Will the next democratic presidential nominee have to deeply love universal healthcare, and how about challenging closely-held assumptions about the employer insurance model, too? Can we still find growth during these times of change? 

Is it really time to start talking about Presidential politics for 2020? With a growing field of Democratic hopefuls already pushing their versions of universal healthcare, it sure is. It feels like 1993 all over again. Is the employer insurance model to blame? We think it shoulders some responsibility. This episode delves into long-held assumptions about the coverage model that supports over 156 million Americans. Is this approach the best way forward for leading us out of the affordability crisis given it helped us get into it? It may be a good way to drive pockets of innovation, but will this framework ever help the country achieve true healthcare cost sustainability? Maybe solving for the country as a whole is not the right lift. It could be that we need to be solving for our specific communities in the future. Listen in to hear our thoughts & then let’s debate. Two minds are always better than one. We end this show with a discussion on if you are a growth mindset leader. Does your organization build the box that your team plays within, or do you foster a culture that sees limitless opportunities even in the face of intense challenges? Buckle up. We’re just getting going. Thanks for stopping by to #ElevateYourHealthcareThinking. 

Research Links & Show Notes:

(1:20) – “Medicare for All” is a rallying cry going into the 2020 Democratic Presidential Nominee process, but the New York Times illustrates the issues & arguments to be made in the next two years – one of which is grappling with the reality that more than 1/3 of all Medicare beneficiaries are now in private Medicare Advantage plans.

(3:45) – Enter Sen. Harris (D-CA) and CNN to signify the difficulties ahead laying out the “Universal Healthcare” case. In her “eliminate all of that” argument at a Town Hall with Jake Tapper, referring to the role that private insurers hold in the marketplace in designing/defining insured access to services, the reactions from the right were swift (causing the Harris campaign to walk back from this edgy rhetoric hours after the original statement was made).

As a side, if you want a nice summary of the eight current proposals (that are known) for pursuing Medicare for All, Vox provides that here.

(7:20) – When considering national systems (one, centralized national payer), it’s worthwhile to note that many countries around the world are really decentralized approaches that are either multiple sickness funds that are highly-regulated that citizens choose (like in Germany) or community-based taxing & “payer” authorities that determine what is needed to deliver services in their regions (like in Denmark). The system in Germany has seen its sickness funds go through consolidation over the past 20 years, which bears some similarities to the consolidation seen in the US model. Tiered pricing for services and different regulatory models represent areas where the US is different than these other systems.

(9:00) – Let’s get into a discussion around the assumptions today surrounding the employer-sponsored model in the US – namely, does this model really hold the keys, due to it’s “scale,” to be the leading entity for solving the affordability crisis we find ourselves in today?

(10:00) – Here’s the American Health Policy Institute paper on “Tipping Points” in the ESI model for your reading pleasure.

Bonus thought – if you have been following the growth of the Health Transformation Alliance, here is the 2015 paper that was presented that helped get that initiative going amongst some of the nation’s biggest employers. The crux of this paper is that even the largest employers were struggling to run an effective healthcare program requiring the need to try something different.

(13:00) – The employer market is made up of a very complex supply chain of healthcare/administrative services, and the advantages of going one direction over another are always changing. This lends itself to the issue that managing a healthcare program is a difficult endeavor for single companies. This market creates winners and losers amongst all key players. It’s designed to do exactly that, as value is often defined by those that can help uncover an edge against the baseline.

(14:15) – In 2017, KFF estimated that 49% of the population was covered in an employer plan; there are beliefs that this is the best market for affordability innovation because of its “size.” The reality is that this is a very fragmented market made up of thousands of employers that scale only to the size of their individual enrollment pools (or aggregated under an insurer’s pool).

(17:00) – A good example of the bifurcation of insurance is the stark difference between the number of employers that offer coverage – in 2017, only 30.2% of employers with 50 lives offered coverage versus 96.6% when you get above 50 employees (according to KFF)

(17:45) – Employers don’t want to fall behind competitors for talent, which keeps upward pricing pressures constant (benefits benchmarking)

(20:50) – Our view regarding the ESI market, because of the way its incentives are set up, is that it is a significant contributor to the overall affordability crisis building within this country

(25:20) – Association Health Plans are back (in some states)! What is old is new again, and projections show at least 3.2 million enrollees will be in these solutions by 2022; the argument are that these plans further erode the small group employer pools held predominantly by insurers, but fragmentation and finding cost advantages in the small group market to help stem the decades-long trend of declining covered lives continues to be a big emphasis for the services market. m4 is all for well-ran, high-reputation AHPs (MEWAs) to form as a solution for communities to get a better handle on designing what works best for them. 

(25:30) – m4 is really a big advocate of transitioning the ESI market toward community-based solutions; if where we live plays a big part in our health, and if each community has specific & unique challenges, then this model seems to make sense more than gaining insurance through employment. Each model has its challenges, but it makes sense to solve healthcare issues for a specific community as opposed to the more broad approach that comes with ESI models. The community approach may be a workable tweak that helps to provide an alternative to the universal healthcare rhetoric. ESI advocates will likely push back on this, and this is a debate that we should be having. Something has to change. What model should drive it?

(31:15) – If the services model wants to perpetuate the employer approach, what solutions will make a difference?

(35:00) – Career tip time! Are you leading a growth-minded organization or team? Here are 12 (not ten) traits here. Sure, growth-minded models still need structure (or you end up with ENRON) & debate on what to pursue. The key is finding ways to motivate market-based thinking amongst your team to continually seek growth opportunities (as opposed to dictating market direction to a team… which can lead to complacency and playing not to lose as the sandbox is already defined).

(41:20) – If you have not done so, please keep your profile up to date on the networking portal.

(42:00) – If you are considering dig.in or 4mul8 memberships in 2019, please keep in mind that this free preview period ends on Feb. 16th. All profiles not contracted at a premium level will revert to the free level (which hides this content) after that date. We look forward to you joining or continuing your work within this special community.

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