Introduction
[00:00:00] Stacey Richter: "Take Two. A Direct Contracted and Actually High Value Network That Elizabeth Mitchell From PBGH Talked About.” Here's a deep cut throwback with Olivia Ross.
[00:00:29] Stacey Richter: This OG of directly contracted high value networks or Centers of Excellence networks came up, name dropped and everything in the episode with Elizabeth Mitchell from PBGH, the Purchaser Business Group of Health from two weeks ago. That was episode 491.
So welcome to this deep cut episode with Olivia Ross from way back pre-pandemic times.
The Employers Centers of Excellence Network (ECEN)
[00:00:53] Stacey Richter: This high value network, its official name is the Employers Centers of Excellence Network or ECEN, and it really came up in a meaningful way in that Elizabeth Mitchell episode, and it came up for two reasons.
Here's reason (1), why the ECEN came up. Because the work in that recent PBGH data demonstration project, and again, listen to the show with Elizabeth Mitchell for more on that if you didn't already. But here's the bottom line, whether you did or you didn't.
The PBGH demonstration project now gives plan sponsors like self-insured employers, with currently available transparency data and claims data. You can see the quality, price, and safety of any given service, and you can compare that price, quality, and safety with other hospitals.
Having this information enables any given self-insured, employer or other plan sponsor to create a high value network or Centers of Excellence network. They can do this all by themselves. They can create a high value network all by themselves. So there's that, and that is a really, really big sea change.
Direct Contracts and Their Benefits
[00:01:57] Stacey Richter: Here's the number (2) reason why this ECEN network is a look back that we should be looking into right about now. ECEN was again, as I just said, a direct contracted network.
And you know what Elizabeth Mitchell said during that recent show, episode 491, she said, it's now confirmed that direct contracts between employers and clinical organizations perform way better than anything that most other third parties have negotiated.
I liked how Jeff Hogan summed this all up. It's a great post, we'll link to it, but Jeff wrote, "Direct contracts have more measurable value than generic, blunt instrument networks. Direct contracts serve the specific interests of the specific group. They also give unique care delivery organizations the opportunity to align their specific services with unique populations without the involvement of confiscatory middlemen.”
Challenges and Opportunities in Healthcare Pricing
[00:02:48] Stacey Richter: And yeah, this is really good news for all you unconfiscatory, TPAs and others out there. This is really an opportunity to prove differentiation from those who enjoy the arbitrage maybe a little too lavishly.
And maybe lavishly is a really great word here actually, because it's allegedly and apparently as per more than one person who would certainly know, self-insured employers pay on average about 30% more in their claims wire for a service than whoever provided said, service got paid. There's 30% added onto the top.
And look, I am certainly not saying that, you know, administrators shouldn't be paid or anything like that. Nobody should be working for free. The only problem here is when this 30% is not being disclosed and it's often not. Brokers are in this arbitrage mix as well. Of course, the not transparent ones I mean, plus others.
I saw Andrew Tsang's graphic, we'll link to it, that showed 27 streams of payment coming out of the middle between plan sponsors paying and a clinician getting paid.
The Demise of the ECEN Network
[00:03:52] Stacey Richter: Okay. So this directly contracted ECEN movie actually does have a sad ending, just FYI. The ECEN high value network that we talked about in the pod that follows it was ultimately dismantled.
Why was it dismantled? I don't know. It did happen right around the time that the independent and really capable TPA, who was administering this whole thing and doing great member engagement also, this TPA was bought out by a larger firm. Maybe the timing was coincidental though.
One last point before I roll tape. TPA obviously stands for third-party administrator. ASO stands for administrative services only.
Future of Direct Contracts
[00:04:31] Stacey Richter: I've been hearing more than once lately that the right way to proceed, in the future, is for employers to negotiate their own direct contracts for all the reasons that we just talked about with high value clinical organizations. And then the TPA should just administer those contracts. administrative services only. Which is exactly what was going on in this ECEN. So let the old be new again.
