Open-network overlap limits differentiation

The Non-Market Reality of Healthcare Carrier Marketplaces with Dr. Jacob Asher. In this episode of Relentlessly Seeking Value, host Stacey Richter introduces the 'No Market' series focused on the healthcare sector's lack of competitive market dynamics, which affects cost and quality.

The episode features a conversation with Dr. Jacob Asher, who has extensive experience as a Chief Medical Officer at major healthcare plans. They discuss the stagnant nature of commercial carrier marketplaces, particularly in California, and the various factors contributing to this stasis, including employer inertia, the influence of employee benefit consultants, and the strategic focus of carriers on Medicare Advantage over commercial business.

They also explore how carriers' dependence on existing provider networks and contractual negotiations based on member volumes contribute to a lack of meaningful competition. The episode highlights the challenges faced by plans attempting to innovate or differentiate on quality and the systemic issues that perpetuate the current equilibrium.

=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Take2-EP398

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00:00 Introduction to the episode.

00:42 The "No Market" series.

01:51 Why is the carrier market boring?

04:26 A breakdown of what follows.

05:48 Six reasons why a marketplace doesn't actually exist.

10:04 Upcoming episodes in the "No Market" series.

10:41 The conversation with Dr. Jacob Asher.

11:01 What is the competitive picture of California's health plans?

11:03 Understanding the California health plan market.

12:28 What the competitive landscape looks like to get market share in California.

12:55 Challenges in market competition.

13:14 What are micro markets and market drivers?

15:14 How brokers and consultants shape the marketplace.

15:49 Why is it difficult to take market share?

16:56 Who was Dr. Asher pitching to and why?

18:56 How is Kaiser's position in the marketplace unique?

19:29 Did employers ever buy plans for quality?

23:23 What does this look like from the payer perspective?

27:42 What improvements have there been to engagement in health plans?

29:47 Have plans gotten better at communicating with employers?

31:19 Why is it hard to compare the Kaiser world to the non-Kaiser world?

31:19 Dr. Asher's final thoughts and reflections.

33:40 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD.