Episode Description:

This episode of "The Strain: Winning the Battle with Big Health Insurance" features guest Patrick Velliky. Patrick is the VP of Government Affairs for Envision Healthcare, one of the largest hospital-based physician groups in the country. In this episode, Patrick shares his insights on the impact of the No Surprises Act through the lens of policy, a space in which every problem is the product of an incentive or motivation. Learn how physicians can make a difference by reaching out to their representatives - every small action cumulatively adds up to equal real change. Discover the challenges physicians face in IDR due to a lack of enforcement mechanisms and payer loopholes, the misalignment of incentives in the industry, and potential solutions to enhance the process of resolving claims. Join us for this deep dive into the complexities of out-of-network claim processing and challenges faced by healthcare providers in the post-NSA world!

Timeline:

00:00 - 03:12: Introduction to Patrick Velliky of Envision Healthcare. Patrick shares his journey from the payer side of the table to provider-side, enabling him to understand how each party approaches important issues. Every problem in the policy space is the product of an incentive or motivation, according to Patrick.

03:12- 05:56: Discussion of policy nuances between hospitals versus physician groups and the importance of bringing providers’ perspectives and stories to Capitol Hill.

5:56 - 6:57: The story of Patrick writing Senator Arlan Specter’s floor eulogy for Ted Kennedy.

6:57 - 13:25 - Discussion of the different ways providers can be effective in advocacy, Envision’s recently launched Advocacy Champions Program, and Patrick’s advocacy work both with societies like EDPMA and ACEP, and Envision.

13:25 - 16:21 - Discussion about the state of underpayments pre-to-post NSA. Reflection on challenges posed by the fact insurers are paid in advance, but providers are paid in arrears. The seemingly “interminable” IDR process.

16:21 - 20:10 - How did a good law like the NSA go so downhill? The team discusses policies which cut providers out of fair payment opportunities. Patrick suggests the aim to reduce federal spending led to an overshooting of goals and negative impacts on providers' financial stability.

20:10 - 21:45 - The conversation shifts to concerns about vertical consolidation within health plans, with insurers becoming the largest employers of physicians. Attention in the policy space is needed to address the consequences of this consolidation.

21:45 - 26:32 - Reflection on downcoding challenges in emergency medicine. Patrick discusses the need for more enforcement mechanisms on payers to ensure the effectiveness of the NSA.

26:32 - 29:53 - Eliot and Patrick discuss the recent New York Times expose about Multiplan. The conversation highlights the predatory nature of compensation schemes like shared savings, creating misalignment of incentives between employers, third-party administrators (TPAs), and healthcare providers.

29:53 - 38:08 - Patrick discusses ways to achieve better reimbursement, challenges in negotiating reimbursements for the ED and with ERISA plans, and highlights the importance of ensuring that clinicians are valued by payers to the same extent they are valued societally. The team also discusses challenges and costs associated with navigating different state IDR models.

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