Cora Opsahl's guest appearances

Cora Opsahl

Relentless Health Value™

OwlTail

In this healthcare podcast, I am speaking with Cora Opsahl, who directs the 32BJ Health Fund. This is the second conversation I’m having with Cora (last one was EP372), but these two conversations are not really linear—so listen in whatever order you want to.   Important to know about Cora’s background, in previous roles, she has worked deep in the inner sanctums of the healthcare industry. So, she came to 32BJ armed with a BS meter that’s finely tuned, which is, as I said last week, an unfortunately essential skill for anyone trying to help patients and members relying on them to successfully navigate the healthcare industry. Here’s a pivotal fact: 56% of total spend at the 32BJ Health Fund goes to hospitals. So, from a “making the juice worth the squeeze” perspective, focusing on hospital prices can have a lot of impact. This is doubly true because of the seriously huge price variations for the same exact types of services at different hospitals, even in the same local market. Because the 32BJ Health Fund demands and gets all of its own data, it can actually run reports and see the impact and nuances of hospital spend very clearly—unlike, frankly, the majority of employers and unions who have zero clue this is all going on behind their backs because they think some other party is actually the fiduciary and not them, which is false, of course. So, let’s just linger on this really high hospital prices that are various across a market for one moment. Here’s a Tweet from Rik Renard: “The price of CABG [coronary artery bypass graft] varies more than 10-fold across US hospitals (ranging from $44,824 to $448,038). There was no evidence to suggest that hospitals that charge higher prices provide a better quality of care.”   WHAT?! An employer could pay $44,000, or it could pay $448,000. Seriously? This is why we can’t have nice raises—because some employer spent $400,000 not on raises but on overpriced hospital services. Ugh … so frustrating. When employers, almost willfully at this juncture, turn a blind eye to all of this because they think it might be disruptive, meanwhile they’re worrying about employee retention and trying to figure out how to give raises. Okay, well, here’s a suggestion: Get your healthcare house in order and then you’ll have enough money for raises, but that aside … In the New York City market, 32BJ used all of the data that we talked about in the last episode (EP372). They used all of that data to deduce, quite crisply, that NewYork-Presbyterian is really, really expensive—even in comparison to other expensive health systems in the New York metro area.   Furthermore, the Fund realized that it could not be sustainable without tackling the challenge of hospital prices. As Cora Opsahl says, “You can’t reduce spend by benefit design alone.” Which reminded me of that famous quote by Uwe Reinhardt, “It’s the prices, stupid.” Which, of course, reminded me of what David Contorno has said a million times, “You can’t pay less for healthcare unless you pay less for healthcare.” I can’t overemphasize these points and their impact on employers and workers. It’s really hard to be competitive in the global marketplace when shelling out an extra $400,000 here and an extra whatever tens of thousand dollars there for fringe benefits that do not actually add any value from the workers’ standpoint and/or confer any additional health. This is just blatantly throwing money away. So, there’s gonna be a few health system peeps listening here who will reflexively mutter under their breath a sentence including the terminology “razor-thin operating margin.” It must be an AHA talking point because I talk to a lot of health system people from all over the country, and “razor-thin operating margin” is invariably the term that gets used. But let’s just dig into that marketing-speak for a moment. While there are some hospitals who assuredly suffered under COVID (or were suffering even before COVID and definitely after), mostly these are rural ones—but let’s not talk about them for a moment. Let’s talk about the large, consolidated health systems who got billions in COVID relief. Are you kidding me with their razor-thin operating margin crocodile tears? Check out “New Study—Hospitals Hike Charges by Up to 18 Times Cost.”   Here’s a few bullet points from that study:  Hospital charges play a major role in mounting healthcare costs, with health expenditures closing in on one-fifth of the gross domestic product (GDP). Hospital profits/margins have mushroomed by 411% since 1999 to a record $88 billion in 2017. The rise in charges coincides with growing hospital mergers and acquisitions by large systems. (This is brutally apparent at this juncture.) The result is increased market consolidation, which leads to, again, higher profits and increased charges, not savings for patients as hospital systems often claim.  Listen to the show with Kevin Schulman, MD (EP366). It explains a lot about how these “razor-thin operating margins” and the “oh no, we’re losing money on Medicare, so we must cost shift” manifest if you actually follow the dollar. As Dr. Schulman says, it’s not A; it’s not B. I mean, it’s not like payers aren’t taking their own piece of the action. You just got to look at their stock valuations to see all that going on. We have a dysfunctional health benefits market and a lot of rational actors in that market doing what you’d expect rational economic actors to do.   So anyway, 32BJ sees in their own data that all this is going on with hospitals, and they aim to stop covering a super expensive hospital in their local market, which is just making bad even worse. It was a whole thing to do this, and in this episode, Cora Opsahl relays the dramatic tale. You can learn more at 32bjhealthfundinsights.org.     Cora Opsahl is the director of the 32BJ Health Fund, a self-funded plan that provides affordable, comprehensive, and innovative health coverage to 200,000 union members and their families. During her time at the Health Fund, Cora has led the implementation of multiple benefit changes: removing NewYork-Presbyterian Hospital System and physicians from the network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and implementing an expanded Centers of Excellence program administered by Mount Sinai Hospital System. These efforts are projected to save over $35 million in 2022. Prior to joining the 32BJ Health Fund, Cora spent 12 years with Express Scripts, a pharmacy benefit manager. During her time there, she held a variety of roles, including Medicare Part D, strategy and acquisitions, operations, and account management. 