Healthcare Battlefield: Budget Cuts, Skepticism, and What Comes Next

No Normal Recording – 232
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Stephanie Wierwille: [00:00:00] This is the no normal show brought to you by BPD. This is where we leave all things status quo, traditional, old school, and boring in the dust. And instead we celebrate the new, the powerful, the innovative, the bold, all while delivering the future to healthcare’s leading brands. I’m Stephanie Rearwell, EVP of engagement here at BPD, and I’m joined by a lovely array of guests.

Desiree Duncan, VP of health equity inclusion. Hello, hello, Des.

Desiree Duncan: Hi, excited to be back.

Stephanie Wierwille: Yeah, I am so excited for this chat. We have a really exciting lineup of interesting and wild topics. And so that is why we’ve brought on Kate Caverneau, VP of communications of our payer provider practice, because there’s all kinds of activity happening right now in the landscape of policy and payer movement.

Hi, Kate. Thank you. Thanks for joining us.

Kate Caverno: Thanks for having me. I love any opportunity I get to chat with you and [00:01:00] Dez. So looking forward to it.

Stephanie Wierwille: Yay.

Desiree Duncan: Yay.

Stephanie Wierwille: It’s a party. Uh, well before we get into the, the wild stuff, um, the constantly shifting landscape we’re living in, we wanted to just start with a little bit of a fun topic, um, you know, add a little bit of levity into this difficult world. And there’s a lot that’s been happening in the TV world lately, right?

I think there’s so many new shows premiering, um, lots of events happening. I am certainly glued to my screen as that escape at the end of the day from all the hard stuff. Um, so, want to hear from you all, what’s keeping you glued either to your big screen or small screen? What are y’all watching? Uh, Dez, do you want to jump in first?

Desiree Duncan: Yeah. I mean, I just arrived at the White Lotus Thailand, uh, season three, uh, just released this past Sunday. of course the first episode is always kind of just setting the stage of who the characters [00:02:00] are. It doesn’t get unhinged yet. The only thing that’s unhinged is Parker Posey’s North Carolina accent. Uh,

Stephanie Wierwille: Yes.

Desiree Duncan: sure if it’s just bad or if it’s Setting up for like a later plot twist around her actual like identity or something. Um, but yeah, that’s, that’s what’s, uh, keeping me glued and I guess giving me joy.

Stephanie Wierwille: Oh, that’s hilarious. I also caught on to that accent, Des, and actually I think her husband does a pretty good accent, maybe? But yeah, hers is wild. And that’s my favorite, the favorite characters is that family right now. The family is just, yes, unhinged. I’m so excited for what we’re going to see.

Kate Caverno: As a former North Carolinian, it’s painful.

Desiree Duncan: I was very curious your opinion, uh, just given your connection, because I was like, this, I mean, each state in the South has kind of a different, you know, tinge to the Southern accent, but the North Carolina one, I was like, this feels, um, unnerving.

Kate Caverno: She’s from a part of North Carolina I’ve never been to, let’s just say that.

Stephanie Wierwille: The character or Parker Posey?

Kate Caverno: [00:03:00] Wherever the accent’s coming from.

Stephanie Wierwille: Oh, I see what you’re saying. Yes, yes, yes.

Kate Caverno: I, you know, we just had the long weekend from President’s Day and, uh, I’m ashamed to say that I I got sucked into Love is Blind with my sister and, finished it over the long weekend. And, uh, I’m, yeah, it was a lot, uh, lots of feels there. I am not proud of how much television I consumed, but snowy, so I’ll, I’ll blame it on that.

Desiree Duncan: Yes, no, no judgment here, Kate, whatsoever. I mean, we got it.

Kate Caverno: concept of getting to know somebody without the, you know, physical, attractive, whatever component. But it does seem Maybe a little too idealistic.

Desiree Duncan: Oh,

Stephanie Wierwille: you’re making me want to watch. Okay, here we go. Okay.

Desiree Duncan: a lifetime ago.

Kate Caverno: This is my first, uh, Toe in the Water [00:04:00] of the Love is Blind series, um, so I was not totally sure what to expect, but it’s interesting. I’ll give it that.

