Rethinking Employer Health Plans for Affordability with Jeff Bak

0:00This is where health insurance leadership comes together. Becker's fourth annual spring payer issues roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details visit Becker's hospital review dot com and click on the events tab in the upper right. We're looking forward to hosting you here in Chicago. Hello everyone, welcome to Becker's healthcare podcast. I'm Scott King, thrilled today to be joined by a very special guest, Jeff Beck, President and Chief Executive Officer with Imagine 360 Jeff. How are you doing? Thanks so much for joining us. Appreciate it. Yes, Scott. Thanks for having me. Looking forward to today. Yeah. You know, we have a lot of big topics to get to in healthcare and with health plans specifically here with you, but just wondering before we get to all that, if you can please toss a little bit about your background and your career.

1:00Yeah, you know, I'm a bit of a liper in healthcare. I've been doing it for 30 years, you know, 20 years or so in the private equity framework working for and with PE firms to help companies grow and improve the services that are providing the industry. And the past seven years, I've been working with what is Imagine 360 where the mission is we're trying to help American families afford, you know, group healthcare. And you know, we, we exist because we're super innovative on trying to figure out ways to do that more affordably without sacrificing the member's experience. And so a lot of evolution, a lot of things that we've put together to try to make all that come to fruition and we're having some nice growth and so we're pretty optimistic about the future. Well, I appreciate you sharing your background information there, Jeff, and great news about the growth. Just the first thing I wanted to ask you, how are your relationships with providers changing

2:04as both sides face cost pressure and workforce shortages? Yeah, you know, for us, we're pretty predictable in what we reimburse the providers. We use a formulaic approach so they know what they're going to get paid. We pay timely and we also have a high percentage of all the members and employees that we work with who pay their deductibles and out of pockets. And so in our book of business, there's not a big chase factor. And I think those three things kind of combined make for a good relationship starting point, not to say that we don't have on occasion providers that want to get paid a little more what we do, but on par, you know, 97 plus percent of the time, we feel like we're delivering real good value and we're doing it quickly and everybody seems to be in a good spot. Where do you see the biggest gap today between payer strategy and operational execution?

3:04Yeah, you know, I think in the employer-sponsored health care arena, there's just a lot of limitations on what's available and, you know, I, we've done a lot of thinking on this and I kind of equate it to, you know, we'd all like to drive a Range Rover, right? It's a beautiful car, it works great, looks good in the driveway, but it's an expensive proposition. It's not for everybody and I think the way most employer-benefit plans have been created is everybody gets a Range Rover, you know, a broad-panel PPO, tons of choice, but it's expensive and so our idea is, can we, can we narrow, right, the number of points of care and access? Still, still, citing, you know, high quality sites of care and try to reduce the cost so

4:06that an employee who may be not be making a lot of money can afford to first, you know, afford the coverage, right, with their contributions. And can we put in a reasonable amount of out-of-pocket before they can use their plan, you know, like a copay or a much smaller deductible level, because what we're seeing is it's very expensive, not everybody can afford it and then when it comes time to use it, people aren't using their plan because there's a barrier to entry, which is a high deductible and a lot of out-of-pocket costs, and it's just not a good long term for the industry. And so we try really hard to make those two things work well for members. Do you think it might be kind of a long battle in addressing those limitations that you mentioned with the employee health plans? I don't think so, you know, we're having success today, we're seeing good adoption, we're getting more done with carrots than we are with sticks. So employees and their families really appreciate lower dollar access to care, and, you know,

5:13we'll take guidance, and we'll take some steerage and ask the question, you know, if I've got four or five hospitals to choose from in town, and you're telling me hospital A and B are somewhat of equal quality, and hospital A has nearly no out-of-pocket and hospital B's got a 5,000, I'm going to hospital A, you know, and I think people are asking for that type of data and that type of design point in order to kind of reduce the overall cost. And, you know, with our solution, we office, you know, for smaller employers, maybe we'll replace what's historically been, you know, the broad panel PPO from BOOKA. With larger employers, they're not going to replace everything overnight. What they will do, though, is they'll bring our solution in as a, you know, as an alternative option, so call it a dual option, where employees can choose with their wallets and with their comfort level and decide which plan they want to have it open enrollment, typically