07:02 What motivated the decision for 32BJ to cut NewYork-Presbyterian out of their network? 09:14 How did 32BJ compare their spending at each hospital in their network? 13:01 “We cannot be sustainable as a health fund … without really tackling the challenge of hospital prices.” 13:38 “It is one of the challenges as a self-funded plan that, even having this data, there’s not a lot we can do with it.” 16:10 What is 32BJ Health Fund’s maternity program? 19:34 What is the HEAL Act, and why did 32BJ Health Fund support it? 21:39 “For us, we just don’t feel it’s right that anyone gets to dictate our benefit.” 22:43 EP368 with Ashleigh Gunter.23:34 Why did 32BJ Health Fund reprice their claims using Medicare rates? 24:58 “It really goes to show you how high the commercial prices are in comparison to Medicare.” 25:52 EP366 with Kevin Schulman, MD.   You can learn more at 32bjhealthfundinsights.org.   @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth What motivated the decision for 32BJ to cut NewYork-Presbyterian out of their network? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth How did 32BJ compare their spending at each hospital in their network? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We cannot be sustainable as a health fund … without really tackling the challenge of hospital prices.” @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It is one of the challenges as a self-funded plan that, even having this data, there’s not a lot we can do with it.” @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is 32BJ Health Fund’s maternity program? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is the HEAL Act, and why did 32BJ Health Fund support it? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “For us, we just don’t feel it’s right that anyone gets to dictate our benefit.” @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why did 32BJ Health Fund reprice their claims using Medicare rates? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It really goes to show you how high the commercial prices are in comparison to Medicare.” @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest’s name for their latest RHV episode! Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O’Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32)

In this healthcare podcast, I am speaking with Cora Opsahl, who directs the 32BJ Health Fund. This is the second conversation I’m having with Cora (last one was <a href="https://relentlesshealthvalue.com/audios/ep372/" rel="noopener nofollow" target="_blank">EP372</a>), but these two conversations are not really linear—so listen in whatever order you want to.   Important to know about Cora’s background, in previous roles, she has worked deep in the inner sanctums of the healthcare industry. So, she came to 32BJ armed with a BS meter that’s finely tuned, which is, as I said last week, an unfortunately essential skill for anyone trying to help patients and members relying on them to successfully navigate the healthcare industry. Here’s a pivotal fact: 56% of total spend at the 32BJ Health Fund goes to hospitals. So, from a “making the juice worth the squeeze” perspective, focusing on hospital prices can have a lot of impact. This is doubly true because of the seriously huge price variations for the same exact types of services at different hospitals, even in the same local market. Because the 32BJ Health Fund demands and gets all of its own data, it can actually run reports and see the impact and nuances of hospital spend very clearly—unlike, frankly, the majority of employers and unions who have zero clue this is all going on behind their backs because they think some other party is actually the fiduciary and not them, which is false, of course. So, let’s just linger on this really high hospital prices that are various across a market for one moment. Here’s a <a href="https://twitter.com/rikrenard/status/1534958000896479232" rel="noopener nofollow" target="_blank">Tweet</a> from Rik Renard: “The price of CABG [coronary artery bypass graft] varies more than 10-fold across US hospitals (ranging from $44,824 to $448,038). There was no evidence to suggest that hospitals that charge higher prices provide a better quality of care.”   WHAT?! An employer could pay $44,000, or it could pay $448,000. Seriously? This is why we can’t have nice raises—because some employer spent $400,000 not on raises but on overpriced hospital services. Ugh … so frustrating. When employers, almost willfully at this juncture, turn a blind eye to all of this because they think it might be disruptive, meanwhile they’re worrying about employee retention and trying to figure out how to give raises. Okay, well, here’s a suggestion: Get your healthcare house in order and then you’ll have enough money for raises, but that aside … In the New York City market, 32BJ used all of the data that we talked about in the last episode (<a href="https://relentlesshealthvalue.com/audios/ep372/" rel="noopener nofollow" target="_blank">EP372</a>). They used all of that data to deduce, quite crisply, that NewYork-Presbyterian is really, really expensive—even in comparison to other expensive health systems in the New York metro area.   