This is Scott Becker with the Beckers HealthCare podcast. I'm thrilled today to be joined by two brilliant leaders. We're joined today by Brett Kaplan and Peter Winslow. Brett and Peter spent a ton of time in the managed care and payer space, and they talked to us about what they do. They're with BRG, Berkeley Research Group. Brett, Peter, can I ask you to take a second to introduce yourself and tell us a little bit about what you do and about BRG?
Yeah. Sure. Great. Thanks, Scott, and and thanks for having us on that podcast. Really excited and and really appreciate it. So as you said, I'm I'm Brett Kaplan. I'm a director here at BRG.
I have, over a decade of experience in management consulting in in the health care space, and I primarily spend my time in the in the managed care space or really revenue strategy, reimbursement strategy around managed care contracting, strategic pricing, and complex enterprises, such as multistate, multi hospital systems, academic medical centers, etcetera, and, comprehensive revenue analytics. So think benchmarking, macro, microeconomic
review, and and things of that nature. And, really, all of that is to in in service of preparing for negotiations, which we'll we'll touch on a little bit later, but I'll hand it over to Peter. Thanks, Brett. Everybody, my name is Peter Winslow. I'm a managing consultant at Berkeley Research Group. I have about four years of experience in management consulting
all within the health care sector. And my primary areas of focus are payer provider contract negotiations, revenue reimbursement strategy development and market trend analysis. And I also serve as the strategic communications and external affairs subject matter expert, within our managed care practice. So great to be here, Scott. No. Thank you so much. And and tell us maybe let's start with a second on payer provider relationships. We're also watch also watching so much fallout
and changes in Medicare Advantage right now. Mhmm. Brett or Peter, can what do you take the lead in telling us what trends are you watching in payer provider relationships currently? What are you seeing?
Yeah. So so thanks, Scott. I think it's really a perfect storm right now of pressures from an economic perspective, a regulatory perspective, thinking, you know, the uncertainty around Medicaid three forty b site neutrality, and site neutrality, any regulatory shifts stemming from the one big beautiful bill and price transparency that's coming through.
And as you mentioned, the Medicare Advantage across that line of business, both from a provider and a payer side, there's rampant, you know, downgrades, denials, delays in payment, prioritization issues, really. So everything is is a an an afflection point from an economic perspective. And, really, that, that leads to tenuous relationships between the payer and provider because it comes
down to margin. Right? It's really what we're watching most closely as hospital margins, being very uncertain today, being compressed today. And now more than ever is why our clients are dependent on the outcomes of these managed care contract negotiations to strengthen their source of the negotiated revenue that they have and try to protect that revenue through securing more favorable contract language.
Yeah. And and what I'll add is is, Scott, that we're we're really seeing we're continuing to see an increasingly contentious negotiation landscape between providers and payers. And, I mean, it's not centered exclusively around reimbursement rates even though both sides are under tremendous financial pressure. I mean, on the provider side, hospitals, health systems alike continue to shoulder challenges associated with labor,
supply chain, capital constraints. You know, these these are by no means new issues, right, all while trying to maintain, you know, quality and access for their patients. But on the payer side, there's a growing scrutiny from regulators and employers demanding cost containment, media and public skepticism, which has been skyrocketing over the last couple of years. And, you know, while inflationary pressures of aging population and and rising utilization
compress their margins. So, I mean, what makes this moment particularly volatile? I'd I'd say that American health care is a hot button divisive topic at the center of discussions touching really our our broader economic and political climate. These these disputes within the health care sector are are no longer isolated events. I mean, they're really proliferating at a rapid speed with increasingly significant implications.
Providers can't afford to adopt a passive stance or rely on the prospect of resolution through pair negotiation, you know, on its own. You know, what we what we think about with clients is establishing a comprehensive, you know, out of network strategy. You know,
that's become imperative. It's and to serve as a means to ensure, you know, equitable positioning of that organization, safeguarding their financial stability, and really preserving the continuity of care when contract discussions reach an impasse. So that's that's kind of what we're seeing. And and we see these tenuous negotiations, you know, across the country. I mean, UMass Memorial Hospital, Blue Cross Blue Shield of Massachusetts, recently resolved one,
in North Carolina. Cigna and u a UNC Health were were at bat with one another, and UHC was was also kinda duking it out with WakeMed and and Lehigh Valley Health Network. So there are many, many others across the country, but those are just a couple that that pop in top of mind. And is there gonna be more tension in these payer provider negotiations? Seems like we go through cycles the last ten, twenty years. With some years, things seem pretty copacetic. Other years, a lot of tension.
What's the temperature currently? I think, to the points we were raising earlier, just the economic realities. I think there is some tension, that's going to continue, but at what point will it ultimately lead to more, you know, more partnership related is what I'm hoping for. And what we try to advise our clients is let's try to find some
common ground. Let's find some win win scenarios when possible, but ultimately be ready for those 10 tenuous kinda conversations and tenuous negotiations moving forward. Thank you. And and talk about as you head into next year, BRGs had this great growing practice, brilliant management consulting and leadership. When you look at this next year, what are you most focused on and excited about heading into 2026? Yeah. Thanks, Scott. And I I think you hit it right on the head with that
one really. It's we're we're in a growth mode, from a firm perspective primarily or or a lot in our health care space. We're making some big investments, which I'm really excited about, bringing expertise from enterprise strategy, managed care contracting and financial management, clinical and operational diligence, and and bringing all the pieces of the health care industry together in an integrated way. So and we just announced that our our leader of Rich Bay Bainer coming
to to the firm. So really excited about the investments and strategic investments from our firm that we're making and what it's gonna do from a professional standpoint, but more importantly, from our clients and how we're gonna be driving really great impact from a client perspective in the marketplace. So, more to come from a BRG in the market, and I'm excited to to be a part of it.
