Health Insurance Providers and Physician Groups: Working Together to Improve Patient Outcomes and Affordability with Matt Eyles Script

[00:00:01.320] Announcer:

America’s healthcare system is almost unanimously viewed as being unaffordable, dysfunctional and severely in need of transformation. APG President and CEO Don Crane talks with leading healthcare executives, physicians and other visionaries to explore solutions to lowering costs and improving quality of care by accelerating the movement toward value-based care models and away from fee-for-service. Want to be inspired by our nation’s foremost thought leaders in health care? Then this show is for you. Here’s your host, Don Crane.

[00:00:32.640] Don Crane:

I want to thank the TDC Group, the exclusive sponsor of our own APG on American Healthcare podcast. We’re glad to have you on board. TSC Group has been serving healthcare organizations and practitioners for over 40 years. They are the nation’s largest physician-owned provider of insurance, risk management and healthcare practice improvement solutions. They work with a range of large and small healthcare groups nationwide. TDC Group is endorsed by such well-known organizations as the American College of Cardiology and the American Society of Plastic Surgeons. To learn more, visit their web page, the TDC Group dot com.

[00:01:12.120] Don Crane:

We have seen over the years that the healthcare delivery system is a complex consisting of very different types of organizations, physician groups, hospitals and health plans to name just a few of the obvious ones. We all contract. We all work together with differing levels and types of collaboration. The delegated model is a good example of that kind of collaboration, where health plans perform various functions and physician groups perform various functions, but very much in partnership. I think it can be said that we co-own the model. As we embark on 2021 with a new Congress and a new administration, I thought it would make sense to check in with one of our chief collaborators. That is Matt Eyles, the CEO of AHIP. I wanted to hear and compare his views and the new administration’s agenda, the progress of the value movement, Medicare Advantage, equity issues and related topics. We had a robust conversation that I think you’ll like. Take a listen.


Matt Eyles, good to have you with us today. Really good to see you. Once upon a time, you spent some time with the Congressional Budget Office. There was a stint at Avalere Health. There was a stint at Coventry and Wyeth. And now you’re the CEO of AHIP and referred to in the press…I’ve seen it, a number of times Mattsism, American healthcare’s top lobbyist you’ve been designated and I hear you laugh a little bit.

So, I might quarrel with…I wouldn’t quarrel with the ranking, I would simply say that you’re far more than just a lobbyist in our view. So anyway, it’s really good to have you with us, and I’m looking forward to this conversation.

[00:03:03.300] Matt Eyles:

Well, thank you, Don. It’s great to be here. I’m looking forward to it, too.

[00:03:06.450] Don Crane:

So very, very good. Well, before we dive into some of our fun, meaty subject, tell us a little bit about AHIP.I know all about AHIP, of course, and I think most of our listeners do. But why don’t you go ahead and give us a little backdrop on your organization.

[00:03:22.140] Matt Eyles:

Sure. Thanks again, Don. So, America’s Health Insurance Plans, we are the national trade association representing really all health insurance providers. I think that’s probably what makes AHIP a little unique is that we have about one hundred and forty member organizations. We represent large national plans like Anthem, Cigna, Humana, Kaiser. We also represent Blue Cross Blue Shield plans. We represent local and regional plans. And like in your backyard out there, Don, so, L.A. Care, which focuses on the Medicaid population in L.A., has about two million members, is a member of our organization.

And so, we have a broad perspective. We also operate in all 50 states and US territories. So, you know, that also makes us a little bit different is that we’re really engaged both at a national federal level, but then also at a state level. We also include supplemental plan members. So, companies like AFLAC or Physicians Mutual in the Medicare supplement world. So, we span the range of health insurance providers and certainly make sure that we’re never bored or dull times at AHIP.

[00:04:44.370] Don Crane:

Yep. I’m sure your hands are full. So, the use of the word providers caught my ear. In other words, you’re not referring to yourselves as insurance carriers, but insurance providers. Did I hear that right?

[00:04:56.340] Matt Eyles:

Yeah, that is how we characterize ourselves. I think we’re providing insurance coverage and, you know, the industry has changed, I’d say, Don, so dramatically over the last decade or so. I think, you know, when I first worked at Coventry, it was right as the right on the cusp of the Affordable Care Act. And it was a very different industry back then. I think really the change in terms of the patient customer centricity, really connecting with consumers and the diversity of both coverage and services that insurers provide has made us rethink things a little bit.