Furthermore, the Fund realized that it could not be sustainable without tackling the challenge of hospital prices. As Cora Opsahl says, “You can’t reduce spend by benefit design alone.” Which reminded me of that famous quote by Uwe Reinhardt, “It’s the prices, stupid.” Which, of course, reminded me of what David Contorno has said a million times, “You can’t pay less for healthcare unless you pay less for healthcare.” I can’t overemphasize these points and their impact on employers and workers. It’s really hard to be competitive in the global marketplace when shelling out an extra $400,000 here and an extra whatever tens of thousand dollars there for fringe benefits that do not actually add any value from the workers’ standpoint and/or confer any additional health. This is just blatantly throwing money away. So, there’s gonna be a few health system peeps listening here who will reflexively mutter under their breath a sentence including the terminology “razor-thin operating margin.” It must be an AHA talking point because I talk to a lot of health system people from all over the country, and “razor-thin operating margin” is invariably the term that gets used. But let’s just dig into that marketing-speak for a moment. While there are some hospitals who assuredly suffered under COVID (or were suffering even before COVID and definitely after), mostly these are rural ones—but let’s not talk about them for a moment. Let’s talk about the large, consolidated health systems who got billions in COVID relief. Are you kidding me with their razor-thin operating margin crocodile tears? Check out “<a href="https://www.nationalnursesunited.org/press/new-study-hospitals-hike-charges-18-times-cost" rel="noopener nofollow" target="_blank">New Study—Hospitals Hike Charges by Up to 18 Times Cost</a>.”   Here’s a few bullet points from that study: <ul> <li>Hospital charges play a major role in mounting healthcare costs, with health expenditures closing in on one-fifth of the gross domestic product (GDP).</li> <li>Hospital profits/margins have mushroomed by 411% since 1999 to a record $88 billion in 2017.</li> <li>The rise in charges coincides with growing hospital mergers and acquisitions by large systems. (This is brutally apparent at this juncture.) The result is increased market consolidation, which leads to, again, higher profits and increased charges, not savings for patients as hospital systems often claim.</li> </ul> Listen to the show with Kevin Schulman, MD (<a href="https://relentlesshealthvalue.com/audios/ep366/" rel="noopener nofollow" target="_blank">EP366</a>). It explains a lot about how these “razor-thin operating margins” and the “oh no, we’re losing money on Medicare, so we must cost shift” manifest if you actually follow the dollar. As Dr. Schulman says, it’s not A; it’s not B. I mean, it’s not like payers aren’t taking their own piece of the action. You just got to look at their stock valuations to see all that going on. We have a dysfunctional health benefits market and a lot of rational actors in that market doing what you’d expect rational economic actors to do.   So anyway, 32BJ sees in their own data that all this is going on with hospitals, and they aim to stop covering a super expensive hospital in their local market, which is just making bad even worse. It was a whole thing to do this, and in this episode, Cora Opsahl relays the dramatic tale. You can learn more at <a href="https://32bjhealthfundinsights.org/" rel="noopener nofollow" target="_blank">32bjhealthfundinsights.org</a>.   Cora Opsahl is the director of the 32BJ Health Fund, a self-funded plan that provides affordable, comprehensive, and innovative health coverage to 200,000 union members and their families. During her time at the Health Fund, Cora has led the implementation of multiple benefit changes: removing NewYork-Presbyterian Hospital System and physicians from the network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and implementing an expanded Centers of Excellence program administered by Mount Sinai Hospital System. These efforts are projected to save over $35 million in 2022. Prior to joining the 32BJ Health Fund, Cora spent 12 years with Express Scripts, a pharmacy benefit manager. During her time there, she held a variety of roles, including Medicare Part D, strategy and acquisitions, operations, and account management. 07:02 What motivated the decision for 32BJ to cut NewYork-Presbyterian out of their network? 09:14 How did 32BJ compare their spending at each hospital in their network? 13:01 “We cannot be sustainable as a health fund … without really tackling the challenge of hospital prices.” 13:38 “It is one of the challenges as a self-funded plan that, even having this data, there’s not a lot we can do with it.” 16:10 What is 32BJ Health Fund’s maternity program? 19:34 What is the HEAL Act, and why did 32BJ Health Fund support it? 21:39 “For us, we just don’t feel it’s right that anyone gets to dictate our benefit.” 22:43 <a href="https://relentlesshealthvalue.com/audios/ep368/" rel="noopener nofollow" target="_blank">EP368</a> with Ashleigh Gunter.23:34 Why did 32BJ Health Fund reprice their claims using Medicare rates? 24:58 “It really goes to show you how high the commercial prices are in comparison to Medicare.” 25:52 <a href="https://relentlesshealthvalue.com/audios/ep366/" rel="noopener nofollow" target="_blank">EP366</a> with Kevin Schulman, MD.   You can learn more at <a href="https://32bjhealthfundinsights.org/" rel="noopener nofollow" target="_blank">32bjhealthfundinsights.org</a>.  @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth What motivated the decision for 32BJ to cut NewYork-Presbyterian out of their network? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth How did 32BJ compare their spending at each hospital in their network? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We cannot be sustainable as a health fund … without really tackling the challenge of hospital prices.” @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It is one of the challenges as a self-funded plan that, even having this data, there’s not a lot we can do with it.” @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is 32BJ Health Fund’s maternity program? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth What is the HEAL Act, and why did 32BJ Health Fund support it? