June 4, 2025 • 51 mins
Tune in to host Chad Mulvany for a breakdown of crucial healthcare policy and legislative updates for the week of June 1, 2025. This premiere episode also features an insightful conversation with Brad Brotherton and Kevin Locke, leaders of the Healthcare Practice at Forvis Mazars. Together, they explore the firm’s point of view on Achieving Health and the core capabilities organizations need to fulfill this important mission in today’s complex landscape.
- Washington Watch [1:57]
- Brotherton & Locke Interview [20:54]
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
On today's episode of Achieving Health,I've got the latest policy
and legislative updates from D.C.
for the week of June 1st, 2025.
Then you'll hear my conversationwith Brad Brotherton and Kevin
Locke, leaders of our health care practiceat Forvis Mazars.
During this conversation, we will exploreour point of view on achieving health
and the core capabilities organizationsneed to fulfill this important mission
(00:23):
in today's landscape.
Stay tuned.
This is AchievingHealth, a podcast from Forvis Mazars,
where we delve into the topicsthat matter most to health
care organizationsacross a continuum of care.
Our goal is to help younavigate the dynamic health care landscape
and achieve health at your organization.
(00:44):
Here's your host, Chad Mulvany.
Welcome to the first episode of AchievingHealth.
Thank you for joining me for this journey.
I'm your host, Chad Mulvaney, director inthe Healthcare practice at Forvis Mazars.
My role at the firm is to helpour clients understand how changes
in federal payment policy will impacthealthcare organizations.
(01:07):
As a bit of background on me, priorto joining Forvis Mazars,
I spent the last 15 years in the DCoffices of the California
Hospital Association and the HealthcareFinancial Management Association.
With both organizations,I was in roles with responsibility
for helping healthcare organizationsunderstand federal payment policy,
providing feedback to CMS and otherstakeholders, and helping both providers
(01:31):
and regulators think through the impact ofchanges in payment policy on the ability
for individuals to access high qualityhealth care in their communities.
And before those experiences,I worked both as a consultant
and for hospitals and health systemsdoing finance and reimbursement work.
So in some way, I've spentmost of my career helping health care
(01:52):
organizations achieve healthby focusing on regulatory excellence.
We'll begin today with a segment calledWashington Watch, where I share updates
on the most recent actions and discussiontopics amongst federal policymakers
and their anticipated impact on healthcare providers and payers.
For those of you who have joined mefor our previous Washington
(02:15):
Watch video series, I’d like to thank youfor coming over to the podcast
and for our brand new listeners,
thank you for listening to mefor the first time around.
So today's remarks reflect informationas of this moment and will change.
The House passed the One Big BeautifulBill Act the week of May 19th.
There were a few minor tweaks to theMedicaid provisions, which we'll discuss.
(02:36):
Also,there are a number of exchange provisions
that I hadn'tpreviously touched on that I'll flag.
And we'll also get into timingand next steps.
Additionally, CMS providedadditional guidance related to price
transparency that will require actionfrom hospitals and will cover that.
The agency also noted that it would expandMedicare Advantage, quoting audits.
(02:57):
Obviously, that's not a paidfor in the House pass version of OBBBA,
but we'll get into the actionsthat it's taking to expand those audits.
And finally, CMS also clarified one ofthe key provisions in the executive order
related to the most favored nationsdrug pricing, executive order.
In terms of the OBBBA update, the House
(03:19):
passed it by a vote of 215 to 214.
The changes to the Medicaidsection were limited,
but will increase the savingsand also the rate of uninsured.
Also for note, there were no additionalpolicies related to Medicare
that were included.
So as of right now, nosite-neutral in the House passed version.
(03:40):
However, because the legislationincreases the deficit, if it is enacted,
it will trigger automatic Medicare cutsunless Congress intervenes.
In terms of the impact on the uninsuredand federal fiscal situation,
the Congressional Budget Office estimatesthat the bill's changes to Medicaid
will reduce federal spending byapproximately $803 billion over ten years.
(04:04):
In addition, the CBO estimatesthe bill's changes to Medicaid
and the health insurance exchangeswill increase
the number of uninsured individualsby 8.6 million by 2023.
To put that increasein the uninsured in context,
the CMS office of the actuary projectsthe number of uninsured
for 2025 at 26.1 million.
(04:27):
So that's a fairly significant increaseover the next ten years.
The OBBBA impactalso is likely understated
as it doesn't include interactionsbetween the provisions.
So when we see a comprehensive score,it is likely that the dollars
in uninsured numbers will go up.
While these are national numbers,they will certainly vary state
(04:48):
by state based on previous policy choicesat the state level, which we'll get into
in more detailin terms of the Medicare sequester.
Despite the reduction in Medicaidspending,
the OBBBA addssignificantly to the federal debt.
And unless Congress takes actionto reduce the deficit or steps in
(05:08):
to prevent future Medicare cuts, The Hilland other outlets are reporting
that current law requires a sequesterof certain mandatory spending programs.
Reductions in Medicarespending for the sequester are limited
to 4% annually, or an estimated 45 billionfor fiscal 2026.
So these cuts would total roughly 490billion
(05:29):
over the 2027 to 2034 period.
Deficit spending, however, in D.C.,is a perpetual issue
which has made this particularMedicare sequester a constant threat.
Congress has always votedto, quote unquote, wipe
the mandatory scorecard cleanwhenever this issue pops up.
However, if Congress were to fail to dothat in this instance and allows the cuts
(05:52):
to take effect, it will compoundthe financial stress facing hospitals.
In terms of the Medicaid amendmentsto secure
support from the HouseFreedom Caucus for the OBBBA.
There were a couple of minutes madeto the Medicaid provisions of the bill.
First,the work requirements were pulled forward.
So instead of taking effecton January 1st, 2029,
(06:15):
as was in the original versionpassed out of the Energy and Commerce
Committee, states must implement workrequirements for the able-bodied expansion
population by December 31st, 2026
or earlier at the state's option.
Second, in terms of state-directedpayments for non-expansion states
for newly approved programs, non-expansionstates, state-directed payments
(06:39):
are capped at 110% of Medicare instead ofat Medicare for expansion states.
For non-expansion statesthat expand Medicaid after enactment,
the cap reverts to 100% ofthe Medicare rate, including for programs
that were initially approved post-passageand are being paid at 110% of Medicare.
(07:00):
One of the unintended consequencesof Medicaid cuts
of this magnitude is that it could forcethe remaining non-expansion states
to provide Medicaid coverageto the expansion population
in order to support safety net hospitalsand other safety net providers.
While the cap increasewhen new state-directed payment programs
for non-expansionstates is intended to combat this,
(07:23):
my inclination is that while it maydelay expansion for a bit,
it will not be enough to addressthe long-term shortfalls
in funding for uncompensated care,which could then lead non-expansion
states to expand Medicaid.
Moving on to the next
amendment to the OBBBA, in terms
of the FMAP reduction for expansion statesthat cover non-qualified immigrants.
(07:47):
The amendment clarifiesthat providing health insurance coverage
to lawfully residing pregnant womenand children does not trigger
a reduction of the Medicaid expansion map.
So it looks like thispolicy will only apply to the 14 states
that cover able-bodiedundocumented adults, and these include
California, New York,Illinois, Washington, new Jersey,
(08:08):
Oregon, Massachusetts, Minnesota,Colorado, Connecticut, Utah, Rhode
Island, the District of Columbia, Maine,and Vermont.
Assuming these states keep the expandedcoverage, Medicaid spending increases
across states ranged from 30 billionin California to 300 million in Vermont,
or as a percentage from 8% of Medicaidspending in Oregon and Washington
(08:32):
to 3% in Massachusetts, Vermont,New York, and Minnesota.
Given the dollars at play,
I think it's going to be difficultfor states to maintain this expansion.
However,this is something that bears watching.
While it has been less reportedand commented on.
The OBBBA also includessignificant changes to the Affordable
(08:53):
Care Act health insurance exchangesor marketplaces.
Of the 8.6 million newly uninsuredthat are projected by 2034,
1 million of those uninsured will beas a result of changes in the exchanges.
So I want to spend a moment just providing
a very high-level summaryof some of those provisions.
Please notethis is not intended to be exhaustive.
(09:14):
One of the changes is to reduce the openenrollment period.
And so starting plan yearsbeginning on January 1st, 2026,
where open enrollmentwill begin on January 1st, 2025.
That open enrollment period will now endon December 15th of 2025.
In recent years, for most states, openenrollment
has lasted from November 1stto January 15th.
(09:37):
And it's worth noting that in 2025,about 40% of enrollees,
or 10 million people,selected plans after December 15th.
The bill
also reduces special enrollmentperiods, or SEPs,
effective for plan yearsbeginning January 1st, 2026.
It eliminates the year-round enrollmentopportunity for people with incomes up
(09:58):
to 150% of the federal poverty level,
also known as the low-income SEP.
It also limitsthe ability of all marketplaces,
including state-based marketplaces,to provide specific types of steps
that are based on the relationshipof people's income to the poverty line.
And again, here, it's worthnoting that about half 47% of marketplace
(10:20):
enrollees had income of lessthan 150% of the federal poverty level.
There are a couple of provisionsrelated to the exchanges
that are somewhat similarto the Medicaid provisions.
And so one of them is a requirement
or more restrictive requirementto verify personal income information
effective for planned yearsbeginning on or after January 1st, 2026.
(10:41):
Enrollees will need to provideadditional documentation and can no longer
simply self-attest to changes of householdincome and family size in cases
when this information is not availablefrom the Treasury Department.
And it also provides a number of scenarioswhere there are now
new triggers for full incomeverification by the exchange.
The rulealso removes an automatic extension
(11:02):
of 90 days for an enrolleeto verify household incomes.
And so some analysts believe thatthis will effectively end auto-renewals
by requiring enrollees to verify income,immigration status, health
coverage status, place of residence,family size, and other information
before premium tax creditsor cost sharing reductions are provided.
(11:23):
And this is effective for taxable yearsbeginning after
December 31st, 2027.
There's also a provisionin the legislation
that requires for recapture of excesspremium tax credits
and so effective for taxable yearsbeginning after December 31st,
2025, requiresthat all premium tax credit recipients
(11:44):
repay the full amount of excess,no matter their income.