Stephanie Wierwille: Well, you said you’re not proud, but I, I’m impressed. I was impressed when you said you finished it. I was like, that’s

Kate Caverno: It’s

Stephanie Wierwille: Cause I saw it. I saw it pop on to my Netflix feed and haven’t even clicked play yet. So congratulations.

Kate Caverno: seven, eight episodes, something like that. It’s too much. Entirely too

Stephanie Wierwille: Okay. All right. Well, I’m also on the white Lotus train does really excited about it. Really happy to be back into it. And I really want to go visit Thailand. Um, Or maybe not, depending on what happens with these monkeys, which seem like they’re maybe a thread, a theme. Um, but my, my more embarrassing one that I’ve started watching is, you know, the Kardashians are back for their millionth season and it’s not good.

Um, it’s not good at all. It’s, it’s like, they’re just trying to concoct new drama. And, uh, so I don’t know, it might be my exit from, [00:05:00] from that embarrassing franchise. We’ll see.

Kate Caverno: you ever wonder if it’s, have you grown to a point where you just don’t appreciate it? Is it, has the content actually changed? Or have you grown? Right?

Stephanie Wierwille: I love that take. Let’s say that I’ve grown. Yeah, let’s say it’s me. It’s all me. I’m so much more mature now. It doesn’t relate. I don’t know.

Desiree Duncan: I had a similar debate with someone about McDonald’s food couple of years ago where I was just like, no, it’s terrible. And it’s like, no, no, no, no, no. The formula hasn’t changed. Maybe your taste buds have just gotten better or something like that. I was like, all right, point counterpoint.

Uh, I still think it’s terrible

Stephanie Wierwille: Mm hmm. ingredients aren’t real anymore. So I feel like they have, the recipe has changed, but what have you,

I would love to know if the recipe changed because those chicken nuggets when I was five were spot on and, uh, they’re not now. So I think the recipe has changed. I don’t know. We should investigate.

Kate Caverno: It has to have. They’ll never tell. They’ll never tell.

Stephanie Wierwille: Yeah. on the internet [00:06:00] somewhere. Someone’s got a video on YouTube about it. Surely.

Some whistleblower.

Kate Caverno: ice cream machine and why it never works, but.

Desiree Duncan: Listen, why can I never get the McFlurry? Why is the machine always broken or being cleaned? Like, y’all just don’t wanna It’s a conspiracy.

Kate Caverno: It

Stephanie Wierwille: It’s part of the charm.

Um, all right. Well,

so with that little bit of levity behind us, um, we’ll get into our first topic here. Last episode, we talked about the Super Bowl and, you know, our takes on it, what was good, what was bad, what was exciting, um, both advertising, marketing, as well as in general. And we had to do a little bit of, uh, A backtrack because I’ll, I’ll, I’ll take it.

I said, Oh, the Poppy commercial, you know, I was excited to see them there. They did an influencer play and then like literally five hours later, boom, the internet blew up on Poppy. So, um, just a little bit of a backtrack. So I’ll just share kind of what [00:07:00] happened because I think it’s actually a really good lesson from a marketing standpoint, um, and applies very much to the work that we do.

So. Poppy had, in addition to their commercial, um, on the Super Bowl, they had done an influencer stunt where they sent vending machines, hot pink vending machines, 32 of them, to social media influencers. They sent them to their house full of Poppy. Soda. And the goal was obviously create buzz, get influencers sharing, get people hopefully buying soda for the Super Bowl and afterwards.

That seems, you know, I can see that, right? Seems like a decent idea. Well, the internet blew up. The interwebs was like, this is terrible. I can’t believe you’re sending vending machines to all these quote, rich, thin, white celebrities. It could have gone to the masses. Imagine if you sent vending machines to schools, to public parks, to hospitals.

Um, imagine what good that could have done in the world. And the internet also got together and calculated and did the math and said these cost approximately 25, 000 per [00:08:00] machine, not to mention the amount you spent on the Super Bowl commercial itself, 8, 10. I think I even saw an estimated 16 million that someone thought, you know, given production and influencers.

So, oof, yikes. That’s tough. Um, what was, I think, good is the founder said, lesson learned. And quickly got on and, uh, filmed a video and shared it and said, Okay, we hear you. Number one. There’s a little fact checking. It didn’t cost 25, 000 per machine. Um, but also we hear you. And so she said, we’d like everyone to help nominate your friends, your family, teachers, locations, your community members for the machines to go to next.

