EP453: Running a TPA (Third-Party Administrator) RFP Process That Is Less of a Wild West Fiduciary Shootout, With Claire Brockbank

[00:00:00] Episode 453, Running a TPA Third-Party Administrator RFP Process That Is Less of a Wild West Fiduciary Shootout.

[00:00:20] American healthcare entrepreneurs and executives you want to know talking, relentlessly seeking value.

[00:00:29] TPA stands for Third-Party Administrator RFP stands for Request for Proposal.

[00:00:35] I'm kicking off the show today with a review that we got recently on Apple Podcasts, and not just because it's a really nice review.

[00:00:42] It's because it's relevant on about nine levels to the show today with Claire Brockbank from 32BJUnion,

[00:00:48] which is all about contracts and the importance of using your own paper for contracts during the RFP process.

[00:00:54] Here is the review.

[00:00:56] I'm the CEO.

[00:00:57] This is the review talking.

[00:00:59] I am the CEO of a large senior living company who has always geeked out on Medicare payment innovation,

[00:01:06] but was bored and disengaged from our own health insurance spend on a self-funded plan.

[00:01:13] It wasn't until I listened to several episodes of Relentless Health Value that were focused towards C-suite audiences that I began to understand that population health and the triple aim should be viewed in all aspects of insurance and health coverage.

[00:01:28] I have since consumed the show frequently while driving my health insurance brokers crazy with questions and accountability.

[00:01:35] The show has not only given me the knowledge that has created confidence in guiding our strategy, but has given me the actual tools to be able to make impactful change.

[00:01:46] I have reached out to several experts interviewed to utilize their services and ideas and have been able to use the CAA, Consolidated Appropriations Act, details to get transparency from my vendors.

[00:01:56] Thank you for giving me what I need to provide the best possible care at reasonable prices for my coworkers and get beyond the insurance noise and smoke screens to understand the opportunities at hand.

[00:02:09] Thank you very, very much.

[00:02:11] This review in and of itself, I'm going to say is kind of a crib note for C-suites for the why, the what and the how to think about their health plan.

[00:02:20] And population health and the triple aim and getting reasonable, affordable prices really should be viewed in all aspects of insurance and health coverage.

[00:02:29] Otherwise, there's 160 million Americans with commercial insurance right now who are not going to get the aforementioned.

[00:02:35] Now, you know what they say.

[00:02:37] A small key can sometimes open a very heavy door.

[00:02:40] In this metaphor, the door is population health at an affordable price for plan members that's just discussed.

[00:02:46] The small key we're talking about today is what's going on with the plan at the contract level.

[00:02:52] What's in those contracts that the plan sponsor is signing?

[00:02:56] In particular, the one with the TPA or ASO or carrier terms I'm kind of using interchangeably here.

[00:03:03] One guest on Relentless Health Value after another has said this about the importance of the contracts the plan sponsor is signing.

[00:03:10] Paul Holmes, Andreas Meng, Cora Opsal from last week.

[00:03:14] It's the contracts that give a plan sponsor the rights and ultimately the power to get the rates they're looking for.

[00:03:21] And also is a big leg up to get the quality and population health they may be seeking.

[00:03:28] Nothing for nothing.

[00:03:29] Because contracts give access to the data needed to get plan members to the care settings that are quantitatively the best.

[00:03:37] But now I'm going to say a hard truth.

[00:03:39] The stuff that Cora Opsal talked about last week, what Claire talked about this week,

[00:03:43] what the CEO who wrote the review above was saying.

[00:03:46] And I have talked to plenty of plan sponsors with lots of grievances about the downstream impacts of what basically goes back to a bad contract.

[00:03:57] And once that bad contract is signed, there's not a whole lot that can be done to fix whatever egregious things are going on as a result of that contract.

[00:04:06] But one example, and Cora and Claire talked about this, it's about how allowing upside down payments, for example,

[00:04:14] that are in a lot of ASO contracts, this allowing of upside down payments.

[00:04:19] I mean, it turns out that 32BJ spent, I think, $10 million paying more than the bill was for one year.

[00:04:27] If somebody signs that contract as handed to them by the carrier,

[00:04:31] then the plan is now contractually obligating themselves to pay more than the price the clinical practice was charging.

[00:04:37] Like, so Doc sends bill for $100 and the carrier pays that practice $200, right, on behalf of the plan sponsor.

[00:04:44] So now the plan sponsor is paying $200 for a $100 bill, right?

[00:04:48] I don't know.

[00:04:49] Is this conflict of interest?

[00:04:50] Is it imprudent?

[00:04:51] Is it not reasonable?

[00:04:53] Said another way, is that a bit of a fiduciary brief on the part of the plan sponsor?

[00:04:57] Question mark.

[00:04:58] So I get why the team at 32BJ pushed back and pushed back hard.

[00:05:03] I get why the leading edge of plan sponsors and more and more C-suites are hot-footing it into conference rooms to plan their RFP process

[00:05:12] and doing it in the way that Claire Brockbank talks about today.

[00:05:15] My name is Stacey Richter.