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “For us, we just don’t feel it’s right that anyone gets to dictate our benefit.” @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Why did 32BJ Health Fund reprice their claims using Medicare rates? @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It really goes to show you how high the commercial prices are in comparison to Medicare.” @CoraOpsahl discusses managing #hospitalpricing on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest’s name for their latest RHV episode! <a href="https://relentlesshealthvalue.com/audios/ep372/" rel="nofollow" target="_blank">Cora Opsahl (EP372)</a>, <a href="https://relentlesshealthvalue.com/audios/encore308/" rel="nofollow" target="_blank">Dr Mark Fendrick (Encore! EP308)</a>, <a href="https://relentlesshealthvalue.com/audios/ep371/" rel="nofollow" target="_blank">Erik Davis and Autumn Yongchu (EP371)</a>, <a href="https://relentlesshealthvalue.com/audios/ep370/" rel="nofollow" target="_blank">Erik Davis and Autumn Yongchu (EP370)</a>, <a href="https://relentlesshealthvalue.com/audios/ep369/" rel="nofollow" target="_blank">Keith Hartman</a>, <a href="https://relentlesshealthvalue.com/audios/encore282/" rel="nofollow" target="_blank">Dr Aaron Mitchell (Encore! EP282)</a>, <a href="https://relentlesshealthvalue.com/audios/inbw34/" rel="nofollow" target="_blank">Stacey Richter (INBW34)</a>, <a href="https://relentlesshealthvalue.com/audios/ep368/" rel="nofollow" target="_blank">Ashleigh Gunter</a>, <a href="https://relentlesshealthvalue.com/audios/ep367/" rel="nofollow" target="_blank">Doug Hetherington</a>, <a href="https://relentlesshealthvalue.com/audios/ep366/" rel="nofollow" target="_blank">Dr Kevin Schulman</a>, <a href="https://relentlesshealthvalue.com/audios/ep365/" rel="nofollow" target="_blank">Scott Haas</a>, <a href="https://relentlesshealthvalue.com/audios/ep364/" rel="nofollow" target="_blank">David Muhlestein</a>, <a href="https://relentlesshealthvalue.com/audios/ep363/" rel="nofollow" target="_blank">David Scheinker</a>, <a href="https://relentlesshealthvalue.com/audios/ep362/" rel="nofollow" target="_blank">Ali Ucar</a>, <a href="https://relentlesshealthvalue.com/audios/ep361/" rel="nofollow" target="_blank">Dr Carly Eckert</a>, <a href="https://relentlesshealthvalue.com/audios/ep360/" rel="nofollow" target="_blank">Jeb Dunkelberger (EP360)</a>, <a href="https://relentlesshealthvalue.com/audios/ep359/" rel="nofollow" target="_blank">Dan O’Neill</a>, <a href="https://relentlesshealthvalue.com/audios/ep358/" rel="nofollow" target="_blank">Dr Wayne Jenkins</a>, <a href="https://relentlesshealthvalue.com/audios/ep357/" rel="nofollow" target="_blank">Liliana Petrova</a>, <a href="https://relentlesshealthvalue.com/audios/ep356/" rel="nofollow" target="_blank">Ge Bai</a>, <a href="https://relentlesshealthvalue.com/audios/ep355/" rel="nofollow" target="_blank">Nikhil Krishnan</a>, <a href="https://relentlesshealthvalue.com/audios/ep354/" rel="nofollow" target="_blank">Shawn Rhodes</a>, <a href="https://relentlesshealthvalue.com/audios/ep353/" rel="nofollow" target="_blank">Pramod John (EP353)</a>, <a href="https://relentlesshealthvalue.com/audios/ep352/" rel="nofollow" target="_blank">Pramod John (EP352)</a>, <a href="https://relentlesshealthvalue.com/audios/ep351/" rel="nofollow" target="_blank">Dr Eric Bricker</a>, <a href="https://relentlesshealthvalue.com/audios/ep350/" rel="nofollow" target="_blank">Katy Talento</a>, <a href="https://relentlesshealthvalue.com/audios/inbw33/" rel="nofollow" target="_blank">Stacey Richter (INBW33)</a>, <a href="https://relentlesshealthvalue.com/audios/inbw32/" rel="nofollow" target="_blank">Stacey Richter (INBW32)</a>

EP373: How to Kick a Big Hospital Out of Your Network, With Cora Opsahl

In this healthcare podcast, I am speaking with Cora Opsahl, who directs the 32BJ Health Fund. Important to know about Cora’s background is this: In previous roles, she’s worked deep in the inner workings of the healthcare industry. So, she came to 32BJ armed with a BS meter that is finely tuned, which is, unfortunately, an essential skill for anyone trying to help the patients and members relying on them to successfully navigate the healthcare industry. So sorry to have to say that, but employers and unions, your employees and members need your help. If you do not help them, then your employees can find themselves defenseless against so many pit traps of financial toxicity and also clinical decision-making that is not made by patients and their clinicians in the service of improving patient outcomes but made by some other party in the service of financial maximization. It is really frightening what goes on in some cases. I really appreciated this interview with Cora Opsahl, which will be two shows, this week and next week. This whole conversation has been really a big bright spot for me and will provide hope, I think, for any employer/union who is seeking ways to protect their members and patients, the ones on their plans and therefore under their aegis and whom they have a fiduciary responsibility to look out for. It also should be a bright spot for dedicated clinicians out there suffering under the weight of moral injury because you are expected to do things that you know are not in your patient’s best interest—or not do things, as the case may be. This whole conversation should put on notice health systems and others who have been really taking advantage of employers who are asleep at the wheel. Change is always really, really slow—until it hits a zeitgeist and then it’s not slow anymore. I just attended the MTVA (Moving to Value Alliance) in Connecticut last month, and there were 30 employers there listening and learning. I hear similar numbers from business coalitions across the country penetrating their local markets (Houston, Indiana, for example). Also, spoiler alert, upcoming conversations with Dave Chase will continue this “yeah, there’s good things happening out there” theme. So, let’s start here with a little bit more about the 32BJ union and their Health Fund that we’ll hear about in this episode. 