So of course the internet didn’t just say, Oh, everything is lovely now. Uh, they continued to pick, but, um, thought it was an interesting lesson for a few things. Number one, is influencer marketing dead? Is it over? Are we tired of influencers? Um, the Kardashians, right? I’m [00:09:00] tired of the show. Are we tired of the rich?

Are we over it? Are we over them getting all these special treatments? Um, maybe. Interesting debate. Also, how can we in marketing Help the communities around us. What are we actually doing? Not just to get our message out, but also help people with our message. Um, and then thirdly, you know, a good lesson on how the founder quickly addressed it and quickly came out with a, okay, got it, heard, moving forward.

So, thought it was a nice, um, You know, just full of lessons, I think. So I’m curious, Dez, I’ll ask you, because I know you, you have, uh, you know, you watch this space of both influencers and celebrities, and I’m curious if you’re seeing a narrative shift there.

Desiree Duncan: Uh, I’m I’m just team either rich. Uh, the masses are fighting back. It was really interesting and kind of cool to see folks kind of unpack like what actually occurred. I mean, we have information. We have access all the things now to because news is kind of a constant. [00:10:00] But to me, it is great example to your point around how the founder actually addressed it, because so often people just like backtrack and backslide and like, you know, shovel themselves by not actually responding into another, um, terrible spiral.

I mean, but light Adela Mullaney, uh, anyone, and it’s about like, Hey, we’re going to clock you on this. We’re, we’re paying attention to the climate, what’s going on, how energy affects, cause all really, really ramping up, um, especially with AI tools. but I don’t know. It’s to me, the influencer in the role that they play, it’s, we, we see it.

It’s fake. We, we don’t. We don’t want that. I know like the royal we right. But speaking for myself, but is this idea of ~what~ do you even understand what’s going on in the world. And I also worry about like some of the [00:11:00] ideas and some of the big ideas that we would love for brands to do. You know, I worry that these kinds of things will hold them back.

From from doing it or taking that risk. Um, this is one of the few instances where my, okay, this didn’t, we didn’t vent and think everything through, but the way that they addressed it makes it feel more like, okay, I, I can do this. I just need to make sure that I’m checking all the boxes, kind of really understanding where the culture is and act accordingly.

And it, yeah, Poppy did not read the room, unfortunately.

Stephanie Wierwille: No, they did not. And it’s one of those things where, could they have seen it coming? I don’t, I don’t even know, honestly. I think, I guess my purview is Culture’s moving really quickly right now, and even, like, all this happened within a span of five days, right? The, the stunt, the commercial, the backlash, the response, the new campaign, it’s just like, whew.

Like, you gotta move quickly. You have to react quickly, and [00:12:00] some things I think you can predict, and some things you can’t. Hopefully we all learn the lesson of how can we use marketing for good. But I don’t think influencers are dead. I think it’s just how do we use them in the right way and use them for good rather than just, you know, frivolity, I guess I would say.

But also, you can’t predict everything, and that’s okay. How you react is really the gold. Um, Kate, I see you nodding. I know your whole team is focused on reacting quickly. That is your job. You’re a metaphorical and literal firefighter.

Kate Caverno: Yeah, yeah, I am. Um, Yeah, I

Desiree Duncan: Okay.

Kate Caverno: do that too. We can, yes, and this situation and it’s going to be okay. It was a really, um, authentic, genuine response that felt very human. I think unlike maybe the Bud Light [00:13:00] scenario that you raised as where. It just felt like we’re going to hold our ground or we’re going to back off or, you know, any of those positions that we don’t have to capitulate to the public pressure so much as acknowledge it and try to, to blend, right, and find the best path forward. And I thought that they did a really nice job.

Stephanie Wierwille: ~Um,~

okay, we’ll move to our next topic here, which actually is also a little bit about culture changes. Um, but we want to, we want to discuss in this topic and the last one as well. What are we expecting from the upcoming administration or current administration upcoming policy changes?

There’s been a lot of conversation about healthcare in the political realm in the past. Three days, month that I think came on pretty quickly back in August that was, not happening even in the June July time frame of the political election and now has become ~the cen~ one of the centerpieces of, of many, [00:14:00] um, certainly.