[00:05:17] This podcast is sponsored by Aventria Health Group.

[00:05:19] I will also say for an open source contract and some other free tools,

[00:05:23] please do head over to the 32BJ Insights website.

[00:05:27] There are links in the show notes.

[00:05:29] And with that, here is your episode.

[00:05:32] Claire Brockbank, welcome to Relentless Health Value.

[00:05:34] Hi, Stacey.

[00:05:35] Thanks for having me.

[00:05:36] We have had multiple people on this podcast who have said in more direct and indirect ways,

[00:05:44] but it all adds up to kind of the same thing.

[00:05:46] A lot of what can go right or what can go wrong will start with how the contract is written initially.

[00:05:53] What happens is you get a contract and often that contract comes from the TPA or the ASO,

[00:06:01] depending on what term you use.

[00:06:03] And it's based on what they want in terms of the rights they have as opposed to what you want.

[00:06:09] And very few of us have contracting expertise.

[00:06:12] So we accept the language and later find out whenever we're trying to do something different

[00:06:18] that, in fact, we can't because we forfeited our rights on the footnote on page 78 of the contract

[00:06:26] and didn't know that.

[00:06:28] So it's a very easy thing to have happen.

[00:06:30] And that is exactly what we discovered when I went to 32BJ.

[00:06:34] But I would say that 95% of employers around the country are in that situation where they

[00:06:39] don't have the expertise, the time, the experience to really look at their contracts.

[00:06:45] So they defer to their TPA.

[00:06:47] And let's kind of talk a little bit or dig into the why, putting the time and effort in

[00:06:51] to understand exactly what you just said, like the terminology and really sitting down

[00:06:55] to do this right.

[00:06:56] So if I don't, maybe let's take the negative case example, if I don't do the contracting

[00:07:02] right, what happens?

[00:07:05] So what happens is that you tie one hand behind your back with respect to being able to innovate.

[00:07:12] You'll find out down the road that perhaps you have no ability to exit a program that your

[00:07:21] vendor offers, even if you find a better alternative.

[00:07:24] One of the things we learned at 32BJ was that we were paying a lot of what we call upside down

[00:07:31] claims and we couldn't do anything about it.

[00:07:34] So you find out as you're moving down that innovation pathway, just how little you can do.

[00:07:41] Maybe most fundamentally is that generally speaking, your contract will tell you that you

[00:07:47] don't own your data.

[00:07:49] Now, CAA requires that you look at your data.

[00:07:52] But if you seed that right in your contract, you have seeded that right.

[00:07:58] And so that's probably the starting point.

[00:08:00] But from there flows so many decisions that you as a responsible administrator might be wanting

[00:08:06] to consider from direct contracting to outside programs to changing your network and any one

[00:08:14] of a number of other examples.

[00:08:15] Taking through the points that you made, it really can curtail your ability to innovate,

[00:08:20] for example, and incrementally improve upon that innovation.

[00:08:24] Like maybe you realize that somebody's point solution or somebody's way that they're solving

[00:08:28] something, i.e. the ASOs is potentially not the best way.

[00:08:31] You have your own idea for how you want to do that.

[00:08:34] I mean, one of the reasons why you became self-insured was so that you had flexibility

[00:08:37] to be able to do the things that you wanted to do only to discover you can't.

[00:08:41] You gave away those rights.

[00:08:42] That was the first thing that you said.

[00:08:44] The other thing is upside down claims.

[00:08:47] You're kind of beholden to them.

[00:08:48] An upside down claim is the clinical organization charges $100 for something.

[00:08:54] The negotiated rate is $400 for that same thing.

[00:08:58] And then the plan pays the $400, which you're like, how often does that happen?

[00:09:03] And Claire, you probably know better than me, but it seems to be happening quite a bit.

[00:09:06] There's a lot of money that gets, I'm going to say, wasted because there's no lesser of.

[00:09:12] In other words, the plan is going to pay the lesser of.

[00:09:15] Exactly.

[00:09:16] When we looked at our claims, we found that that amount was in the millions for us.

[00:09:21] A significant number.

[00:09:23] That's an amount of money that we could save without any friction on our members or any disruption.

[00:09:30] Simply saying, we'll pay the provider what he or she has billed us for.

[00:09:36] Certainly pay them that full amount, but not more.

[00:09:39] And we are not able to do that under the terms of many contracts.

[00:09:44] Which is just crazy.

[00:09:45] So, you know, right there is millions of dollars that could be saved exactly like you just said.

[00:09:50] I mean, there's no disruption, if we want to use the disruption word, on plan members at all.

[00:09:56] It's just the plan is paying the amount that the provider was willing to charge.

[00:10:00] So the two things that we talked about so far is it limits plan flexibility to do innovation,

[00:10:05] to do things that the plan would like to do based on what it knows about its own patient population.

[00:10:10] Paying upside down claims becomes something you're contractually obligated to do as a plan.

[00:10:15] There's issues with the data, like what do you own?

[00:10:18] What don't you own?

[00:10:19] It's constantly a conversation that shouldn't, you know, like how much time can we waste having conversations about data that you're supposed to own just like flat out.