32BJ represents about 200,000 members. They are mostly in residential and commercial real estate—so, for example, your doormen, your maintenance workers, your security, your cleaners, amongst others. Members are in about 11 states, but a lot of them are in the New York City metro area. These union members who are in the fund work for over 5000 different employers. The 32BJ Health Fund has zero-dollar premiums. Also, employees have no premium contribution. Wowza on that point—that’s a huge benefit. Here’s one more thing that I’m gonna say about the 32BJ Health Fund overseen by Cora Opsahl, my guest today. Let’s talk about their amazing leadership, because I do not, nor should anyone else, take exceptional leadership for granted. We have had one guest after another on this podcast who, when asked what it takes to actually attain value for plan members or attain the quadruple aim, what it takes to navigate and overcome bureaucracy and inertia, every one of those thought leaders asked the “What does it take?” question came back with the following included in their list: It takes leadership. Real leadership. The mark of an exceptional leader is one who can conceive of a big mission statement, a goal to deliver better for their members at lower costs, and also the chops and determination to operationalize that vision. This operationalization requires brainpower and relentless dedication to untangle the deliberate opacity that some current healthcare stakeholders absolutely rely on as a business strategy. It takes work to get to the bottom of and disarm some deliberately labyrinthine and noncompetitive contract terms. Let me just pause for a beat on these basically egregious contract terms. Certain healthcare stakeholders seem to consider it somehow their birthright and their privilege to demand that employer and union customers sign on some pretty insane dotted lines—to the detriment of members and employees. By the way, if anyone is thinking CAA right now, I’m right there with you. Talking about the new Consolidated Appropriations Act that went into effect late 2021, and it’s gonna take a lot of C-suite executives by surprise when they’re named in class action lawsuits. So, there is another impetus to question bad contract terms if anyone at an employer or union needs an additional reason besides the health and safety of employees and members to justify getting their healthcare house under control. For more on the CAA, the Consolidated Appropriations Act, listen to the show with Christin Deacon (EP342).   But as I mentioned a moment ago, we are breaking this conversation up into two power-packed episodes. This first one gets into everything that the 32BJ Health Fund does with their data. They have lots of data. They demand it. Next week’s show gets into their unprecedented decision to kick a major local health system out of their network. This decision was also a data-driven decision, but it’s a whole other conversation, which is why it is now a whole other episode. So, besides kicking out overly expensive health systems from their network, here’s other things that 32BJ is currently doing with their data and which other employers and unions may get a few ideas from. If you have the data, you (like 32BJ) can use it to:  Make smart benefit decisions that are validated, not just guesses. Before you decide to do something (add a wellness program etc), be able to model it accurately for how much it will actually cost you—which, spoiler alert, is most of the time not what the vendor will estimate. You have way more data than the vendor does, so you can certainly use it to great effect in this way. Make sure that the right members are being communicated with so that benefit designs are successful. As Ashleigh Gunter said in EP368, success when changing benefit designs has a lot more to do with communication than many realize. Create dashboards for leadership that may show trend lines, for example, which could be very helpful to ensure that the fund doesn’t run out of money etc … little things like that. Figure out how much the fund is spending on various procedures and where. There’s all this talk right now about the crazy variability of prices for the same exact service in the same local market. At one hospital, a colonoscopy could literally cost $10,000; and in another hospital—same quality, same basically everything—that same colonoscopy will be $2000 or $3000. I mean, there’s a 500% delta or something in some of these cases. Ensure that if a vendor said they were going to do something, that they are actually doing it. This is especially meaningful for point solutions because of the whole squeezing the balloon thing. I can save money in a silo, and you won’t realize that those dollars are getting transferred elsewhere unless you are doing your own math. This is a big deal if you start thinking about how pharmacy benefits are typically siloed from medical benefits. So, if I’m a pharmacy benefit manager, I can talk about how much I’m saving by denying patients drugs without consideration of the medical downstream implications of that. Ensure you’re not paying a bill and writing a check for more than the bill was for, which is weirdly common. There’s a whole show with Dawn Cornelis (EP285) about this. 32BJ has an engineering team that is creating an app to help members navigate to great doctors with fair prices.  All of these things roll into basically three categories:  Cutting wasteful spending and finding fraud Making smart benefit decisions Being able to see trends and forecast the future, which is really helpful for financial solvency etc  As Cora Opsahl says, “I think we [all can] recognize [that] you [cannot] make smart … decisions and be a fiduciary of [a] fund without having [data].” You can learn more at 32bjhealthfundinsights.org.    Cora Opsahl is the director of the 32BJ Health Fund, a self-funded plan that provides affordable, comprehensive, and innovative health coverage to 200,000 union members and their families. During her time at the Health Fund, Cora has led the implementation of multiple benefit changes: removing NewYork-Presbyterian Hospital System and physicians from the network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and implementing an expanded Centers of Excellence program administered by Mount Sinai Hospital System. These efforts are projected to save over $35 million in 2022. Prior to joining the 32BJ Health Fund, Cora spent 12 years with Express Scripts, a pharmacy benefit manager. During her time there, she held a variety of roles, including Medicare Part D, strategy and acquisitions, operations, and account management. 08:55 How much data does 32BJ Health Fund have, where do they get it, and how do they use it? 10:56 How did 32BJ Health Fund successfully demand their data from 100% of their vendors? 11:45 “We feel it’s really important that we own this information ourselves.” 12:08 “It always concerns me—if a vendor doesn’t want to give you the information, what are they hiding?” 