Episode 1: What “Achieving Health” Means for Healthcare Organizations
Transcript
00;00;00;00 - 00;00;24;21
Speaker 1
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 conversation with Brad Brotherton and Kevin Locke, leaders of our health care practice at Forvis Mazars. During this conversation, we will explore our point of view on achieving health and the core capabilities organizations need to fulfill this important mission in today's landscape.
00;00;24;27 - 00;00;27;15
Speaker 1
Stay tuned.
00;00;27;18 - 00;00;49;17
Speaker 2
This is Achieving Health, a podcast from Forvis Mazars, where we delve into the topics that matter most to health care organizations across a continuum of care. Our goal is to help you navigate the dynamic health care landscape and achieve health at your organization. Here's your host, Chad Mulvany.
00;00;49;19 - 00;01;19;02
Speaker 1
Welcome to the first episode of Achieving Health. Thank you for joining me for this journey. I'm your host, Chad Mulvaney, director in the Healthcare practice at Forvis Mazars. My role at the firm is to help our clients understand how changes in federal payment policy will impact healthcare organizations. As a bit of background on me, prior to joining Forvis Mazars, I spent the last 15 years in the DC offices of the California Hospital Association and the Healthcare Financial Management Association.
00;01;19;04 - 00;01;49;10
Speaker 1
With both organizations, I was in roles with responsibility for helping healthcare organizations understand federal payment policy, providing feedback to CMS and other stakeholders, and helping both providers and regulators think through the impact of changes in payment policy on the ability for individuals to access high quality health care in their communities. And before those experiences, I worked both as a consultant and for hospitals and health systems doing finance and reimbursement work.
00;01;49;12 - 00;02;20;15
Speaker 1
So in some way, I've spent most of my career helping health care organizations achieve health by focusing on regulatory excellence. We'll begin today with a segment called Washington Watch, where I share updates on the most recent actions and discussion topics amongst federal policymakers and their anticipated impact on health care providers and payers. For those of you who have joined me for our previous Washington Watch video series, I’d like to thank you for coming over to the podcast and for our brand new listeners,
00;02;20;15 - 00;02;41;29
Speaker 1
thank you for listening to me for the first time around. So today's remarks reflect information as of this moment and will change. The House passed the One Big Beautiful Bill Act the week of May 19th. There were a few minor tweaks to the Medicaid provisions, which we'll discuss. Also, there are a number of exchange provisions that I hadn't previously touched on that I'll flag.
00;02;42;01 - 00;03;06;02
Speaker 1
And we'll also get into timing and next steps. Additionally, CMS provided additional guidance related to price transparency that will require action from hospitals and will cover that. The agency also noted that it would expand Medicare Advantage, quoting audits. Obviously, that's not a paid for in the House pass version of OBBBA, but we'll get into the actions that it's taking to expand those audits.
00;03;06;04 - 00;03;35;16
Speaker 1
And finally, CMS also clarified one of the key provisions in the executive order related to the most favored nations drug pricing, executive order. In terms of the OBBBA update, the House passed it by a vote of 215 to 214. The changes to the Medicaid section were limited, but will increase the savings and also the rate of uninsured. Also for note, there were no additional policies related to Medicare that were included.
00;03;35;16 - 00;04;04;17
Speaker 1
So as of right now, no site-neutral in the House passed version. However, because the legislation increases the deficit, if it is enacted, it will trigger automatic Medicare cuts unless Congress intervenes. In terms of the impact on the uninsured and federal fiscal situation, the Congressional Budget Office estimates that the bill's changes to Medicaid will reduce federal spending by approximately $803 billion over ten years.
00;04;04;20 - 00;04;31;03
Speaker 1
In addition, the CBO estimates the bill's changes to Medicaid and the health insurance exchanges will increase the number of uninsured individuals by 8.6 million by 2023. To put that increase in the uninsured in context, the CMS office of the actuary projects the number of uninsured for 2025 at 26.1 million. So that's a fairly significant increase over the next ten years.
00;04;31;05 - 00;04;57;00
Speaker 1
The OBBBA impact also is likely understated as it doesn't include interactions between 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 by state based on previous policy choices at the state level, which we'll get into in more detail in terms of the Medicare sequester.
00;04;57;02 - 00;05;26;19
Speaker 1
Despite the reduction in Medicaid spending, the OBBBA adds significantly to the federal debt. And unless Congress takes action to reduce the deficit or steps in to prevent future Medicare cuts, The Hill and other outlets are reporting that current law requires a sequester of certain mandatory spending programs. Reductions in Medicare spending for the sequester are limited to 4% annually, or an estimated 45 billion for fiscal 2026.
00;05;26;22 - 00;05;57;15
Speaker 1
So these cuts would total roughly 490 billion over the 2027 to 2034 period. Deficit spending, however, in D.C., is a perpetual issue which has made this particular Medicare sequester a constant threat. Congress has always voted to, quote unquote, wipe the mandatory scorecard clean whenever this issue pops up. However, if Congress were to fail to do that in this instance and allows the cuts to take effect, it will compound the financial stress facing hospitals.