[00:05:43.080] Don Crane:

Very good. Well, let’s dive into one of our favorite parlor games around here, and I think all across Washington, DC, actually, which is sort of handicapping or forecasting the Biden Administration healthcare agenda and really maybe also Congress with that. So, we are newly into the new administration post-election and so on. What do you guys predict in terms of MA and value movement and everything else? What do you see the agenda being?

[00:06:14.640] Matt Eyles:

Yeah, it’s a big agenda, Don, right? I mean, here we are, you know, in the second part of March now. And, you know, it’s I think, it’s important to think about it in a couple of different phases. Of course, everyone marks the start of a new administration with the first hundred days and what you’re able to do. But that’s really just the start of it. I mean, we think about sort of four broad priorities for this administration and certainly COVID and economic recovery being job one, two, and three.

But health ties into it in addition to social justice, immigration reform, affordability, coverage, and what they’re going to do on the regulatory side to try and undo some of the last administration’s efforts. And we have now new legislation that was just enacted, incredibly important, I think, especially for the country, with respect to not just economic recovery, but also in terms of coverage and coverage expansion. And, you know, how they implement some of these changes will be very important.

You know, looking ahead, whether it’s an infrastructure tax package, it’s not really entirely clear how the other health issues that are out there will factor into and when they will make it sort of onto the sort of top of the agenda, whether it’s issues around Medicare, issues with respect to prescription drugs. I think we’re in a little uncertain time period here, just not knowing what’s going to happen, especially with respect to getting through this package and working through the vaccine rollout.

I think if COVID has taught us anything, you know, over the past year, it’s just that we should expect the unexpected and we’re not really entirely sure how things will evolve. And if someone has a crystal ball and tells you that they can see into the future, you know, especially right now, I’d say maybe listen to them because they might be a little bit better at it right now.

[00:08:33.090] Don Crane:

Around here, we use tea leaves. You use crystal balls, huh? Yeah, no, it’s the most interesting environment. But let me swing into one area that’s maybe a little more concrete, and that’s Medicare Advantage, which is, of course, hugely important to both our organizations. So many of our members regard MA as really, in a way, their maybe favored business line in terms of the opportunity to deliver high quality. And it’s capitated certainly at the planned level and oftentimes sub-capitated. So, there’s much to like about Medicare Advantage. But what do you predict for the future of MA? And with that question, you can guess I’m sort of implying that there’s this talk about cuts to MA and the like to bring it into sort of parity with the original Medicare and so forth. So, what are you seeing there?

[00:09:28.290] Matt Eyles:

Yeah, I mean, I think we’ve been very encouraged that over the last several years in particular, that Medicare Advantage has become much more of a bipartisan program and it continues to grow significantly. We’re at now, I think, the latest report is, you know, 26, 27 million of Medicare enrollees are part of a Medicare Advantage plan. And I think that’s very encouraging because we know it provides better value, extra benefits, and I think just is a superior value proposition to the fee-for-service program.

So, I’m encouraged that it will continue to grow and that people’s perception has changed. But that said, there’s not without challenges. In the short term, we know where we’ve seen issues with respect to the so-called audio-only telehealth encounters and how that could impact the program for next year if some changes don’t happen. What the new administration’s perspective is going to be on the program and payments and it gets very wonky and detailed very quickly when you’re talking about risk adjustment and things like that.

But I do think that there is a bit of a misperception out there with respect to the cost of Medicare Advantage. And we’ve sort of written recently about some of the analysis that have come up from MEDPAC and others that we think aren’t really apples-to-apples comparisons, at least in terms of the fee-for-service program and Medicare Advantage. And we think it’s important that we set the record straight to make sure that when you’re comparing the two, that you do so on a level playing field.

I do think also that, you know, the partnerships between MA plans and physician groups and others, you know, will continue to grow and be strong. It’s a really important relationship and one that I only see getting sort of deeper and expanding over time.

[00:11:52.980] Don Crane:

So, you know, I agree with those observations. And, you know, we’re going to be working with you going forward. This we think of as a sort of a jointly-owned program, as it were. I mean, indeed, I think probably most people think of it as a health plan program, but we think of it as a physician group program. So, it’s really both. Right? I think and we’ll be working with you going forward.