And it also eliminates costsharing reductions
so effective for planned yearsbeginning on or after January 1st, 2026.
Returns to funding costsharing reductions through payments
from the federal government with explicitcongressionally appropriated funds.
So this provision effectivelyends, quote unquote, silver
(12:06):
loading,which reduces premiums for silver plans.
And it's worth rememberingthat the second-lowest-cost silver plan
is the benchmarkfor calculating exchange subsidies,
which then subsequently reducesthe size of the premium tax credits
available to all thosewho qualify for marketplace coverage.
In terms of state
impact of Medicaid and exchangeprovisions, analysis from the Kaiser
(12:31):
Family Foundation estimatesthe federal Medicaid cuts in the OBBBA
would reduce state spending by 20%per beneficiary on average.
However, the impact on per-beneficiaryspending would vary significantly
based on state policy choicespre-dating the legislation.
So, for example,the impact on per-beneficiary spend ranges
(12:52):
from a low of 6% to a high of 50%.
Not surprisingly,the bill's impact on state-level uninsured
rates tends to be correlatedwith the spending cuts.
A separate analysis from the Kaiser FamilyFoundation projects a 0% increase
at the low end for some states,while at the high end, other states
could experience increasesof the uninsured in excess of 4%.
(13:14):
As a result of the OBBBA.
The enhanced premium tax credits,which separate from this,
are are scheduled to sunset on December31st, 2025.
The impact on non-expansion statesuninsured rate increases significantly.
In terms of timing and next steps,
the legislation is currentlywith the Senate for consideration,
(13:37):
where it isvery likely that it will be amended.
While Speaker Johnson has stressedthat the House version represents
a delicate balance that is the only onethat can pass that chamber,
we've certainly heardfrom various senators and even President
Trumpabout the need to change the package.
And again, here, like the House,the storylines are very similar.
So, for example,you have Senators Rand Paul of Kentucky
(14:00):
and Ron Johnson of Wisconsinwho are concerned about the federal debt
and would like to seemore deficit reduction.
And at the other end of that spectrum,you have senators Josh Hawley of Missouri
and Murkowski of Alaska who are concerned
about the impact of Medicaid changes.
And Senator Hawley in particularis concerned about the capital
(14:20):
and provider taxes.
Given that Missouri hasn'tmaxed out its program,
my speculation is the work requirementsdelay of the Biden administration's
final rules that would streamlineeligibility and enrollment fee increase
requirements for Redetermination,and changes to FMAP for states
that provide coverageto certain undocumented individuals
won't seesignificantly significant changes.
(14:43):
These were all relativelynon-controversial and I think fall,
for the most part,cleanly into the category
of fraud, waste and abuse,at least from a messaging standpoint.
In the 2026elections, however, I do suspect
that provider taxes and state-directedpayments could be in play.
However, not sure at this momenthow that will break.
(15:05):
Whether we'll see
a further
tightening down of provider taxes ormaybe some loosening of that requirement.
If the requirements are loosened,it'll be interesting to see, or be worth
following to see, how that's paidfor, given the size of the impact
on the federal debt of this bill.
Senate Majority Leader Thune
aspires to pass that chamber's versionby the July 4th recess.
(15:27):
I will say that
the more the Senate tweaks the bill,the harder it will be for Speaker Johnson
to get the package back through the Houseand to President Trump's desk.
If something does get to PresidentTrump's desk –
and my money is still on themgetting something there –
it will likely be mid-to end of July for timing.
And again,
same issues that plague the Housewill complicate the debate in the Senate.
(15:49):
And when you start to think about votecount,
Senator Paul is likely ano unless that bill reduces the deficit.
So therefore, at this point,Majority Leader Thune can only afford
to lose two more senators,assuming everyone's present.
Moving on
to price transparency,the week of May 19th,
CMS announced a new pricetransparency RFI.
(16:12):
That announcement also included guidancefor hospitals and provided a timeline
for an updated schema for the health plantransparency-in-coverage file.
For the healthhospital price transparency requirements,
CMS reminded hospitals that the 2024 OPPS
final rule requiresa standard charge dollar amount
(16:33):
that must be included in the machinereadable file if it can be calculated.
The guidance notes that more machinereadable files than anticipated include
nine nines for the standard dollar amountsthat could not be calculated.
Moving forward,hospitals should discontinue
encoding the nine nines in the machinereadable file
and instead an actual dollar amountbased on the average payment
(16:56):
a hospital has receivedfor an item or service
derived from electric remittanceadvice transaction data for items
or services rendered within the last12 months should be encoded.
It is not clear from the guidancewhen hospitals must come into compliance
with this new guidance.
For health plans via the transparencyand coverage requirements,
(17:17):
CMS announces that an updated, machinereadable file schema is intended
to address concerns regarding the healthplan files inaccessibility
due to file size, data integrity,
and a lack of critical contextthat limits full transparency.
It will be available on October 1st, 2025,and plans
will have until February 2nd, 2026to come into compliance with it.
(17:40):
Not surprisingly, CMS is taking actionon both plan and provider files
to increase the quality of data providedat some point during this administration.
I would anticipate the agency will attemptto reconcile both the plan
and hospital files to verify accuracy.
This is going to be difficult,if not impossible, due
to a variety of technical reasons.
(18:01):
However, it certainly won't stop the tradepress from generating
clickbait headlines.
Moving on
to CMS‚ expansion of Medicare Advantagecoding audits.
The week of May 19th, CMS announcedit will expand
risk adjustment data validation,or RADV audits,
to confirm that diagnoses used for riskadjustment and payment are accurate.
(18:25):
These audits will apply
to all eligible MedicareAdvantage contracts for each payment year,
and expedite the completion of auditsfor payment years 2018 through 2024.
CMS plans on hiring over 1,900
additional coders by September 1st, 2025,and deploy, quote unquote,
advanced systems to review recordsand flag unsupported diagnoses.
(18:49):
CMS plansto increase the audits from approximately
60 plans a yearto approximately 550 plans per year.
It also plans to increasethe number of records
audited from 35 per healthplan per year to between 35
and 200 recordsin all newly initiated audits.
The House didn't even sniff at thisas a reconciliation
(19:11):
pay for and my guess is the Senatewon't either in its changes.
While I suspect that CMS and the OIGwill carry through with the expanded
audits and attemptto recoup any identified overpayments,
the plans will challengerecruitment efforts in courts.
Therefore, it is likely that
take years for CMS to recover fundsif they are able to recover funds at all.
(19:31):
Last thing I want to cover is
the Most Favored Nationsdrug pricing, executive order.
HHS recentlyclarified that only brand name drugs
that do not have a genericor biosimilar competitor
will be subject to the MFNdrug pricing policy.
The Most Favored Nation targetprice is the lowest price in an OECD
country, with a GDP per capitaof at least 60% of the US GDP per capita.
(19:57):
This, it's worthnoting, is a much broader attempt
to implement MFN pricing policiesthan the prior Trump administration,
which only focused on Medicare PartB, separately payable drugs.
It remains to be seenif the administration will attempt
to revive a similar Medicare policyas part of this
broader effort.
(20:20):
grounds,
specifically the way the administrationtried to implement the policy,
there are also technical argumentsagainst a part B
Most Favored Nations modelthat were not argued in court.
So that's that's something that remainsto be watched.
That concludes this episode's WashingtonWatch.
Up next, I'll have a conversationwith my guests, Kevin Locke
(20:42):
and Brad Brotherton as we talk aboutForvis Mazars Healthcare Point of View.
I'd like to welcome our
guest for today's episode,Brad Brotherton and Kevin Locke.
Brad is the National Sector Leader for theHealthcare practice at Forvis Mazars,
(21:04):
where he leads and supports assurance, taxand consulting teams across the firm
to serve clients nationwideand across the continuum of care.
Kevin is the managing principal forHealthcare Consulting at Forvis Mazars.
Kevin leads teams that provide consultingservices for health care organizations,
encompassing strategy
(21:25):
and finance, performance improvement,reimbursement, and payer services.
Kevin, Brad, great to have you with us.
Appreciate your time and the conversation.
Thanks for the invite Chad.
Looking forward to this discussion.
Yeah, definitely. Chad. Episode one here.
We're excited.
So thanks for having Kevinand I join you today.
Before we jump into the conversation,maybe, Brad, if you could tell us a little
(21:48):
bit about your background in health careand how you came to this field?
Yeah, happy to Chad.
And, none of my background isprofessional podcast radio interviewee.
So coming at this fresh this day, but,
my background really started,with the firm over 25 years ago.
(22:09):
Started as a new CPAcoming in to the firm
and really started on the audit practice, quickly got paired up
with the healthcare team,which is really growing fun team
here in here in our officein southern Missouri,
and spent a long time, working with that team,
(22:29):
kind of worked my waythrough a lot of different audit roles,
eventually ending up as an audit partnerfor hospital and health system
clients, and along the way, had the chanceto do a lot of different things.
I did a lot of regulatory reimbursementcost report work and strategy work,
even at one timegot the chance to start our 340B pharmacy
(22:51):
consulting practice, backwhen that was really in its infancy.
So I've seen the firmfrom a lot of different angles
and had a chance to work with a lotof our great teams, over the years.
But but what drew me in to the healthcarepractice,
really beyondjust the team of professionals
and the work that we were doingwas really the impact that we were able
(23:13):
to have on communitiesand important organizations
that were serving patientsand communities, across the country.
That was fun for me.
It was it was exciting in a placeI wanted to,
to be curious about and learn more.
There was no shortage of challenges. Yeah.
I think any of us that have been in
in health care for a long timeknow how diverse each day can be
(23:36):
and what each day's set ofchallenges are going to be,
and how we were helping clientsthrough that.
And so I really got excited about it.
Ended up spending my career here.
It's been a lot of fun.
Met a lot of great peopleand a lot of great organizations.
And as I stepped into the national sectorrole,
last summer, really got excitedabout this point of view process.
(23:58):
The Kevin and I have worked on leadingand really where we are today and,
you know, excited to spend some more timetalking about that.
Yeah. No.
And just from from my perspective,when I first joined the firm,
I was excitedto have the opportunity to work on it
because the conceptsthat we're about to talk
about are very much aligned with both,
you know, my personal beliefsand also some of the work
(24:18):
that I'd done, it to meand, and other organizations.
So I think it all ties it together nicely.