And all this is very good news, again, for great clinicians, great clinical organizations, and truly transparent TPAs and brokers who align themselves with the fiduciary responsibilities of their clients.
Themes that come up today include employers, ganging up to get better prices on direct contracts. Cora Opsahl and Mark Cuban talked about this some.
Olivia also in the show that follows, she gets kind of deep into how quality was assessed. Just the depth of the value assessment that went on there. It actually went down to the physician level and all this is really important ingredients here to really be able to select a center of excellence based on actual value.
Because as has been said multiple times by multiple people on the show, most carrier “high value networks,” when you actually look at who's included in those high value networks, you look at their quality and their price. These places are not high value by most normal definitions of high value. Anyway, so question mark.
One last thing besides my normal thank you to Aventria Health Group for sponsoring this episode. I am so pleased to thank Payerset for donating to help Relentless Health Value stay on the air.
Payerset is a price transparency company with a mission to democratize healthcare pricing. Love that. Payerset empowers healthcare organizations, payers, employers and benefits coalitions with the most complete set of real market pricing data. They benchmark every negotiated rate and claim tracking reimbursement trends and delivering the actionable insights needed for smarter contract negotiations and a more transparent healthcare system.
So with that, here is my earlier conversation with Olivia Ross.
Interview with Olivia Ross
[00:06:29] Stacey Richter: Olivia Ross, welcome to Relentless Health Value.
[00:06:31] Olivia Ross: Thanks for having me.
Benefits of Centers of Excellence for Employers
[00:06:33] Stacey Richter: Doing Centers of Excellence, obviously there's an a benefit to the employee, like higher quality care is always gonna be a benefit to the employee. But if I'm an employer, and let's just pretend I'm A CFO, who's particularly focused on the bottom line, is there a benefit to Centers of Excellence or what is the compelling benefit?
[00:06:51] Olivia Ross: Reminder, we're working with self-insured employers. Every dollar that doesn't go out the door towards healthcare is a dollar kept by that CFO to spend in some other area of their organization.
So when they're looking at the decision making in terms of where to send patients, right now in the sort of normal self-insured market, they're using a carrier network typically, and there's no information available. Really, honestly about the quality, but in particular about the cost.
So it's very unpredictable, huge variation. You've probably seen studies on this, but things like five or tenfold, even within one city, and definitely across the nation for the same procedure. So there's an opportunity with contracting, with a center of excellence to both create a set price that is reasonable and fair, as well as having that consistency and predictability.
So that's one place, and in our program we use a prospective bundle, meaning before we even get started as part of the contracting process, we're determining a set single rate for the cost of care for everything surrounding the procedure. It's usually about an eight to 10 day episode, so relatively short because of the travel component, but that includes the facility, all the physician fees.
Initial outpatient care. So the patient is staying in that Center of Excellence city post discharge and getting things like physical therapy. All that is one standard price.
And that price is, we negotiate to be quite competitive since we do know that employers are paying for patients to travel, for example, and waiving the cost share. But to be frank, that wouldn't be enough to drive this.
Where the cost savings comes from, the largest cost savings in addition to the competitive bundles, is from the improvements in quality. So if we have a center and a surgeon that's operating with a far lower rate of, for example, surgical site infections or readmissions, avoiding those costs is an incredible opportunity for savings for the employer.
And then the other piece, and this is market in the spine care world, there is a great deal of unnecessary and inappropriate care happening. So surgeries that are being done in local markets, or even in situations where the first surgery never should have happened, and now as patient's on their second, third, fourth surgery because someone made an overly aggressive decision in treatment.
We're able to avoid that by only working with centers that have a multidisciplinary approach that are really being thoughtful about whether surgery's the right option. So every avoided unnecessary surgery again, those dollars stay with the self-insured employer.
[00:09:19] Stacey Richter: And that's probably an under-appreciated quality metric. There's very little or very few quality metrics on, was the surgery necessary to begin with?