So, this brings me to a tactical question. How bold of me to ask this in front of a big audience right now with you, but I want your advice. So, you recall we’ve looked at, I think, IHA’s studies that compare capitated delegated to fragmented PPO fee-for-service, right? We’ve talked about those. And in recent editions of the IHA Atlas it has become quite clear that at least in California, where these studies have been conducted, Medicare Advantage is vastly more efficient than original Medicare.

So, I think at the last data batch was I can’t recall twenty-seventeen or something…but in the last report as they compared total cost of care in Medicare Advantage versus total cost of care in original Medicare, this is in California with the data of, I think, 10 health plans, all the groups covering virtually all the Medicare law is so huge and very, very solid, solid study. And the result was shocking, which is to say that the total cost of care in MA was a whopping 35 percent lower than in original Medicare. You know, sort of pause, waiting for the applause or something. In other words, that level of efficiency, which we, of course, regard as proof positive that it’s a better model, certainly when we’re talking affordability. I’m not talking about quality or patient satisfaction or physician satisfaction, though we could get to that. But clearly, cost is a huge issue. So, here’s my here’s my question to you, Matt. We’re about ready to commission a redo of that work. And I actually wonder if it’s so good that we shouldn’t publicize it because there will be those in Congress and elsewhere, MEDPAC, that will quickly regard savings, lower total cost of care as being synonymous with profit.

And they will think that, yes, those profiteering medical groups and health plans, there they go again, robbing the poor coffers of American treasury. So, we have this sort of twin issue here. Good that there is such efficiency. Hey, we need more of this. Let’s put the pedal down. But are we inviting basically the argument that we’re overpaid? What recommendation do you have for me?

[00:14:48.540] Matt Eyles:

I think it’s…I think we need to lean into that one. It’s a better model. Second, that it demonstrates the benefits of partnerships and collaboration to get to a better outcome at a lower cost, and that what we want to do is to find ways to replicate that in other parts of the healthcare system. And what can we learn from Medicare Advantage and the superior model that we can port it over to other parts of the healthcare system? I mean, I think we’ll definitely need to be mindful of the notion that, well, then, if you’re so efficient, you can do it on less.

But you also need to recognize what else are we getting as a result of Medicare Advantage and the value that it creates and the supplemental benefits, I think, now have shown during the pandemic how incredibly valuable the program is. And we’re going to be putting out some research soon, too, that’s going to show that Medicare Advantage enrollees are faring better in terms of access to care during the pandemic than those in traditional fee-for-service. And I mean, that’s the way that I will go with this kind of work.

And we need to reward and incentivize this kind of efficiency in other parts of the system rather than looking at ways that, OK, let’s just cut this. Now, of course, there’s always going to be those that, you know, want to just focus on the bottom line of dollars. But I think the value that we’re able to deliver, I think the beneficiary and consumer stories…these are real life examples of how people are faring better because of the program that we’ll have to lean into.

[00:16:54.390] Don Crane:

So, I agree completely with what we’ve been saying to those that we’ve been talking with is that, look, to the extent that it’s more efficient and it generates more quote-unquote profit. Those profits are then used to enhance the benefits and also not just necessarily, you know, vision and dental and the like and maybe even handrails and the sort of social kinds of benefits that, you know, we’re seeing now with supplemental benefits, but also just more and better care management infrastructure and services and support.

And so, you know, it goes to better care for the beneficiaries, which, hey, everybody is what it’s supposed to be all about. So, just because it’s better…why would you get something that’s better for seniors. So, I think we’ve got a harmony going here that we’re going to need to really maximize on here in the coming months and quarters. I think I see MEDPAC, I see others, this talk about, you know, cuts to Medicare Advantage is frustrating, to say the least. I think so.

[00:18:04.320] Matt Eyles:

Yeah. And I think it is frustrating. And I think we just have to make sure that, you know, we’re being clear on how we’re comparing the different parts of the program and being very transparent about how we’re measuring cost, how we’re measuring outcomes. Because when you get down to it, I think the value proposition, it’ll be clear.

[00:18:32.520] Don Crane:

Yep, I agree. So, you hit on a word I want to shift to, if I may, and that’s value as in the value movement. How do you think it’s going?