~But, uh,~

~what,~ one of the key, of course, headlines that we’re seeing right now is that Robert F. Kennedy jr has confirmed as Trump’s health secretary. So he’s officially at the helm of the department of health and human services, the HHS. And yes, there was all kinds of controversy leading up to that.

Millions of dollars spent by groups opposing the nomination. Of course, the hearing that we saw, which was, um, got very spicy and it was very uncertain whether he would have enough. Senators backing him to get through, but, uh, was, was fully confirmed and has already made some changes. So we’ve already seen announcements around NIH funding cut, um, that will directly affect innovation and research, including clinical trials and including academic medical centers that are.

that some of, you know, them are funded by, um, some of these grants. So there’s already jobs in the line. There’s already a lot happening there. Um, the future of vaccine policy is of course, being hotly debated because RFK Jr has shared things in the past [00:15:00] that show that he may be a vaccine skeptic. However, is saying out loud, we’re not.

taking away vaccines. We just want more science. So what does that mean? I think with the what does it mean is where everyone’s getting really confused and flustered. Um, and then of course the CDC, you know, there were cuts made there up to 10%. Uh, happened on Friday. So it’s not just about RFK jr. It’s about all the folks in play, like, you know, Dr. Oz as well and Dr. Marty McCary, Commissioner of the Food and Drug Association. Dr. Oz, um, with CMS. Um, so there’s all these new folks at play and I think the question right now is A. How did we get here? Is Maha real? What does it mean? B. What do we expect from a policy standpoint? We’ve already seen some things and see, most importantly, from a health care organization standpoint, what do we do about it?

So that’s just a little bit of what’s happened. That’s not all of what’s happened. It would take us all day. Um, but I’ll just [00:16:00] pause there and see if either one of you have any, um, you know, what are you thinking as you’ve seen all this play out?

Kate Caverno: Yeah, Stephanie said, you know, he said, we want more science, which is really interesting coming from. Someone who is not a scientist and not a doctor and, uh, to, to have. That person questioning the science and the medical advances that we’ve made, uh, to date. So, you know, that’s interesting, I guess. Um, but I, I also maybe naively believe that people think they’re doing good, and they they go to work every day trying to be better. Um, and so I, I want to give him the benefit of the doubt that that is truly, he’s coming from a good place. Um, it’s, it’s about sort of surrounding how, how do we in the industry make sure that he’s surrounded by. The right information, [00:17:00] quote, unquote, the right people, um, and that the, the folks who have the science and who can influence the decisions and the policies, um, are doing that, um, and that they’re heard. that’s, I think, where we’re, uh, where we’re gonna have a little bit of turbulence in the coming weeks and months.

Stephanie Wierwille: A little bit. Maybe a lot. Maybe some, uh, major rough air, as they say in the skies, which is a whole nother sidebar. But anyway, um, oof. Um, but I, I like your, I think you have a very measured take. So I just want to build upon that. I think You know, I look at the phrase make America healthy again and I’m like that deeply resonates with me and with, you know, think about hospitals missions.

That is the mission is to help communities be healthier where we disagree and where there’s lots of turbulence is the how, how do we do that? And so cuts to NIH cuts to CDC discussions about vaccines, you know, [00:18:00] SSRIs. You know, all of that discussion of like, should we take them off the table? Should we take weight loss drugs off the table for children?

That is where all the turbulence comes into play. And so I love your point about how do we surround, how do we bring out the right physicians? scientists, researchers, because what I love to look at, you know, who’s, who is surrounding Bobby Kennedy right now. It is influencers. And many of them, honestly, I’ve read their books, like Dr.

Marty McCary, um, who, who, you know, is in charge himself. Um, Dr. Casey means and Callie means Vanny Hari. Those are folks that are, that were literally sitting behind him in the hearings and that are his advisors. And what they say is they’re looking for, you know, healthier food in this country. better school lunches, better hospital cafeteria food, by the way, nutrition, that kind of thing.

None of that by itself is difficult or harmful. What is difficult is when you remove the ability to access [00:19:00] medication and research and clinical trials. And so I love your point of let’s understand who surrounds them. And let’s also figure out how do we also bring, you know, the researchers into that mix.