00;05;57;18 - 00;06;29;09
Speaker 1
In terms of the Medicaid amendments to secure support from the House Freedom Caucus for the OBBBA. There were a couple of minutes made to the Medicaid provisions of the bill. First, the work requirements were pulled forward. So instead of taking effect on January 1st, 2029, as was in the original version passed out of the Energy and Commerce Committee, states must implement work requirements for the able-bodied expansion population by December 31st, 2026 or earlier at the state's option.
00;06;29;11 - 00;07;00;06
Speaker 1
Second, in terms of state-directed payments for non-expansion states for newly approved programs, non-expansion states, state-directed payments are capped at 110% of Medicare instead of at Medicare for expansion states. For non-expansion states that expand Medicaid after enactment, the cap reverts to 100% of the Medicare rate, including for programs that were initially approved post-passage and are being paid at 110% of Medicare.
00;07;00;08 - 00;07;34;18
Speaker 1
One of the unintended consequences of Medicaid cuts of this magnitude is that it could force the remaining non-expansion states to provide Medicaid coverage to the expansion population in order to support safety net hospitals and other safety net providers. While the cap increase when new state-directed payment programs for non-expansion states is intended to combat this, my inclination is that while it may delay expansion for a bit, it will not be enough to address the long-term shortfalls in funding for uncompensated care, which could then lead non-expansion
00;07;34;18 - 00;08;16;25
Speaker 1
states to expand Medicaid. Moving on to the next amendment to the OBBBA, in terms of the FMAP reduction for expansion states that cover non-qualified immigrants. The amendment clarifies that providing health insurance coverage to lawfully residing pregnant women and children does not trigger a reduction of the Medicaid expansion map. So it looks like this policy will only apply to the 14 states that cover able-bodied undocumented adults, and these include California, New York, Illinois, Washington, new Jersey, Oregon, Massachusetts, Minnesota, Colorado, Connecticut, Utah, Rhode Island, the District of Columbia, Maine, and Vermont.
00;08;16;27 - 00;08;41;10
Speaker 1
Assuming these states keep the expanded coverage, Medicaid spending increases across states ranged from 30 billion in California to 300 million in Vermont, or as a percentage from 8% of Medicaid spending in Oregon and Washington to 3% in Massachusetts, Vermont, New York, and Minnesota. Given the dollars at play, I think it's going to be difficult for states to maintain this expansion.
00;08;41;17 - 00;09;11;17
Speaker 1
However, this is something that bears watching. While it has been less reported and commented on. The OBBBA also includes significant changes to the Affordable Care Act health insurance exchanges or marketplaces. Of the 8.6 million newly uninsured that are projected by 2034, 1 million of those uninsured will be as a result of changes in the exchanges. So I want to spend a moment just providing a very high-level summary of some of those provisions.
00;09;11;19 - 00;09;37;13
Speaker 1
Please note this is not intended to be exhaustive. One of the changes is to reduce the open enrollment period. And so starting plan years beginning on January 1st, 2026, where open enrollment will begin on January 1st, 2025. That open enrollment period will now end on December 15th of 2025. In recent years, for most states, open enrollment has lasted from November 1st to January 15th.
00;09;37;15 - 00;10;03;26
Speaker 1
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 enrollment periods, or SEPs, effective for plan years beginning January 1st, 2026. It eliminates the year-round enrollment opportunity for people with incomes up to 150% of the federal poverty level, also known as the low-income SEP.
00;10;03;28 - 00;10;30;20
Speaker 1
It also limits the ability of all marketplaces, including state-based marketplaces, to provide specific types of steps that are based on the relationship of people's income to the poverty line. And again, here, it's worth noting that about half 47% of marketplace enrollees had income of less than 150% of the federal poverty level. There are a couple of provisions related to the exchanges that are somewhat similar to the Medicaid provisions.
00;10;30;22 - 00;10;53;09
Speaker 1
And so one of them is a requirement or more restrictive requirement to verify personal income information effective for planned years beginning on or after January 1st, 2026. Enrollees will need to provide additional documentation and can no longer simply self-attest to changes of household income and family size in cases when this information is not available from the Treasury Department.
00;10;53;12 - 00;11;23;21
Speaker 1
And it also provides a number of scenarios where there are now new triggers for full income verification by the exchange. The rule also removes an automatic extension of 90 days for an enrollee to verify household incomes. And so some analysts believe that this 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 credits or cost sharing reductions are provided.
00;11;23;24 - 00;11;57;08
Speaker 1
And this is effective for taxable years beginning after December 31st, 2027. There's also a provision in the legislation that requires for recapture of excess premium tax credits and so effective for taxable years beginning after December 31st, 2025, requires that all premium tax credit recipients repay the full amount of excess, no matter their income. And it also eliminates cost sharing reductions so effective for planned years beginning on or after January 1st, 2026.
00;11;57;11 - 00;12;25;14
Speaker 1
Returns to funding cost sharing reductions through payments from the federal government with explicit congressionally appropriated funds. So this provision effectively ends, quote unquote, silver loading, which reduces premiums for silver plans. And it's worth remembering that the second-lowest-cost silver plan is the benchmark for calculating exchange subsidies, which then subsequently reduces the size of the premium tax credits available to all those who qualify for marketplace coverage.
