This episode features an interview with Scott Burton, Commercial Market President at Providence Health Plan. Since joining the organization in 2022, Scott has been influential in the growth of central PHP business and engagement with channel partners. In his current role, Scott is responsible for state and regional commercial sales and growth strategies. In this episode, Kirk and Scott explore the impact of rising healthcare costs on employers, the shifting role of benefits administrators, and the evolving relationships between health systems and employers.
This episode features an interview with Scott Burton, Commercial Market President at Providence Health Plan. Since joining the organization in 2022, Scott has been influential in the growth of central PHP business and engagement with channel partners. In his current role, Scott is responsible for state and regional commercial sales and growth strategies.
In this episode, Kirk and Scott explore the impact of rising healthcare costs on employers, the shifting role of benefits administrators, and the evolving relationships between health systems and employers.
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“ We're having conversations with many of our employers around, alright, how do we think about benefit design differently? Can we continue to move toward value-based contracting even in today's really challenging world? Employers have a lot of power to impact change, again, large employers and small. I think we're having conversations now that we haven't had in the last decade plus in healthcare and we need to. We need to move to a new paradigm because today's system is clearly broken.” – Scott Burton
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Episode Timestamps:
*(00:55): Scott’s career journey
*(02:41): Why employers should care about the state of health systems
*(08:36): The opportunity health systems have to work with employers
*(12:09): Scott breaks down Providence Health Plan
*(19:24): PHP’s role in community health plans
*(29:47): Scott's advice for employers working with local health systems
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Links:
Connect with Scott on LinkedIn
Learn more about Collective Health
[00:00:00] Kirk McConnell: Healthcare costs are rising, benefits are confusing, and the system doesn't always work for the people who need it most. But it doesn't have to be that way. Smart employers and their brokers are flipping the script, cutting costs, making things simpler in creating a health benefits experience their people love.
[00:00:22] Kirk McConnell: Welcome to the Benefits Playbook. I'm Kirk McConnell, and in each episode we uncover the bold strategies that are rewriting the rules of self-funded health benefits. Today I'm thrilled to be joined by Scott Burton, the Commercial Market President at Providence Health Plan. Scott, thank you so much for joining us today.
[00:00:40] Scott Burton: Yeah, thanks for having me, Kirk.
[00:00:42] Kirk McConnell: Scott, today I think we're gonna be able to dive into a really interesting topic, which is the relationship between large health systems and employers, and I think you're really well positioned to kind of talk about that. Let's start with your background, though. What sparked your interest in this field and how did you get to where you are today?
[00:01:02] Scott Burton: My daughter was born and I was in the midst of transitioning careers my past life. I was a television anchor and reporter for about 15 years all over the west coast and was looking for that next calling. And so my daughter was born and it wasn't the best of experiences it, it was our first child. We didn't quite know what to expect and it just felt like we were kind of being moved through a complex system.
[00:01:25] Scott Burton: And so as I was looking to change careers, I thought what would motivate me. What would inspire me is, is truly a calling for my, my next career. And I landed on healthcare and have really worked against the North Star since that day of wanting to have an active seat at the table to make healthcare better for her generation.
[00:01:43] Scott Burton: And then I've added, as my parents have gotten older for their generation as well.
[00:01:48] Kirk McConnell: And so your role today, the Commercial Market President at Providence Health Plan, kinda walk me through your day to day. What are the things you're focused on when you wake up?
[00:01:57] Scott Burton: Multidimensional for sure. So I oversee all of our employer-sponsored business, everything from account management to new sales, working with our underwriting team on pricing the business, working closely with our product team on what's the next product innovation we want to bring out to market.
[00:02:13] Scott Burton: Are we pricing it appropriately? Are we marketing appropriately? And then, you know, full P&L management, right? How is the profitability of our business setting us up? For a sustainable long path to be here for those that we serve, not only today, but for years into the future. So each day is a little bit different, but it always seems to, uh, move through those themes.
