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Whether you're a provider, a biopharma company, or a health plan, visit veradigm.com. That's veradigm.com to learn how Veradigm can help you too. Hello, Hello, everyone. This is Jacob Emerson with the Becker's Payer Issues podcast. Thrilled today to be joined by Alan Silver, who's the president of Centene's Ambetter Health Solutions business. That's the part of the company that focuses on ICRA. Alan, thank you so much for taking the time to be with me on the podcast today.
Appreciate it, Jacob. I I really appreciate the time. Yeah. And we're glad you're here with us. Before we dive into everything we wanna talk with you about, can you tell us a little bit more about yourself, your background in health care, and what it is that you're doing today at Centene? Yeah. Jacob, thank you so much for the time today as I mentioned. As you stated,
my name is Alan Silver. I'm the president of Ambetter Health Solutions, which is the brand of Centene Corporation that's focused on ICRA. I'm sure most of your audience knows, but for those that don't, ICRA stands for individual coverage health reimbursement arrangement, which is a new type of employer sponsored health benefits plan with a focus on flexibility customization using the individual market.
Prior to, joining this role, I spent more than twenty years at, consultant brokerage house called, Willis Towers Watson, where I led retiree and ICRA initiatives. And I'm just really excited
to be in this role. I I think that the reality is I spent a lot of time working with employers and and many, many employers at the current moment in time are seeing the status quo of their group health plan hasn't been working well for them and and really wanna focus on the innovation that ICRA provides as an alternative to that status quo approach. Absolutely. And, you know, Alan, we're hearing so much about ICRA more and more as time goes on both in the private sector and
and at the government level. So talk to us about why did Centene wanna create this position? Why are you the first president of ICRA at the company? Yeah. I I think, it's some of it is based in the kind of tradition of what Ambetter Health is. Ambetter Health is the largest individual market,
carrier in the market. It's been creating tailored health care plans to millions over the past decade, and there's an understanding that we have a responsibility if there is an individual market solution such as ICRA that we need to be championing and championing and leading that effort, to keep pace with an evolving landscape and bringing in somebody that has the experience of traditional group health plans and trying to understand how we might innovate in the individual market
realm to meet the needs of employers. So I think it's been really important for Centene to have somebody at the head of this strategy, which represents a great opportunity for Centene in particular and the market as at large. Absolutely. It makes complete sense. So there's market demand for this. Employers are asking for this kind of new model, Alan. Yeah. If we're backing up for a second for our audience, just to level set here, what does the ICRA landscape look like right
now? How many enrollees are out there, and and who are some of the employers that are actually interested in this model? Yeah. I think it's a fair question, Jacob. I think that the the current environment is is one of constant evolution. From the HRA council data that we have and some other data points that we have out there, we right now can see somewhere between 500,000 and a million people eligible for an ICRA and some 250,000 to 750,000 people actually enrolling.
The the point in time nature of those estimates makes it a very wide range, but it started to become a a significant kind of portion of the employer sponsored landscape. The leaders in this space have been small group employers, and the reason why is because the direct comparison between small group rates on insurance and individual market rates has been something that, a lot of small group employers have have taken the opportunity to seize the the more efficient way of providing benefits.
Interestingly enough, though, 83% of them hadn't provided insurance before. So this provides a significant opportunity for them to provide a benefit that they haven't provided in the past. The last thing that I'll say about the the number of lives and and the growth that's out there is just this concept of the greatest growth sector segment of the market is actually in employers with 200 and more lives.
So larger midsize midsize and larger employers are really coming into this space because they understand the promise of what ICRA can do for them and understand there may be a different way given the population that they're covering. Sure. That's a really interesting last point that you just made there, Alan, that you are seeing a lot of large employers
interested in this. But at the same time, you're also seeing a lot of, small employers offering this kind of model, offering insurance for the first time to their employees through this. So it's that's a really interesting, dichotomy there. But I wonder you know, we're hearing so much now about, ICRA changes at the federal level. How how do you see this market continuing to evolve, let's say, over the next five years or so?