00;12;25;16 - 00;12;55;18
Speaker 1
In terms of state impact of Medicaid and exchange provisions, analysis from the Kaiser Family Foundation estimates the federal Medicaid cuts in the OBBBA would reduce state spending by 20% per beneficiary on average. However, the impact on per-beneficiary spending would vary significantly based on state policy choices pre-dating the legislation. So, for example, the impact on per-beneficiary spend ranges from a low of 6% to a high of 50%.
00;12;55;20 - 00;13;25;28
Speaker 1
Not surprisingly, the bill's impact on state-level uninsured rates tends to be correlated with the spending cuts. A separate analysis from the Kaiser Family Foundation projects a 0% increase at the low end for some states, while at the high end, other states could experience increases of the uninsured in excess of 4%. As a result of the OBBBA. The enhanced premium tax credits, which separate from this, are are scheduled to sunset on December 31st, 2025.
00;13;26;01 - 00;13;53;14
Speaker 1
The impact on non-expansion states uninsured rate increases significantly. In terms of timing and next steps, the legislation is currently with the Senate for consideration, where it is very likely that it will be amended. While Speaker Johnson has stressed that the House version represents a delicate balance that is the only one that can pass that chamber, we've certainly heard from various senators and even President Trump about the need to change the package.
00;13;53;16 - 00;14;17;24
Speaker 1
And again, here, like the House, the storylines are very similar. So, for example, you have Senators Rand Paul of Kentucky and Ron Johnson of Wisconsin who are concerned about the federal debt and would like to see more 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.
00;14;17;26 - 00;14;42;29
Speaker 1
And Senator Hawley in particular is concerned about the capital and provider taxes. Given that Missouri hasn't maxed out its program, my speculation is the work requirements delay of the Biden administration's final rules that would streamline eligibility and enrollment fee increase requirements for Redetermination, and changes to FMAP for states that provide coverage to certain undocumented individuals won't see significantly significant changes.
00;14;43;01 - 00;15;12;24
Speaker 1
These were all relatively non-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 2026 elections, however, I do suspect that provider taxes and state-directed payments could be in play. However, not sure at this moment how that will break. Whether we'll see a further tightening down of provider taxes or maybe some loosening of that requirement. If the requirements are loosened,
00;15;12;26 - 00;15;36;13
Speaker 1
it'll be interesting to see, or be worth following to see, how that's paid for, given the size of the impact on the federal debt of this bill. Senate Majority Leader Thune aspires to pass that chamber's version by the July 4th recess. 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 House and to President Trump's desk.
00;15;36;16 - 00;15;56;14
Speaker 1
If something does get to President Trump's desk – and my money is still on them getting something there – it will likely be mid- to end of July for timing. And again, same issues that plague the House will complicate the debate in the Senate. And when you start to think about vote count, Senator Paul is likely a no unless that bill reduces the deficit.
00;15;56;14 - 00;16;25;28
Speaker 1
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 price transparency RFI. That announcement also included guidance for hospitals and provided a timeline for an updated schema for the health plan transparency-in-coverage file. For the health hospital price transparency requirements,
00;16;26;00 - 00;17;01;20
Speaker 1
CMS reminded hospitals that the 2024 OPPS final rule requires a standard charge dollar amount that must be included in the machine readable file if it can be calculated. The guidance notes that more machine readable files than anticipated include nine nines for the standard dollar amounts that could not be calculated. Moving forward, hospitals should discontinue encoding the nine nines in the machine readable file and instead an actual dollar amount based on the average payment a hospital has received for an item or service derived from electric remittance advice
00;17;01;20 - 00;17;32;21
Speaker 1
transaction data for items or services rendered within the last 12 months should be encoded. It is not clear from the guidance when hospitals must come into compliance with this new guidance. For health plans via the transparency and coverage requirements, CMS announces that an updated, machine readable file schema is intended to address concerns regarding the health plan files inaccessibility due to file size, data integrity, and a lack of critical context that limits full transparency.
00;17;32;24 - 00;17;56;16
Speaker 1
It will be available on October 1st, 2025, and plans will have until February 2nd, 2026 to come into compliance with it. Not surprisingly, CMS is taking action on both plan and provider files to increase the quality of data provided at some point during this administration. I would anticipate the agency will attempt to reconcile both the plan and hospital files to verify accuracy.
00;17;56;18 - 00;18;25;06
Speaker 1
This is going to be difficult, if not impossible, due to a variety of technical reasons. However, it certainly won't stop the trade press from generating clickbait headlines. Moving on to CMS‚ expansion of Medicare Advantage coding audits. The week of May 19th, CMS announced it will expand risk adjustment data validation, or RADV audits, to confirm that diagnoses used for risk adjustment and payment are accurate.
00;18;25;08 - 00;18;56;23
Speaker 1
These audits will apply to all eligible Medicare Advantage contracts for each payment year, and expedite the completion of audits for 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 records and flag unsupported diagnoses. CMS plans to increase the audits from approximately 60 plans a year to approximately 550 plans per year.