[00:18:41.580] Matt Eyles:

Well, I’d say the pandemic, again, has shown that the importance of the value movement and we know from across the country over the past year that those physician groups and providers and others that are in value-based arrangements fared much better than those that were still, you know, sort of grasping and holding on to fee-for-service. I mean, I think that’s clear. Have we made as much progress as we could have over the past decade? Probably not, right? I mean, we know that these arrangements take time, that they’re complicated, that they’re hard. You need to sort of start where providers and plans are and sort of make incremental progress. But I do think that coming out of COVID that there will be an acceleration like we see in so many different parts of healthcare, whether it be telemedicine or others. Those things that worked and that are really shown to deliver better results or that have been an important sort of safety net during this, I think are only going to get stronger and accelerate faster. It seems like the rate and pace of change in so many different areas just has gotten so much faster than it was. And I’m optimistic that the value movement will sort of be on that train as well.

[00:20:19.120] Don Crane:

Well, I’m happy to hear about that optimism. Frankly, shooting straight with you, we’re concerned around here. I mean, so you see the geo movement…the geographic direct contracting model not movement model, excuse me…being suspended, not eliminated, but put back on the shelf. I think CMMI did that with a kidney care pilot as well. And we don’t really, you know, that’s sort of on the downside and on the upside we’re not seeing where they’re going, frankly. And so, there’s concern there. Were you guys…you share that concern generally as to CMMI and then specifically, how about the geographic model? I know that some of your members were very interested in that.

[00:21:04.390] Matt Eyles:

Yeah. I mean, it’s a really good question. And I think it’s just a new administration is going to, I think, hit the pause button and say, you know what, we want to evaluate how we want to move forward in the right way. So, I wasn’t terribly surprised by that. And I think each administration sort of has that right to say, OK, where do we want to take this? You know, with respect to the geo model, you know, I think we want to make sure at least that both plans and providers can participate in these models going forward.

We want to make sure that we’re not disrupting existing models at the same time where we already have integrated coverage and care. Yes, some of our members were absolutely interested in it. And I think, you know, CMMI and with new leadership there and Liz Fowler is an extraordinarily capable leader and individual. I’m sure we’ll have opportunities to have really meaningful discussions with her and the staff and CMS leadership about what direction it should go.

[00:22:25.680] Don Crane:

So, as to that direction, your definition of value involves capitation and actually capitation with delegation, as you see really across a lot of parts of the country and certainly a lot in California. How does that square with your members’ definition of value? How do they define value-based contracting?

[00:22:47.200] Matt Eyles:

Right. Well, I think there’s lots of different iterations, right? I mean, it goes all the way from, you know, capitation models to bundles to, I mean, and I don’t know that there’s one sort of flavor of it….and we know, you know, the data shows that there’s significant differences across the country in terms of where we are with respect to value-based contracting and whether or not you’re getting to the nirvana of population-based management or again, whether you’re doing some of these more incremental steps like episodic bundles. I think it runs the spectrum across that. Obviously, in California, you all have been working on this for a lot longer than some other parts of the country and I think are much more advanced. But I can’t say that there’s like one definition of value that our members are looking at when they’re coming into contract. And one interesting area that I will highlight that is a challenge. And I welcome your perspective on it, too, which is how do you factor in pharmaceuticals, biopharmaceuticals, especially newer, much more expensive therapies into these models?

Where do they fit? And can we use the same sort of value-based arrangements that we have with providers on the pharmaceutical side? Just because it’s harder to manage, right. And the cost shocks to the system are complicated when you’re introducing, you know, expensive new therapies with, you know, six- or even seven-figure price tags. And I think that’s an area where we need to do a bit more work to figure out how can we fold that part of healthcare into the value movement?

[00:24:43.420] Don Crane:

No, I agree with you and I’ll get to that in a minute. But let me let me pursue a little bit further of this, quote-unquote, definition of value or value-based contracting. So, the discussion of incremental, the word incremental suggests to me that it’s an evolutionary sort of a process and suggests to me that there must be, one would think, some vision of what the destination looks like, right. So, where we will ultimately be, where do we want to go? We’re directionally heading north. Where does it get us? And that would be my question to you. What is, quote-unquote, end state is probably too strong a word…I’ll just say destination…where are we headed? We’re not headed just to a bundle. I assume we’re headed to something quite a bit more than just a bundle. So, what do you guys view the destination as in value-based contracting?