[00:10:27] You might want to do some direct contracting that you're unable to do.

[00:10:30] The whole network, you're beholden to third party contracts.

[00:10:34] And Cora Opsal was on the podcast from 32BJ earlier talking about just the issues that can crop up there.

[00:10:42] If we were just kind of going to quantify how much could potentially be saved by doing contracting right, do you have any assessments?

[00:10:51] You know, we tried to quantify that just with a few key items.

[00:10:55] Some of the things we haven't talked about include some of the itemized bill reviews and claim savings, some of the payment integrity that Justin Leder on your show has spoken about.

[00:11:05] But we came up with some projected savings that were close to between 75 and $100 million.

[00:11:12] Now, you can't necessarily reap all those savings, right?

[00:11:16] But it's real money.

[00:11:18] It's very, very real money.

[00:11:20] And as an example for some context on that, we saved about $30 million, eliminating New York Presbyterian from our network.

[00:11:30] Our contract technically didn't allow us to do that.

[00:11:33] We had to push for that.

[00:11:34] So that money that I just gave you, the $100 million, doesn't include that.

[00:11:38] That's just a third of what you could save from some of these other, what I'm going to call mostly administrative options.

[00:11:46] So this is not like changing the couch cushions that we're talking about here.

[00:11:49] Like this stuff really matters.

[00:11:50] Today, what I would love to talk to you about, Claire Brockbank, is what could arguably or maybe inarguably be considered the best way to really take the power back relative to contracting terms, which is to do an RFP, a request for proposal that starts with your contract, as opposed to starts with the vendor's contract that now you're trying to edit their contract.

[00:12:15] The best way to do this is start with your own.

[00:12:18] So why don't we begin at the beginning?

[00:12:22] How would you describe how this process starts and kind of like what you're doing?

[00:12:26] In a typical process of going out to find a new TPA, you put a set of questions together about all the things you want that TPA to do for you, what services they offer, a very typical RFP.

[00:12:38] And that's a fine process to have.

[00:12:40] A broker or consultant might help you with that.

[00:12:43] But what happens is that the salespeople answer those questions, right?

[00:12:48] You go through the whole process of getting an approval from your board or whatever your decision making process is.

[00:12:54] And then you go and you start the contract.

[00:12:57] And then the lawyers get involved and they say, well, the sales guys didn't have it quite right.

[00:13:03] By that time, you've fallen in love with your solution.

[00:13:06] It's a difficult process to go through an RFP and you're stuck.

[00:13:10] You've lost all your power.

[00:13:13] Typically, what winds up happening, the plan sponsor is talking to someone on the sales side.

[00:13:18] The salesperson may enthusiastically agree that certain things could potentially be done that the plan sponsor wants.

[00:13:28] Then the process continues into the lawyer phase.

[00:13:32] And it actually turns out that maybe some of the things were a little bit overpromised, etc.

[00:13:37] Like welcome the real world.

[00:13:40] And here we are.

[00:13:41] And sometimes that contracting process is still going a full year into implementation.

[00:13:47] There's a timing issue also.

[00:13:49] You're trying to implement a program because you have a deadline and you're doing the contract.

[00:13:54] You're always triaging, right?

[00:13:57] And so the contract often gets a little bit of short shrift.

[00:14:01] Got it.

[00:14:02] Okay.

[00:14:02] So as opposed to that, what do you recommend?

[00:14:06] You want to get everybody in the room at the same time when you're making these decisions.

[00:14:11] So we send out the RFP and send out your contract at the same time and say, in order to accept your RFP response, you have to send us a redlined version of the contract.

[00:14:52] Okay.

[00:14:54] So you have to do that.

[00:14:56] And then you have to do that.

[00:14:58] And then you have the response from all participants at the same time.

[00:15:01] so all the respondents are also together in that metaphorical room.

[00:15:06] You know, you do it simultaneously so that as the decision is being made,

[00:15:10] you're looking at all of the RFPs, all of the red lines from all of the companies together.

[00:15:16] Do it simultaneously so that as the decision is being made, you're looking at both.

[00:15:22] You know you're not going to get your full contract,

[00:15:24] but then make the vendors justify why they're not giving you something that you want.

[00:15:31] You also have an opportunity then to put in place everything you want in the contract

[00:15:38] to have a parallel question in the RFP.

[00:15:41] We call them Easter eggs, right?

[00:15:43] So you can find where those parallel questions are.

[00:15:47] You as the purchaser know that.

[00:15:49] But it allows you to say, okay, well, your sales guy said yes to this,

[00:15:55] but your lawyer said no to that.

[00:15:59] They're the same things.

[00:16:01] Would you like to reconsider?

[00:16:03] And so you can have a conversation and get those discrepancies out,

[00:16:07] but it gives you a great negotiating point when you do that.

[00:16:11] So the long and the short is you send them out together.

[00:16:14] You get the responses back at the same time,

[00:16:17] and you are both seeing what they said in common,

[00:16:21] but also doing some compare and contrast.