00;18;56;25 - 00;19;24;28
Speaker 1
It also plans to increase the number of records audited from 35 per health plan per year to between 35 and 200 records in all newly initiated audits. The House didn't even sniff at this as a reconciliation pay for and my guess is the Senate won't either in its changes. While I suspect that CMS and the OIG will carry through with the expanded audits and attempt to recoup any identified overpayments, the plans will challenge recruitment efforts in courts.
00;19;25;06 - 00;19;46;20
Speaker 1
Therefore, it is likely that take years for CMS to recover funds if they are able to recover funds at all. Last thing I want to cover is the Most Favored Nations drug pricing, executive order. HHS recently clarified that only brand name drugs that do not have a generic or biosimilar competitor will be subject to the MFN drug pricing policy.
00;19;46;22 - 00;20;16;11
Speaker 1
The Most Favored Nation target price is the lowest price in an OECD country, with a GDP per capita of at least 60% of the US GDP per capita. This, it's worth noting, is a much broader attempt to implement MFN pricing policies than the prior Trump administration, which only focused on Medicare Part B, separately payable drugs. It remains to be seen if the administration will attempt to revive a similar Medicare policy as part of this broader effort.
00;20;20;11 - 00;20;55;12
Speaker 1
grounds, specifically the way the administration tried to implement the policy, there are also technical arguments against a part B Most Favored Nations model that were not argued in court. So that's that's something that remains to be watched. That concludes this episode's Washington Watch. Up next, I'll have a conversation with my guests, Kevin Locke and Brad Brotherton as we talk about Forvis Mazars Healthcare Point of View.
00;20;55;15 - 00;21;19;05
Speaker 1
I'd like to welcome our guest for today's episode, Brad Brotherton and Kevin Locke. Brad is the National Sector Leader for the Healthcare practice at Forvis Mazars, where he leads and supports assurance, tax and consulting teams across the firm to serve clients nationwide and across the continuum of care. Kevin is the managing principal for Healthcare Consulting at Forvis Mazars.
00;21;19;07 - 00;21;34;06
Speaker 1
Kevin leads teams that provide consulting services for health care organizations, encompassing strategy and finance, performance improvement, reimbursement, and payer services. Kevin, Brad, great to have you with us. Appreciate your time and the conversation.
00;21;34;08 - 00;21;37;08
Speaker 3
Thanks for the invite Chad. Looking forward to this discussion.
00;21;37;10 - 00;21;43;29
Speaker 4
Yeah, definitely. Chad. Episode one here. We're excited. So thanks for having Kevin and I join you today.
00;21;44;01 - 00;21;52;13
Speaker 1
Before we jump into the conversation, maybe, Brad, if you could tell us a little bit about your background in health care and how you came to this field?
00;21;52;16 - 00;22;35;11
Speaker 4
Yeah, happy to Chad. And, none of my background is professional podcast radio interviewee. So coming at this fresh this day, but, my background really started, with the firm over 25 years ago. Started as a new CPA coming 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 office in southern Missouri, and spent a long time, working with that team, kind of worked my way through a lot of different audit roles, eventually ending up as an audit partner
00;22;35;11 - 00;23;02;19
Speaker 4
for hospital and health system clients, and along the way, had the chance to do a lot of different things. I did a lot of regulatory reimbursement cost report work and strategy work, even at one time got the chance to start our 340B pharmacy consulting practice, back when that was really in its infancy. So I've seen the firm from a lot of different angles and had a chance to work with a lot of our great teams, over the years.
00;23;02;19 - 00;23;28;06
Speaker 4
But but what drew me in to the healthcare practice, really beyond just the team of professionals and the work that we were doing was really the impact that we were able to have on communities and important organizations that were serving patients and communities, across the country. That was fun for me. It was it was exciting in a place I wanted to, to be curious about and learn more.
00;23;28;09 - 00;23;45;25
Speaker 4
There was no shortage of challenges. Yeah. I think any of us that have been in in health care for a long time know how diverse each day can be and what each day's set of challenges are going to be, and how we were helping clients through that. And so I really got excited about it. Ended up spending my career here.
00;23;45;25 - 00;24;06;17
Speaker 4
It's been a lot of fun. Met a lot of great people and a lot of great organizations. And as I stepped into the national sector role, last summer, really got excited about this point of view process. The Kevin and I have worked on leading and really where we are today and, you know, excited to spend some more time talking about that.
00;24;06;19 - 00;24;20;23
Speaker 1
Yeah. No. And just from from my perspective, when I first joined the firm, I was excited to have the opportunity to work on it because the concepts that we're about to talk about are very much aligned with both, you know, my personal beliefs and also some of the work that I'd done, it to me and, and other organizations.
00;24;20;23 - 00;24;27;13
Speaker 1
So I think it all ties it together nicely. So Brad, thank you for sharing that background. Kevin, could you do the same please?
00;24;27;16 - 00;24;50;13
Speaker 3
Absolutely. And Brad, thanks for for that tee-up and in some ways, Brad's background and my match up. In some ways they're very different. But where they match up Chad is I fell in love with healthcare in very much the same way Brad did. I started my career with, Andersen Consulting back in the day after we had split from Arthur Andersen and before we rebranded Accenture.