Desiree Duncan: addition to that around like who you’re keeping around, I know that we, we saw a lot of headlines and a lot of stories around, you know, so many folks, um, leaving their positions at some of the federal orgs, right. Again, we don’t know exactly what, um, the conversations are, you know, what the written contracts are like, what’s going on. However, there’s a piece of me that thinks about the idea of brain drain, right? And like, it’s a fine balance and it’s a decision to obviously you have to make, you know, personally for yourself of, okay, do I stay and like, make sure that this whole thing doesn’t down? Or do I, Jump ship because this is completely against, you know, my values and, you know, kind of where I’m [00:20:00] aligning and that’s a tough decision to make.

And like I said, we don’t know how some of these folks got there, but a part of me is more around the lines of stay in it to see what’s going on. And to that point, read all the things, uh, I mean. We have to keep ourselves informed and not just so there is that piece of, okay, I want to believe in altruism, but then also I want to arm myself with my own facts of like what is actually kind of written about what is the plan of a M.

A. H. A. Or, you know, what we saw with project 2025 and how that’s coming to life. It’s just read the thing, stay informed and stay up to date.

~ ~

Kate Caverno: ~I, ~huge Dez, I think, uh, to sit passively by and wait, not a good strategy, um, but, um, to be actively involved, whether that means you’re working with your health Uh, association, your state association, um, or just at the local level and doing some scenario planning, right? What [00:21:00] happens if X, Y, or Z and having a game plan ready, talking with your leadership, your boards to say, Hey, in the, in the event X, here’s our proposed response so that when, if those things happen, you’re not caught flat footed and you’re not, In, uh, you know, hurry up and scramble to decide how we move forward mode, you sort of, um, ready for it, uh, to some degree, whatever degree you can be, ~um, and I think that maybe ~I’m not saying it’s fear mongering, right?

It’s not like we’re preparing for, for the apocalypse. That’s not what I’m saying, but to, to be actively in what’s happening, and preparing at the, at your organization’s level for how you want address those things.

Stephanie Wierwille: very wise. Yes. So I’m going to build on what both of you all said. So yes, Des, I love the call to action of lean in and, and read what’s happening. And I, I would also add to [00:22:00] that, deeply understand the cultural shift. So there has been a cultural shift and frankly, it’s not new news. It’s been bubbling for a decade. This idea of. You know, we’ve seen it since the pandemic of science versus, um, uh, alternative medicine or even faith based treatments, all those kinds of things that has been bubbling. That’s not new news. What’s also not new news is this frustration with big food, big ag, big pharma, big healthcare. That’s not new news.

So all of that bubbling under the surface led us to this giant break that happened, I think, since August where now it’s in the forefront. And, and I would say. Take the emotion out of it, kind of to build on what you’re saying, Kate. This is really tough stuff. I just want to say out loud, this is really difficult.

The idea, you know, this is very personal to healthcare organizations. These cuts that are potentially happening, the conversation around Medicaid, very deeply personal, will, will, will, if it happens the way it’s starting to play out, deeply [00:23:00] influence and impact revenue. It’ll impact, it’s already impacting funding.

It will impact patient outcomes. either for the good or for bad. Um, it will impact your doctor’s day to day. So it’s really hard to take the emotion out. But I think as of right now, how do we understand what is the cultural sea change? How did we get here? Why? And more importantly, I love your point of scenario planning, Kate.

So what happens if and when Medicaid is cut? What, how will the funding cuts play out? How will they impact your bottom line? How will they impact your service lines? How will they impact your patient? Play all, put all of that on paper. Scenario plan without emotions and then say, okay, where do we need to lean in and fight and where can we lean in and collaborate?

So for example, this idea of more alternative and preventative medication or medicine or medical treatments. Doctors have been asking for that for a very long time in a sense of how can we blend, you know, how do we help people lose weight, for example, while also [00:24:00] giving them the heart treatments they need.

That’s an example of the blend. There might be things that you can do to collaborate while you are also bringing forward the science. Um, and I’ll just add we’ve already seen many physicians come and speak in the news, you know, like Children’s Hospital, uh, CHOP, CHOP, uh, was speaking, I think I’ve seen UCSF in the news.

So academic medical centers are already bringing their doctors forward, which is a wonderful thing to do.

