22] Stacey Richter: Evan Anderson, thank you so much for being on Relentless Health Value today.
[00:37:26] Evan Anderson: It was a pleasure.