[00:02:34] Kirk McConnell: Now we'll get into some specifics of Providence and Providence Health Plan, but let's zoom way out for a second. Let's talk about the state of health systems and kinda the implications for employers. And so when you speak generally, there's a lot of new stories now about some of the headwinds that large health systems are facing.
[00:02:52] Kirk McConnell: Labor costs are going up. Tariffs are impacting their costs. You have government revenue coming down. There's a lot of articles about Medicaid changes and Medicare changes. If you're an employer and if you're running a benefits plan, why do you care about that? Why is that gonna impact you?
[00:03:12] Scott Burton: Yeah, well, several fronts.
[00:03:14] Scott Burton: First and foremost, the cost for employers is the pace of it certainly is the highest it has been year over year since about 2007. If we think about annual trend shifting, and so, you know, for most employers the cost of their benefits is amongst their top three expenses is a company, and so being able to budget for that account for that within your operating budget is, is really, really important.
[00:03:37] Scott Burton: The second component of it, I think, is employers are bearing a larger burden of the nation's healthcare costs each and every year. There was a Kaiser Family Foundation study that looked at private cost shifting from 2014 to 2024. That is how much more are private employers who are getting, you know, their benefits through private insurance pain versus Medicare and Medicaid.
[00:04:02] Scott Burton: Over that 10 year time from 2014 to 2024, the cost of private insurance for inpatient care grew almost 50%. Conversely, Medicare. 25% Medicaid, 21%. So we're seeing where health systems are not able to collect enough fees from the government to pay for the care of their delivery. They're passing those costs on to employers at an increasing level.
[00:04:30] Scott Burton: So that component, particularly in today's environment, is really important for an employer to keep their eye on. And then the last piece is, yeah, I think we're seeing the expectations of employees moving from benefits is a nice to have to benefits is a table stake and wanting a benefits package that treats not only the physical but the mental as well.
[00:04:50] Scott Burton: And so I'm seeing this shift of employers not only seeing themselves as benefit administrators, but also a healthcare strategists for the population that they employ.
[00:05:00] Kirk McConnell: You know, that makes a a lot of sense. And so if, if you're an employer or just someone that thinks about employer benefits, you wake up in the morning, you're reading news articles about this, what are the questions you should be asking yourself or kinda what are the things that should be top of mind every time you see health systems in the news?
[00:05:17] Scott Burton: Yeah. What I think really looking at the component costs, who are those health systems serving? What does the community look like? What state do you live in? Right? These vary, you know, state by state, the west coast has a tendency to see a lot of private cost shifting. For example, in Oregon, where I'm joining you from today.
[00:05:34] Scott Burton: Private payers pay 263% of Medicare in Washington. That's 269%, so depending on the state that you're in. And then of course, there's just a lot that's happening in Washington DC these days, and it's changing regularly. So really keeping track of which bills seem to be having inertia. Will they impact your business or not?
[00:05:57] Scott Burton: And then thinking, you know, short and long term. Alright, what questions do I need to be asking my consultant? What questions do I need to be asking my plan administrator or my carrier to help me navigate not only, you know, the benefits offering, but also the financial mechanisms that really surround the benefits.
[00:06:15] Kirk McConnell: You mentioned that as these things change, one of the things that's probably impossible is just to keep thinking about things the same way in the status quo. So let's tackle that from both angles. Let's be the employer first. I have to imagine historically when you saw news about negotiation or price shifting, kinda your first call was, call the carrier, see what they're doing about it.
[00:06:35] Kirk McConnell: Do you think there's an opportunity for employers to work more directly or more thoughtfully with health systems now?
[00:06:43] Scott Burton: I do in several different ways. I think we're seeing, you know, kind of as I alluded to earlier, this fundamental shift in how employers kind of view their roles from benefits administrator to workforce health strategists, let's call it.
