EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl

In this episode Stacey Richter interviews Cora Opsahl from the 32BJ Health Fund to examine the intricate dynamics between fiduciary duties and the entrenched status quo in healthcare. The discussion focuses on the challenges employers face when dealing with anti-competitive contracts and their responsibility to ensure plan expenses are reasonable. Cora Opsahl is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to remove NewYork-Presbyterian — a big, consolidated, expensive hospital — from their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. Employees also got their biggest raise ever; employers got a premium holiday and a 3% rate increase cap for a number of years after that. The episode's show notes include a template health savings calculator for plan sponsors and a template contract, both made available by 32BJ. WHAT YOU'LL LEARN ✅ Why 32BJ Health Fund's decision to remove NewYork-Presbyterian from their network in 2018 became a case study in what fiduciary duty can actually accomplish ✅ How analyzing claims data allowed 32BJ Health Fund to completely reshape its benefit design ✅ What anticompetitive contract rights limited 32BJ's ability to manage its own benefit design, and how those rights carry both cost and quality implications ✅ Why 32BJ Health Fund has moved beyond benefit design alone to actively manage and control the contracting process itself ✅ Cora Opsahl's four non-negotiables, and her advice for getting high-quality healthcare at an affordable price WHY THIS MATTERS Kicking a big, consolidated, expensive hospital system out of network sounds risky. For 32BJ Health Fund, it enabled $40 total out-of-pocket maternity benefits, employees' biggest raise ever, a premium holiday for employers, and years of a 3% rate increase cap. Cora Opsahl's case for fiduciary duty isn't theoretical — it's backed by what happened when 32BJ actually exercised it. MENTIONED IN THIS EPISODE EP419 with Andreas Mang: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Episode Page 🔗 Healthcare Industry Acronyms and Terms ✉️ 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. 06:16 Why is it imperative for employers to do something differently when it comes to being plan sponsors? 09:22 How analyzing claims data allowed 32BJ Health Fund to reshape their benefit design. 12:09 What anticompetitive rights did 32BJ run into that limited 32BJ Health Fund from managing their benefit design? 14:12 How do these anticompetitive rights have quality implications as well as cost implications? 18:43 How did 32BJ Health Fund remove NewYork-Presbyterian from their network, and how much did it save 32BJ Health Fund per year? 19:46 What did the healthcare savings allow the unions and employers to do? 20:46 Study by Zack Cooper, PhD. 21:26 Why rising healthcare costs has pushed 32BJ Health Fund to move beyond benefit design to manage healthcare spend. 24:15 Why 32BJ Health Fund wants to control the contracting process. 27:18 What are 32BJ Health Fund's four non-negotiables? 33:17 Wall Street Journal article on health insurance contract. 35:30 Upcoming episode with Claire Brockbank. 36:14 What is the challenge that exists in our current healthcare environment? 37:43 Cora's advice on how to get high-quality healthcare at an affordable price.