So Brad,thank you for sharing that background.
Kevin, could you do the same please?
Absolutely.
And Brad, thanks for for that tee-upand in some ways,
Brad's background and my match up.
In some ways they're very different.
But where they match upChad is I fell in love with healthcare
(24:39):
in very much the same way Brad did.
I started my careerwith, Andersen Consulting back in the day
after we had split from Arthur Andersenand before we rebranded Accenture.
And so I spent a couple of the early yearsof my career,
doing consulting work,but not necessarily in healthcare.
Did some government work,did a little bit of healthcare.
(25:01):
So I kind of fell in lovewith the idea of consulting.
And then when I left Andersen,I went to work for a healthcare provider.
We were an owner-operator of outpatientimaging and some other outpatient
services.
It was a for-profit companythat competed with the not-for-profit
hospitals on some of those more profitableoutpatient services.
(25:24):
And so I spent about 12 years there.
So I had a few yearsof consulting in my background.
Then I got into healthcare and just fellin love with the industry of healthcare.
Right?
The the economic challenges, the,the, the opportunities to serve
in a very unique way in terms
of, helping folks improve their livesand that kind of thing.
(25:46):
So it's just a really interestingcombination
of things happening in healthcare that I fell in love with.
So then I started my own consulting firmand, took those 4 or 5 years
of consulting experience, took those 10or 12 years of healthcare provider
experience,and started a healthcare strategy
consulting firm with a couple of other partners.
(26:10):
And we merged that firm into Dixon Hughes.
Dixon Hughes became DHG.
DHG then merged with BKD to become Forvis.
And then the integrationwith Mazars as well.
So I've just followed the integrationpath of our firm.
Once we merged our healthcareconsulting firm into DHG back in the day.
So it's been a really interestingand fun journey.
(26:31):
There are some, some really cool thingsthat that I appreciate about the industry.
I'm probablyless of a finance guy than Brad
and probably less of a regulatory guythan either Chad, you or Brad.
More of a strategy guy.
I've spent most of my careerdoing strategic planning for hospitals
and health systems, and it's been very,very rewarding, as you can imagine.
(26:54):
Just kind of watchingand helping organizations evolve and grow
and become more importantto their communities.
So that's what I really appreciatedabout the last 30 plus years of doing,
strategic planning for hospitalsand health systems.
So now I serve as the managing partner,managing principal
of our healthcareconsulting practice here at Forvis Mazars.
(27:14):
Very proud of the team and the workthat we do in the marketplace.
And, just really appreciate our clientsand the way that they serve
their communities as well.
I want to
pick up on points that you and Brad made.
But before I do, Kevin,I just want to say that
neither Brad or I hold it against youthat you're not a regulatory guy.
We we welcome all types.
(27:35):
Thank you.
Thank you for my strategy brainto wrap around the details of regulatory.
It just doesn't work very wellsometimes, as you guys both know.
But it's probably why you're a healthierhuman being.
So, you know, when Ithe thing that attracted me to the firm
and you guys both touched on itin your opening statement,
(27:57):
you know, many of,just about everyone that I spoke
with that I knew from prior backgroundbefore I joined the firm,
even before the interview process, peoplethat I knew,
everyone was passionateabout what they did
because one, they found it intellectuallyengaging and two, it was that bigger
tie to mission of I'mdoing something to help improve the health
(28:19):
of individuals in the community,the efficiency of care delivery,
and make sure that at the end of the day,there are resources there to,
for those when they need itso that we can serve,
the health systems can be successfuland continue to serve.
And that that really resonates with meand I think will continue to be a theme
throughout this podcast.
So I love the fact that you both teedthat up coming out of the gate.
(28:41):
Well, I if I could just real quickpull that thread for a second.
Chad, because you mentioneda couple of things, right?
That the I think we're all passionate
about healthcare and about serving,ultimately, the patient.
Right, that that's reallywhere the health care,
industry, is unique, right?
We are diligent and very passionate about
(29:01):
serving patientsand improving their health.
However, along the way,there's plenty of opportunity to,
improve operations and improve financialperformance and improve strategic
alignment and all of those thingsthat also have to be in place,
in order to effectivelyserve the end patient.
(29:21):
And I think that's where a lot of usget the energy right.
There are real business challengesto tackle within the healthcare industry,
and as we tackle those,we get better at serving the end patient.
And I think that that feeds the passion,and it's really an interesting industry
for that reason. In my opinion.
Yeah, and that's exactly right.
(29:41):
And the way that I've always thought aboutit is somebody needs to deal with
cleaning out the regulatory,the finance, the operational underbrush
so that clinicians can godo the thing that they are here to do and
really the gift that they've been givenand share that with the community.
And, you know, Chad, I think another item
there really distinguishesour firm is the number of professionals
(30:03):
that have gone extremely deepwithin the sector.
So, you know,
we call ourselves the health care sectorand we all are aligned there.
But within there, there's so manydifferent parts of the continuum of care
industries that that are within thereand how our teams have devoted themselves
to understanding all of the intricacies,
(30:24):
in their in their viewpoints
on community health centers, post-acute
care, home-based care, hospitals,you know, all of that
really subniche industry specialization,I believe is fun to watch,
across the firmand really know that I've got quick
answers to hard questions,when I need them.
(30:46):
And to that point, not just quick answers,but the quick right answer,
because you've got somebody who is a mileand a half deep on the topic at least.
Yeah, exactly. Right.
Kevin, you alluded to this earlier
about the evolution ofof how we became Forvis Mazars.
Could you and Brad share a little bitabout the evolution of market
point of views both at Forvis Mazarsand kind of with the legacy firms?
(31:10):
Yeah, absolutely.
Thanks for that.
The, the point that Brad madeabout how broad and deep
our team is is so importantto answering this question, Chad, because,
very early on in the in the evolutionof the healthcare practice
and our firm, we,we felt it was very important
that we pull togetherall of that expertise
(31:34):
and take a stand in the marketplaceabout certain things that we believe.
And that's reallywhat became our point of view.
We just felt that that with athat the depth and breadth of experience
and expertise
as well as kind of the market presence,the size and scale of who we were,
it was important that we not just react towhat was happening in the marketplace,
(31:57):
but that we have a position on whatwe think the industry should be doing.
The path that it should be moving down,
the opportunitiesthat it should be tackling.
And so very early on,I want to say maybe in the early 2000s,
we put out our first point of view.
And, the firm of course, has evolvedquite a bit since then.
Our practice has evolvedquite a bit since then,
(32:19):
and our point of view has evolvedquite a bit since then as well.
But very early on, as the industry itself
was wrestling with the idea of value,
remember that whole transitionthat I believe and I think all three of us
believe we're still in the middleof that transition from volume to value.
But that was what triggeredour first point of view.
(32:40):
It was that we really believed and took
a stand and tried to encouragethe industry as a whole.
And we all know there's a lot of different
constituents in our industry,many of whom have competing interests.
Right.
But we we try to design a point of viewthat said,
we believe the industry needs to movefaster toward the idea of value
(33:03):
and the idea of taking riskand the idea of paying for,
improving lives and improving outcomesand that whole idea of risk and value.
So our very first point of view back then,
we called risk capability,and we were trying to find a term
that encourage the industry to move toward
(33:23):
taking risk and and delivering value.
And so we called it, risk capability.
We developed certain capabilities
that we felt folksneeded to accelerate in the marketplace.
And over time, that that concept of risk
for us and our point of viewevolved to a concept of value
and now has evolved to a concept of healthand achieving health
(33:47):
that we're going to talk about todayand I'm sure in future episodes as well.
But, Chad, my point is,first of all, that early on
we thought it was importantto take a position
and try to move the industryin a certain direction
that that original point of viewwas trying to encourage the industry
as a whole to move toward the conceptof risk or the concept of value,
(34:09):
and that over time, that has evolvedreally nicely to what we're now calling,
Achieving Health.
And it incorporatesa lot of those original ideas about having
a bigger-picture perspective on howwe move all of the constituents toward,
achieving health, whether that'sfinancial health, regulatory
health, strategic health, economichealth, or the health of the patient.
(34:33):
And we've tried to incorporateall of that in our new point of view.
Yeah.
And, Kevin, I think it's interesting to,to think about
what the term valuethat was used historically.
You know, that word within healthcarekind of changed on us over time to where
now, in a lot of settings,when you talk about value,
people immediatelybegin to think about value based care,
(34:54):
bundled-payment arrangements,ACO arrangements, those types of things.
And that really wasn't the core focusof value in the in the point of view.
It was always around patient focused care.
How do we focus on communitiesand organizations and all of that.
And so really challenging thatand reframing that,
that point of view was, was importantfor us to to begin to do.
(35:18):
Yeah.
And I think and would be interested,I think you two guys agree
that even now almost,I'm going to say 15 years later, Brad.
And since we put that putthat first point of view out,
I think the industry as a wholestill struggles
with the definition of value, right?
And and is it more narrowly defined aroundcertain alternative payment models,
or is it more broadly defined aroundhow we, as all of the constituents
(35:42):
in, in the healthcareindustry are intentional about providing
value to those constituents, valueto patients, value
to families, value to communities, valueto providers.
In our firm and our point of view,we're trying to take a much broader,
definition of value.
I think the industrystill kind of struggles with
(36:04):
what is our collectivedefinition of value.
Yeah, I agree with you, Kevin,and that's why
I'm excited about wherewe've landed with Achieving Health.
I mean, I think it's it's easyfor organizations, no matter
their size, complexity, where they fitacross the continuum to understand.
We're focusing on patients gettinghealthier, communities getting healthier.
(36:28):
And in order do in order to do that,our organization has to be healthy itself.
And, you know, getting alignedaround that from from an achieving health
point of view, is excitingto see all that come together.
You know, you guys have said somethingthat really resonated with me
in talking about the differencebetween value and achieving health.
(36:49):
And, Kevin, you alluded to this, that,you know, we've been on, quote unquote,
the value journey,
I think, for a lot longer than many of uswould have anticipated.
And, you know, whenwhen we started this in the early aughts
and it's really started to pick upsteam in 2009-10
after the passage of the Affordable CareAct, is the fact that we
as an industry talked about itand we talked about including the patient.
(37:11):
But we didn't talk about thingslike achieving health
that would resonate with patientsand with consumers and with communities.