[00:06:54] Scott Burton: So for example, let's take behavioral health and how might we access behavioral health care. There was a study that Mercer just released a few weeks ago, mid-July. It's their 2026 employer survey on health and benefit strategies, and they surveyed about 711 employers across the country. All industries, all sizes.
[00:07:14] Scott Burton: 76% of those respondents say they're gonna provide digital resources for stress management and resiliency next year. 51% of those said we wanna make sure that we offer live resources for stress management and resiliency. And then 40% said, you know, they plan to offer actually manager your training to help them recognize colleagues with behavioral health issues.
[00:07:38] Scott Burton: So I think if you're an employer. Where do we get those solutions from? Well, some cases you may get them from a point solution, if you will, a digital vendor. There's other opportunities to work with a health plan and a delivery system to provide behavioral healthcare just as one paradigm. So for example, we're part of Providence, a broader delivery system where the health plan and then the delivery system operates across seven states.
[00:08:03] Scott Burton: We've worked with them to create a model that we call behavioral health concierge. It's a real high touch behavioral healthcare that's delivered virtually. It was originally created for our doctors coming out of the pandemic, and now we're offering it to our employer customers and their employees to provide a similar level of high touch care.
[00:08:24] Scott Burton: So just one example of how employers are asking different questions that can then lead to new relationships with both health plans and delivery systems directly.
[00:08:34] Kirk McConnell: And you talk about those different questions. Let's talk about the delivery systems for a second. I have to imagine that they are thinking differently as well.
[00:08:42] Kirk McConnell: It's no longer we will work with employers only through large medical networks. What do you think some of those health system conversations are now about? What opportunities are there to work directly with employers?
[00:08:56] Scott Burton: For years now, I think we have heard discussions of direct to employer. Right. And those have often been reserved for the largest employers nationwide.
[00:09:05] Scott Burton: I'm continuing to hear more of that conversation emerging now as prices have continued to increase. I'm sure you are as well. I think it's still relegated to the larger employer, and I say that for a couple reasons. If you were to establish a direct to and provider relationship, alright. Let's call it reference-based pricing for certain treatments, or a parallel fee for service chassis, and that relationship is direct between the employer and the provider.
[00:09:33] Scott Burton: Somebody still has to administer your claims, somebody still has to provide customer service. Somebody still has to provide that digital member experience. There is more in the ecosystem that's required. And so while I think that, you know, those types of conversations can continue to happen and they are happening, we, for example, support a large national employer where they have a direct contract with our delivery system and we administer their benefits.
[00:09:59] Scott Burton: They're getting the best of both worlds. I'm starting to hear some conversations probably picking up in that vein of how do we as providers, payers, and employers come together as a three-legged stool to get at some of not only the cost, but also the member experience challenges that we face in healthcare today.
[00:10:20] Kirk McConnell: What do you think is driving that change? Because I think what you said makes a lot of sense that it used to be the Fortune 10 company has to work with the large hospital CEO to figure out some sort of what I'll call almost an unnatural relationship. Now, it sounds like those people are coming together to say, Hey, this isn't just for Fortune 10.
[00:10:39] Kirk McConnell: How do we make it a little more scalable? How do you think those conversations are changing?
[00:10:43] Scott Burton: Well, we're at a breaking point. First of all, for employers, there's more pressure to figure out a solution. So this was, I think, middle of last year in 2024 where Kaiser Family Foundation released a survey. They had talked to employers.
[00:10:57] Scott Burton: This is of 5,000 employees of larger, so the larger employers. But they said, where are you in your ability to continue to fund employee benefits? And they said, you know, 90%. Nine outta 10 said by 2030, they weren't sure if they were gonna be able to afford to offer employee benefits anymore. That's the largest employer.
[00:11:16] Scott Burton: Now imagine you move down market with some of those smaller employers who don't have the means to absorb costs. They are absolutely at a breaking point. So they are trying to look for other options. We're having conversations with many of our employers around, alright, how do we think about benefit design differently?