00;24;50;15 - 00;25;09;23
Speaker 3
And so I spent a couple of the early years of my career, doing consulting work, but not necessarily in healthcare. Did some government work, did a little bit of healthcare. So I kind of fell in love with the idea of consulting. And then when I left Andersen, I went to work for a healthcare provider.
00;25;09;25 - 00;25;35;03
Speaker 3
We were an owner-operator of outpatient imaging and some other outpatient services. It was a for-profit company that competed with the not-for-profit hospitals on some of those more profitable outpatient services. And so I spent about 12 years there. So I had a few years of consulting in my background. Then I got into healthcare and just fell in love with the industry of healthcare.
00;25;35;03 - 00;26;10;00
Speaker 3
Right? The the economic challenges, the, the, the opportunities to serve in a very unique way in terms of, helping folks improve their lives and that kind of thing. So it's just a really interesting combination of things happening in health care that I fell in love with. So then I started my own consulting firm and, took those 4 or 5 years of consulting experience, took those 10 or 12 years of healthcare provider experience, and started a healthcare strategy consulting firm with a couple of other partners.
00;26;10;03 - 00;26;37;08
Speaker 3
And we merged that firm into Dixon Hughes. Dixon Hughes became DHG. DHG then merged with BKD to become Forvis. And then the integration with Mazars as well. So I've just followed the integration path of our firm. Once we merged our healthcare consulting firm into DHG back in the day. So it's been a really interesting and fun journey. There are some, some really cool things that that I appreciate about the industry.
00;26;37;10 - 00;27;01;23
Speaker 3
I'm probably less of a finance guy than Brad and probably less of a regulatory guy than either Chad, you or Brad. More of a strategy guy. I've spent most of my career doing strategic planning for hospitals and health systems, and it's been very, very rewarding, as you can imagine. Just kind of watching and helping organizations evolve and grow and become more important to their communities.
00;27;01;23 - 00;27;24;20
Speaker 3
So that's what I really appreciated about the last 30 plus years of doing, strategic planning for hospitals and health systems. So now I serve as the managing partner, managing principal of our healthcare consulting practice here at Forvis Mazars. Very proud of the team and the work that we do in the marketplace. And, just really appreciate our clients and the way that they serve their communities as well.
00;27;24;23 - 00;27;35;26
Speaker 1
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 you that you're not a regulatory guy. We we welcome all types.
00;27;35;28 - 00;27;46;18
Speaker 3
Thank you. Thank you for my strategy brain to wrap around the details of regulatory. It just doesn't work very well sometimes, as you guys both know.
00;27;46;20 - 00;28;25;03
Speaker 1
But it's probably why you're a healthier human being. So, you know, when I the thing that attracted me to the firm and you guys both touched on it in your opening statement, you know, many of, just about everyone that I spoke with that I knew from prior background before I joined the firm, even before the interview process, people that I knew, everyone was passionate about what they did because one, they found it intellectually engaging and two, it was that bigger tie to mission of I'm doing something to help improve the health of individuals in the community, the efficiency of care delivery, and make sure that at the end of the day, there are
00;28;25;03 - 00;28;41;04
Speaker 1
resources there to, for those when they need it so that we can serve, the health systems can be successful and continue to serve. And that that really resonates with me and I think will continue to be a theme throughout this podcast. So I love the fact that you both teed that up coming out of the gate.
00;28;41;07 - 00;29;04;09
Speaker 3
Well, I if I could just real quick pull that thread for a second. Chad, because you mentioned a couple of things, right? That the I think we're all passionate about healthcare and about serving, ultimately, the patient. Right, that that's really where the health care, industry, is unique, right? We are diligent and very passionate about serving patients and improving their health.
00;29;04;12 - 00;29;34;13
Speaker 3
However, along the way, there's plenty of opportunity to, improve operations and improve financial performance and improve strategic alignment and all of those things that also have to be in place, in order to effectively serve the end patient. And I think that's where a lot of us get the energy right. There are real business challenges to tackle within the healthcare industry, and as we tackle those, we get better at serving the end patient.
00;29;34;13 - 00;29;40;19
Speaker 3
And I think that that feeds the passion, and it's really an interesting industry for that reason. In my opinion.
00;29;40;21 - 00;29;56;12
Speaker 1
Yeah, and that's exactly right. And the way that I've always thought about it is somebody needs to deal with cleaning out the regulatory, the finance, the operational underbrush so that clinicians can go do the thing that they are here to do and really the gift that they've been given and share that with the community.
00;29;56;14 - 00;30;43;05
Speaker 4
And, you know, Chad, I think another item there really distinguishes our firm is the number of professionals that have gone extremely deep within the sector. So, you know, we call ourselves the health care sector and we all are aligned there. But within there, there's so many different parts of the continuum of care industries that that are within there and how our teams have devoted themselves to understanding all of the intricacies, 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 firm and really know that I've got quick answers to hard
00;30;43;05 - 00;30;46;04
Speaker 4
questions, when I need them.
00;30;46;06 - 00;30;54;14
Speaker 1
And to that point, not just quick answers, but the quick right answer, because you've got somebody who is a mile and a half deep on the topic at least.