You know, when you say value to a patientor a consumer, that's not what they want.
They want to be,they want to achieve optimal health.
And I think that's why that framing isso important, because the words do matter.
How does the concept of achieving health
(37:33):
apply to health care organizationsas well as those that they serve?
I know we've touched on it
a little bit in our previous conversation,but really wanted to kind of pull it
together succinctly.
Yeah, great.
Great question, Chad.
And, I think that there is thisand our point of view wrestles
with this, this balancing of:
What does achieving healthmean to the different constituents
(37:57):
that are our part of our,our health care industry?
And each one has a little bitdifferent perspective.
And we tried to tackle thatfrom the provider perspective
and try to tackle it from the payerperspective, try to tackle it
from the, that communityand and the patient's perspective.
But but I think at a high level, Chad,what how this kind of all fits together
(38:19):
is that we believe that the end goal
of improving the health of our patients
and our communities is achievable,
but requires the organizationsthat deliver that care
and that and the people that deliverthat care to also be more healthy
(38:41):
in terms of their work-life balance,in terms of their regulatory excellence,
in terms of their clinical perspectives,in terms of their financial performance,
achieving betterhealth in all of those areas, from a
from an individualand organizational perspective, allows us
to treat patients in a way that improvestheir overall health as well.
(39:06):
So we're trying to tackle itfrom the perspective
of all of those different constituents.
With the end goal of achieving, improvedhealth of, of people and communities.
But organizations have to be healthyin order to deliver that level of care.
And Kevin.
Yeah, really well said.
But I think one thingthat that was really apparent
(39:28):
as we work throughthis is that it was going to take work,
cooperation, collaboration and involvementby many different stakeholders.
I mean, you talked about it,but how do we involve the payers,
as part of this,
along with the providers,how do we evolve the regulatory framework?
And so the rules that we have to, to, operate within.
(39:50):
How does that become a keypart of how organizations achieve health?
And then how does the community
and the patients really respondto the healthcare organizations?
How how receptive and trustingare they in their communities?
All of those are critical to helpeverybody be successful
in achieving healththroughout the whole sector.
(40:13):
When you think about the benefitsof achieving health, what are those?
What are the benefits of achieving healthfor health care organizations?
We've been pretty
intentionalabout trying to articulate that, Chad.
And there's a a handful of ideasthat that we've rallied around.
But if you think about a healthcareorganization
(40:34):
that has improved, if we're going to talkabout the capabilities
to get there,but but has improved organizational health
and therefore are delivering better healthto their patient and their communities,
there are some some benefits,some side benefits to that.
We think it creates a betterbrand recognition in the marketplace
(40:55):
and therefore creates,improved competitive advantage, right?
If you're in the marketas a highly-effective, highly-healthy
organization, contributingto the improved health
of your patients in your communities,that becomes a strategic advantage.
We think.
So that's number one.
Number two, is kind of that brandand that reputation
(41:16):
and that abilityto present yourself in the market
in a new and uniqueand we think differentiating way.
So that's a second thought.
It also I thinkis attractive to other providers.
So you become a better partnerin the marketplace, right?
Organizations are always looking forhow do we align with our physicians,
(41:36):
how do we align with other organizationsa little bit more effectively?
And I think you become more attractiveas a partner, as a benefit as well.
We'll also talk about things like economichealth and regulatory health.
And those things contribute to reducedrisk right there.
There are certainly risksto health care organizations.
But as you improvethe health of your organization,
(42:00):
you become a tighter risk bearing entity
and reduce your risk in the marketplace,whether that's regulatory or otherwise.
A couple of other things to,
again, you think about betterfinancial performance.
You're going to nowimprove access to other resources,
whether that's capital or growth or,
alignment, those kinds of things,those resources that are critical.
(42:23):
Financial resources, people resources,those things become more
readily availableas you become a healthier organization.
And then I think the ultimate onethat we've talked about a couple of times
already is that you genuinelyare delivering better care
and therefore improved health ofyour patients in your community as well.
(42:43):
So I think there's lots of side benefits.
Chad, if and when and again, we believewhen organizations get this right.
The other thing,Kevin, that I would add is really wanting
to change the viewpoint from
how do we become sustainable organizations
to reallyhow do we become thriving organizations
(43:05):
that are helping our community moveforward and our patients achieve health?
And, you know,I think what you articulated, Kevin,
you kind of went through
several of those pointsis all around that thriving enterprise.
And how do we becomea destination of choice?
Who's looking at,you know, to to acquire the right talent?
And where do organizations want to come tofor increased collaboration
(43:29):
and partnership opportunities?
All those types of things.
Why don’t you want to be you want to beworking with a thriving organization.
And one of the
things that I also resonated with me isboth of you were talking about
the benefits of it, and moving to thrivingor continuing to thrive
is when you think about the conceptsthat underline
(43:49):
achieving health,they tend to create a virtuous cycle.
Like, we’ll use staffing as an example.
If you were able to become
an employer of choice,you're able to hit your growth strategies
as you become more successful,can offer a better benefits back,
and you are more likely to obtainnot only the talent you need, but
a higher skill level across both clinicaland administrative functions.
(44:09):
And so there is sort of a reinforcingimpact
of really focusing on thisand getting it right across time.
And it's to your point, Kevin,it's an incredibly difficult thing to do
because like anything elsethat has a strong culture component to it,
you have to think about itevery minute of every day.
Because if you take your eye off of it,you slip.
And then people notice that,and then you start to encounter issues.
(44:32):
And it's interesting.
Chad, thinking about how
there's a cycleand how different pieces kind of reinforce
other componentsthat, that, that you're mentioning there.
That also applies as you think aboutour core capabilities that we identified.
Yes, we went through this process.
Five things continued,to resound across the team
(44:55):
that was working on itand now list them out really quickly.
But it's strategic agility,aligned growth, regulatory
excellence, financial disciplineand talent optimization.
And it's that same cycle that you wereyou were indicating that,
you know,you can't be just totally focused in one
and take your eye off all of the othercomplimentary capablities that are there.
(45:16):
It really takes, the work of all of those
to make sure we're hitting on all cycleshere, for achieving health.
No, I think that's a great point,because any example
that we could talk about right now,we should list out,
you know,
if you thinkabout a successful organization
and you think about somethingthat they've achieved,
you can generally tie in, okay,there was a strategy component to it.
(45:37):
There was an intentional growthcomponent to it.
You know, they were makingfinancially disciplined decisions
and all of that was informedby a strong regulatory function.
And I'm sure right now, you and Iand Kevin can probably think of 3 or 4
different examples from clientsthat we could walk through.
When you think about the concepts behindachieving health,
I think they've always been relevant.
But what was the Why now?
(45:59):
for us in refreshing our marketpoint of view around these concepts?
All right.
For me it was a combinationof a number of different things.
One was we are, have exited
the challenges of the Covidera in many ways,
but we need to move out of that eraas quickly as possible.
(46:19):
So I think that was one thing.
It was a recognition that we're at kindof a milestone in the industry.
And that we sort of capturethat opportunity
to tackle the bigger picture issue of
how do we move the industry forwardnow, after that time?
(46:39):
Two was what what Bradmentioned a few minutes ago,
the size and scale and scopeand depth of our firm, our health
care industry and our health care sectorwithin the Forvis Mazars firm,
just was at a point where
articulating on behalf of that that, that,that sector was critically important.
(47:03):
We have so many clients across all,
sub niches and parts of the care continuum
that it was important that we captureideas are relevant to all of those.
So you had you were emergingfrom a certain part of the, a certain
era in the marketand needing to move beyond that.
We were evolving as a firmand needed to put
(47:24):
some ideas in the marketplacethat were relevant to us.
And then the third thing was,
we thought just, too
narrow of a definition of certain things
that we believe are going to be criticalto the industry moving forward.
And we've talked about those. Right.
The idea of risk back in the day,the idea of value back in the day,
(47:44):
the narrow definitionsof some of those critical elements
that our industry is talking about,but maybe not executing on very well.
So we felt the need to to be much broader,much more holistic
in, in definingwhere we believe the industry needs to go.
If each of you could leave our listenerswith one takeaway
related to achieving healthin 2025, what would it be?
(48:07):
For me, Chad, it's collaboration.
Yeah, that's the thing
that it stuck out to meas we had reflected on the on the document
that it's going to take the joint workat multiple stakeholders
to really move the industry forwardtoward achieving health.
And and so, you know what I get askedby our teams are we talk about that more.
That's really the themethat sticking out for me consistently.
(48:31):
For me it's
this is achievable.
And I just it's it's yes,these are high conceptual ideas
of of improving and achievingbetter health.
That is a big picture idea,but it is actually doable
if you break it down into how do we do it.
(48:55):
There are actionable steps that canactually contribute to achieving health.
So that'smaybe the point that I want to leave.
That, that and I totally agree with Brad.
Collaboration across the continuumof care, collaboration
across the different constituents,absolutely critical.
But if we do the right things
(49:15):
in that spirit of collaboration,we can actually achieve health.
And I think that'sthat's got to be foundational
to how we move forward, is the beliefthat it's that it is, in fact, achievable.
Brad.
Kevin, thanks again for joining me today.
It was a great conversation.
I really appreciate you
taking the time to share your insightsinto Achieving Health.
(49:37):
I also want to thank all our listenersfor tuning in.
If you'd like to learn more
about the ideas and conceptswe discussed in today's episode,
there's a link in the show noteswhere you can download and read our Market
Point of View.
I hope you'll join me in two weeksfor the next episode of
Achieving Health.
You can follow
(49:57):
Achieving Healthon your favorite podcast platform or visit
forvismazars.us/AchievingHealthPodcastto learn more.
New episodes are released the firstand third Wednesday of each month.
Achieving Health is producedby Forvis Mazars LLP, an independent
member of Forvis Mazars Global, aleading global professional services
(50:18):
network, ranked among the largest publicaccounting firms in the United States.
The firm's 7,000 dedicated team membersprovide an Unmatched Client Experience
through the delivery of assurance, taxand consulting services for clients
in all 50 states and internationallythrough the Global Network.
The information set forth in this podcastcontains
(50:39):
the analysis and conclusionsof the panelists based upon his, her,
or their research and analysis of industryinformation and legal authorities.
Such analysis and conclusionsshould not be deemed opinions
or conclusions by Forvis Mazarsor the panelists
as to any individual situationas situations are fact-specific.