[00:11:34] Scott Burton: Can we continue to move toward value-based contracting, even in today's really challenging world, both on the medical side and the pharmacy side. So employers big and small are having different conversations with us as a health plan, different conversations with the delivery system. And I think that's a good thing.
[00:11:53] Scott Burton: Employers have a lot of power to impact change. Again, large employers and small. I think we're having conversations now that we haven't had, you know, in the last decade plus in healthcare and we need to move to a new paradigm 'cause today's system is clearly broken.
[00:12:07] Kirk McConnell: You've been using we a lot. Tell us more about the we, tell us about Providence Health Plan, how it relates to the broader Providence system, and then we'll kind of go from there.
[00:12:15] Scott Burton: As I mentioned earlier, Providence as a system operates across seven Western states providing care in hospital settings, doctor office settings, medical groups, and we are the health plan. Providence Health Plan is the health plan that is part of the Providence family. We have been operating for a little more than 40 years as a health plan, the broader Providence, over 140 years.
[00:12:40] Scott Burton: And so together I think we have a lot of power and our ability to think about how healthcare is delivered differently moving forward. I don't know what the future's gonna look like. I don't know that anybody has the crystal ball, but I am a firm believer that wherever we end on the other side of the crisis, that we find ourselves in healthcare today, I am a firm believer that it's gonna come from an integrated model or a payvider model.
[00:13:05] Scott Burton: And I say that after spending 13 years with the blues, where the conversations were more zero sum games of provider contracting. Sure there were joint operating meetings, but the conversations we get to have now as a help plan with our delivery system and then centering what you know, solutions might we be able to bring to employers.
[00:13:26] Scott Burton: Vastly different than I've ever been able to have in my career before. We think about, you know, creating access where access may not exist. We operate in eastern Washington, and as we are bringing a couple employers into Providence Health Plan, we actually work with our delivery system to address some of the access challenges for primary care and wanted to make sure that folks coming out of a closed model had the ability to come in and receive care immediately.
[00:13:52] Scott Burton: We sat down with our providers, our provider partners in Spokane, and we figured out not only how do we create access, but how did we make sure that continuity of care needs continuity of pharmacy was accounted for. Those are discussions that are, I would argue, are easily had with the system and a health plan working together.
[00:14:10] Kirk McConnell: Let's keep going and let's go broader than Providence Health Plan, but you use the term payviders, so provider systems that are also their own health plan. If you're an employer, why would you work with a payvider as opposed to working with a system through another major carrier? How does it feel different or what's exciting about that opportunity?
[00:14:29] Scott Burton: Yeah. Well, let's hit two paradigms there. First cost, right? If I look at our contracts, our reimbursement contracts with our delivery system, and this is not uncommon for payviders across the country, there are generally more advantageous reimbursement terms. So how much money is being paid, her service that's delivered there are generally more advantageous reimbursement terms between family companies.
[00:14:54] Scott Burton: We have a firewall in place at Providence. We don't know what our delivery system reimburses other carriers, but we do believe, and we have reason to believe that we are at best in market, if not at a minimum market parity. So at a minimum on a fee for service chassis, I think those payviders are creating a more economic environment to pay for each piece of care that is delivered.
[00:15:17] Scott Burton: Then there's the opportunity to have value-based conversations. So when we're really thinking about how do we get off the fee for service model and get into a model where you're paying for quality health outcomes, maybe over a care journey, again, I think we're able to have different conversations as one unified company.
[00:15:37] Scott Burton: Then, you know, the big nationals are where there's often a zero sum game of how much are you gonna give me in my reimbursement contract? Then finally it's that patient or member experience. I can log into my system and I know our Chief Medical Officer talks about this all the time. She can log into our system and we use Microsoft Teams.