12:34 “It’s not just getting the data; it’s then using the data.” 15:44 “Without data, you’re really just taking a guess; and guesses are never gonna get you where you need to go.” 17:23 EP285 with Dawn Cornelis.17:42 Is the cost of creating a data analytics team worth the cost savings of those data discoveries? 21:07 “The use of data has really built our knowledge.” 22:55 “It’s really important to us that as we make benefit decisions, we’re doing it smartly.” 27:34 EP358 with Wayne Jenkins, MD.27:42 How is 32BJ Health Fund making their data knowledge actionable? 30:14 “If we can figure out how to make telehealth accessible … there may be an opportunity for telehealth … to upset some of these … monopoly systems or low-choice options.” 32:25 “It’s really easy to think that we can solve this problem through benefit design … but in the end … it’s the price.” You can learn more at 32bjhealthfundinsights.org.   @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth How much data does 32BJ Health Fund have, where do they get it, and how do they use it? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth How did 32BJ Health Fund successfully demand their data from 100% of their vendors? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We feel it’s really important that we own this information ourselves.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It always concerns me—if a vendor doesn’t want to give you the information, what are they hiding?” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It’s not just getting the data; it’s then using the data.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Without data, you’re really just taking a guess; and guesses are never gonna get you where you need to go.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth Is the cost of creating a data analytics team worth the cost savings of those data discoveries? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The use of data has really built our knowledge.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It’s really important to us that as we make benefit decisions, we’re doing it smartly.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth How is 32BJ Health Fund making their data knowledge actionable? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If we can figure out how to make telehealth accessible … there may be an opportunity for telehealth … to upset some of these … monopoly systems or low-choice options.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It’s really easy to think that we can solve this problem through benefit design … but in the end … it’s the price.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest’s name for their latest RHV episode! Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O’Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294)

In this healthcare podcast, I am speaking with Cora Opsahl, who directs the 32BJ Health Fund. Important to know about Cora’s background is this: In previous roles, she’s worked deep in the inner workings of the healthcare industry. So, she came to 32BJ armed with a BS meter that is finely tuned, which is, unfortunately, an essential skill for anyone trying to help the patients and members relying on them to successfully navigate the healthcare industry. So sorry to have to say that, but employers and unions, your employees and members need your help. If you do not help them, then your employees can find themselves defenseless against so many pit traps of financial toxicity and also clinical decision-making that is not made by patients and their clinicians in the service of improving patient outcomes but made by some other party in the service of financial maximization. It is really frightening what goes on in some cases. I really appreciated this interview with Cora Opsahl, which will be two shows, this week and next week. This whole conversation has been really a big bright spot for me and will provide hope, I think, for any employer/union who is seeking ways to protect their members and patients, the ones on their plans and therefore under their aegis and whom they have a fiduciary responsibility to look out for. It also should be a bright spot for dedicated clinicians out there suffering under the weight of moral injury because you are expected to do things that you know are not in your patient’s best interest—or not do things, as the case may be. This whole conversation should put on notice health systems and others who have been really taking advantage of employers who are asleep at the wheel. Change is always really, really slow—until it hits a zeitgeist and then it’s not slow anymore. I just attended the MTVA (Moving to Value Alliance) in Connecticut last month, and there were 30 employers there listening and learning. I hear similar numbers from business coalitions across the country penetrating their local markets (Houston, Indiana, for example). Also, spoiler alert, upcoming conversations with Dave Chase will continue this “yeah, there’s good things happening out there” theme. So, let’s start here with a little bit more about the 32BJ union and their Health Fund that we’ll hear about in this episode. 32BJ represents about 200,000 members. They are mostly in residential and commercial real estate—so, for example, your doormen, your maintenance workers, your security, your cleaners, amongst others. Members are in about 11 states, but a lot of them are in the New York City metro area. These union members who are in the fund work for over 5000 different employers. The 32BJ Health Fund has zero-dollar premiums. Also, employees have no premium contribution. Wowza on that point—that’s a huge benefit. Here’s one more thing that I’m gonna say about the 32BJ Health Fund overseen by Cora Opsahl, my guest today. Let’s talk about their amazing leadership, because I do not, nor should anyone else, take exceptional leadership for granted. We have had one guest after another on this podcast who, when asked what it takes to actually attain value for plan members or attain the quadruple aim, what it takes to navigate and overcome bureaucracy and inertia, every one of those thought leaders asked the “What does it take?” question came back with the following included in their list: It takes leadership. Real leadership. The mark of an exceptional leader is one who can conceive of a big mission statement, a