The listener should performtheir own analysis and form
(51:01):
their own conclusionsregarding any specific situation.
Further, the panelists conclusionsmay be revised without notice,
with or without changes in industryinformation and legal authorities.
On today's episode of Achieving Health,I've got the latest policy
and legislative updates from D.C.
for the week of June 1st, 2025.
Then you'll hear my conversationwith Brad Brotherton and Kevin
Locke, leaders of our health care practiceat Forvis Mazars.
During this conversation, we will exploreour point of view on achieving health
and the core capabilities organizationsneed to fulfill this important mission
(00:23):
in today's landscape.
Stay tuned.
This is AchievingHealth, a podcast from Forvis Mazars,
where we delve into the topicsthat matter most to health
care organizationsacross a continuum of care.
Our goal is to help younavigate the dynamic health care landscape
and achieve health at your organization.
(00:44):
Here's your host, Chad Mulvany.
Welcome to the first episode of AchievingHealth.
Thank you for joining me for this journey.
I'm your host, Chad Mulvaney, director inthe Healthcare practice at Forvis Mazars.
My role at the firm is to helpour clients understand how changes
in federal payment policy will impacthealthcare organizations.
(01:07):
As a bit of background on me, priorto joining Forvis Mazars,
I spent the last 15 years in the DCoffices of the California
Hospital Association and the HealthcareFinancial Management Association.
With both organizations,I was in roles with responsibility
for helping healthcare organizationsunderstand federal payment policy,
providing feedback to CMS and otherstakeholders, and helping both providers
(01:31):
and regulators think through the impact ofchanges in payment policy on the ability
for individuals to access high qualityhealth care in their communities.
And before those experiences,I worked both as a consultant
and for hospitals and health systemsdoing finance and reimbursement work.
So in some way, I've spentmost of my career helping health care
(01:52):
organizations achieve healthby focusing on regulatory excellence.
We'll begin today with a segment calledWashington Watch, where I share updates
on the most recent actions and discussiontopics amongst federal policymakers
and their anticipated impact on healthcare providers and payers.
For those of you who have joined mefor our previous Washington
(02:15):
Watch video series, I’d like to thank youfor coming over to the podcast
and for our brand new listeners,
thank you for listening to mefor the first time around.
So today's remarks reflect informationas of this moment and will change.
The House passed the One Big BeautifulBill Act the week of May 19th.
There were a few minor tweaks to theMedicaid provisions, which we'll discuss.
(02:36):
Also,there are a number of exchange provisions
that I hadn'tpreviously touched on that I'll flag.
And we'll also get into timingand next steps.
Additionally, CMS providedadditional guidance related to price
transparency that will require actionfrom hospitals and will cover that.
The agency also noted that it would expandMedicare Advantage, quoting audits.
(02:57):
Obviously, that's not a paidfor in the House pass version of OBBBA,
but we'll get into the actionsthat it's taking to expand those audits.
And finally, CMS also clarified one ofthe key provisions in the executive order
related to the most favored nationsdrug pricing, executive order.
In terms of the OBBBA update, the House
(03:19):
passed it by a vote of 215 to 214.
The changes to the Medicaidsection were limited,
but will increase the savingsand also the rate of uninsured.
Also for note, there were no additionalpolicies related to Medicare
that were included.
So as of right now, nosite-neutral in the House passed version.
(03:40):
However, because the legislationincreases the deficit, if it is enacted,
it will trigger automatic Medicare cutsunless Congress intervenes.
In terms of the impact on the uninsuredand federal fiscal situation,
the Congressional Budget Office estimatesthat the bill's changes to Medicaid
will reduce federal spending byapproximately $803 billion over ten years.
(04:04):
In addition, the CBO estimatesthe bill's changes to Medicaid
and the health insurance exchangeswill increase
the number of uninsured individualsby 8.6 million by 2023.
To put that increasein the uninsured in context,
the CMS office of the actuary projectsthe number of uninsured
for 2025 at 26.1 million.
(04:27):
So that's a fairly significant increaseover the next ten years.
The OBBBA impactalso is likely understated
as it doesn't include interactionsbetween the provisions.
So when we see a comprehensive score,it is likely that the dollars
in uninsured numbers will go up.
While these are national numbers,they will certainly vary state
(04:48):
by state based on previous policy choicesat the state level, which we'll get into
in more detailin terms of the Medicare sequester.
Despite the reduction in Medicaidspending,
the OBBBA addssignificantly to the federal debt.
And unless Congress takes actionto reduce the deficit or steps in
(05:08):
to prevent future Medicare cuts, The Hilland other outlets are reporting
that current law requires a sequesterof certain mandatory spending programs.
Reductions in Medicarespending for the sequester are limited
to 4% annually, or an estimated 45 billionfor fiscal 2026.
So these cuts would total roughly 490billion
(05:29):
over the 2027 to 2034 period.
Deficit spending, however, in D.C.,is a perpetual issue
which has made this particularMedicare sequester a constant threat.
Congress has always votedto, quote unquote, wipe
the mandatory scorecard cleanwhenever this issue pops up.
However, if Congress were to fail to dothat in this instance and allows the cuts
(05:52):
to take effect, it will compoundthe financial stress facing hospitals.
In terms of the Medicaid amendmentsto secure
support from the HouseFreedom Caucus for the OBBBA.
There were a couple of minutes madeto the Medicaid provisions of the bill.
First,the work requirements were pulled forward.
So instead of taking effecton January 1st, 2029,
(06:15):
as was in the original versionpassed out of the Energy and Commerce
Committee, states must implement workrequirements for the able-bodied expansion
population by December 31st, 2026
or earlier at the state's option.
Second, in terms of state-directedpayments for non-expansion states
for newly approved programs, non-expansionstates, state-directed payments
(06:39):
are capped at 110% of Medicare instead ofat Medicare for expansion states.
For non-expansion statesthat expand Medicaid after enactment,
the cap reverts to 100% ofthe Medicare rate, including for programs
that were initially approved post-passageand are being paid at 110% of Medicare.
(07:00):
One of the unintended consequencesof Medicaid cuts
of this magnitude is that it could forcethe remaining non-expansion states
to provide Medicaid coverageto the expansion population
in order to support safety net hospitalsand other safety net providers.
While the cap increasewhen new state-directed payment programs
for non-expansionstates is intended to combat this,
(07:23):
my inclination is that while it maydelay expansion for a bit,
it will not be enough to addressthe long-term shortfalls
in funding for uncompensated care,which could then lead non-expansion
states to expand Medicaid.
Moving on to the next
amendment to the OBBBA, in terms
of the FMAP reduction for expansion statesthat cover non-qualified immigrants.
(07:47):
The amendment clarifiesthat providing health insurance coverage
to lawfully residing pregnant womenand children does not trigger
a reduction of the Medicaid expansion map.
So it looks like thispolicy will only apply to the 14 states
that cover able-bodiedundocumented adults, and these include
California, New York,Illinois, Washington, new Jersey,
(08:08):
Oregon, Massachusetts, Minnesota,Colorado, Connecticut, Utah, Rhode
Island, the District of Columbia, Maine,and Vermont.
Assuming these states keep the expandedcoverage, Medicaid spending increases
across states ranged from 30 billionin California to 300 million in Vermont,
or as a percentage from 8% of Medicaidspending in Oregon and Washington
(08:32):
to 3% in Massachusetts, Vermont,New York, and Minnesota.
Given the dollars at play,
I think it's going to be difficultfor states to maintain this expansion.
However,this is something that bears watching.
While it has been less reportedand commented on.
The OBBBA also includessignificant changes to the Affordable
(08:53):
Care Act health insurance exchangesor marketplaces.
Of the 8.6 million newly uninsuredthat are projected by 2034,
1 million of those uninsured will beas a result of changes in the exchanges.
So I want to spend a moment just providing
a very high-level summaryof some of those provisions.
Please notethis is not intended to be exhaustive.
(09:14):
One of the changes is to reduce the openenrollment period.
And so starting plan yearsbeginning on January 1st, 2026,
where open enrollmentwill begin on January 1st, 2025.
That open enrollment period will now endon December 15th of 2025.
In recent years, for most states, openenrollment
has lasted from November 1stto January 15th.
(09:37):
And it's worth noting that in 2025,about 40% of enrollees,
or 10 million people,selected plans after December 15th.
The bill
also reduces special enrollmentperiods, or SEPs,
effective for plan yearsbeginning January 1st, 2026.
It eliminates the year-round enrollmentopportunity for people with incomes up
(09:58):
to 150% of the federal poverty level,
also known as the low-income SEP.
It also limitsthe ability of all marketplaces,
including state-based marketplaces,to provide specific types of steps
that are based on the relationshipof people's income to the poverty line.
And again, here, it's worthnoting that about half 47% of marketplace
(10:20):
enrollees had income of lessthan 150% of the federal poverty level.
There are a couple of provisionsrelated to the exchanges
that are somewhat similarto the Medicaid provisions.
And so one of them is a requirement
or more restrictive requirementto verify personal income information
effective for planned yearsbeginning on or after January 1st, 2026.
(10:41):
Enrollees will need to provideadditional documentation and can no longer
simply self-attest to changes of householdincome and family size in cases
when this information is not availablefrom the Treasury Department.
And it also provides a number of scenarioswhere there are now
new triggers for full incomeverification by the exchange.
The rulealso removes an automatic extension
(11:02):
of 90 days for an enrolleeto verify household incomes.
And so some analysts believe thatthis will effectively end auto-renewals
by requiring enrollees to verify income,immigration status, health
coverage status, place of residence,family size, and other information
before premium tax creditsor cost sharing reductions are provided.
(11:23):
And this is effective for taxable yearsbeginning after
December 31st, 2027.
There's also a provisionin the legislation
that requires for recapture of excesspremium tax credits
and so effective for taxable yearsbeginning after December 31st,
2025, requiresthat all premium tax credit recipients
(11:44):
repay the full amount of excess,no matter their income.
And it also eliminates costsharing reductions
so effective for planned yearsbeginning on or after January 1st, 2026.
Returns to funding costsharing reductions through payments
from the federal government with explicitcongressionally appropriated funds.
So this provision effectivelyends, quote unquote, silver
(12:06):
loading,which reduces premiums for silver plans.