[00:16:23] So you know just what you will and won't get before you make that final decision.

[00:16:29] So send them out together.

[00:16:30] You get them back.

[00:16:32] You can see what everybody's disagreeing to, what those terms are.

[00:16:36] But then the more interesting, potentially points of analysis, what I'm hearing you say, Claire,

[00:16:43] is, you know, what if one large ASO agrees to something,

[00:16:49] and then you have another one that doesn't agree to it,

[00:16:54] you're empowering yourself to be able to say in response to them saying,

[00:16:59] oh, we can't do it.

[00:17:00] No one can do it.

[00:17:01] You're saying, actually, that's not the case.

[00:17:03] Someone else can do it.

[00:17:04] Why can't you do it?

[00:17:05] I think it's the more...

[00:17:07] Exactly.

[00:17:08] And so normally when you do this without doing the contract,

[00:17:11] you don't know what all the other carriers will do in the end, right?

[00:17:15] But this gives you an amazing insight if you're typically all of the Bukas will respond

[00:17:21] to a decent-sized RFP.

[00:17:23] And so now you have in front of you what Aetna says they can do,

[00:17:26] what United says they can do, what Anthem says they can do contractually.

[00:17:31] And so we got the message all the time from one carrier or another saying,

[00:17:35] you know, it's just not industry practice.

[00:17:38] We totally get what you're trying to do,

[00:17:40] but it's not the norm and the industry's not set up for this.

[00:17:45] And it's quite delightful to go back and say,

[00:17:47] well, you're brethren.

[00:17:50] Some of them have agreed to do this, so let's talk about that.

[00:17:53] And then it becomes problem-solving as opposed to you having to say,

[00:17:57] oh, I didn't realize that.

[00:17:59] So it puts you in a very different position

[00:18:03] in terms of negotiating what it is that you want to do.

[00:18:07] I can really see that this helps flatten the asymmetrical information that typically exists.

[00:18:16] Because in normal circumstances,

[00:18:18] that is sufficient for an ASO to tell any given employer,

[00:18:23] like that given employer has done one contract every,

[00:18:27] however long the ASO term is, right?

[00:18:30] You know, with a limited number of carriers.

[00:18:33] And so basically if the ASO, if the carrier says,

[00:18:36] oh no, no one does that,

[00:18:38] the employer is in kind of a bad spot to do anything but say,

[00:18:44] okay.

[00:18:45] Exactly.

[00:18:46] But if you're getting all of this information simultaneously,

[00:18:49] then to a certain extent,

[00:18:51] the employer has as much or more information.

[00:18:54] Well, I would never say that because it's always asymmetrical,

[00:18:56] but has a leg to stand on.

[00:18:58] They have some amount of information where they can say,

[00:19:01] no, actually that's not true.

[00:19:03] You probably got some interesting responses

[00:19:05] because I can imagine that most who work at an ASO

[00:19:08] have never heard someone say that before.

[00:19:12] Absolutely.

[00:19:13] And they would say, well, who says that?

[00:19:16] Is that relevant?

[00:19:17] Or let's talk about whether you can do it.

[00:19:19] So, and they knew of course,

[00:19:21] that we had responses from across the spectrum.

[00:19:24] It just changed the dynamic of the conversation pretty dramatically.

[00:19:29] Now, you did say something as we were talking.

[00:19:32] Most of the, even the largest carriers will respond to,

[00:19:36] using your words,

[00:19:37] even a decent sized RFP.

[00:19:40] Do recognize that we are talking about 32 BJ here that has 200,000,

[00:19:44] I think, member lives.

[00:19:45] Do you have any thoughts on, you know,

[00:19:48] like I think if you're a very small,

[00:19:50] if you're some Bob's soda in a small town or something,

[00:19:55] like you may not have quite the scale to get a large carrier to respond

[00:20:00] if you have your own contract.

[00:20:01] Or what are your thoughts relative to like,

[00:20:03] how big you have to be?

[00:20:05] Or if there's other factors in play,

[00:20:07] relative to getting an ASO or a TPA to respond using your contract?

[00:20:13] That is a great question because of course we come from a position of

[00:20:16] privilege at BJ because of our size,

[00:20:19] but there's two different paths you can take.

[00:20:21] So the contract that we spent enormous amount of time and resources to

[00:20:26] develop,

[00:20:27] we'll make that available.

[00:20:28] And if you're Bob's soda,

[00:20:30] if you're aware of it,

[00:20:31] at least you can say,

[00:20:33] well,

[00:20:33] you redlined this for other purchasers.

[00:20:36] Why can't you give us the red lines you did essentially for them?

[00:20:40] Right.

[00:20:40] This was not a bizarre and unusual contract.

[00:20:43] So there's that.

[00:20:44] But plan B of course is always to use the resources you have at your

[00:20:50] disposal,

[00:20:51] but to be maybe go in with your eyes more wide open about a few key things

[00:20:57] that you want to tackle and pay attention to those.

[00:21:01] So you,

[00:21:01] you don't have to,

[00:21:02] you know,

[00:21:02] boil the ocean,

[00:21:04] but every step you take forward is progress.