[00:09:29] Olivia Ross: You're 100% correct. Many of the markers we look at for quality don't consider whether the surgery should have happened at all. And I spoke at one point, for example, to the Leapfrog Group, and we're talking about spine safety, and what I was saying is, there's no surgery that's safe if it was an inappropriate surgery to begin with. You're putting that patient through undue risk in a number of different ways.
So when we're talking about quality, a 100%, one of our major things we're looking for from the very beginning is centers that have a commitment to evaluating each patient and considering whether surgery is really the best and most effective route for them, and involving them in that decision making process so that you don't see patients who are told they shouldn't have surgery.
And then, I don't love this phrase, but go doctor shopping back home to find someone who will operate. Because unfortunately, there are surgeons that are very aggressive in their treatment approach. And will pursue having completing surgery on a patient when maybe there's a 20% chance of improving that patient's status, where physical therapy has a 75% chance of improving that patient's status.
[00:10:36] Stacey Richter: And I could see another driving force, honestly being consolidation in the marketplace. That a lot of employers, especially if you're in certain geographies, I mean, not even talking about, well, sort of talking about rural, but irrespective of the population size in that geography, if there's consolidation and these large, massive healthcare provider organizations start having the influence to raise prices in that geography, then this also is a way for an employer to escape that monopoly.
[00:11:07] Olivia Ross: You are absolutely correct. This is a way to create market pressure and competition even when it doesn't exist in a particular local regional space area. It's very exciting, I think, to have a model like this that creates positive disruption in the healthcare system. So what we're saying to one of those mega systems that's consolidated is you may think there's no competition, but us as an employer, we are willing to pay for our patients to travel somewhere else so that they can have access to similar quality but at higher value.
Quality Metrics and Selection Process
[00:12:17] Stacey Richter: You had mentioned before, Olivia, that you're very careful about how you select Centers of Excellence and the quality metrics. You know, maybe some of them being a little bit not traditional that you use in order to make these selections. Who gets to be in the Pacific Business Group on Health Network? You wanna add some color there? How do you do this?
[00:12:35] Olivia Ross: One of the things we pride ourselves on is the rigor with which we select both our centers, so our facilities as well as the providers, the surgeons that participate and are approved for our network.
Our program, which we call the Employers Centers of Excellence Network. Bear with me, I'm gonna go with ECEN. because otherwise you're gonna get sick of hearing me say Employers Centers of Excellence Network over and over again.
So we talked to employers from the very beginning and they all said, this really has to be a quality led project. We want to see that you are going out there and identifying the best quality providers for our beneficiaries to go to.
So we started thinking about, okay, what information is available about quality? Look at, you know, every public source you can come up with. From there though, we do reach out, or oftentimes we're contacted by a center and do a pretty basic request for information.
And that focuses on a few quality metrics, I think, that are kind of widely recognized. Things like volume, for example. So we have center volume minimums, as well as volume minimums for the specific surgeons down to the procedure level. We also, in that RFI process, make sure there's access to a suite of services, you know, urgent care specialist access, etc.
And then we introduce the concept that's so important to our program that we're looking for prospective bundles. As well as give them a heads up that if they move forward in their process, we're gonna be asking for a lot more data down to the physician level. And not every system's ready to do that.
After we do the RFI, where we really separate ourselves I think for most programs, and this is to your exact point about looking for things that are harder to see. We do what's called a team assessment.
And a team assessment means we get on the phone with center representatives, including a surgeon, and start asking questions like, how do you decide if someone's appropriate for surgery? And many employers have heard me say this, but I can't say it enough. I have talked to many facilities where they are incredibly strong in their clinical outcomes, but what I hear the surgeon say is, I look at the medical records. I look at the imaging, perhaps they say, I follow my society's guidelines and I decide.
That many “I’d” is not what we're looking for in this program, we wanna hear both how a patient is involved in that process and there's a shared decision making going on. We also wanna hear about a multidisciplinary approach so that surgeons are being thoughtful.