[00:25:35.800] Matt Eyles:

Yeah, I mean, I think ultimately, it’s in a capitated model, right, where you’re focused on how do you deliver the highest quality care at the lowest cost ultimately. And it has to be more, I think, through capitated-based payment models, whether they’re at a group level, at a population level, I think that’s really where, ultimately, we want to head. You know, not these smaller increments…we might have to take some of the incremental steps to ultimately get there. But we’ve got to be focused on the bigger picture of how do we really get to a shared risk model that is making sure that there’s adequate payments in the system to cover the population. But working collaboratively to improve quality, to improve outcomes at that higher level not at the episodic.

[00:26:38.650] Don Crane:

So, you know, telling you what you already know. You know, some of the groups per my members are saying, look, the plans are not giving us risk-based contracts. We’re ready and they’re not. And then we know equally that some of the plans are going, you know, we’d love to do capitation delegation downstream, but the groups aren’t ready. So, we have to sort of cross finger pointing thing about readiness. And so, what’s your perspective on that generally?

And then, you know, should we jointly be addressing that in perhaps a very big way in terms of trying to help with the readiness, educational programs, infrastructure funding, grants, loans, whatever…should that be going on?

[00:27:21.790] Matt Eyles:

I think all of the above and I think, right, I’m sure both sides are right at some level, right? I’m sure there are examples that we can point to on both sides where the sort of opening assertion that you’re making is right. And I think what we need to do is to really understand what’s happening at a granular specific level. How can we make sure that we’re making decisions and looking at options based on the best available data about what’s really happening and then what’s the plan to move forward? And I do think that there are opportunities for us to collaborate in that way to make sure that we’re not talking past one another, but we’re having a conversation and really having a shared understanding about what the situation is so that we can move forward in the most thoughtful way and educate…it starts with good information and then taking it with education and then making decisions about where do we want to partner, where do we want to move forward with investments. And I think that’s really the path forward.

[00:28:35.110] Don Crane:

So, I think I agree. I’ll tell you, we keep hearing the sort of rising volume of some of the employers about direct contracting. So, PBGH, as I think you know, is being pretty public about wanting to start direct contracting with providers. I don’t know the full extent of their plans on it, but they’re pell-mell interested in doing it and complaining, I think publicly, about health plans, not delivering what they need and want. So, how do you react to that and view this employer movement? Probably too strong a word, but interest in direct contracting with groups?

[00:29:17.830] Matt Eyles:

Look, I think it really comes down to the bigger frustration among various different stakeholders in the system. And I’ll say it including, you know, some of our members about overall affordability, right? I mean, that’s really what this is, I think, getting to. And how do you think about making the system more affordable at the end of the day? I don’t know that direct contracting is really going to achieve that goal. I think that there are ways that we need to look at what’s happening within the system and some of the underlying trends that we’re seeing, whether it’s with respect to sort of consolidation or acquiring practices and what we’re able to do with respect to costs or networks.

I think there’s a lot of different innovations that we can look at there. But I don’t know that direct contracting, at the end of the day, is going to do anything more than essentially the conversation we just had about value and it being really much more akin to like a bundle than something that is at value at a higher level. I mean, again, I understand the frustrations and we need to really have a discussion about how do we make the system more affordable. But we’re not there right now. And I think that’s what’s manifesting in some of the efforts to do things like direct contracting.

[00:30:50.860] Don Crane:

So, another request for a bit of advice from you, if I may. I mean, here we are trying to collaborate and work well with you, right. And we want to do that for sure, for sure. And yet the door is knocking and employers are coming to us and saying they want a direct contract, right. So, these are the early-stage kind of conversations. And, you know, we’re interested in hearing what they say. We worry. And this is where my question goes, Matt, that we’ll all alienate you because we’re not necessarily trying to blow up the system, but we depend on, you know, payer contracting all day long. That’s our lifeblood. Should we worry that these conversations with the employer community will in some manner erode our relationship and somehow alienate you guys?

[00:31:41.320] Matt Eyles:

Well, I think right now it’s a different segment, right. So, I think the relationships that we have on the Medicare Advantage side are so deep and a strong that I’d like to think that we can have these conversations and still say we know what’s working, we know what’s happening in one side of the market, let’s have a conversation about what’s going on in the employer commercial market and what differences are there.

What lessons can we learn from MA, again, that potentially ports over to other parts of the market so that we can work effectively in these collaborations? And I think it’s, again, being sort of open and transparent about what’s working, what’s not working, and what can we apply from a program that we know is working very well into other parts of the of the healthcare system.

