EP348: Your Burning Questions About Payviders Answered! With Jeb Dunkelberger

In Episode 348, Stacey Richter talks with Jeb Dunkelberger, CEO of Sutter Health | Aetna, about payviders — entities that both deliver care and write insurance products, taking on risk rather than just capitated payments or direct contracting. Jeb explains the concept of "demand destruction" and why taking on value-based risk is easier the smaller a percentage of total healthcare spend an organization represents. The conversation also digs into workforce repurposing and what actually happens to costs, jobs, and hospitals if the industry succeeds in taking money out of the system.

WHAT YOU'LL LEARN

✅ What a payvider actually is — an entity that delivers care and writes insurance products and takes risk for them

✅ The concept of "demand destruction," and why it's easier to take on value-based risk the smaller your share of total healthcare spend

✅ What incentivizes providers to partner with payers in a payvider model

✅ Why taking costs out of the healthcare system raises hard questions about hospital closures and job losses

✅ What it means to repurpose and upskill the healthcare workforce as value-based care changes what's needed

WHY THIS MATTERS

It's just math: the amount of lives times the amount of utilization multiplied by your unit costs. Value-based care is fundamentally about demand destruction — and if a health system is also the largest employer in town, unit cost concessions year over year raise a hard question about whether that system, and the jobs it supports, can actually survive the transition.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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=== CONNECT WITH THE RHV TEAM ===

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00:00 Introduction.

03:58 What all does Sutter Health | Aetna entail?

04:31 What does it mean to be a "performance network"?

04:48 What does it mean to be a payvider?

06:35 How common are payviders?

07:31 "We are writing direct risk."

09:21 How does the fully insured product work?

12:30 "You want to hold their feet to the fire, from a value-based perspective."

12:42 What's the incentive for providers to partner with payers?

15:25 "It's just math. It's the amount of lives times the amount of utilization multiplied by your unit costs."

20:58 "You have to have a day of reckoning, and that only comes from financial incentives creating that gateway out."

24:55 How do we think about reform and taking money out of the healthcare system?

26:58 "We also have to talk about repurposing the workforce."

27:27 "We need to upskill our workforce."

30:14 "Can a health system survive as the largest employer, year over year, if they give unit cost concessions, year over year? … The answer is no."