goal to deliver better for their members at lower costs, and also the chops and determination to operationalize that vision. This operationalization requires brainpower and relentless dedication to untangle the deliberate opacity that some current healthcare stakeholders absolutely rely on as a business strategy. It takes work to get to the bottom of and disarm some deliberately labyrinthine and noncompetitive contract terms. Let me just pause for a beat on these basically egregious contract terms. Certain healthcare stakeholders seem to consider it somehow their birthright and their privilege to demand that employer and union customers sign on some pretty insane dotted lines—to the detriment of members and employees. By the way, if anyone is thinking CAA right now, I’m right there with you. Talking about the new Consolidated Appropriations Act that went into effect late 2021, and it’s gonna take a lot of C-suite executives by surprise when they’re named in class action lawsuits. So, there is another impetus to question bad contract terms if anyone at an employer or union needs an additional reason besides the health and safety of employees and members to justify getting their healthcare house under control. For more on the CAA, the Consolidated Appropriations Act, listen to the show with Christin Deacon (<a href="https://relentlesshealthvalue.com/audios/ep342/" rel="noopener nofollow" target="_blank">EP342</a>).   But as I mentioned a moment ago, we are breaking this conversation up into two power-packed episodes. This first one gets into everything that the 32BJ Health Fund does with their data. They have lots of data. They demand it. Next week’s show gets into their unprecedented decision to kick a major local health system out of their network. This decision was also a data-driven decision, but it’s a whole other conversation, which is why it is now a whole other episode. So, besides kicking out overly expensive health systems from their network, here’s other things that 32BJ is currently doing with their data and which other employers and unions may get a few ideas from. If you have the data, you (like 32BJ) can use it to: <ul> <li>Make smart benefit decisions that are validated, not just guesses. Before you decide to do something (add a wellness program etc), be able to model it accurately for how much it will actually cost you—which, spoiler alert, is most of the time not what the vendor will estimate. You have way more data than the vendor does, so you can certainly use it to great effect in this way.</li> <li>Make sure that the right members are being communicated with so that benefit designs are successful. As Ashleigh Gunter said in <a href="https://relentlesshealthvalue.com/audios/ep368/" rel="noopener nofollow" target="_blank">EP368</a>, success when changing benefit designs has a lot more to do with communication than many realize.</li> <li>Create dashboards for leadership that may show trend lines, for example, which could be very helpful to ensure that the fund doesn’t run out of money etc … little things like that.</li> <li>Figure out how much the fund is spending on various procedures and where. There’s all this talk right now about the crazy variability of prices for the same exact service in the same local market. At one hospital, a colonoscopy could literally cost $10,000; and in another hospital—same quality, same basically everything—that same colonoscopy will be $2000 or $3000. I mean, there’s a 500% delta or something in some of these cases.</li> <li>Ensure that if a vendor said they were going to do something, that they are actually doing it. This is especially meaningful for point solutions because of the whole squeezing the balloon thing. I can save money in a silo, and you won’t realize that those dollars are getting transferred elsewhere unless you are doing your own math. This is a big deal if you start thinking about how pharmacy benefits are typically siloed from medical benefits. So, if I’m a pharmacy benefit manager, I can talk about how much I’m saving by denying patients drugs without consideration of the medical downstream implications of that.</li> <li>Ensure you’re not paying a bill and writing a check for more than the bill was for, which is weirdly common. There’s a whole show with Dawn Cornelis (<a href="https://relentlesshealthvalue.com/audios/ep285/" rel="noopener nofollow" target="_blank">EP285</a>) about this.</li> <li>32BJ has an engineering team that is creating an app to help members navigate to great doctors with fair prices.</li> </ul> All of these things roll into basically three categories: <ol> <li>Cutting wasteful spending and finding fraud</li> <li>Making smart benefit decisions</li> <li>Being able to see trends and forecast the future, which is really helpful for financial solvency etc</li> </ol> As Cora Opsahl says, “I think we [all can] recognize [that] you [cannot] make smart … decisions and be a fiduciary of [a] fund without having [data].” You can learn more at <a href="https://32bjhealthfundinsights.org/" rel="noopener nofollow" target="_blank">32bjhealthfundinsights.org</a>.  Cora Opsahl is the director of the 32BJ Health Fund, a self-funded plan that provides affordable, comprehensive, and innovative health coverage to 200,000 union members and their families. During her time at the Health Fund, Cora has led the implementation of multiple benefit changes: removing NewYork-Presbyterian Hospital System and physicians from the network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and implementing an expanded Centers of Excellence program administered by Mount Sinai Hospital System. These efforts are projected to save over $35 million in 2022. Prior to joining the 32BJ Health Fund, Cora spent 12 years with Express Scripts, a pharmacy benefit manager. During her time there, she held a variety of roles, including Medicare Part D, strategy and acquisitions, operations, and account management. 08:55 How much data does 32BJ Health Fund have, where do they get it, and how do they use it? 10:56 How did 32BJ Health Fund successfully demand their data from 100% of their vendors? 11:45 “We feel it’s really important that we own this information ourselves.” 12:08 “It always concerns me—if a vendor doesn’t want to give you the information, what are they hiding?” 