And it's worth rememberingthat the second-lowest-cost silver plan
is the benchmarkfor calculating exchange subsidies,
which then subsequently reducesthe size of the premium tax credits
available to all thosewho qualify for marketplace coverage.
In terms of state
impact of Medicaid and exchangeprovisions, analysis from the Kaiser
(12:31):
Family Foundation estimatesthe federal Medicaid cuts in the OBBBA
would reduce state spending by 20%per beneficiary on average.
However, the impact on per-beneficiaryspending would vary significantly
based on state policy choicespre-dating the legislation.
So, for example,the impact on per-beneficiary spend ranges
(12:52):
from a low of 6% to a high of 50%.
Not surprisingly,the bill's impact on state-level uninsured
rates tends to be correlatedwith the spending cuts.
A separate analysis from the Kaiser FamilyFoundation projects a 0% increase
at the low end for some states,while at the high end, other states
could experience increasesof the uninsured in excess of 4%.
(13:14):
As a result of the OBBBA.
The enhanced premium tax credits,which separate from this,
are are scheduled to sunset on December31st, 2025.
The impact on non-expansion statesuninsured rate increases significantly.
In terms of timing and next steps,
the legislation is currentlywith the Senate for consideration,
(13:37):
where it isvery likely that it will be amended.
While Speaker Johnson has stressedthat the House version represents
a delicate balance that is the only onethat can pass that chamber,
we've certainly heardfrom various senators and even President
Trumpabout the need to change the package.
And again, here, like the House,the storylines are very similar.
So, for example,you have Senators Rand Paul of Kentucky
(14:00):
and Ron Johnson of Wisconsinwho are concerned about the federal debt
and would like to seemore deficit reduction.
And at the other end of that spectrum,you have senators Josh Hawley of Missouri
and Murkowski of Alaska who are concerned
about the impact of Medicaid changes.
And Senator Hawley in particularis concerned about the capital
(14:20):
and provider taxes.
Given that Missouri hasn'tmaxed out its program,
my speculation is the work requirementsdelay of the Biden administration's
final rules that would streamlineeligibility and enrollment fee increase
requirements for Redetermination,and changes to FMAP for states
that provide coverageto certain undocumented individuals
won't seesignificantly significant changes.
(14:43):
These were all relativelynon-controversial and I think fall,
for the most part,cleanly into the category
of fraud, waste and abuse,at least from a messaging standpoint.
In the 2026elections, however, I do suspect
that provider taxes and state-directedpayments could be in play.
However, not sure at this momenthow that will break.
(15:05):
Whether we'll see
a further
tightening down of provider taxes ormaybe some loosening of that requirement.
If the requirements are loosened,it'll be interesting to see, or be worth
following to see, how that's paidfor, given the size of the impact
on the federal debt of this bill.
Senate Majority Leader Thune
aspires to pass that chamber's versionby the July 4th recess.
(15:27):
I will say that
the more the Senate tweaks the bill,the harder it will be for Speaker Johnson
to get the package back through the Houseand to President Trump's desk.
If something does get to PresidentTrump's desk –
and my money is still on themgetting something there –
it will likely be mid-to end of July for timing.
And again,
same issues that plague the Housewill complicate the debate in the Senate.
(15:49):
And when you start to think about votecount,
Senator Paul is likely ano unless that bill reduces the deficit.
So therefore, at this point,Majority Leader Thune can only afford
to lose two more senators,assuming everyone's present.
Moving on
to price transparency,the week of May 19th,
CMS announced a new pricetransparency RFI.
(16:12):
That announcement also included guidancefor hospitals and provided a timeline
for an updated schema for the health plantransparency-in-coverage file.
For the healthhospital price transparency requirements,
CMS reminded hospitals that the 2024 OPPS
final rule requiresa standard charge dollar amount
(16:33):
that must be included in the machinereadable file if it can be calculated.
The guidance notes that more machinereadable files than anticipated include
nine nines for the standard dollar amountsthat could not be calculated.
Moving forward,hospitals should discontinue
encoding the nine nines in the machinereadable file
and instead an actual dollar amountbased on the average payment
(16:56):
a hospital has receivedfor an item or service
derived from electric remittanceadvice transaction data for items
or services rendered within the last12 months should be encoded.
It is not clear from the guidancewhen hospitals must come into compliance
with this new guidance.
For health plans via the transparencyand coverage requirements,
(17:17):
CMS announces that an updated, machinereadable file schema is intended
to address concerns regarding the healthplan files inaccessibility
due to file size, data integrity,
and a lack of critical contextthat limits full transparency.
It will be available on October 1st, 2025,and plans
will have until February 2nd, 2026to come into compliance with it.
(17:40):
Not surprisingly, CMS is taking actionon both plan and provider files
to increase the quality of data providedat some point during this administration.
I would anticipate the agency will attemptto reconcile both the plan
and hospital files to verify accuracy.
This is going to be difficult,if not impossible, due
to a variety of technical reasons.
(18:01):
However, it certainly won't stop the tradepress from generating
clickbait headlines.
Moving on
to CMS‚ expansion of Medicare Advantagecoding audits.
The week of May 19th, CMS announcedit will expand
risk adjustment data validation,or RADV audits,
to confirm that diagnoses used for riskadjustment and payment are accurate.
(18:25):
These audits will apply
to all eligible MedicareAdvantage contracts for each payment year,
and expedite the completion of auditsfor payment years 2018 through 2024.
CMS plans on hiring over 1,900
additional coders by September 1st, 2025,and deploy, quote unquote,
advanced systems to review recordsand flag unsupported diagnoses.
(18:49):
CMS plansto increase the audits from approximately
60 plans a yearto approximately 550 plans per year.
It also plans to increasethe number of records
audited from 35 per healthplan per year to between 35
and 200 recordsin all newly initiated audits.
The House didn't even sniff at thisas a reconciliation
(19:11):
pay for and my guess is the Senatewon't either in its changes.
While I suspect that CMS and the OIGwill carry through with the expanded
audits and attemptto recoup any identified overpayments,
the plans will challengerecruitment efforts in courts.
Therefore, it is likely that
take years for CMS to recover fundsif they are able to recover funds at all.
(19:31):
Last thing I want to cover is
the Most Favored Nationsdrug pricing, executive order.
HHS recentlyclarified that only brand name drugs
that do not have a genericor biosimilar competitor
will be subject to the MFNdrug pricing policy.
The Most Favored Nation targetprice is the lowest price in an OECD
country, with a GDP per capitaof at least 60% of the US GDP per capita.
(19:57):
This, it's worthnoting, is a much broader attempt
to implement MFN pricing policiesthan the prior Trump administration,
which only focused on Medicare PartB, separately payable drugs.
It remains to be seenif the administration will attempt
to revive a similar Medicare policyas part of this
broader effort.
(20:20):
grounds,
specifically the way the administrationtried to implement the policy,
there are also technical argumentsagainst a part B
Most Favored Nations modelthat were not argued in court.
So that's that's something that remainsto be watched.
That concludes this episode's WashingtonWatch.
Up next, I'll have a conversationwith my guests, Kevin Locke
(20:42):
and Brad Brotherton as we talk aboutForvis Mazars Healthcare Point of View.
I'd like to welcome our
guest for today's episode,Brad Brotherton and Kevin Locke.
Brad is the National Sector Leader for theHealthcare practice at Forvis Mazars,
(21:04):
where he leads and supports assurance, taxand consulting teams across the firm
to serve clients nationwideand across the continuum of care.
Kevin is the managing principal forHealthcare Consulting at Forvis Mazars.
Kevin leads teams that provide consultingservices for health care organizations,
encompassing strategy
(21:25):
and finance, performance improvement,reimbursement, and payer services.
Kevin, Brad, great to have you with us.
Appreciate your time and the conversation.
Thanks for the invite Chad.
Looking forward to this discussion.
Yeah, definitely. Chad. Episode one here.
We're excited.
So thanks for having Kevinand I join you today.
Before we jump into the conversation,maybe, Brad, if you could tell us a little
(21:48):
bit about your background in health careand how you came to this field?
Yeah, happy to Chad.
And, none of my background isprofessional podcast radio interviewee.
So coming at this fresh this day, but,
my background really started,with the firm over 25 years ago.
(22:09):
Started as a new CPAcoming in to the firm
and really started on the audit practice, quickly got paired up
with the healthcare team,which is really growing fun team
here in here in our officein southern Missouri,
and spent a long time, working with that team,
(22:29):
kind of worked my waythrough a lot of different audit roles,
eventually ending up as an audit partnerfor hospital and health system
clients, and along the way, had the chanceto do a lot of different things.
I did a lot of regulatory reimbursementcost report work and strategy work,
even at one timegot the chance to start our 340B pharmacy
(22:51):
consulting practice, backwhen that was really in its infancy.
So I've seen the firmfrom a lot of different angles
and had a chance to work with a lotof our great teams, over the years.
But but what drew me in to the healthcarepractice,
really beyondjust the team of professionals
and the work that we were doingwas really the impact that we were able
(23:13):
to have on communitiesand important organizations
that were serving patientsand communities, across the country.
That was fun for me.
It was it was exciting in a placeI wanted to,
to be curious about and learn more.
There was no shortage of challenges. Yeah.
I think any of us that have been in
in health care for a long timeknow how diverse each day can be
(23:36):
and what each day's set ofchallenges are going to be,
and how we were helping clientsthrough that.
And so I really got excited about it.
Ended up spending my career here.
It's been a lot of fun.
Met a lot of great peopleand a lot of great organizations.
And as I stepped into the national sectorrole,
last summer, really got excitedabout this point of view process.
(23:58):
The Kevin and I have worked on leadingand really where we are today and,
you know, excited to spend some more timetalking about that.
Yeah. No.
And just from from my perspective,when I first joined the firm,
I was excitedto have the opportunity to work on it
because the conceptsthat we're about to talk
about are very much aligned with both,
you know, my personal beliefsand also some of the work
(24:18):
that I'd done, it to meand, and other organizations.
So I think it all ties it together nicely.
So Brad,thank you for sharing that background.
Kevin, could you do the same please?
Absolutely.
And Brad, thanks for for that tee-upand in some ways,
Brad's background and my match up.
In some ways they're very different.
But where they match upChad is I fell in love with healthcare
(24:39):
in very much the same way Brad did.