[00:15:59] Scott Burton: Other companies might use Slack, but having internal conversation about care management, it's not having to reach out to a different company. We operate on a similar promise of no care for and ease the way of our members. Our values are aligned, right? Hey, vital or integrated delivery systems and health plans across the nation all have similar aspects in that regard.
[00:16:21] Scott Burton: So I think you look at, you know, the affordability of healthcare. We have, I think, a greater ability to impact costs. And I think on the member experience and patient experience side, we have a greater ability to impact a real high quality member of patient experience as well.
[00:16:36] Kirk McConnell: Yeah, the visual that comes to mind as you talk about this, I almost feel like you have members and employers on one side and the delivery system on the other side.
[00:16:44] Kirk McConnell: The payvider relationship is really the ability to say, let's eliminate as many middlemen in the middle as possible. Because the more direct that relationship is, maybe the more fulfilling it is for all involved.
[00:16:55] Scott Burton: Agree, agree. And I think we're at a place, Kirk, where we need to be thinking differently as employers, payers, and providers, right?
[00:17:04] Scott Burton: The days of those provider terminations that are resolved in the 11th hour, guess what? Midnight's ticking. Now we're seeing those terminations occur and they're staying terminated, not even to speak of the patient experience. And so while we talk about payer, provider and health plan, I think you add in the employer dynamic and now you've got four folks around the table who can envision what
[00:17:29] Scott Burton: employers need, what their employee populations need, what a health plan's value can bring to the table, and what a delivery system can do. That's a powerful dynamic that historically I think we've all operated from our various quarters.
[00:17:43] Kirk McConnell: Yeah. You said something really interesting that I want to go back to.
[00:17:45] Kirk McConnell: You said a lot of these terminations used to be resolved at the 11th hour. I know for a lot of members and for a lot of employers, you get that note, Hey, in 30 days we may drop out of network. And we're just used to two days before saying, oh good news, we've renegotiated. What's changing? Why is it actually going to network termination now?
[00:18:05] Scott Burton: Well first the notifications are often required by state regulators, and so there goes the 30 day notice and that's a good thing. You know, consumers and patients need to be aware, but it's in that window of time where, you know, if you go back to classic negotiation, your zone of potential agreement has gotten really, really small.
[00:18:21] Scott Burton: The providers, you know, if you look at the headlines, they are really in some fragile states and, you know, particularly in rural areas of the country, they're having to navigate some really challenging financial times. They don't have the ability to simply say, okay, great.
[00:18:38] Scott Burton: Payers will take a huge cut. The other side, you know, the payers are at a place where, you know, they're seeing their costs needing to be passed through to the employer increasing. We already talked about the private cost shift earlier in the dialogue. So they're trying to get to a place where, no, I really need to see this number.
[00:18:57] Scott Burton: All of that compressed by the fact that cost of labor inflation, all of that has risen at historic levels. The divide is larger than ever, and the common ground, that zone of potential agreement is smaller than ever. And so we're seeing those terminations actually happen and the terminations staying in place.
[00:19:16] Scott Burton: We have one in Oregon now that everyone thought would be resolved in the 11th hour. We are now in July, and those two entities still have contract.
[00:19:24] Kirk McConnell: You know, it makes me think that more than ever, healthcare is still local. Those dynamics are still local. Those relationships are still local. Walk me through as a kind of what I'll call a community health plan.
[00:19:36] Kirk McConnell: How is your involvement in those local politics or dynamics potentially different than a national carrier?
[00:19:42] Scott Burton: Right. Healthcare is local, and I would argue that those regional or local health plans, while we have our challenges in terms of not operating with the scale and resources that a lot of the nationals do, when it comes down to knowing our communities, understanding when you're asking a member to drive from their home to a certain provider, are you asking them to drive over a mountain range?
[00:20:05] Scott Burton: Are you asking them to go across a freeway that's had traffic for the last four years? The nationals don't often understand that, right? You've got decisions that are being made at a national level, and you're needing to scale those decisions across the country. You know, I sit here in Portland, Oregon, and when we sit across the table from our employers.
