EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl

Oct 10, 2024

Cora Opsahl, Director of the 32BJ Health Fund, plays a pivotal role in serving over 200,000 members by negotiating cost savings and improved healthcare benefits. In their conversation, they delve into the challenges of fiduciary duties and the entrenched status quo in healthcare. Opsahl shares how data analysis reshaped their benefit design and enabled significant savings by kicking a major hospital out of their network. The discussion highlights the importance of collaboration between employers and unions to tackle escalating healthcare costs and enhance member welfare.

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ANECDOTE

32BJ's Initial Crisis

32BJ Health Fund faced a fiscal crisis 15 years ago, with claims exceeding premiums.
They hired a data analyst and started analyzing their claims data to gain control over their spending.

INSIGHT

Price Discrepancies

Analyzing claims data revealed large price discrepancies for the same procedures at different hospitals.
For example, a colonoscopy cost $10,000 at NYP versus $4,000 at Mount Sinai.

ANECDOTE

Anti-Competitive Contracts

32BJ tried to tier their benefits based on price, incentivizing members to choose lower-cost hospitals.
However, their TPA's contract with NYP prevented them from tiering NYP up due to an "all products" clause.

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In this episode I interview Cora Opsahl from the 32BJ Health Fund to examine the intricate dynamics between fiduciary duties and the entrenched status quo in healthcare. The discussion focuses on the challenges employers face when dealing with anti-competitive contracts and their responsibility to ensure plan expenses are reasonable. Cora Opsahl, my guest today, is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to kick NewYork-Presbyterian, a big, consolidated, very expensive hospital, out of their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. And also, employees got their biggest raise ever; employers got a premium holiday and a 3% rate increase for a bunch of years after that; and yeah … this is where we start the conversation today. Furthermore, you will find links to a template health savings calculator for plan sponsors and also a template contract (again for plan sponsors) that 32BJ has made available, in our show notes.

To Read the Full Show Notes with the Mentioned Links Visit the Episode Page.

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06:16 Why is it imperative for employers to do something differently when it comes to being plan sponsors?

09:22 How analyzing claims data allowed 32BJ Health Fund to reshape their benefit design.

12:09 What anticompetitive rights did 32BJ run into that limited 32BJ Health Fund from managing their benefit design?

14:12 How do these anticompetitive rights have quality implications as well as cost implications?

18:43 How did 32BJ Health Fund remove NewYork-Presbyterian from their network, and how much did it save 32BJ Health Fund per year?

19:46 What did the healthcare savings allow the unions and employers to do?

20:46 Study by Zack Cooper, PhD.

21:26 Why rising healthcare costs has pushed 32BJ Health Fund to move beyond benefit design to manage healthcare spend.

24:15 Why 32BJ Health Fund wants to control the contracting process.

26:00 EP419 with Andreas Mang.

27:18 What are 32BJ Health Fund’s four non-negotiables?

33:17 Wall Street Journal article on health insurance contract.

35:30 Upcoming episode with Claire Brockbank.

36:14 What is the challenge that exists in our current healthcare environment?

37:43 Cora’s advice on how to get high-quality healthcare at an affordable price.