I started my careerwith, Andersen Consulting back in the day
after we had split from Arthur Andersenand before we rebranded Accenture.
And so I spent a couple of the early yearsof my career,
doing consulting work,but not necessarily in healthcare.
Did some government work,did a little bit of healthcare.
(25:01):
So I kind of fell in lovewith the idea of consulting.
And then when I left Andersen,I went to work for a healthcare provider.
We were an owner-operator of outpatientimaging and some other outpatient
services.
It was a for-profit companythat competed with the not-for-profit
hospitals on some of those more profitableoutpatient services.
(25:24):
And so I spent about 12 years there.
So I had a few yearsof consulting in my background.
Then I got into healthcare and just fellin love with the industry of healthcare.
Right?
The the economic challenges, the,the, the opportunities to serve
in a very unique way in terms
of, helping folks improve their livesand that kind of thing.
(25:46):
So it's just a really interestingcombination
of things happening in healthcare that I fell in love with.
So then I started my own consulting firmand, took those 4 or 5 years
of consulting experience, took those 10or 12 years of healthcare provider
experience,and started a healthcare strategy
consulting firm with a couple of other partners.
(26:10):
And we merged that firm into Dixon Hughes.
Dixon Hughes became DHG.
DHG then merged with BKD to become Forvis.
And then the integrationwith Mazars as well.
So I've just followed the integrationpath of our firm.
Once we merged our healthcareconsulting firm into DHG back in the day.
So it's been a really interestingand fun journey.
(26:31):
There are some, some really cool thingsthat that I appreciate about the industry.
I'm probablyless of a finance guy than Brad
and probably less of a regulatory guythan either Chad, you or Brad.
More of a strategy guy.
I've spent most of my careerdoing strategic planning for hospitals
and health systems, and it's been very,very rewarding, as you can imagine.
(26:54):
Just kind of watchingand helping organizations evolve and grow
and become more importantto their communities.
So that's what I really appreciatedabout the last 30 plus years of doing,
strategic planning for hospitalsand health systems.
So now I serve as the managing partner,managing principal
of our healthcareconsulting practice here at Forvis Mazars.
(27:14):
Very proud of the team and the workthat we do in the marketplace.
And, just really appreciate our clientsand the way that they serve
their communities as well.
I want to
pick up on points that you and Brad made.
But before I do, Kevin,I just want to say that
neither Brad or I hold it against youthat you're not a regulatory guy.
We we welcome all types.
(27:35):
Thank you.
Thank you for my strategy brainto wrap around the details of regulatory.
It just doesn't work very wellsometimes, as you guys both know.
But it's probably why you're a healthierhuman being.
So, you know, when Ithe thing that attracted me to the firm
and you guys both touched on itin your opening statement,
(27:57):
you know, many of,just about everyone that I spoke
with that I knew from prior backgroundbefore I joined the firm,
even before the interview process, peoplethat I knew,
everyone was passionateabout what they did
because one, they found it intellectuallyengaging and two, it was that bigger
tie to mission of I'mdoing something to help improve the health
(28:19):
of individuals in the community,the efficiency of care delivery,
and make sure that at the end of the day,there are resources there to,
for those when they need itso that we can serve,
the health systems can be successfuland continue to serve.
And that that really resonates with meand I think will continue to be a theme
throughout this podcast.
So I love the fact that you both teedthat up coming out of the gate.
(28:41):
Well, I if I could just real quickpull that thread for a second.
Chad, because you mentioneda couple of things, right?
That the I think we're all passionate
about healthcare and about serving,ultimately, the patient.
Right, that that's reallywhere the health care,
industry, is unique, right?
We are diligent and very passionate about
(29:01):
serving patientsand improving their health.
However, along the way,there's plenty of opportunity to,
improve operations and improve financialperformance and improve strategic
alignment and all of those thingsthat also have to be in place,
in order to effectivelyserve the end patient.
(29:21):
And I think that's where a lot of usget the energy right.
There are real business challengesto tackle within the healthcare industry,
and as we tackle those,we get better at serving the end patient.
And I think that that feeds the passion,and it's really an interesting industry
for that reason. In my opinion.
Yeah, and that's exactly right.
(29:41):
And the way that I've always thought aboutit is somebody needs to deal with
cleaning out the regulatory,the finance, the operational underbrush
so that clinicians can godo the thing that they are here to do and
really the gift that they've been givenand share that with the community.
And, you know, Chad, I think another item
there really distinguishesour firm is the number of professionals
(30:03):
that have gone extremely deepwithin the sector.
So, you know,
we call ourselves the health care sectorand we all are aligned there.
But within there, there's so manydifferent parts of the continuum of care
industries that that are within thereand how our teams have devoted themselves
to understanding all of the intricacies,
(30:24):
in their in their viewpoints
on community health centers, post-acute
care, home-based care, hospitals,you know, all of that
really subniche industry specialization,I believe is fun to watch,
across the firmand really know that I've got quick
answers to hard questions,when I need them.
(30:46):
And to that point, not just quick answers,but the quick right answer,
because you've got somebody who is a mileand a half deep on the topic at least.
Yeah, exactly. Right.
Kevin, you alluded to this earlier
about the evolution ofof how we became Forvis Mazars.
Could you and Brad share a little bitabout the evolution of market
point of views both at Forvis Mazarsand kind of with the legacy firms?
(31:10):
Yeah, absolutely.
Thanks for that.
The, the point that Brad madeabout how broad and deep
our team is is so importantto answering this question, Chad, because,
very early on in the in the evolutionof the healthcare practice
and our firm, we,we felt it was very important
that we pull togetherall of that expertise
(31:34):
and take a stand in the marketplaceabout certain things that we believe.
And that's reallywhat became our point of view.
We just felt that that with athat the depth and breadth of experience
and expertise
as well as kind of the market presence,the size and scale of who we were,
it was important that we not just react towhat was happening in the marketplace,
(31:57):
but that we have a position on whatwe think the industry should be doing.
The path that it should be moving down,
the opportunitiesthat it should be tackling.
And so very early on,I want to say maybe in the early 2000s,
we put out our first point of view.
And, the firm of course, has evolvedquite a bit since then.
Our practice has evolvedquite a bit since then,
(32:19):
and our point of view has evolvedquite a bit since then as well.
But very early on, as the industry itself
was wrestling with the idea of value,
remember that whole transitionthat I believe and I think all three of us
believe we're still in the middleof that transition from volume to value.
But that was what triggeredour first point of view.
(32:40):
It was that we really believed and took
a stand and tried to encouragethe industry as a whole.
And we all know there's a lot of different
constituents in our industry,many of whom have competing interests.
Right.
But we we try to design a point of viewthat said,
we believe the industry needs to movefaster toward the idea of value
(33:03):
and the idea of taking riskand the idea of paying for,
improving lives and improving outcomesand that whole idea of risk and value.
So our very first point of view back then,
we called risk capability,and we were trying to find a term
that encourage the industry to move toward
(33:23):
taking risk and and delivering value.
And so we called it, risk capability.
We developed certain capabilities
that we felt folksneeded to accelerate in the marketplace.
And over time, that that concept of risk
for us and our point of viewevolved to a concept of value
and now has evolved to a concept of healthand achieving health
(33:47):
that we're going to talk about todayand I'm sure in future episodes as well.
But, Chad, my point is,first of all, that early on
we thought it was importantto take a position
and try to move the industryin a certain direction
that that original point of viewwas trying to encourage the industry
as a whole to move toward the conceptof risk or the concept of value,
(34:09):
and that over time, that has evolvedreally nicely to what we're now calling,
Achieving Health.
And it incorporatesa lot of those original ideas about having
a bigger-picture perspective on howwe move all of the constituents toward,
achieving health, whether that'sfinancial health, regulatory
health, strategic health, economichealth, or the health of the patient.
(34:33):
And we've tried to incorporateall of that in our new point of view.
Yeah.
And, Kevin, I think it's interesting to,to think about
what the term valuethat was used historically.
You know, that word within healthcarekind of changed on us over time to where
now, in a lot of settings,when you talk about value,
people immediatelybegin to think about value based care,
(34:54):
bundled-payment arrangements,ACO arrangements, those types of things.
And that really wasn't the core focusof value in the in the point of view.
It was always around patient focused care.
How do we focus on communitiesand organizations and all of that.
And so really challenging thatand reframing that,
that point of view was, was importantfor us to to begin to do.
(35:18):
Yeah.
And I think and would be interested,I think you two guys agree
that even now almost,I'm going to say 15 years later, Brad.
And since we put that putthat first point of view out,
I think the industry as a wholestill struggles
with the definition of value, right?
And and is it more narrowly defined aroundcertain alternative payment models,
or is it more broadly defined aroundhow we, as all of the constituents
(35:42):
in, in the healthcareindustry are intentional about providing
value to those constituents, valueto patients, value
to families, value to communities, valueto providers.
In our firm and our point of view,we're trying to take a much broader,
definition of value.
I think the industrystill kind of struggles with
(36:04):
what is our collectivedefinition of value.
Yeah, I agree with you, Kevin,and that's why
I'm excited about wherewe've landed with Achieving Health.
I mean, I think it's it's easyfor organizations, no matter
their size, complexity, where they fitacross the continuum to understand.
We're focusing on patients gettinghealthier, communities getting healthier.
(36:28):
And in order do in order to do that,our organization has to be healthy itself.
And, you know, getting alignedaround that from from an achieving health
point of view, is excitingto see all that come together.
You know, you guys have said somethingthat really resonated with me
in talking about the differencebetween value and achieving health.
(36:49):
And, Kevin, you alluded to this, that,you know, we've been on, quote unquote,
the value journey,
I think, for a lot longer than many of uswould have anticipated.
And, you know, whenwhen we started this in the early aughts
and it's really started to pick upsteam in 2009-10
after the passage of the Affordable CareAct, is the fact that we
as an industry talked about itand we talked about including the patient.
(37:11):
But we didn't talk about thingslike achieving health
that would resonate with patientsand with consumers and with communities.
You know, when you say value to a patientor a consumer, that's not what they want.
They want to be,they want to achieve optimal health.
And I think that's why that framing isso important, because the words do matter.
How does the concept of achieving health
(37:33):
apply to health care organizationsas well as those that they serve?