[00:20:24] Scott Burton: We talk at a local level. You have employees who reside in Eastern Oregon. I know you have some challenges with providers. We're gonna go out in the behavioral health space, for example, and we're gonna work to bring new providers into our network to make sure we're addressing those access challenges that your employees in that rural community happen to be facing.
[00:20:43] Scott Burton: Just one example of the types of dialogues I think are well suited for local and regional carriers are harder for the nationals, you know, to address just based on their scale. I think the other component is we're seeing the pace of decision making needing to increase. Particularly, you know, as employers are evaluating their choices for, you know, benefit design as they're managing cash flow on high cost claims, a whole host of dimensions where just the pace of information is flowing faster.
[00:21:13] Scott Burton: We can leave our office here and immediately go to the corporate headquarters as a customer in 15 minutes and sit face to face with them and have that dialogue. I don't need to hop on a plane and fly from New York or Atlanta or Minneapolis to get here. I can be there that day. Then finally, I think it's just the community, Kirk.
[00:21:31] Scott Burton: We operate in the same communities where our employers, employees live, work, reside, raise their families. I'm proud of the fact that we invest community dollars back into not-for-profits that create a solid safety net for community health needs. Those are the types of things that I think, you know, local and regional health plans are really leaning into, and rightfully so.
[00:21:55] Kirk McConnell: And yet, I would argue that probably cuts both ways because while you have the local relationships, you don't have billions of dollars in innovation and product development, and yet you need to go out and win business really with the way you're able to take care of members and employers. How have you thought about that?
[00:22:12] Kirk McConnell: What do you need to deliver to the market where you have those local relationships, but maybe not all the bells and whistles of a national carrier? How have you figured out how to think through that?
[00:22:24] Scott Burton: A couple different dimensions. First, we're scrappy, and I love that we're scrappy. There's so much waste in healthcare.
[00:22:30] Scott Burton: Yes, it would be nice to have an unlimited checkbook. Sure, but that's dollars that our employer customers are paying, right? That's not our money. Those are our members' dollars. And so I'm glad that we operate in a real scrappy fashion and we make hard decisions. Is this something that the market really wants?
[00:22:47] Scott Burton: Is this a must have, a nice to have? A need to have or just a luxury? And so making those challenging calls with the input of our employers in our members in mind, we do day in and day out. While the nationals may have the resources, I think it forces us to make really smart decisions along the way as well that I hope and believe reduces waste in the system.
[00:23:10] Scott Burton: The other piece is we don't need to be an expert in everything, right? Our value is rooted in our access to our delivery system and the incredible care and affordability that we can offer through that direct relationship to Providence. But we find partners where those who are doing things that would cost us millions of dollars to build ourselves and or years to develop ourselves, we can establish relationships kind of best in class.
[00:23:40] Scott Burton: That's difficult sometimes for a national to do because you're starting to bifurcate, you know, your value is a big national entity. It's, you know, anathema to the model of we're gonna build everything and control vertically and horizontally our integration. We can find best in class partners. And we've done that.
[00:23:58] Scott Burton: Talking with you today, Collective Health. It's been our pleasure to partner with you, for example, and how we administer our self-funded benefits moving forward, starting in the fall. So just an example of different ways, I think local and regional health plans can still compete, can actually use it to their advantage to eliminate waste and still at the end of the day deliver, if not exceed the expectations of the board.
[00:24:20] Kirk McConnell: And I think sometimes being scrappy is a strength and a moment of such change. If you were to guess, how do you think the next five years are gonna feel different in the payvider world versus maybe the last five or 10?
[00:24:32] Scott Burton: I'm having a hard time sometimes seeing the next six months. You're looking for five years.
[00:24:37] Scott Burton: I'd probably answer it in a couple ways. Those delivery systems and health plans, who can find ways to create enterprise value for their customers and of course for themselves as well, but for their customers, I think have a tremendous advantage. And in five years from now, could be light years ahead of their competition.