12:34 “It’s not just getting the data; it’s then using the data.” 15:44 “Without data, you’re really just taking a guess; and guesses are never gonna get you where you need to go.” 17:23 <a href="https://relentlesshealthvalue.com/audios/ep285/" rel="noopener nofollow" target="_blank">EP285</a> with Dawn Cornelis.17:42 Is the cost of creating a data analytics team worth the cost savings of those data discoveries? 21:07 “The use of data has really built our knowledge.” 22:55 “It’s really important to us that as we make benefit decisions, we’re doing it smartly.” 27:34 <a href="https://relentlesshealthvalue.com/audios/ep358/" rel="noopener nofollow" target="_blank">EP358</a> with Wayne Jenkins, MD.27:42 How is 32BJ Health Fund making their data knowledge actionable? 30:14 “If we can figure out how to make telehealth accessible … there may be an opportunity for telehealth … to upset some of these … monopoly systems or low-choice options.” 32:25 “It’s really easy to think that we can solve this problem through benefit design … but in the end … it’s the price.” You can learn more at <a href="https://32bjhealthfundinsights.org/" rel="noopener nofollow" target="_blank">32bjhealthfundinsights.org</a>.  @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth How much data does 32BJ Health Fund have, where do they get it, and how do they use it? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth How did 32BJ Health Fund successfully demand their data from 100% of their vendors? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “We feel it’s really important that we own this information ourselves.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It always concerns me—if a vendor doesn’t want to give you the information, what are they hiding?” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It’s not just getting the data; it’s then using the data.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “Without data, you’re really just taking a guess; and guesses are never gonna get you where you need to go.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth Is the cost of creating a data analytics team worth the cost savings of those data discoveries? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “The use of data has really built our knowledge.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It’s really important to us that as we make benefit decisions, we’re doing it smartly.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth How is 32BJ Health Fund making their data knowledge actionable? @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “If we can figure out how to make telehealth accessible … there may be an opportunity for telehealth … to upset some of these … monopoly systems or low-choice options.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth “It’s really easy to think that we can solve this problem through benefit design … but in the end … it’s the price.” @CoraOpsahl discusses #healthdata on our #healthcarepodcast. #healthcare #podcast #digitalhealth Recent past interviews: Click a guest’s name for their latest RHV episode! <a href="https://relentlesshealthvalue.com/audios/encore308/" rel="nofollow" target="_blank">Dr Mark Fendrick (Encore! EP308)</a>, <a href="https://relentlesshealthvalue.com/audios/ep371/" rel="nofollow" target="_blank">Erik Davis and Autumn Yongchu (EP371)</a>, <a href="https://relentlesshealthvalue.com/audios/ep370/" rel="nofollow" target="_blank">Erik Davis and Autumn Yongchu (EP370)</a>, <a href="https://relentlesshealthvalue.com/audios/ep369/" rel="nofollow" target="_blank">Keith Hartman</a>, <a href="https://relentlesshealthvalue.com/audios/encore282/" rel="nofollow" target="_blank">Dr Aaron Mitchell (Encore! EP282)</a>, <a href="https://relentlesshealthvalue.com/audios/inbw34/" rel="nofollow" target="_blank">Stacey Richter (INBW34)</a>, <a href="https://relentlesshealthvalue.com/audios/ep368/" rel="nofollow" target="_blank">Ashleigh Gunter</a>, <a href="https://relentlesshealthvalue.com/audios/ep367/" rel="nofollow" target="_blank">Doug Hetherington</a>, <a href="https://relentlesshealthvalue.com/audios/ep366/" rel="nofollow" target="_blank">Dr Kevin Schulman</a>, <a href="https://relentlesshealthvalue.com/audios/ep365/" rel="nofollow" target="_blank">Scott Haas</a>, <a href="https://relentlesshealthvalue.com/audios/ep364/" rel="nofollow" target="_blank">David Muhlestein</a>, <a href="https://relentlesshealthvalue.com/audios/ep363/" rel="nofollow" target="_blank">David Scheinker</a>, <a href="https://relentlesshealthvalue.com/audios/ep362/" rel="nofollow" target="_blank">Ali Ucar</a>, <a href="https://relentlesshealthvalue.com/audios/ep361/" rel="nofollow" target="_blank">Dr Carly Eckert</a>, <a href="https://relentlesshealthvalue.com/audios/ep360/" rel="nofollow" target="_blank">Jeb Dunkelberger (EP360)</a>, <a href="https://relentlesshealthvalue.com/audios/ep359/" rel="nofollow" target="_blank">Dan O’Neill</a>, <a href="https://relentlesshealthvalue.com/audios/ep358/" rel="nofollow" target="_blank">Dr Wayne Jenkins</a>, <a href="https://relentlesshealthvalue.com/audios/ep357/" rel="nofollow" target="_blank">Liliana Petrova</a>, <a href="https://relentlesshealthvalue.com/audios/ep356/" rel="nofollow" target="_blank">Ge Bai</a>, <a href="https://relentlesshealthvalue.com/audios/ep355/" rel="nofollow" target="_blank">Nikhil Krishnan</a>, <a href="https://relentlesshealthvalue.com/audios/ep354/" rel="nofollow" target="_blank">Shawn Rhodes</a>, <a href="https://relentlesshealthvalue.com/audios/ep353/" rel="nofollow" target="_blank">Pramod John (EP353)</a>, <a href="https://relentlesshealthvalue.com/audios/ep352/" rel="nofollow" target="_blank">Pramod John (EP352)</a>, <a href="https://relentlesshealthvalue.com/audios/ep351/" rel="nofollow" target="_blank">Dr Eric Bricker</a>, <a href="https://relentlesshealthvalue.com/audios/ep350/" rel="nofollow" target="_blank">Katy Talento</a>, <a href="https://relentlesshealthvalue.com/audios/inbw33/" rel="nofollow" target="_blank">Stacey Richter (INBW33)</a>, <a href="https://relentlesshealthvalue.com/audios/inbw32/" rel="nofollow" target="_blank">Stacey Richter (INBW32)</a>, <a href="https://relentlesshealthvalue.com/audios/encore294/" rel="nofollow" target="_blank">Dr Steve Schutzer (Encore! EP294)</a>