Desiree Duncan: I can’t help but think about, I mean, medicine is still relatively new, right? And some of the More insane practices like lobotomies, you know, they, were not that long ago. So there’s so much to be, um, learned, researched, you know, figured out. And I think that’s kind of where people are feeling is like, okay, uh, in a way. feel like we might even be behind and or some of these alternative methods actually really worked with worked for me more so than taking another pill. How can we incorporate more of [00:25:00] these things? Uh, like for me, uh, I, I used what was a holistic, um, chiropractic, uh, practices, um, a little over a decade ago and it. At the time I just did it because, you know, someone in my life recommended it and I was like, I don’t, I didn’t know what to expect. But six weeks after I was, it was very intense. It was like three days a week for like six weeks. the way that my, the blood was actually flowing through my body was incredible. If I had just stuck with what the doctor was saying, I would have just been taking another pill. So there is this sense of. I, in the culture, a sense of, I feel like there is more out there that I can be having access to that I don’t right now.

Stephanie Wierwille: Yeah, and I think your point is, how do we hear people and their lived experiences and marry that with the doctor recommendations? That’s what people are wanting. The problem is, it could, it could come to life in the short term as, you know, more [00:26:00] vaccine skepticism, you know, reduction of people listening to their doctors.

So it’s a very difficult place to play. But I think, you know, as a marketer, our job as marketers and communicators is to first and foremost, understand the culture, understand the audiences, understand why this stuff is happening, and then, you know, make sure that we’re advocating on behalf of our business, which is a very difficult place to be.

And on behalf of. Physicians. So I think just to, just to sum it up, um, you know, don’t, don’t mishear us. We’re not saying this is, you know, sunshine and rainbows. We’re saying red flag, huge red flag, fiery red flag, but stop and understand, remove the emotion scenario plan, dig deep into this. This is maybe the most important thing happening in healthcare right now.

Um, I would say it’s the most important thing and it’s going to have a major impact. And our job as marketers and communicators is to understand all The aspects of it and to help, um, you know, be the voice of that market.

Kate Caverno: Yeah, I think

Stephanie Wierwille: Okay.

Kate Caverno: [00:27:00] huge point, Stephanie. I think the, uh, idea of just proactively articulating your value and your stance and leaning into your mission for, for these not for profit systems specifically, where here to serve people the best. To the best of our ability, that’s, and try as best as possible to remove the politics from it. Um, I think, I think back to the Dobbs decision specifically, you know, 22, was it? Um, and we were working with health systems who said we can’t say anything because we don’t want to alienate half of our, of our market, right? okay, well, I understand that from a But also, the few folks who seek those services, right, we’re really alienating them, and that’s who we need to be focused on.

So if you can put the [00:28:00] politics to the side for half a second, how does serving the population line up with your mission, line up with whatever you’re able to actually execute within your community, that’s where you need to focus.

Stephanie Wierwille: Yes. Find that Venn diagram, right?

Desiree Duncan: of like, we’re moving the politics for it. Let’s not forget the fact that Mitch McConnell. Voted against R. F. K. Jr. as health secretary. This is based off of not his politics, but of his own lived experience as a polio survivor. so it’s looking at the Zoom out, look at the contextual piece of the story.

Of like, what are we saying here? Like, what is happening? Understanding our history so that we Can continue to progress and, you know, don’t make some of the same mistakes or even just knowing that, hey, this is a potential. Of course, we saw a lot of the vaccine hesitancy during covid and, you know, where we [00:29:00] kind of are now with, uh, various viruses kind of just bouncing around and in and out of all of our systems as we continue getting sick all the time. yeah. But it’s something to be understood about a like we had said earlier about who you’re keeping around you of really, really between the lines and then really just understanding our history and that there is so much more to be discovered.

Stephanie Wierwille: absolutely. So speaking of policy and leaning in and understanding it, um, We’ll shift to our last topic here, which, uh, we just published on bpdhealthcare. com slash insights, a blog post, uh, from our amazing comms team here, which Kate is representing, which is things to expect from the second Trump administration and the 119th Congress.

And it goes into all. The things you need to know around DOJ, Department of Government Efficiency, what is possibly being cut or reviewed from a healthcare standpoint, um, the potential policies that are coming up, executive orders and all the, all the orders, all of them, [00:30:00] um, that, that we’ve seen so far, tariffs, ~the T word, um,~ trans rights, and so much more.