Absolutely. And just and just to reiterate Brett's points, I mean, we we were able to join in in a group of really intelligent and passionate leaders. I mean, there there are people at this firm that are incredibly impressive and contribute so much to, you know, developing health care solutions that benefit, you know, not only our clients, but the patients that they serve.
And and it's just such a great opportunity to to be at BRG and and to see what we're we're actively building out and and, you know, like Brett said, much more to come, and and we're very excited for what's coming down the road. And and, Brett, I'll ask you this question. You come from a brilliant family of physicians and lawyers and and, actually, athletes as well.
Do you ever feel like that you're on the right side of history by moving into consulting in health care versus law or medicine or or sports? How do you look at that? Thanks, Scott. So I I like to think I take the the good of both, my my paths that I've seen, ahead of me. I really appreciate in the health care world of really having the altruistic
helping people aspect. But, at the end of the day, the lawyer in me in in brokering conversations, working with people, and and the administrative side of the health care industry to kinda move it forward, my job is hopefully to make, the clinician's job easier. So I'm trying to fuse the two of them. And, you know, if you think about it, everything's a little bit of a sport, so that's, I think, part of
the negotiation in me too. So I do my best to try to to blend all of my background together and and take what I think is is the good, and and move it forward. So You are a remarkable leader, and by chance, I happen to know some of, Brett's family. I'm gonna ask you one more question, and you do not have to answer this. Okay. Who is a better athlete, Mickey or Gary? Oh, that's that's a tough one. I think it depends on the sport, but I'd be remiss to say, that my uncle did play Michael Jordan back
in in high school days. So that'd be a tough one. That'd be a tough one. That's a very well well way of stating it without offending your father. I think that was really well put. I I have to tell you, it's it's a pleasure to visit with the two of you. Aside from knowing a little bit of Brett's family, brilliant, brilliant people, Peter and Brett are brilliant, leaders and management consultants at BRG. Brett or Peter, take the lead on the next question.
Advice to emerging leaders, emerging careerists, what what advice would you give to emerging leaders, emerging professionals? Yeah. I think, really, there's two that I would like to to voice. First is be curious. Right? We're in such a a complex
world of that's ever changing. So being a lifelong learner, and I think that's why I I chose consulting, it's all about lifelong learning and just driving personal growth through learning a new skill, deeper understanding of anything in your area of expertise or not in your area of expertise too. Trying to keep pace with all the change that's happening in in not just the health care industry, but but industries
writ large around AI, etcetera. So I think just being curious is something that never stopped learning, is is something I definitely, continue to to tell people as as whoever listens to me, and and Peter probably is is, rolling his eyes as I say that because I've definitely told him to him too. But the other one I think is is about being a kind of a self starter and looking for ways to make somebody else's life a little easier.
Again, whether that's your boss or your manager, a client, a colleague, or even a friend, by lending a hand or or stretching your role, you will advance to wherever that next step may be professionally and personally. If you just think about how can I make that that person's life a little bit better, a little bit easier, a little bit more manageable? But but I think that's that last point is so well taken and so well stated.
People often don't realize in a professional organization or any business, whatever you're doing, so much of what you do is about trying to help whoever you're working with make things a little bit easier, a little more concise, a little bit better, and and and to solve problems rather than to create more problems. I just I just love that actually. Peter, let me turn it to you. Any piece of advice you could give to emerging leaders?
Yeah. Absolutely. And and I really kinda draw on some of my past experiences. You know, before I I put the consulting hat on, I was an investigative reporter based in Chicago. And, you know, one of the things that has done me personally very well and that that I see really effective leaders doing is is is networking and just being open to connections. I mean, Scott, you're one of the best
to do it yourself. I mean, you know, the way that we are able to to get connected and just build these bridges and start forming a relationship has, you know, been invaluable, and it's something that, you know, I'm looking forward to going into the future. But, I mean, effective leaders really recognize that networking isn't just about, you know, collecting contacts or filling the Rolodex. Right? It's about cultivating meaningful relationships. So they invest time in the individuals. They they
listen. They and and they build this trust and and and curate a broad and diverse contact list. So, you know, these connections benefit both their personal growth and their organization's success. I mean, they open doors to collaboration, innovation, problem solving, and and it makes networking a a strategic leadership skill rather than seeming like a transactional activity. And I think that point of developing real relationships versus a transactional
activity is is right on. I mean, the more that long term people are available to each other, it it's not so much you do this, I gotta get that, or vice versa. It's more, you know, over time, you figure out where there's synergistic opportunities for people and that work for everybody. And and I
think that's right on. I think that's just a very I think that's a great perspective on networking and relationship building versus the alternative, which is everything's good, bro, quorum, transactional, which is very short lived and and leads to very flawed relationships, quite frankly. Right. Brett and Peter, I I wanna thank you both for taking the time to join us today on the Becker's Healthcare podcast. For me, this is a tremendous pleasure to
visit with the both of you. Thank you so much for taking the time and joining us. Thank you. Thank you, Scott. The pleasure is ours. Thanks, Scott.