I know we've touched on it
a little bit in our previous conversation,but really wanted to kind of pull it
together succinctly.
Yeah, great.
Great question, Chad.
And, I think that there is thisand our point of view wrestles
with this, this balancing of:
What does achieving healthmean to the different constituents
(37:57):
that are our part of our,our health care industry?
And each one has a little bitdifferent perspective.
And we tried to tackle thatfrom the provider perspective
and try to tackle it from the payerperspective, try to tackle it
from the, that communityand and the patient's perspective.
But but I think at a high level, Chad,what how this kind of all fits together
(38:19):
is that we believe that the end goal
of improving the health of our patients
and our communities is achievable,
but requires the organizationsthat deliver that care
and that and the people that deliverthat care to also be more healthy
(38:41):
in terms of their work-life balance,in terms of their regulatory excellence,
in terms of their clinical perspectives,in terms of their financial performance,
achieving betterhealth in all of those areas, from a
from an individualand organizational perspective, allows us
to treat patients in a way that improvestheir overall health as well.
(39:06):
So we're trying to tackle itfrom the perspective
of all of those different constituents.
With the end goal of achieving, improvedhealth of, of people and communities.
But organizations have to be healthyin order to deliver that level of care.
And Kevin.
Yeah, really well said.
But I think one thingthat that was really apparent
(39:28):
as we work throughthis is that it was going to take work,
cooperation, collaboration and involvementby many different stakeholders.
I mean, you talked about it,but how do we involve the payers,
as part of this,
along with the providers,how do we evolve the regulatory framework?
And so the rules that we have to, to, operate within.
(39:50):
How does that become a keypart of how organizations achieve health?
And then how does the community
and the patients really respondto the healthcare organizations?
How how receptive and trustingare they in their communities?
All of those are critical to helpeverybody be successful
in achieving healththroughout the whole sector.
(40:13):
When you think about the benefitsof achieving health, what are those?
What are the benefits of achieving healthfor health care organizations?
We've been pretty
intentionalabout trying to articulate that, Chad.
And there's a a handful of ideasthat that we've rallied around.
But if you think about a healthcareorganization
(40:34):
that has improved, if we're going to talkabout the capabilities
to get there,but but has improved organizational health
and therefore are delivering better healthto their patient and their communities,
there are some some benefits,some side benefits to that.
We think it creates a betterbrand recognition in the marketplace
(40:55):
and therefore creates,improved competitive advantage, right?
If you're in the marketas a highly-effective, highly-healthy
organization, contributingto the improved health
of your patients in your communities,that becomes a strategic advantage.
We think.
So that's number one.
Number two, is kind of that brandand that reputation
(41:16):
and that abilityto present yourself in the market
in a new and uniqueand we think differentiating way.
So that's a second thought.
It also I thinkis attractive to other providers.
So you become a better partnerin the marketplace, right?
Organizations are always looking forhow do we align with our physicians,
(41:36):
how do we align with other organizationsa little bit more effectively?
And I think you become more attractiveas a partner, as a benefit as well.
We'll also talk about things like economichealth and regulatory health.
And those things contribute to reducedrisk right there.
There are certainly risksto health care organizations.
But as you improvethe health of your organization,
(42:00):
you become a tighter risk bearing entity
and reduce your risk in the marketplace,whether that's regulatory or otherwise.
A couple of other things to,
again, you think about betterfinancial performance.
You're going to nowimprove access to other resources,
whether that's capital or growth or,
alignment, those kinds of things,those resources that are critical.
(42:23):
Financial resources, people resources,those things become more
readily availableas you become a healthier organization.
And then I think the ultimate onethat we've talked about a couple of times
already is that you genuinelyare delivering better care
and therefore improved health ofyour patients in your community as well.
(42:43):
So I think there's lots of side benefits.
Chad, if and when and again, we believewhen organizations get this right.
The other thing,Kevin, that I would add is really wanting
to change the viewpoint from
how do we become sustainable organizations
to reallyhow do we become thriving organizations
(43:05):
that are helping our community moveforward and our patients achieve health?
And, you know,I think what you articulated, Kevin,
you kind of went through
several of those pointsis all around that thriving enterprise.
And how do we becomea destination of choice?
Who's looking at,you know, to to acquire the right talent?
And where do organizations want to come tofor increased collaboration
(43:29):
and partnership opportunities?
All those types of things.
Why don’t you want to be you want to beworking with a thriving organization.
And one of the
things that I also resonated with me isboth of you were talking about
the benefits of it, and moving to thrivingor continuing to thrive
is when you think about the conceptsthat underline
(43:49):
achieving health,they tend to create a virtuous cycle.
Like, we’ll use staffing as an example.
If you were able to become
an employer of choice,you're able to hit your growth strategies
as you become more successful,can offer a better benefits back,
and you are more likely to obtainnot only the talent you need, but
a higher skill level across both clinicaland administrative functions.
(44:09):
And so there is sort of a reinforcingimpact
of really focusing on thisand getting it right across time.
And it's to your point, Kevin,it's an incredibly difficult thing to do
because like anything elsethat has a strong culture component to it,
you have to think about itevery minute of every day.
Because if you take your eye off of it,you slip.
And then people notice that,and then you start to encounter issues.
(44:32):
And it's interesting.
Chad, thinking about how
there's a cycleand how different pieces kind of reinforce
other componentsthat, that, that you're mentioning there.
That also applies as you think aboutour core capabilities that we identified.
Yes, we went through this process.
Five things continued,to resound across the team
(44:55):
that was working on itand now list them out really quickly.
But it's strategic agility,aligned growth, regulatory
excellence, financial disciplineand talent optimization.
And it's that same cycle that you wereyou were indicating that,
you know,you can't be just totally focused in one
and take your eye off all of the othercomplimentary capablities that are there.
(45:16):
It really takes, the work of all of those
to make sure we're hitting on all cycleshere, for achieving health.
No, I think that's a great point,because any example
that we could talk about right now,we should list out,
you know,
if you thinkabout a successful organization
and you think about somethingthat they've achieved,
you can generally tie in, okay,there was a strategy component to it.
(45:37):
There was an intentional growthcomponent to it.
You know, they were makingfinancially disciplined decisions
and all of that was informedby a strong regulatory function.
And I'm sure right now, you and Iand Kevin can probably think of 3 or 4
different examples from clientsthat we could walk through.
When you think about the concepts behindachieving health,
I think they've always been relevant.
But what was the Why now?
(45:59):
for us in refreshing our marketpoint of view around these concepts?
All right.
For me it was a combinationof a number of different things.
One was we are, have exited
the challenges of the Covidera in many ways,
but we need to move out of that eraas quickly as possible.
(46:19):
So I think that was one thing.
It was a recognition that we're at kindof a milestone in the industry.
And that we sort of capturethat opportunity
to tackle the bigger picture issue of
how do we move the industry forwardnow, after that time?
(46:39):
Two was what what Bradmentioned a few minutes ago,
the size and scale and scopeand depth of our firm, our health
care industry and our health care sectorwithin the Forvis Mazars firm,
just was at a point where
articulating on behalf of that that, that,that sector was critically important.
(47:03):
We have so many clients across all,
sub niches and parts of the care continuum
that it was important that we captureideas are relevant to all of those.
So you had you were emergingfrom a certain part of the, a certain
era in the marketand needing to move beyond that.
We were evolving as a firmand needed to put
(47:24):
some ideas in the marketplacethat were relevant to us.
And then the third thing was,
we thought just, too
narrow of a definition of certain things
that we believe are going to be criticalto the industry moving forward.
And we've talked about those. Right.
The idea of risk back in the day,the idea of value back in the day,
(47:44):
the narrow definitionsof some of those critical elements
that our industry is talking about,but maybe not executing on very well.
So we felt the need to to be much broader,much more holistic
in, in definingwhere we believe the industry needs to go.
If each of you could leave our listenerswith one takeaway
related to achieving healthin 2025, what would it be?
(48:07):
For me, Chad, it's collaboration.
Yeah, that's the thing
that it stuck out to meas we had reflected on the on the document
that it's going to take the joint workat multiple stakeholders
to really move the industry forwardtoward achieving health.
And and so, you know what I get askedby our teams are we talk about that more.
That's really the themethat sticking out for me consistently.
(48:31):
For me it's
this is achievable.
And I just it's it's yes,these are high conceptual ideas
of of improving and achievingbetter health.
That is a big picture idea,but it is actually doable
if you break it down into how do we do it.
(48:55):
There are actionable steps that canactually contribute to achieving health.
So that'smaybe the point that I want to leave.
That, that and I totally agree with Brad.
Collaboration across the continuumof care, collaboration
across the different constituents,absolutely critical.
But if we do the right things
(49:15):
in that spirit of collaboration,we can actually achieve health.
And I think that'sthat's got to be foundational
to how we move forward, is the beliefthat it's that it is, in fact, achievable.
Brad.
Kevin, thanks again for joining me today.
It was a great conversation.
I really appreciate you
taking the time to share your insightsinto Achieving Health.
(49:37):
I also want to thank all our listenersfor tuning in.
If you'd like to learn more
about the ideas and conceptswe discussed in today's episode,
there's a link in the show noteswhere you can download and read our Market
Point of View.
I hope you'll join me in two weeksfor the next episode of
Achieving Health.
You can follow
(49:57):
Achieving Healthon your favorite podcast platform or visit
forvismazars.us/AchievingHealthPodcastto learn more.
New episodes are released the firstand third Wednesday of each month.
Achieving Health is producedby Forvis Mazars LLP, an independent
member of Forvis Mazars Global, aleading global professional services
(50:18):
network, ranked among the largest publicaccounting firms in the United States.
The firm's 7,000 dedicated team membersprovide an Unmatched Client Experience
through the delivery of assurance, taxand consulting services for clients
in all 50 states and internationallythrough the Global Network.
The information set forth in this podcastcontains
(50:39):
the analysis and conclusionsof the panelists based upon his, her,
or their research and analysis of industryinformation and legal authorities.
Such analysis and conclusionsshould not be deemed opinions
or conclusions by Forvis Mazarsor the panelists
as to any individual situationas situations are fact-specific.
The listener should performtheir own analysis and form
(51:01):
their own conclusionsregarding any specific situation.
Further, the panelists conclusionsmay be revised without notice,
with or without changes in industryinformation and legal authorities.
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