And, um, And so, you know, I would just say before we get into this, uh, it was actually one of our clients over a, over a dinner that we had in Las Vegas last year. She said something that really stuck with me, and it is that you have to understand policy if you’re in healthcare, if you’re a marketer, if you’re a communications professional.

You have to understand policy. You have to be looking at it. You can’t shy away from it because healthcare is innately political, whether we like it or not, it is very much driven by policy. So it’s, it’s a scary place to be. It’s hard to read the news. Sometimes it’s hard to say, what do we do about this?

Where are we right now? Why is this happening? Am I for or against personally? None of that really matters. The point is. This, this is where we are and policy dramatically impacts and will dramatically impact every healthcare organization this year. So with that behind us, um, I, I think Kate, you have a really interesting perspective as you work in the payer world every single day and you’re [00:31:00] seeing how policy affects, you know, pay, payer and provider relationships.

So I’m, I’m curious from you, you know, what’s top of mind for you right now as you look out into this, this world,

Kate Caverno: It’s a little bit daunting. I’ll say that. Um, you know, you mentioned the budget cuts and, and what DOJ is doing. And, uh, I think Elon has already backed off the 2 trillion cut number, just recognizing that that’s pretty steep. Um, but health spending accounts for about 26 percent of the federal budget. And is discretionary spending. So that means it doesn’t have to be spent. So we’ve already seen pauses on Medicare, Medicaid. Um, and maybe that was an accident or not, who knows. Um, but I would anticipate that there will be. cuts there. Um, and we know that that spending is already, um, than what it needs to be to cover the actual cost of care. Um, Medicare Medicaid actually underpay providers by [00:32:00] about a hundred billion dollars according to the American hospital association. So, um, as you’re, uh, considering your contracts, ~Um, they, the,~ the pressure on those commercial contracts specifically becomes greater, um, and, uh, you know, what’s happening with the budget and the fact that, I think the number is 10, 000 Americans become Medicare. every single day and will continue until 2030 that gap that we’re already feeling is just going to continue to widen and, uh, the federal government is not necessarily coming to save you. Um, so looking at those, those commercial contracts specifically, uh, is going to be really critical over the next two years, um, because that sets your trajectory for the next. Three to five years. and then, you know, that, that’s speaking really broadly when you consider rural hospitals, [00:33:00] independent hospitals who don’t necessarily have the resources of some of the larger, Systems that may be, you know, across multiple states, even, um, that’s a really challenging spot for them to be in.

And I think there’s a ton of criticism around consolidation, uh, and what that does for quality and cost. And, you know, all of these things are just sort of compounding issues We have to, to your point, Stephanie, be aware of the policies because there are policies, uh, that are potentially governing, uh, that consolidation, but if that’s your only option, right, if you don’t have the policies backing the spending, I mean, it’s, it’s a big, nasty web of Stuff that is going to be really hard to apart. Um, for anybody, I think

Stephanie Wierwille: a nasty web of stuff.

Kate Caverno: of

Stephanie Wierwille: [00:34:00] Yes. Yes.

Kate Caverno: technical term~ term.~

Stephanie Wierwille: It is. There’s the sound bite. Yeah. And, and I think, you know, this, this whole underlying theme seems to be, it’s a brown dollars right now. And it always has been, but especially right now, you know, to your point around whether it is the commercial contracts, whether it’s what the rural hospitals are going to face, whether it’s the Medicaid situation, whether it’s.

Doge. And I’m going to refer back to something from the Joe public retreat that we hosted in Charleston in December, Paul Keckley, healthcare ~economist,~ economist kicked us off and just did a, you know, let’s dive into the deep end headfirst conversation.

Kate Caverno: Good

Stephanie Wierwille: And a lot of what he said back in December was All eyes are going to be on the dollars in every single realm in 2025 and beyond.

And what that means is you have to recognize and realize, you know, that, that every single eye is going to be on, um, healthcare spending costs. And, yes, chasing health systems as well as pharma, as, as well as, [00:35:00] you know, big food. He didn’t talk about that, but, you know, we just kind of had that discussion. But it’s all around where are the incentivizations happening? And so what I thought was really interesting was he said, let’s be honest, is there waste in the healthcare system? Yes. You know, is sometimes C suite pay too high? Yes. It’s the hard thing to talk about. But what can you do to get ahead to recognize, okay, when we’re in a situation where there are cuts happening, when there is eyeballs on us, when our financials are shared, when we’re being asked for more price transparency, when we are in a negotiation, how, how do we be honest about that and, and not saying change everything, but just recognize what’s going to be under scrutiny.