00;30;54;20 - 00;30;56;11
Speaker 4
Yeah, exactly. Right.
00;30;56;13 - 00;31;09;28
Speaker 1
Kevin, you alluded to this earlier about the evolution of of how we became Forvis Mazars. Could you and Brad share a little bit about the evolution of market point of views both at Forvis Mazars and kind of with the legacy firms?
00;31;10;00 - 00;31;38;13
Speaker 3
Yeah, absolutely. Thanks for that. The, the point that Brad made about how broad and deep our team is is so important to answering this question, Chad, because, very early on in the in the evolution of the healthcare practice and our firm, we, we felt it was very important that we pull together all of that expertise and take a stand in the marketplace about certain things that we believe.
00;31;38;13 - 00;32;06;28
Speaker 3
And that's really what became our point of view. We just felt that that with a that 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 to what was happening in the marketplace, but that we have a position on what we think the industry should be doing. The path that it should be moving down, the opportunities that it should be tackling.
00;32;06;28 - 00;32;38;12
Speaker 3
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 evolved quite a bit since then. Our practice has evolved quite a bit since then, and our point of view has evolved quite a bit since then as well. But very early on, as the industry itself was wrestling with the idea of value, remember that whole transition that I believe and I think all three of us believe we're still in the middle of that transition from volume to value.
00;32;38;14 - 00;33;12;28
Speaker 3
But that was what triggered our first point of view. It was that we really believed and took a stand and tried to encourage the 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 view that said, we believe the industry needs to move faster toward the idea of value and the idea of taking risk and the idea of paying for, improving lives and improving outcomes and that whole idea of risk and value.
00;33;12;28 - 00;33;51;15
Speaker 3
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 taking risk and and delivering value. And so we called it, risk capability. We developed certain capabilities that we felt folks needed to accelerate in the marketplace. And over time, that that concept of risk for us and our point of view evolved to a concept of value and now has evolved to a concept of health and achieving health that we're going to talk about today and I'm sure in future episodes as well.
00;33;51;18 - 00;34;15;11
Speaker 3
But, Chad, my point is, first of all, that early on we thought it was important to take a position and try to move the industry in a certain direction that that original point of view was trying to encourage the industry as a whole to move toward the concept of risk or the concept of value, and that over time, that has evolved really nicely to what we're now calling, Achieving Health.
00;34;15;11 - 00;34;36;19
Speaker 3
And it incorporates a lot of those original ideas about having a bigger-picture perspective on how we move all of the constituents toward, achieving health, whether that's financial health, regulatory health, strategic health, economic health, or the health of the patient. And we've tried to incorporate all of that in our new point of view.
00;34;36;22 - 00;34;58;25
Speaker 4
Yeah. And, Kevin, I think it's interesting to, to think about what the term value that was used historically. You know, that word within healthcare kind of changed on us over time to where now, in a lot of settings, when you talk about value, people immediately begin to think about value based care, bundled-payment arrangements, ACO arrangements, those types of things.
00;34;59;02 - 00;35;17;29
Speaker 4
And that really wasn't the core focus of value in the in the point of view. It was always around patient focused care. How do we focus on communities and organizations and all of that. And so really challenging that and reframing that, that point of view was, was important for us to to begin to do.
00;35;18;02 - 00;35;56;03
Speaker 3
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 put that first point of view out, I think the industry as a whole still struggles with the definition of value, right? And and is it more narrowly defined around certain alternative payment models, or is it more broadly defined around how we, as all of the constituents in, in the healthcare industry are intentional about providing value to those constituents, value to patients, value to families, value to communities, value to providers.
00;35;56;05 - 00;36;07;29
Speaker 3
In our firm and our point of view, we're trying to take a much broader, definition of value. I think the industry still kind of struggles with what is our collective definition of value.
00;36;08;02 - 00;36;35;00
Speaker 4
Yeah, I agree with you, Kevin, and that's why I'm excited about where we've landed with Achieving Health. I mean, I think it's it's easy for organizations, no matter their size, complexity, where they fit across the continuum to understand. We're focusing on patients getting healthier, communities getting healthier. And in order do in order to do that, our organization has to be healthy itself.
00;36;35;03 - 00;36;42;26
Speaker 4
And, you know, getting aligned around that from from an achieving health point of view, is exciting to see all that come together.
00;36;42;28 - 00;37;11;23
Speaker 1
You know, you guys have said something that really resonated with me in talking about the difference between value and achieving health. 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 us would have anticipated. And, you know, when when we started this in the early aughts and it's really started to pick up steam in 2009-10 after the passage of the Affordable Care Act, is the fact that we as an industry talked about it and we talked about including the patient.
00;37;11;23 - 00;37;30;22
Speaker 1
But we didn't talk about things like achieving health that would resonate with patients and with consumers and with communities. You know, when you say value to a patient or 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 is so important, because the words do matter.
00;37;30;24 - 00;37;43;01
Speaker 1
How does the concept of achieving health apply to health care organizations as 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.