[00:24:58] Scott Burton: And what do I mean by industry or rather enterprise value? It's looking end to end. At the cost dynamics and how together can we address those? It's looking end-to-end at where can we create a better patient experience and smooth and ease the way of those who walk into our hospitals and then need their claims process and may call into customer service.
[00:25:21] Scott Burton: It's looking at solutions not by line of business or by payer versus provider, but looking at it holistically. And for every dollar that we invest, how do we create three? That multiplier, one plus one doesn't always equal two, sometimes it equals three. I think that that is a reality of where the winners will come out in the integrated model.
[00:25:43] Scott Burton: They just have the ability to have different conversations.
[00:25:45] Kirk McConnell: What do those conversations look like with larger employers who might say, yes, I have 2,000 people in Washington, but I have 10,000 people outside of Washington. Is that not a good fit, or should they be thinking about it differently?
[00:25:59] Scott Burton: There's a couple dimensions to that.
[00:26:01] Scott Burton: First, you know, earlier in, in our discussion, we were talking about direct to a provider, direct to employer relationships. I think that has a tendency to break down, or at least it's another dimension that an employer needs to think about. If you are a smallish employer or medium sized employer, and your population lives precisely within the footprint of a provider.
[00:26:21] Scott Burton: Maybe you can have that direct to employer, direct to provider contract discussion, find the right health plan to do that. But if you have employees, let's say you're headquartered in Washington and you've got a big fab plant in Florida. Well, you're gonna need a different network partner. We have a relationship with Cigna nationwide that provides access to billions of doctors across the country.
[00:26:44] Scott Burton: And we found when we, you know, entered into that relationship several years ago, that it was a must. As we started to work with employers that had multi-state needs, Providence alone couldn't satisfy that. And so, you know, as I think about creating a network that meets your local, regional, and national needs.
[00:27:04] Scott Burton: You know, I think those are the conversations that employers really need to be thinking about. In a past life, I worked with an employer who was in acquisition mode, and we actually worked very closely looking at what markets were they, you know, endeavoring to enter, and what did the network access look like for their employees.
[00:27:20] Scott Burton: We can still have conversations like that now here at Providence Health Plan with our customers as they go through acquisition and growth mode, in partnership with their consultant to say, okay, what does that network access look like through Cigna? Do we need to establish any other network relationships in person or virtually to make sure that your employees have access to care?
[00:27:39] Scott Burton: That goes to the conversations that are increasing.
[00:27:42] Kirk McConnell: You talk about those other relationships, I think a lot of people that are hearing about this space for the first time, maybe assume, oh, a Providence Health Plan means it's a closed network with only access to Providence providers. What would you say to those folks that kind of have that mindset?
[00:27:59] Scott Burton: It's the best of both worlds, right? So, if you want to access a Providence provider, you're gonna get high quality care in all of our Providence facilities. It, you know, again, likely the best cost in the market, the best price in the market. But if you, you know, want to go see a doctor that is not named Providence, we have that network access via Cigna,
[00:28:19] Scott Burton: we also have network contracts directly with providers and key geographies where we know members need to have access. We are fortunate, Kirk, in that we do have a relationship with Providence as a delivery system, but as a health plan, we are also making sure that we can stand on our own two feet as a provider aligned.
[00:28:38] Scott Burton: I don't say Providence aligned, a provider aligned health plan. Making sure that, you know, access to high quality care is required by our customers and our members. That we have the right contracts in place to make that happen. And we're fortunate today to have a lot of those, you know, secured and in place.
[00:28:55] Scott Burton: I think the other element to it is as well, and this might be a dynamic that's adjacent to your question, but because we are part of an integrated delivery system, when we have conversations with providers not named Providence, I think we speak their language a little bit better. We understand the pressures that they face.