[00:21:06] Yes.

[00:21:06] You 32 BJ,

[00:21:08] and this is really cool that you guys have chosen to do this.

[00:21:11] You are making the contract that you wrote open source.

[00:21:15] So if anyone is interested in seeing what you did,

[00:21:19] we'll put a link in the show notes to where that contract can be found.

[00:21:23] So that's certainly one thing that even a small self-insured employer may be

[00:21:27] able to do,

[00:21:28] i.e.

[00:21:29] get ahold of that contract that 32 BJ is making available and using it as at

[00:21:35] least a leverage point.

[00:21:36] And,

[00:21:37] you know,

[00:21:37] again,

[00:21:37] that carrier may say,

[00:21:39] well,

[00:21:39] I'm not going to do this whole thing,

[00:21:40] but it does enable,

[00:21:41] as you just said,

[00:21:42] Bob Soda,

[00:21:43] any smaller employer to be able to focus on,

[00:21:46] well,

[00:21:47] these are the three things very specifically that I want.

[00:21:50] And then the negotiation,

[00:21:52] the conversations around those priority things.

[00:21:54] Did I get that right?

[00:21:55] You did.

[00:21:56] Absolutely.

[00:21:57] I think there's one other thing and that's be savvy about most employers use a

[00:22:01] broker or a consultant and there's deep loyalty to those brokers and

[00:22:06] consultants,

[00:22:07] but ask the question of your,

[00:22:09] your broker,

[00:22:11] ask for that 408 B2 technical term,

[00:22:15] but ask for that disclosure probe deeply as to where else that broker

[00:22:20] consultant is getting money.

[00:22:22] Will they make a little extra because they've hit a bonus threshold?

[00:22:26] If they place you with one TPA over another,

[00:22:30] do they get commission streams for some of those ancillary services?

[00:22:34] Really probe on who they are accountable to and or beholden to.

[00:22:40] Make sure you ask those questions and hopefully loyalty to your broker or

[00:22:46] consultant proves to be well-founded,

[00:22:48] but you might be surprised how often there are conflicts.

[00:22:53] And you again,

[00:22:54] know those conflicts so that you can manage them as a savvy buyer.

[00:22:58] Good advice.

[00:22:59] You know,

[00:23:00] if I want to even defend some of the ABCs and brokers out there,

[00:23:04] some of them work for company,

[00:23:05] like they don't even know sometimes what their company is doing.

[00:23:08] This is a whole can of worms and topic unto itself.

[00:23:12] There's a lot going on.

[00:23:13] Be really aware of it.

[00:23:15] And if you bring up the idea potentially of like doing something like this and

[00:23:20] it's a bit of a litmus test,

[00:23:22] if your EBC or broker tries to shut it down without much conversation,

[00:23:25] that probably tells you more than almost anything else.

[00:23:29] Exactly.

[00:23:29] If your broker starts to say,

[00:23:31] I call it the D word disruption.

[00:23:34] If your broker starts to say,

[00:23:36] that's going to be really disruptive and starts to scare you about how this might play out for your employees,

[00:23:44] that should be a red flag to you.

[00:23:46] That is just a magic word for anyone in the industry to say,

[00:23:52] to put a halt on change.

[00:23:54] There's some quote,

[00:23:55] I'm going to butcher it.

[00:23:56] It's something like,

[00:23:57] listen to what they're telling you.

[00:23:58] They are telling you what's going on.

[00:24:01] Listen.

[00:24:01] Listen.

[00:24:01] There's just like a lot of factors here that I think that the self-insured employers

[00:24:06] who are really knowledgeable about what's going on are fully aware of.

[00:24:12] And certainly the benefit consultants,

[00:24:14] et cetera,

[00:24:14] who are listening to this show are even more aware of.

[00:24:17] So I'm a self-insured employer or even I'm an employee benefit consultant.

[00:24:21] It is walking into a shark tank here.

[00:24:23] You know,

[00:24:24] to start this process is really to throw hands.

[00:24:28] These are fighting words.

[00:24:29] Who can I rely on to help me?

[00:24:32] How do I ensure that I have the expertise on my side to be able to pull this off successfully?

[00:24:39] I think what you're trying to do,

[00:24:41] this is true of any change in healthcare,

[00:24:43] you're trying to stack the deck in your favor.

[00:24:46] And that's the best you can do.

[00:24:48] You talked about a level playing field and said,

[00:24:50] well,

[00:24:51] you know,

[00:24:51] it's hard to imagine it ever being level.

[00:24:53] So first you're thinking about whether you're going to use your own contract or our open source contract.

[00:24:59] You've talked to your broker.

[00:25:00] Hopefully just by saying you're paying attention,

[00:25:03] they are a little more attuned to it.

[00:25:06] And then think about your kitchen cabinet of people,

[00:25:09] if you will,

[00:25:11] that help you.

[00:25:12] And again,

[00:25:13] knowing their biases.

[00:25:14] So you're managing those biases.