It's amazing how quickly you can pick up on those things in just about a 45 minute phone call. And the other thing that really comes out in that discussion that's so important to our program, because it's travel based, we are working with a local home provider, a PCP, typically to support that patient before and after they go into the program.
[00:15:18] Stacey Richter: When you were talking about the PCPs there, does that mean PCPs back in the employer geography, or are those PCPs that are in the Center of Excellence that you're contemplating?
[00:15:28] Olivia Ross: No, this is a local physician. Typically it's a PCP that the patient has identified in their local market that they are willing to take the patient back and do their follow-up care after they go through the Center of Excellence program.
[00:15:42] Stacey Richter: So what we were talking about originally was, what are the requirements for the Center of Excellence? You listed, help me out here. They need to have volume minimums. They need to have certain standard quality scores. They need to be able to do the prospective bundles, they need to have a team assessment. Was that it?
[00:15:59] Olivia Ross: Yeah, so team assessment is what we call our step in the review process, the center selection process. But really what it comes down to is hearing from them, the two big things we're looking for there is commitment to appropriateness. And thinking about how they're working with a patient as well as other nonsurgical team members on that assessment and their openness and experience working with external clinicians and their sort of response to the model that we describe about working with a home PCP.
[00:16:27] Stacey Richter: Yeah, and that makes a ton of sense because I think it's becoming all the more clear. I mean, there's a study a day if you choose to look for them about the importance of a multidisciplinary approach.
Pick any chronic care condition, for example, but even in the diagnostic part of the patient journey, that requires or is so much better if you have different individuals of different experiences and different backgrounds who are weighing in.
And then exactly like you said, I mean, nobody knows the patient better than the patient. So any process that ignores a patient's help in the diagnostics, but then also their opinion on the selected treatment is surely not ideal.
[00:17:07] Olivia Ross: Yeah, and their preferences, their tolerance for pain, their job type and what their ability to take time off. I mean, all of these things are a factor in their decision making around the timing and the actual decision around treatment. And you would be, maybe you wouldn't be, but many people are shocked how infrequently those kinds of conversations are happening between patients and their surgeons.
Patient Journey and Communication
[00:17:29] Stacey Richter: Okay, so back to the very beginning of the process now, and this is something that has been discussed a lot and highlighted as an issue and I don't see a whole lot of solutions, and that is that patient is put on a trajectory. They go pick a place, any place, and they are told they need some kind of cardiovascular surgery or musculoskeletal surgery or pick something and then the patient goes and gets it.
And the employer finds out later, like, how are you intervening during the patient journey to ensure that these patients are communicated with ahead of time?
[00:18:08] Olivia Ross: That is always the challenge. Self-insured employers, biggest complaint often is that patients are unaware of the many benefits they offer to them, and that trying to get the word out is, can be difficult.
In our program, there's a couple of different things. One, of course, we promote it in open enrollment materials and around benefit design. You know, when they're describing in their summary plan design or if they go on their carrier website and search joint replacement, this information about the program will pop up.
We also share patient testimonials. So someone hearing from, oh, you're also a cashier at Lowe's who had their left knee replacement done at Johns Hopkins. I think I might be comfortable doing that myself now that I've heard from you. And so we do a lot around that, sharing testimonials, and some employers have chosen to do some targeted outreach.
So for example, based on a diagnostic someone had, or let's say they went through a series of physical therapy or had a MRI done, they can reach out with a postcard. Or if they have a concierge vendor, sometimes a concierge vendor will do direct outreach to patient upstream to make sure they're aware of this program, should they proceed towards surgery.
Unfortunately, the reality is many patients find out when they go to get a pre-authorization for the procedure and someone says, did you know the benefit is less than it would be if you went to a Center of Excellence? So the patient will be told that after someone told them they need surgery, which makes a discussion a little bit harder, and we can dive into how we handle that.
But I think we are looking for more and more opportunities to intervene upstream.