00;37;43;04 - 00;38;14;01
Speaker 3
Yeah, great. Great question, Chad. And, I think that there is this and our point of view wrestles with this, this balancing of: What does achieving health mean to the different constituents that are our part of our, our health care industry? And each one has a little bit different perspective. And we tried to tackle that from the provider perspective and try to tackle it from the payer perspective, try to tackle it from the, that community and and the patient's perspective.
00;38;14;01 - 00;38;58;16
Speaker 3
But but I think at a high level, Chad, what how this kind of all fits together is that we believe that the end goal of improving the health of our patients and our communities is achievable, but requires the organizations that deliver that care and that and the people that deliver that care to also be more healthy 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 better health in all of those areas, from a from an individual
00;38;58;16 - 00;39;21;24
Speaker 3
and organizational perspective, allows us to treat patients in a way that improves their overall health as well. So we're trying to tackle it from the perspective of all of those different constituents. With the end goal of achieving, improved health of, of people and communities. But organizations have to be healthy in order to deliver that level of care.
00;39;21;26 - 00;39;46;28
Speaker 4
And Kevin. Yeah, really well said. But I think one thing that that was really apparent as we work through this is that it was going to take work, cooperation, collaboration and involvement by 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?
00;39;46;28 - 00;40;13;16
Speaker 4
And so the rules that we have to, to, operate within. How does that become a key part of how organizations achieve health? And then how does the community and the patients really respond to the healthcare organizations? How how receptive and trusting are they in their communities? All of those are critical to help everybody be successful in achieving health throughout the whole sector.
00;40;13;19 - 00;40;22;15
Speaker 1
When you think about the benefits of achieving health, what are those? What are the benefits of achieving health for health care organizations?
00;40;22;17 - 00;40;46;16
Speaker 3
We've been pretty intentional about trying to articulate that, Chad. And there's a a handful of ideas that that we've rallied around. But if you think about a healthcare organization that has improved, if we're going to talk about the capabilities to get there, but but has improved organizational health and therefore are delivering better health to their patient and their communities,
00;40;46;19 - 00;41;12;03
Speaker 3
there are some some benefits, some side benefits to that. We think it creates a better brand recognition in the marketplace and therefore creates, improved competitive advantage, right? If you're in the market as a highly-effective, highly-healthy organization, contributing to the improved health of your patients in your communities, that becomes a strategic advantage. We think.
00;41;12;06 - 00;41;40;07
Speaker 3
So that's number one. Number two, is kind of that brand and that reputation and that ability to present yourself in the market in a new and unique and we think differentiating way. So that's a second thought. It also I think is attractive to other providers. So you become a better partner in the marketplace, right? Organizations are always looking for how do we align with our physicians, how do we align with other organizations a little bit more effectively?
00;41;40;14 - 00;42;07;13
Speaker 3
And I think you become more attractive as a partner, as a benefit as well. We'll also talk about things like economic health and regulatory health. And those things contribute to reduced risk right there. There are certainly risks to health care organizations. But as you improve the health of your organization, you become a tighter risk bearing entity and reduce your risk in the marketplace, whether that's regulatory or otherwise.
00;42;07;16 - 00;42;43;13
Speaker 3
A couple of other things to, again, you think about better financial performance. You're going to now improve access to other resources, whether that's capital or growth or, alignment, those kinds of things, those resources that are critical. Financial resources, people resources, those things become more readily available as you become a healthier organization. And then I think the ultimate one that we've talked about a couple of times already is that you genuinely are delivering better care and therefore improved health of your patients in your community as well.
00;42;43;13 - 00;42;50;25
Speaker 3
So I think there's lots of side benefits. Chad, if and when and again, we believe when organizations get this right.
00;42;50;28 - 00;43;17;18
Speaker 4
The other thing, Kevin, that I would add is really wanting to change the viewpoint from how do we become sustainable organizations to really how do we become thriving organizations that are helping our community move forward and our patients achieve health? And, you know, I think what you articulated, Kevin, you kind of went through several of those points is all around that thriving enterprise.
00;43;17;21 - 00;43;37;16
Speaker 4
And how do we become a destination of choice? Who's looking at, you know, to to acquire the right talent? And where do organizations want to come to for increased collaboration and partnership opportunities? All those types of things. Why don’t you want to be you want to be working with a thriving organization.
00;43;37;19 - 00;44;09;24
Speaker 1
And one of the things that I also resonated with me is both of you were talking about the benefits of it, and moving to thriving or continuing to thrive is when you think about the concepts that underline 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 obtain not only the talent you need, but a higher skill level across both clinical and administrative functions.
00;44;09;26 - 00;44;27;29
Speaker 1
And so there is sort of a reinforcing impact of really focusing on this and getting it right across time. And it's to your point, Kevin, it's an incredibly difficult thing to do because like anything else that has a strong culture component to it, you have to think about it every minute of every day. Because if you take your eye off of it, you slip.
00;44;27;29 - 00;44;32;12
Speaker 1
And then people notice that, and then you start to encounter issues.
00;44;32;14 - 00;44;58;19
Speaker 4
And it's interesting. Chad, thinking about how there's a cycle and how different pieces kind of reinforce other components that, that, that you're mentioning there. That also applies as you think about our core capabilities that we identified. Yes, we went through this process. Five things continued, to resound across the team that was working on it and now list them out really quickly.