[00:32:43.210] Don Crane:

So, let me…time is running and I got a couple other topics I definitely want to spend some time with you on. The next one is hot on our desks around here, and that is consolidation. So, and I think it’s made more hot by, let’s be frank, Xavier Becerra, who we support, think highly of, you know, as Attorney General, he’s filed actions, antitrust actions and the like that have drawn a lot of attention to this issue of consolidation. There’s all these studies and reports indicating that consolidation writ large, not just limited to horizontal group to group or vertical, this to that, but consolidation writ large is actually increasing costs and not improving quality.

So, here’s where my question goes, though. So, hospital friends of mine say, look, it’s the health plans and others in the industry, devices and pharmaceuticals, but particularly the health plans that we contract with that have consolidated so much in our county or geography. We’ve got but two or three or four…a small number, and we almost have to…I don’t think they want to say this publicly because it’ll get them in hot water…we almost have to consolidate, get bigger and the like, you know, in order to meet the consolidation on the other side of the table on health plans.

So, whether that’s a good or bad argument, I don’t know. But I think this is going to be a hotter issue for all of us, Matt, particularly with Xavier Becerra as the Secretary of HHS. What are your perspectives on the consolidation issue?

[00:34:26.250] Matt Eyles:

Yeah, I mean, I don’t know that the data on the health insurance side sort of bears out the same way that what we’ve seen from the on the provider side. I’ll start from that point.

I mean, I think we need, again, need to be really clear and transparent about what’s happening based on data. And, you know, the consolidation that we’ve seen on the provider side, you know, can happen and fly below the radar in a much greater way when you’re talking acquisition of physician and group practices and specialty groups and other things than when you’re having the acquisition of a one health insurer by another. Those are very public. Those need to be improved by regulators, right, at a state level, but at a federal level, potentially, you know, depending upon what happens.

And I think that we are going to see more activity and oversight, whether it be from the FTC, at HHS and others. And I think we need to be very mindful, but we need to be clear about what’s happening based on the data out there. But, right, it’s something we should be thinking about.

[00:35:49.470] Don Crane:

What about private equity? I think it’s Ways and Means or Energy and Commerce…I saw something called flash across my screen yesterday…is holding hearings coming up soon on whatever the influence or of private equity into the healthcare field. What do you think of that?

[00:36:07.200] Matt Eyles:

That’s a really great question. I think there’s two types of private equity, right? There’s those private equity investors that have a bona fide interest in coming up with a better model to reduce costs where they see upside, where they improve quality, where they make the technology simpler, easier, better to use and have motivations really to make the system better.

There are other parts that are really looking to exploit loopholes for their own benefit. And I think those are the ones that we all need to be concerned about. Because coming back to the notion that affordability is the biggest problem, if the investment is really about how to just make, again, exploit loopholes or parts of the system for their own financial benefit, those are the ones that we need to be really concerned about. So, I don’t know that you can paint it with a single brush.

You really have to look at what are the goals of the private equity investors and what types of efforts are they investing?

[00:37:28.320] Don Crane:

Yeah, I agree, just like consolidation…there’s good consolidation for good reasons, and there’s bad consolidation for bad reasons. And the same thing can be said about private equity. I think you can react to my thought on it, which is, hey, regulators, et al, that are interested in this subject, do ask the question what private equity sees, where they see profit and maybe we learn from it.

So, if they want to double down and expand on primary care and they think that will generate a savings and they’re into eliminating waste and that will produce savings, which is a synonym for profit, don’t you suppose we could learn from them and perhaps emulate a wee bit in some of the existing programs? In other words, before we throw them out the door, let’s pick their brains. Does that make sense?

[00:38:21.020] Matt Eyles:

Yeah, no, that does. I mean, because I mean, we had a lot of experience recently on the surprise bills front where we know private equity was making investments to essentially continue to exploit loopholes. And we felt that was the wrong approach, right. But I think the type of investments that you’re talking about, Don, are ones that are trying to, again, come up with a better way of operating that lead to better outcomes, lower costs, higher quality, more efficiency. And those are the kinds of investments that I think all of us can learn from.