[00:19:39] Stacey Richter: And then you had mentioned you have some suggestions for how to best approach this conversation if the employee was told by their normal orthopod or whomever that they need a spine surgery and like, you know, has the surgery scheduled and they get all the way to that point and then they call in for the preauth or send in for the preauth.
So that's the point in their journey that they are like, you know, how do you treat a patient who thinks they're gonna have surgery next Thursday?
[[00:20:05] Stacey Richter: This whole thing, how do you insert yourself in the middle of an ongoing patient journey is a big deal to get it right because get it wrong and patients will not steer themselves over to your chosen, whoever.
Listen to the shows with Matt McQuide, listen to the shows with Dr. Christine Hale and or Dr. Eric Bricker [EP472] for deep dives into how to do this right. All these links will be in the show notes, but Olivia's comments that follow are also very, very instructive.]]
[00:20:32] Olivia Ross: It sort of differs by condition with joint replacement.
The Centers of Excellence are doing a direct review of the patient record, looking at the imaging, talking to the patient, sometimes talking to the PCP, and if what they determine is that surgery's not appropriate, they're communicating that back virtually. And they're also providing an alternative recommendation or guidance on why the surgery's not appropriate.
So sometimes the patient's never tried conservative therapy.
[00:20:56] Stacey Richter: When does this happen though? You've got a patient, they called in for a pre-authorization, they think they're getting surgery next Thursday. And what happens at that point? How do the patient records go? You know, are they told on the preauth? Nope. You know, like, we gotta go through this other process now. Or like, what does that look like in, in real life?
[00:21:16] Olivia Ross: Unfortunately, sometimes there is really just a full stop and they, it can be a little bit jarring for a patient to say, I thought I was going in for my surgery with Dr. Smith next week, and now you're telling me that I won't have coverage.
Again we do everything we can to avoid that, but in that event, and I would be remiss, and I should have noted them earlier, but I wanna take a moment to mention that we work with a really amazing third-party administrator that makes this program on a day-to-day basis possible.
They have the customer service team. So what I'm about to tell you more about. A nurse care management team, and they're handling the billing and claims adjudication, working directly with our centers on a day-to-day basis. And part of this process from selection on.
PBGH really leads the way in terms of identifying quality and working on continuous quality improvement with our centers. But the day-to-day operations really do require whether you're gonna do this as an employer on your own, or through a program like ours. A TPA, that understands how to use, do alternative payment, and understands these really specific needs of this patient population.
So in the event someone is told, “Hey, sorry, your surgery is denied.” They'll be given information about who they can talk to about the COE benefit and what the program looks like. And we have an amazing team of patient advocates that can really help diffuse the situation, explain to the patient, and oftentimes the the relief is that, oh, I'm not gonna get it paid for at home, but that means I'm gonna have no out of pocket. It's gonna be a 100% covered.
Someone else is gonna book my travel for me and make this as simple as possible. And there's this really high touch concierge feeling. That's not typically what patients are receiving in their local market. So we're are able to kind of smooth that process for some patients who are, and maybe it can be a little bit jarring at first.
And again, we do everything to limit the number of patients that have that experience. Usually they're hearing about it further upstream, but even in the event they aren't. We have a team of individuals helping make that process easier.
[00:23:13] Stacey Richter: If I'm a provider organization, especially if I'm in one of these markets where I've consolidated and I'm charging whatever I wanna charge as a hospital system, like why would I even contemplate this?
[00:23:24] Olivia Ross: To circle back briefly on the center’s selection process, that phone call gives us a chance to find out from a center, are you philosophically aligned that this and recognize that this is where the market is headed. And we can find out pretty quickly before we move on to, for example, once they get through the call, centers have to go through an extremely rigorous RFP process and an in-person site visit.
And it's interesting what we hear from our centers that oftentimes, even those who don't move forward, the process of going through a rigorous RFP review that asks about things like patient education, asks about things like multidisciplinary decision making. It's a chance for them to really evaluate their program and understand what's important to employers.
