Why the Commercial Carrier Market Never Changes — Six Reasons There Is No Market. Take 2 of EP398

Six Reasons California's Health Plan Market Share Never Changes, Year After Year. Take Two Episode 398. In this Take Two rebroadcast, Stacey Richter revisits a conversation with Jacob Asher, MD, who spent 14 years as a health plan chief medical officer in California—first at Anthem, then Blue Cross, then Cigna, then UnitedHealthcare—about why the relative market share of the state's biggest commercial carriers hasn't budged in over a decade. Dr. Asher and Stacey unpack why California's commercial health plan market functions less like a competitive marketplace and more like a stalemate. Stacey opens the episode with six reasons—drawn from conversations with Dr. Asher, Wendell Potter, and Lauren Vela—for why that stagnation persists nationwide, not just in California. WHAT YOU'LL LEARN ✅ Why California's largest health plans—Kaiser, the Blues, and others—have kept nearly the same relative market share for over 14 years despite an apparently competitive landscape ✅ How carriers use higher self-insured employer rates as leverage to negotiate lower Medicare Advantage rates, since it's the employer's money on the commercial side but the carrier's own money in Medicare Advantage ✅ Why Dr. Asher never once heard a sales rep say an employer chose a health plan because of quality rather than price ✅ How provider discount negotiations create a circular dynamic: the biggest plan gets the best price because of its member volume, which lets it offer the lowest premium, which keeps it the biggest plan ✅ Why Kaiser's closed, capitated network makes its cost and quality performance nearly impossible to benchmark against the "same hospitals, same doctors" non-Kaiser market ✅ Six systemic reasons—employer inertia, EBC incentives, ASO economics, provider network overlap, volume-based discounting, and the absence of quality-based buying—for why the commercial carrier market stays boring WHY THIS MATTERS If plan sponsors assume competition among carriers will naturally hold down costs or lift quality, this episode is a reality check: in California's commercial market, membership rankings have barely moved in 14 years, and the underlying incentives—volume-based discounts, Medicare Advantage trade-offs, and a total absence of quality-based buying—actively work against disruption. Real change, as Stacey puts it, has to be actively pursued rather than assumed; no one is going to hand plan sponsors a better deal. MENTIONED IN THIS EPISODE EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD: Apple Podcasts | Spotify | Other Apps === LINKS === 🔗 Show Notes with all mentioned links: Show Notes ✉️ Enjoy this podcast? Subscribe to the free weekly newsletter 🫙 Support the podcast with a small donation to the Tip Jar 🎤 Follow us on Apple Podcasts 🎤 Follow us on Spotify 📺 Subscribe to our YouTube channel === CONNECT WITH THE RHV TEAM === ✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X 00:00 Introduction to the episode. 00:42 The "No Market" series. 01:51 Why is the carrier market boring? 04:26 A breakdown of what follows. 05:48 Six reasons why a marketplace doesn't actually exist. 10:04 Upcoming episodes in the "No Market" series. 10:41 The conversation with Dr. Jacob Asher. 11:01 What is the competitive picture of California's health plans? 11:03 Understanding the California health plan market. 12:28 What the competitive landscape looks like to get market share in California. 12:55 Challenges in market competition. 13:14 What are micro markets and market drivers? 15:14 How brokers and consultants shape the marketplace. 15:49 Why is it difficult to take market share? 16:56 Who was Dr. Asher pitching to and why? 18:56 How is Kaiser's position in the marketplace unique? 19:29 Did employers ever buy plans for quality? 23:23 What does this look like from the payer perspective? 27:42 What improvements have there been to engagement in health plans? 29:47 Have plans gotten better at communicating with employers? 31:19 Why is it hard to compare the Kaiser world to the non-Kaiser world? 31:19 Dr. Asher's final thoughts and reflections.