[00:25:16] But to your earlier point,

[00:25:17] Stacey,

[00:25:18] you should have an attorney.

[00:25:19] The other thing that I think we underestimate is there are more employers and organizations starting to think about this than ever before.

[00:25:29] When I tried to do this five years ago,

[00:25:31] I couldn't,

[00:25:31] I felt like I was a lone voice in the wilderness.

[00:25:33] But now there are coalitions.

[00:25:36] There are groups like the National Alliance,

[00:25:39] Health Transformation Alliance,

[00:25:41] Purchasing Business Group on Health,

[00:25:43] who are all starting to pool their voices and find some sounding boards.

[00:25:48] Do some,

[00:25:49] have you seen this?

[00:25:50] What have you thought about that?

[00:25:52] Who responded really well?

[00:25:54] That kind of thing,

[00:25:55] right?

[00:25:55] It's using your network.

[00:25:56] And so that you have a few people helping you,

[00:26:00] coaching you,

[00:26:02] reminding you,

[00:26:03] and validating that it's what you're asking for is reasonable.

[00:26:07] So some of that is just finding some people and they're out there.

[00:26:11] If you listen to your podcast,

[00:26:13] Stacey,

[00:26:13] you could jot down a dozen people right off the cuff that you could probably call and ask for help with.

[00:26:20] I love how you're saying put together your kitchen cabinet.

[00:26:24] Julie Selesnik,

[00:26:25] when she was on the show,

[00:26:26] also talked about this,

[00:26:27] you know,

[00:26:27] in the context of a fiduciary committee,

[00:26:29] the whole idea being,

[00:26:31] get the right people with the right expertise who know a lot about this.

[00:26:36] And maybe you can pull from the coalitions for sure.

[00:26:38] Listen to the show there.

[00:26:39] I totally agree with you.

[00:26:40] There's a lot of very smart people who could add a lot of value into a formal or informal kind of board of advisors,

[00:26:48] advisors,

[00:26:48] if you will,

[00:26:49] you know,

[00:26:50] or RFP board of advisors that can work together.

[00:26:53] So the two things can happen.

[00:26:54] You know,

[00:26:55] number one,

[00:26:56] that this can be done as efficiently as possible,

[00:26:58] but also number two,

[00:27:00] so that you have the support network and the sounding boards to maintain your confidence that you're going down a good path and that you are doing the right thing.

[00:27:10] Because if you're talking to people all day who are telling you you're nuts,

[00:27:15] you sort of need your own people who are patting you on the shoulder and keeping your confidence and your inspiration up to move forward.

[00:27:24] I think there's one other thing too,

[00:27:26] Stacey,

[00:27:26] and that's it right now.

[00:27:28] I wish this weren't true,

[00:27:29] but this is still unusual.

[00:27:31] There's a cadre of people there.

[00:27:33] You know,

[00:27:33] they're your people who are listening to your podcast.

[00:27:35] And most of us have a sort of evangelical zeal about this.

[00:27:40] So this is the time to ask for help.

[00:27:42] I reach out to people that I hear on your podcast or on Dave Chase's material,

[00:27:47] wherever.

[00:27:48] And because there's still a relatively small cadre,

[00:27:52] nobody will not offer to help.

[00:27:54] So take advantage of that.

[00:27:56] So on the one hand,

[00:27:57] it's a drag being part of a minority trying to change something.

[00:28:01] But the silver lining part of that is there are fellow travelers out there who would like to see the crowd get bigger.

[00:28:08] I love how you put that.

[00:28:10] That is so inspirational.

[00:28:11] And it is a large reason why I started talking about the Relentless South Valley tribe,

[00:28:15] because this is a community of very dedicated,

[00:28:18] driven individuals who are trying to do the right thing.

[00:28:21] And to your point,

[00:28:22] I have heard any number of people say exactly the same thing,

[00:28:25] which makes my heart just so warm in the sense that there are so many people who are so willing to be helpful.

[00:28:34] And if when embarking upon a process like this,

[00:28:37] having that community surrounding you can make really,

[00:28:41] really all the difference.

[00:28:42] And I think sometimes we...

[00:28:43] I'm so glad that you brought that up, Claire,

[00:28:45] because I think sometimes that is forgotten.

[00:28:47] And then both for IQ and EQ reasons,

[00:28:52] people can feel lost and alone.

[00:28:54] And that's never a good place to be.

[00:28:56] Something that you had said earlier,

[00:28:58] I also just want to highlight here,

[00:29:00] especially relative to the attorneys that someone may be using.

[00:29:05] It's really important to ensure that anyone on the team,

[00:29:08] including the attorney,

[00:29:09] we're kind of coaching them to think outside the box,

[00:29:11] because especially in a profession such as the law,

[00:29:14] and you definitely want a lawyer who's worried about precedent, right?

[00:29:17] So like cast a no shade here,

[00:29:19] but you may get the this is not how it's done comments.

[00:29:22] Do you have any advice there?

[00:29:24] Oh, that is a great point, Stacey.

[00:29:26] And we worked with an amazing attorney

[00:29:29] who had a depth of experience in healthcare,

[00:29:31] but that was exactly the initial response we got.

