EP373: How to Kick a Big Hospital Out of Your Network, With Cora Opsahl

How One Union Health Fund Cut a Major Hospital From Its Network, With Cora Opsahl. Why 32BJ Health Fund Decided a Major NYC Hospital System Wasn't Worth the Price. Episode 373. Stacey Richter continues her conversation with Cora Opsahl, director of the 32BJ Health Fund, about the data-driven decision to remove NewYork-Presbyterian from the fund's network—and what it took operationally to actually pull it off. WHAT YOU'LL LEARN ✅ Why 56% of 32BJ Health Fund's total spend goes to hospitals, making hospital pricing the highest-impact place to focus ✅ How the same procedure, like a CABG, can cost 10x more at one hospital than another in the same market with no quality difference ✅ Why 32BJ concluded it could not be sustainable without directly tackling hospital prices, since "you can't reduce spend by benefit design alone" ✅ Why claims of "razor-thin operating margins" don't hold up for large, consolidated health systems that received billions in COVID relief and posted record profit growth ✅ Why 32BJ repriced its claims using Medicare rates to reveal how far commercial prices had diverged ✅ What the HEAL Act is, and why 32BJ Health Fund supported it as part of asserting more control over its own benefit design WHY THIS MATTERS Removing a major hospital system from a network is disruptive and politically fraught, but Opsahl's account shows what it looks like when a fiduciary actually acts on what its own data reveals about price versus quality. For other employers and unions weighing whether a similar move is possible, 32BJ's experience is a rare real-world case study rather than a theoretical argument. MENTIONED IN THIS EPISODE EP368 with Ashleigh Gunter: Apple Podcasts | Spotify | Other Apps EP366 with Kevin Schulman, MD: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 📺 Subscribe to our YouTube channel 🎤 Listen on Apple Podcasts 🎤 Listen on Spotify === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction. 07:02 What motivated the decision for 32BJ to cut NewYork-Presbyterian out of their network? 09:14 How did 32BJ compare their spending at each hospital in their network? 13:01 "We cannot be sustainable as a health fund … without really tackling the challenge of hospital prices." 13:38 "It is one of the challenges as a self-funded plan that, even having this data, there's not a lot we can do with it." 16:10 What is 32BJ Health Fund's maternity program? 19:34 What is the HEAL Act, and why did 32BJ Health Fund support it? 21:39 "For us, we just don't feel it's right that anyone gets to dictate our benefit." 23:34 Why did 32BJ Health Fund reprice their claims using Medicare rates? 24:58 "It really goes to show you how high the commercial prices are in comparison to Medicare."