00;44;58;19 - 00;45;24;01
Speaker 4
But it's strategic agility, aligned growth, regulatory excellence, financial discipline and talent optimization. And it's that same cycle that you were you were indicating that, you know, you can't be just totally focused in one and take your eye off all of the other complimentary capablities that are there. It really takes, the work of all of those to make sure we're hitting on all cycles here, for achieving health.
00;45;24;03 - 00;45;45;23
Speaker 1
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 think about a successful organization and you think about something that they've achieved, you can generally tie in, okay, there was a strategy component to it. There was an intentional growth component to it. You know, they were making financially disciplined decisions and all of that was informed by a strong regulatory function.
00;45;45;24 - 00;46;03;27
Speaker 1
And I'm sure right now, you and I and Kevin can probably think of 3 or 4 different examples from clients that we could walk through. When you think about the concepts behind achieving health, I think they've always been relevant. But what was the Why now? for us in refreshing our market point of view around these concepts?
00;46;03;29 - 00;46;39;23
Speaker 3
All right. For me it was a combination of a number of different things. One was we are, have exited the challenges of the Covid era in many ways, but we need to move out of that era as quickly as possible. So I think that was one thing. It was a recognition that we're at kind of a milestone in the industry. And that we sort of capture that opportunity to tackle the bigger picture issue of how do we move the industry forward now, after that time?
00;46;39;26 - 00;47;14;21
Speaker 3
Two was what what Brad mentioned a few minutes ago, the size and scale and scope and depth of our firm, our health care industry and our health care sector within the Forvis Mazars firm, just was at a point where articulating on behalf of that that, that, that sector was critically important. We have so many clients across all, sub niches and parts of the care continuum that it was important that we capture ideas are relevant to all of those.
00;47;14;21 - 00;47;38;12
Speaker 3
So you had you were emerging from a certain part of the, a certain era in the market and needing to move beyond that. We were evolving as a firm and needed to put some ideas in the marketplace that 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 critical to the industry moving forward.
00;47;38;12 - 00;47;59;11
Speaker 3
And we've talked about those. Right. The idea of risk back in the day, the idea of value back in the day, the narrow definitions of 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 defining where we believe the industry needs to go.
00;47;59;13 - 00;48;07;24
Speaker 1
If each of you could leave our listeners with one takeaway related to achieving health in 2025, what would it be?
00;48;07;27 - 00;48;26;18
Speaker 4
For me, Chad, it's collaboration. Yeah, that's the thing that it stuck out to me as we had reflected on the on the document that it's going to take the joint work at multiple stakeholders to really move the industry forward toward achieving health. And and so, you know what I get asked by our teams are we talk about that more.
00;48;26;18 - 00;48;31;10
Speaker 4
That's really the theme that sticking out for me consistently.
00;48;31;13 - 00;49;03;22
Speaker 3
For me it's this is achievable. And I just it's it's yes, these are high conceptual ideas of of improving and achieving better health. That is a big picture idea, but it is actually doable if you break it down into how do we do it. There are actionable steps that can actually contribute to achieving health. So that's maybe the point that I want to leave.
00;49;03;25 - 00;49;28;02
Speaker 3
That, that and I totally agree with Brad. Collaboration across the continuum of care, collaboration across the different constituents, absolutely critical. But if we do the right things in that spirit of collaboration, we can actually achieve health. And I think that's that's got to be foundational to how we move forward, is the belief that it's that it is, in fact, achievable.
00;49;28;05 - 00;49;49;20
Speaker 1
Brad. Kevin, thanks again for joining me today. It was a great conversation. I really appreciate you taking the time to share your insights into Achieving Health. I also want to thank all our listeners for tuning in. If you'd like to learn more about the ideas and concepts we discussed in today's episode, there's a link in the show notes where you can download and read our Market Point of View.
00;49;49;20 - 00;49;56;08
Speaker 1
I hope you'll join me in two weeks for the next episode of Achieving Health.
00;49;56;11 - 00;50;22;06
Speaker 2
You can follow Achieving Health on your favorite podcast platform or visit forvismazars.us/AchievingHealthPodcast to learn more. New episodes are released the first and third Wednesday of each month. Achieving Health is produced by Forvis Mazars LLP, an independent member of Forvis Mazars Global, a leading global professional services network, ranked among the largest public accounting firms in the United States.
00;50;22;13 - 00;50;47;13
Speaker 2
The firm's 7,000 dedicated team members provide an Unmatched Client Experience through the delivery of assurance, tax and consulting services for clients in all 50 states and internationally through the Global Network. The information set forth in this podcast contains the analysis and conclusions of the panelists based upon his, her, or their research and analysis of industry information and legal authorities.
00;50;47;13 - 00;51;20;23
Speaker 2
Such analysis and conclusions should not be deemed opinions or conclusions by Forvis Mazars or the panelists as to any individual situation as situations are fact-specific. The listener should perform their own analysis and form their own conclusions regarding any specific situation. Further, the panelists conclusions may be revised without notice, with or without changes in industry information and legal authorities.