So we ask about, for example, do they collect patient reported outcomes on things like pain function, quality of life. Do they submit to a multi-institutional registry? And those are all aspects that we require in our program that providers that want to be ahead of the curve in terms of what employers are looking for and what patients are looking for, they value this process.
And of course many of them see, okay, great. I want to be selected because then I can use this as an opportunity to test my ability to, for example, provide an alternative payment option such as a prospective bundle. And we can give them a lot of coaching through that process. And it's also, of course, an opportunity for them to be public that they've been recognized for having made it through this gauntlet of center selection.
So going through that process allows them to both recognize and see where their quality potentially is failing or they need to improve it. So that's a huge win for them. Test alternative payment, which is where many providers are now recognizing the market is headed. And then the third place, and this is a very practical consideration, is in many markets it's difficult to shift to get additional local volume.
We're bringing them business from outside of their typical service area, so it's new additional patients that they typically would never have seen. So even at a more competitive price point, there's still an upside to them getting this new business.
[00:25:33] Stacey Richter: And you might have mentioned this before, but it's also becoming increasingly more noticed, let's say, that even within any given academical medical center or Center of Excellence, that there are physicians with varying levels of skill and performance.
So, if you identify a COE and you include them in your network, is it whoever the surgeon is or the physician is within that COE, or are you actually selecting like, I want you, you, you, and you, but not you guys?
[00:26:06] Olivia Ross: We are selecting specific surgeons. Even within the RFP process, one of the things that really differentiates our center selection is that we are looking for not just center level outcomes. So things like the readmission rate at the center level or their quality outcomes look like. We wanna know the same set of measures at the physician level.
[[00:26:29] Stacey Richter: They are selecting individual specific physicians by procedure. Think about that and now think about the billboards where entire hospitals are put on some number one list for broad stroke excellence and something or other. It's not just ECEN by the way, who has realized the sometimes wide quality variability between surgeons.
Seems like there's no magic trick where just like all surgeons attain exactly the same skill level because they all happen to work geographically proximal to each other.]]
[00:26:58] Olivia Ross: So for this specific position of the lumbar fusions that he or she did last year, how many of them had a surgical site infection? How many of them had to return to the OR?
And that is an incredibly important thing is to recognize that it's both the center and all different things about the center, including, you know, how their processes work, what their nursing staff looks like, are their scrub tech satisfied. I mean, all these things are crucial and why you need to really look at the center level, but then the performance of the individual surgeon and their commitment to this kind of program is the second half of that puzzle.
Continuous Quality Improvement
[00:27:35] Stacey Richter: I know that one of the things that you are doing is kind of managing quality improvement efforts in the, you know, the joint replacement space, spine care, and then I think bariatric surgery as well, as well as oncology centers. Like what are you doing there?
So is this something that you're collecting all this data from these Center of Excellence and obviously using it for the purpose that we've been talking about, but then there's also a broader element to this as well.
[00:28:02] Olivia Ross: Yeah, so we are both doing all this work on this upfront process, finding out our center's good and surgeons qualifying to be a part of the network. But once they're in the network, they are required and honestly are very enthusiastic about supporting and participating in continuous quality improvement.
And that means we're feeding back data to them about how their patients are performing, both in terms of outcomes as well as things like how long is it taking from the time we refer a patient to the time they're getting a decision about surgery.
So we're constantly helping them understand both from an operational perspective, how they're comparing to their peers so we can build opportunities for shared learning as well as then on the outcome side, we can look for opportunities if one center has far few patients having to have a return trip. Or they're having better flow in terms of working with PCPs or getting medical records sooner.
All those are opportunities for shared learning and allows us to raise the level of care across all of our centers.
The other thing that's so exciting that we hear from our facilities is the learnings from the Employers Centers of Excellence network are able to be applied to other aspects of the care they're providing to non ECEN patients. So things that they're learning, like the advantages of a follow-up call from a nurse, 24 hours postdischarge that they're doing with our patients. They're saying, wow, we're learning so much about this. We're keeping people from going to the ER. Let's start doing this for all of our patients.