[00:29:35] But we spent some time describing what we were doing

[00:29:38] and why and what our thinking was behind it.

[00:29:42] And she became such an ally and an advocate

[00:29:45] to the point where sometimes we had to say,

[00:29:47] it's okay to let go of this one,

[00:29:49] but we had to educate her

[00:29:51] because it's a different way of thinking.

[00:29:53] And so it's not that she was opposed or anti

[00:29:57] or co-opted by the industry.

[00:29:59] You might find that,

[00:30:00] but in our case, at least,

[00:30:02] it was just a different way of thinking.

[00:30:04] And so just because your attorney has been really great

[00:30:07] at ERISA and detailed contract stuff,

[00:30:10] they may not be questioning the fundamental drivers

[00:30:14] of healthcare and that dynamic, right?

[00:30:17] And so if you stop and say,

[00:30:19] we're doing something different,

[00:30:21] and this is why,

[00:30:22] it's really, really important

[00:30:24] because you will then get a read

[00:30:26] on your attorney earlier in the process.

[00:30:28] And then again, you have to decide

[00:30:31] at least knowing the biases are really important

[00:30:34] and or deciding that the biases are too great

[00:30:36] and you need somebody different.

[00:30:39] So if we're kind of recapping

[00:30:40] where we are in this conversation,

[00:30:42] the stepwise approach here is

[00:30:45] as you enter the RFP season,

[00:30:49] if you will,

[00:30:49] try to start with your own paper

[00:30:51] because if you write your own contract

[00:30:52] and then get respondents

[00:30:54] to edit what you have,

[00:30:56] then you have all of the advantages

[00:30:58] that we talked about earlier.

[00:31:00] You can get an example contract

[00:31:02] from the 32BJ website

[00:31:03] as at least a starting point.

[00:31:05] And again, we will link to that in the show notes.

[00:31:07] From there,

[00:31:08] you definitely want to be assembling

[00:31:10] a kitchen cabinet to help you.

[00:31:12] And that could be formal,

[00:31:13] it could be informal, right?

[00:31:15] It could be some variation

[00:31:16] of the fiduciary committee

[00:31:17] or some kind of board of advisors

[00:31:19] that you have assembled

[00:31:20] to help you through this process.

[00:31:22] It also should probably include an attorney

[00:31:26] and probably some other job descriptions.

[00:31:28] And you're going to rely on them for IQ,

[00:31:30] but then also for inspiration

[00:31:33] and emotional support.

[00:31:35] In addition,

[00:31:36] you may be able to get help

[00:31:37] from coalitions and others.

[00:31:39] What does good look like, right?

[00:31:41] Like, so say I am large or small

[00:31:44] and I actually go down this route.

[00:31:46] What do I consider,

[00:31:48] especially first time out?

[00:31:49] What is success?

[00:31:50] How does it appear?

[00:31:51] That is a great question.

[00:31:53] And my team always laughs at me

[00:31:55] because I'm always telling them,

[00:31:57] don't let perfect be the enemy of good.

[00:31:59] You won't get all of what you ask for.

[00:32:01] You may get a third of what you ask for.

[00:32:04] But I think some of your speakers

[00:32:06] have talked about each concession

[00:32:08] that is made to you as a purchaser

[00:32:11] is a step down the path.

[00:32:13] So be happy with a third of it if you want.

[00:32:15] You've sent the message

[00:32:16] to the vendor community

[00:32:18] that you are paying attention.

[00:32:19] This is an incremental process.

[00:32:22] You know, you are trying to change the dynamics

[00:32:24] of what, 20% of our economy.

[00:32:26] But what I would also really stress,

[00:32:28] it would be good for you to do

[00:32:30] because it'll help you measure your progress.

[00:32:32] We have maybe a dozen bullet points

[00:32:35] of things that we weren't getting

[00:32:37] that our contract limited us to.

[00:32:40] And we sort of tracked

[00:32:41] what we ended up with.

[00:32:43] We did focus on what we didn't get,

[00:32:45] but we said,

[00:32:46] wow, we have full data ownership now.

[00:32:48] We have this, we have that.

[00:32:50] So celebrate your victories.

[00:32:52] But also know you just are only going to get

[00:32:54] a portion of them.

[00:32:55] But next time around, you'll get more.

[00:32:57] And because you got a portion of them,

[00:32:59] the next employer will get that one easily,

[00:33:02] more easily, and they may get a new one.

[00:33:04] So just think of it as very, very incremental.

[00:33:07] I love how you said that.

[00:33:09] This is not going to be like,

[00:33:11] we're going to take the mountain

[00:33:12] in the next five days.

[00:33:14] This is more of a,

[00:33:15] it's a little bit of a slog.

[00:33:16] It's incremental.

[00:33:17] This year we get this.

[00:33:19] And it also is one of those

[00:33:21] tipping point kinds of things

[00:33:23] where if people are around you,

[00:33:24] if other employers are,

[00:33:25] if everyone starts to ask for the same things,

[00:33:27] then it becomes easier for everybody.