Yeah. So I think the next eighteen to twenty four months are crucial to the growth of ICRA. It's growing year over year. But the reality of the situation is, I wanna take a little bit of a a a look at what employer group sponsored
coverage is is doing these days. And the the issue that we have is a multigenerational workforce, four generations of people working within the workforce today, and that can include the young professional that's relatively healthy, the family of four with, two kids under three, somebody managing a chronic condition, people on benefits to kind of bridge the gap in their retirement to Medicare. Those are just four examples of people that need very different things from their health care.
So the growth in ICRA is going to come from this concept of kind of a direct to consumer type of approach to health care. We anticipate this model becoming more and more streamlined in the next few years, but we absolutely need, some some technology enhancements, some some education, some decision support tools to come out to make that view and vision of that multigeneration generational use, workforce become a reality in the ICRA space.
Sure. No. That makes complete sense. And it really sounds like, at the end of the day, what this what this model offers is flexibility to employers. I wonder then what what you would say are some of the biggest challenges you're seeing facing AMCA. And when you're when you're talking about to employers, when you're promoting this new model, what are some of the top challenges you're hearing hearing there? Yeah. I I think it's it's
basically mostly about education. If if I had to drive one point home, it's education, and it's education for employers themselves. It's education for, brokers, both on a group and the individual basis. But it's also education for health systems and education, for payers just to get to a place where we all understand what the future of this could look like. It's a new category growing at speed, and it's gonna face some
challenges. I think beyond the education, two or one or two other things could be just the concept of the technology really needing to embrace the world of, you know, frankly, consumers making their own choice on health insurance. So we need to get to a place of decision support where pipes are connected between carrier and broker and employer and ICRA administrator altogether to make this a fundamentally good experience.
And then we bear responsibility at places like Ambetter for us to meet the needs for individuals and what they want for their health insurance. That talks about us building networks, building, designs, having good relationships at the local level with health systems, with providers to ensure that people actually want to produce want to purchase our health insurance coverage that we are providing to them.
Absolutely. So really just getting more information about this new model out there sounds very key, to more growth in this market. What do you what do you think other insurers should know, Alan? I mean, should most insurers be considering entering this market at this point? Jacob, the the words I wanna use here are I think other insurers will need to have a very intentional strategy around
entering the ICRA space. It's kind of an obvious play for us at Ambetter because we don't have a group business for us to sit there and say, oh my gosh. We're taking things from the group business to the individual. For us, we are pushing an individual solution, and that's why we see ourselves
as a leader in this space. For other carriers, that may not be the case, but I think they're going to wanna either make a determination that they are in with us in this kind of building of a direct to consumer world or maybe it's just not for them. It's going to be very important for us to all understand that you can't really do this off the side of your desk. You actually need to commit to meet the needs of the employee population. Absolutely. So a strong strategy here. It's it's
gonna be different for every company. That makes sense. Before we go, Alan, you've got the ears of a lot of other health plan leaders from all over the country right now. What else do you wanna tell them about this market? Anything else we we really need to hit home on today? Yeah. Jacob, I think you could hear it in my voice. I am very, very passionate about this. I am very much looking forward to the challenge of building ICRA
in this country. It comes from a couple different places, but the biggest place that it comes from is I think, that employer sponsored insurance was built for a different time, a time when everybody came into the office or the store or the factory, and employers only had to worry about people that lived close to where they worked. So it's really easy for employers to understand what the health kind of construct was in the markets where they had people.
Well, as I mentioned earlier, with a multigenerational workforce, if we add on the concept of remote and hybrid work, all of a sudden, you have employees that are working nowhere close to an office or, in some cases, very far away from the people that they're associated with. And as a result of that, employers
have to make a choice. And the choice is, do I now go out and try to learn what's different about the health systems where all of my people are, or do I rely on someone to help deliver deliver a solution at the local level through ICRA? I I think that's a fair choice, and employers need to be intentional about
that choice. What I'll just say coming out of that conversation is, at Ambetter, our focus is improving the lives of the people we serve at the local level in the communities we serve them. So we are well positioned and you will see us commit to the ICRA strategy at a very local level, which will be a great option for many, many employers. Fantastic. Well, I think that's a great place
to leave things. Alan, I wanna thank you for taking the time to sit down with us and for sharing your insights with our listeners. We really appreciate it. Jacob, appreciate the time. Thank you so much. And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit beckershospitalreview.com.