[00:29:15] Scott Burton: Again, it's not a zero sum game of I need to get this out of the contract, and you need to get that. We enjoy some really preferred partner relationships with providers across our states that have leaned in in their side as well to some really difficult conversations. We find a middle ground for those people that we jointly serve as payers and providers in the community.
[00:29:35] Scott Burton: So I think there's also an advantage, you know, to working with those integrated models, even if you're not having a conversation or accessing care through their core delivery system partner.
[00:29:45] Kirk McConnell: You know, as we wrap up, what would be your final pitch to an employer to say, Hey, things are changing. This is why I think you should be more open to the idea of working more directly with your local health systems.
[00:30:00] Scott Burton: I guess I would ask them what's their other choice, right? The data and the surveys say they've reached a breaking point. In the conversations that I've had over the last 15 years in this business, I think I've sensed an increasing frustration from employers of the status quo. We need to be having different conversations, and they have power in this equation as purchasers to impact change.
[00:30:23] Scott Burton: And so ask the good questions, right? Push your health plan, push your local delivery system to work. In different ways than we've worked historically. I don't think there's anyone out there that says healthcare right now is on a sustainable path for the future. It is in tremendous change.
[00:30:42] Scott Burton: The greatest we've seen since the advent of the ACA and now is the time for employers to be asking different questions and to push us. And I welcome that. We have an employer advisory council and we bring some of our leading employers together and we share, we kind of pull back the curtain a little bit and we say, here's what's coming forward.
[00:31:00] Scott Burton: Where are we hitting the mark? Where are we missing? What could we be doing better to serve you as an employer and your employees? And we get some pretty good feedback, some that's positive. And yep, keep doing what you're doing. Others, it's critical. You need to be doing more in this area. And we take that and we work with our delivery system partners, or we work within our health plan to try to get better.
[00:31:19] Scott Burton: And so I don't know that looking in the rear view mirror as an option anymore, we need to be looking out the front windshield. And I look forward to working with employers and encourage employers to help pull healthcare forward.
[00:31:31] Kirk McConnell: I think there's one thing we can probably all agree on. Things are gonna look very different in five years, but I think it's gonna be a positive change.
[00:31:39] Kirk McConnell: To your point, I think disruption is creating new opportunities and new conversations that out of necessity, we all need to be more open to.
[00:31:47] Scott Burton: Think about how much we've evolved just, you know, in the last 15 years. And it feels like in the slog of the day, it's challenging. Healthcare's a complex and challenging environment.
[00:31:58] Scott Burton: Oftentimes it's bureaucratic and sticky process is decades behind other industries. The consumer experience you get with an Amazon completely different than the historical healthcare model, for example. But, I still get wind in my sails when I step back from time to time and I look around at how much progress we have made.
[00:32:19] Scott Burton: We're taking the right steps ahead and this is a very critical time in our industry to take more bold steps. There will be some no regret moves we're all gonna have to make, and there's gonna be some trials and we're gonna fall and we're gonna get to the other side of that. And that's good. It's, again, full circle to how we started this conversation, why I wake up day in and day out, wanting a seat at the table to help influence healthcare to make it better for my daughter's generation.
[00:32:44] Scott Burton: She's 15 now and I look forward to when she's my age and the things she'll get to benefit from in healthcare that is the result of the work we're all doing today.
[00:32:53] Kirk McConnell: Well, Scott. This has been great. If people want to continue the conversation with you, how can they get in touch with you?
[00:33:00] Scott Burton: Look me up on LinkedIn.
[00:33:01] Scott Burton: Very, very active on LinkedIn. I love the conversations that occur there and look forward to meeting folks and having dialogues just like this. Thank you for hosting today, Kirk.
[00:33:09] Kirk McConnell: Thank you very much, Scott. Thank you for joining.
[00:33:11] Producer: This podcast is brought to you by Collective Health, a health benefit solution that guides employees toward healthier lives and companies toward healthier bottom lines. Check us out at collectivehealth.com.