[00:33:29] So it's kind of a bit of a common good thing.

[00:33:31] And I'm also thinking back here

[00:33:34] to what you said at the top of this conversation

[00:33:35] relative to like focus on the three things.

[00:33:38] So what it also enables you to do

[00:33:39] is really have a clear eyed vision

[00:33:43] at the really important things

[00:33:45] that you want to focus on

[00:33:47] and pay attention there.

[00:33:48] So you may not get everything,

[00:33:50] but as long as you get some portion

[00:33:51] of your really important things,

[00:33:53] it actually could have an outsized impact

[00:33:55] on what you're trying to do with your plan.

[00:33:59] Claire Brockbank,

[00:34:00] is there anything I neglected to ask you

[00:34:02] that you think is important to add here?

[00:34:04] I think there's one other thing,

[00:34:06] and that's that as a strategy person

[00:34:08] and as the person who likes to commit to change,

[00:34:10] you get to that contract and you think,

[00:34:12] all right, what do we do next?

[00:34:14] But you can't stop there.

[00:34:15] So it's really important.

[00:34:17] You've gotten this change, right?

[00:34:19] In your purchasing relationship with your ASO,

[00:34:22] and you are going to have to keep

[00:34:25] holding their feet to the fire.

[00:34:27] You're going to have to keep

[00:34:29] setting in place the milestones

[00:34:31] where you're going to double check

[00:34:32] that in the contract,

[00:34:33] you said you would do this.

[00:34:35] Are you doing it?

[00:34:36] Especially the things

[00:34:37] that maybe you had to dicker over, right?

[00:34:40] You have to police this.

[00:34:41] They are not going to

[00:34:42] because they're not vested.

[00:34:44] Many of these things,

[00:34:45] they don't particularly want to do.

[00:34:47] So it's really important

[00:34:48] to not stop just before the finish line,

[00:34:51] if you will.

[00:34:52] And I definitely hear you,

[00:34:54] you know, because additionally,

[00:34:55] this might be something

[00:34:56] that that carrier ASO

[00:34:57] doesn't typically commit to.

[00:34:59] So trying to rely on their internal processes

[00:35:02] to make sure that your contract

[00:35:04] is adequately adjudicated

[00:35:06] as per the terms of the contract,

[00:35:09] you can see how that might be an issue.

[00:35:11] Even with the best of intention.

[00:35:13] So they're committed to it,

[00:35:15] but you're right.

[00:35:16] It's that these are not typical processes.

[00:35:18] It gets turned over to the ops team.

[00:35:20] They didn't understand what was going on.

[00:35:22] So you have to,

[00:35:24] A, you have to engage in a partnership.

[00:35:25] You've picked a partner.

[00:35:27] It shouldn't be an adversarial relationship,

[00:35:29] but you've picked a partner

[00:35:30] and you've asked them to do something different.

[00:35:33] So keep them honest.

[00:35:34] And this is just part of purchasing discipline.

[00:35:37] It is kind of interesting

[00:35:38] when we have these conversations,

[00:35:39] because if the purchase was for anything else

[00:35:43] besides health benefits,

[00:35:45] it wouldn't be a question

[00:35:46] from like the purchasing team

[00:35:48] over at the employer

[00:35:49] that obviously if they sign a contract

[00:35:52] with someone,

[00:35:53] that it's their responsibility

[00:35:54] as the customer

[00:35:55] to make sure that the vendor

[00:35:56] is delivering on the agreed upon contract.

[00:35:59] Do you know what I'm saying?

[00:36:00] So like, I guess how I,

[00:36:02] in a way would sum up

[00:36:03] the last point that you're making,

[00:36:05] which is a really good one,

[00:36:06] is that, you know,

[00:36:07] the customer has to,

[00:36:09] is part of ensuring

[00:36:10] that the agreed upon contract

[00:36:14] is fully delivered upon.

[00:36:16] Exactly.

[00:36:17] Claire Brockbank,

[00:36:18] where would you direct people to go

[00:36:20] for more information?

[00:36:22] And one of those links

[00:36:23] is going to be to the sample contract.

[00:36:24] But is there anywhere else

[00:36:26] that you would direct people?

[00:36:27] I would direct them

[00:36:28] to our 32BJ Health Insights website,

[00:36:32] where we have a number of tools

[00:36:34] for employers.

[00:36:35] You can reach out directly.

[00:36:36] And because again,

[00:36:38] as a fellow traveler,

[00:36:39] you will always have

[00:36:40] time and attention from us.

[00:36:42] Claire Brockbank,

[00:36:42] thank you so much

[00:36:43] for being on Relentless Health Value today.

[00:36:45] Thank you, Stacey.

[00:36:46] This was so exciting.

[00:36:46] I'm such a fan.

[00:36:48] This is Sean Grimminger,

[00:36:49] President and CEO

[00:36:50] of the National Alliance

[00:36:51] of Healthcare Purchaser Coalition.

[00:36:52] If you like this podcast,

[00:36:54] I strongly recommend subscribing

[00:36:56] and leaving a review.