6:18with quite a bit of savings and maybe a little less choice, but, you know, that trade-off has to happen if you're going to save some money in healthcare. What's one investment or initiative you believe will most reshape how health plans operate over the next two to three years? Yeah, I, you know, I'm a big proponent that when you bring together as many as the pieces of the car, or, you know, as many of the parts of the car as possible, and can talk through, you know, an entire end-to-end solution, and that end-to-end solution has its primary objective and goal of trying to save as much as you can for each of the pieces and parts, whether that's how you administer it, whether that's your narrow network strategy, or you're out of area RDP strategy, you know, whether that's a pharmacy-benefit solution that's transparent and doesn't want to take any skin from the rebates, like the objective is,

7:22if you can put that together and get a compelling value proposition that says, it's turnkey, you're going to save 25 or 30% of what you're spending right now, and good news, there's kind of one quarterback for all your needs, whether that's a clinical need, or a make-in-appointment need, or just a general question about I need my ID card, that the ability to control the member experience when you have all those pieces and parts together, and your main objective has been what's the lowest common price denominator we can compete, we can put together and put that in a package, and then just service the heck out of it, and make members really feel like they came to the right spot, and you're going to be really prescriptive on where to use care, and as importantly, be there when they need you from a clinical perspective, you know, it's gone a long way. I think the other thing I would say quickly is, you know, being able to build enough trust with employees and their families over the course of a

8:26year where you could reach back out to them and say, you know, you're getting this particular specialty drug at a site that is five times more expensive than doing it at another site, and they're both in your community, you could save some money, the employer and plan could save some money, you know, will you trust us on this one and make the change, and so getting permission and building trust to be able to have a conversation about changing side of care is critically important, not everybody can do it, we feel like it's one of our specialties, and I think that's another big thing that we're going to see as a reshape in the future. Absolutely, and you mentioned a lot of great ways to serve members there as well, and Jeff, if you could change one regulatory or industry practice tomorrow to improve affordability and access, what would it be and why? You know, this is a bit self-serving, and maybe a more narrow answer than you might get from another health plan, but like we don't enjoy the benefit of brand recognition, at least not yet,

9:32and so when you're not a blues logo on a card or, you know, a united health care on the front door, you really need to fight for mental shelf space, and you need to really help the brand what it is we're trying to do, and a lot of brokers who do all of our selling, right, we're a broker driven business, have a misconception about, imagine 360, or what I'll say, alternative health plan solutions, we did a broad survey, reached out to hundreds of brokers with the third party, and the reveal was that a lot of brokers think they know what an alternative health plan is, that uses reference-based pricing, but when you ask them to cite a few basic statistics, they'll say things like, well, they probably only say five or 10%, and you're going to get balanced bills, you know, 50% of the time, and you can't access the facilities and the doctors you want to

10:32access, and when we tell them today's facts, which are, hey, 97% of the time, providers accept the reimbursement, and 99% of the time, you can see the provider you want to see, and you don't save five or 10, you save 20 or 25, and we'll guarantee it, the broker sentiment changes almost immediately to, yeah, I do that tomorrow, and it's our job to figure out how we get that message out there, and to make sure that that's what people are hearing, because if they're not hearing it and believing it, they're not going to take it to their employers. The last thing I wanted to ask you, Jeff, what issue is putting the most pressure on health plan margins right now in your eyes, and how are you responding differently in 2026? Yeah, I mean, we're trying to be really mindful of the fact that we're not asking people to do anything we wouldn't do ourselves. We're on our own health plan. All of our 1600 employees

11:37use the imagines 360 approach. We've got hundreds of thousands of other employees and hundreds of referenceable clients that are doing it as well, and they all have a member experience that they would tell you is better than average, better than the average market. We have things like, you know, we track a lot of stuff, NPS scores at 78%, member satisfaction, on any call that we take 98% with a savings that's really material. And so we think that pairing those two things really creates for us a differentiator in the market, and I think it allows people to get the best of both worlds an experience you can be proud of, and savings you can bank. In fact, we guarantee our savings so that if we don't meet the numbers that we've all committed to, we make a hole on that dollar for dollar. And so it is not something you have to

12:39take a leap of faith on. It's something you can take to the bank. Jeff, thanks for joining the podcast and for a great conversation. I look forward to working with you again soon. Yeah, likewise. Thanks for the time.