So there's a really cool halo effect. I wanna bring up one thing that I didn't have the chance to dive into, which around appropriateness just briefly. Which is that in the spine care space in particular, what we see is over 50% of patients that are told locally to have surgery are reviewed by our Centers of Excellence and counseled against a surgical option.
And that is a, a huge number. And what we realized from the very beginning and credit to pioneers like Walmart, who began to develop this model and who we've been able to work with and expand it. Those patients have access to a comprehensive in-person evaluation to sit with the Centers of Excellence multidisciplinary team: so pain management, physical medicine, and the surgeon themselves to hear why surgery is not the best option, and to counsel them on what they can do instead.
And that is a critical element of this program in terms of the quality, the patient experience, and our outcomes because we wanna make sure those patients feel cared for and they also know what they should do if surgery is not going to help.
[00:30:27] Stacey Richter: You had mentioned the Leapfrog Group, which obviously is a nationwide, I think they're a nonprofit that was also founded by, I think it was GE Employers.
In any event, in order to measure, I think it started out more broadly, hospital quality. It's more become patient safety, but is anything that you're doing, does it overlap with them, you know, relative to appropriate care? As you said before, you know, any surgery that was done inappropriately is just not safe.
[00:30:56] Olivia Ross: We collaborate with a number of different organizations, including the great team at Leapfrog, to understand what metrics they're looking for in terms of determining their safety scores or their, you know, overall grades that they're giving to hospitals. We wanna make sure that we're in alignment with what they are hearing from employers is most important.
So I think the best opportunities for us is to continuously learn from each other about what criteria we both believe defines quality. We're able to get to a much more granular level than what they're doing on the Leapfrog side with the specific conditions, specific surgeons, etc.
But, it's a great opportunity for us and we frequently collaborate with folks like Leapfrog, or National Quality Foundation, other coalitions, specific employers who are doing initiatives on their own, again, to the extent possible, to drive consistent expectations for the providers who do want to succeed in these kinds of models.
[00:31:51] Stacey Richter: And is the Employees Centers of Excellence Network, you're kind of leveraging the buying power of all of the members of PBGH in order to establish the best pricing that you can get because of the volume of patients that are available there.
[00:32:08] Olivia Ross: So we're leveraging the combined influence of the employers who are participating in ECEN. So obviously having Walmart's, you know, million Plus Lives really helps us.
But other large employers like Lowe's and McKesson have really allowed us to approach the market. But we do open the program up to any employer. Pacific Business Group on health employers are given a slightly lower price point to access the program, but it's open to anyone and we are, as I mentioned earlier, really seeing more interest from smaller employers or regional employers with a concentration in, you know, one specific area that maybe aren't a good fit for our national initiatives at the PBGH level, the Pacific Business Group on health level but could be a participant in ECEN.
So what it takes, and anyone, I encourage anyone to reach out to me, I'm happy to talk more. But what it takes is to join the Employers Centers of Excellence Network through a contract, a single contract with our TPA partner Health Design Plus.
So this is carved out from your regular medical plan offering sits right on top of it. You don't even have to change your normal benefit design if you don't want to. And through that single agreement, an employer can access our entire network, all conditions, all hospitals. We're maintaining those contracts with the providers to make sure they're staying competitive, to make sure that they are continuously evaluated in terms of which surgeons are approved, etc.
If we're doing all that backend management and a single contract gets you access to all of that, as well as the customer service, nurse care management, claims adjudication and billing, reporting, etc.
What we heard from employers is to do this, it needs to be straightforward, as you know, as simple as possible, and all the ideal situation is under one roof.
So that's really what we've created with this program.
Conclusion and Final Thoughts
[00:33:56] Stacey Richter: Olivia, I thank you so much for being on the Relentless Health Value Podcast today.
[00:34:00] Olivia Ross: I really appreciate the opportunity to talk with you, Stacey. Thanks so much.