[00:39:03.890] Don Crane:

Yep, yep, I agree. So, let me turn to perhaps the thorniest of issues here as we wrap up, and that is health disparities and equity. So, as you and I both well know and we’ve all seen, the pandemic has really revealed the depth and worse than depth of disparities. So, communities of color are experiencing COVID infections and death at 200, 300, 400 percent higher than Caucasian populations and so forth. So, there’s a problem. How do we go about fixing it, Matt? I mean, it occurs to me there are no, there’s no billing codes for addressing racial injustice. But there are payment models that might be helpful. I mean, so this you can see where I’m going with this. Well, how do you think we address…and redress might be the better word…health disparities in healthcare?

[00:40:06.350] Matt Eyles:

It is our probably biggest problem that we need to all have a sustainable focus on, right. This cannot be a short-term effort. We need to make sure that whatever we do, it can again be lasting and sustainable. I do think payment models can be helpful to address this. And just even from what we see, again, coming back to Medicare Advantage or what we see in Medicaid and the ability to really help improve equity by working in unique collaborations to really address the problems where they happen on the ground, you know, at the most local level to address the social factors, to educate. I mean, there are there’s no shortage of areas where I think we need to make sure that we’re focusing on health equity. How do we make sure we have culturally-sensitive, appropriate providers in our networks?

How do we make sure that we’re being diverse and inclusive in terms of how we sort of think? I mean, there’s again, there’s no silver bullet. I think it does, though, require us to think about how can we measure progress in this area. I think it’s, some of it will be subjective, but we really do need to start looking at how do we move the needle on getting outcomes in communities of color, in diverse populations at the same level that more affluent groups are experiencing.

And we need to really come up with a way to measure that and to make sure that we are, in fact, headed in the right direction, because otherwise we’ll be having these same conversations. I was speaking at a conference a few weeks ago, and Chris Jennings reminded me at the AHIP conference that President Clinton had put out a big health equity initiative at the end of his administration in the late 90s. And here we are, 2021, and it certainly doesn’t feel like things are much better in two decades hence, but I know for sure that the commitment is there to make sure that it changes this time.

[00:42:56.110] Don Crane:

So, you know, you can guess my view on this and it all starts with Medicare Advantage. So, as we’ve both seen, the penetration of MA growing everywhere is higher by percentage in communities of color than it is in non-color communities…Caucasian communities…suggesting to me that it provides a better service and so forth. And it makes me also think that the payment model is where these incentives start. So, whether it’s a capitated health plan or capitated physician group or sub-capitated physician group, the existence of racial injustice and other shortcomings in the system, hurt the population’s health, which elevates their acuity, which increases the cost, which is against our interest.

And so, you know, it just seems so obvious to me that while we probably need much more in the way of programs, that a very good place to start would be the payment model, where you basically create and align incentives such that the carrier and the physicians want to eliminate those injustices and disparities to basically help make the population healthier, which is where the profit lies, being quite frank. So, is that crazy talk or does that make sense?

[00:44:17.470] Matt Eyles:

Well, I think you’ve hit on one of the most important sort of misconceptions about the Medicare Advantage program is that there’s a perception that it serves a younger, healthier, whiter population than, in fact, it does. And I think it needs to be clear that the demographics and the diversity of enrollment within MA is far different than what the perception is. And I do think that what you highlighted with respect to the payment models being part of the reason leading to a better value proposition. And it’s something that I think we need to do a better job of making sure that people are aware of, because I think it can be a really important driver of improvements in health equity for Medicare beneficiaries.

[00:45:16.060] Don Crane:

Well, I completely agree. It sounds like we have work to do, Matt. A little bit. But we look forward on our end doing that with you. And I just want to thank you very, very much for this opportunity. We’ll do it again. Come back and see us…we’ll measure and see if we’re getting the job done or not one of these days. But anyway, thank you. Thank you very much, Matt. Stay healthy.

[00:45:36.710] Matt Eyles:

OK, thank you. Don, it’s been great.

[00:45:39.580] Don Crane:

OK, take care.

As you may have observed, our annual conference this year will now be held in person December 9th through December 11th at the Marriott Marquis San Diego Marina. Please save the date and be sure to register. It will be, to say the least, an extraordinarily welcome and refreshing chance to see each other in person once again. In the meantime, stay safe and be well.


Thanks for listening to APG on American Healthcare with your host, APG President and CEO Don Crane. For more information about APG and transcripts of this show, visit the APG website at APG dot org.