Desiree Duncan: And being in communication with policy makers and the, the young policy advisors to these different, um, congressional folks, um, this is something that was really kind of eye opening to me. at the, [00:36:00] uh, conference this past year, um, where they were talking about the, so most health systems, they have policy, uh, experts within their system, but then they are, they’re also of course working with their state associations and of course the American hospital association on these things. And, um, knowing that right now it’s. We need to be in constant communication with these folks, you know, not necessarily, you know, lobbying efforts, um, but conversations need to be had and understood and that some of these, uh, do not, what the message was basically, uh, at Sushmid was, you know, do not underestimate some of these young policymakers, these policy advisors, you know, because you’re wanting to get to the, uh, Congress person, the Senator and what have you, they’re not the ones that are writing these policies. It’s these folks that have just graduated from George Washington University, uh, Georgetown, what have you, uh, American University, NDC, and of course, I’m sure other universities across the country. [00:37:00] But these are the folks that are really the ones that are architecting some of these things to be in relationship and communication with them.

And do not belittle, um, because again, they are the ones writing these things and they need to understand your point of view.

Stephanie Wierwille: That’s so interesting. I have not thought of it that way. That is really interesting. Um, Kate, I’m curious, what, what are, what are you advising clients in this landscape? As you pointed out, you know, and as you kind of talked about, uh, what we’re walking into from a payer standpoint, um, what do systems need to be thinking about as in terms of, you know, from a payer provider standpoint or communications in general, what are your recommendations?

Kate Caverno: Yeah, it’s for a lot of systems. uncomfortable to talk about the finances and to talk about why health care is expensive and, um, that’s not to say that the, we can blame the model, right? The model. We know there’s a challenge with the model. Um, [00:38:00] and we can’t just. sit back and not change it because it’s going to be hard. Um, so I, I think to the point of like, po policymakers are in the process of trying to better. that’s happening over here. But your ability as a health system to influence that policy is, is probably not as great, right, as maybe if you were the payer. Um, So the council that we’re providing is really about explaining your value, talking to your communities and being clear about the services that you bring, the value, like I said. And marrying that, starting to marry that with the, the financial realities of bringing that value to the community. Um, I had a great opportunity a couple months ago to tour a brand new children’s hospital. It was stunning. It was, every, every detail was thought of, [00:39:00] every Uh, from a patient experience perspective, I mean, I, I wouldn’t wish anybody to have to spend any amount of time in a children’s hospital, right?

But, if you’re going to, this is the place to be. And, as we were walking through, my payer brain, um, was thinking, have to advocate for really strong contracts. allowed this kind of technology, research, spectacular funding, right, is required to run this facility. do you cut? Where do you, where do you, where do you say to a parent, sorry, we can’t afford to have that service? Or to a, you know, a kid and look them in the eye and say, sorry, we don’t do that here, we have to send you away. that’s a really hard place to be for a health system. Explaining that value to the community to payers before you’re ever in a negotiation and help bring them in, show them around, um, and make that human to [00:40:00] human connection as much as you can. At the end of the day, it’s going to be business. It’s going to be about dollars and cents, but if you have that relationship in place before you get to the negotiation table. It helps. Um, and then just being really creative, I guess, about the contracts that you’re looking for. Um, recognizing that the payer on the other side has goals that they’re trying to meet and they are not going to be the same as the goals that you are trying to meet, but how do you think differently outside the box, um, to get to a rate structure or language that maybe is different than what you set out for, but achieves the same end result.

Stephanie Wierwille: That is so well said and it hits, hits so hard, I think, you know, I think this is actually a good place to kind of wrap up because your story is so beautiful, Kate, and so real, which is okay. You know, healthcare is very expensive, and we’re [00:41:00] being looked at, yes, from payers, yes, in our contracts, yes, from Doge on round cuts.

And like I said before, you know, yes, there’s waste, but to your point, like, what do you cut? That is such a powerful question. And I think that’s what the narrative, that’s what the narrative needs to be. to be, that’s where I’ll, I’ll recognize the value attack, you know, which we’ve mentioned before. Um, but that’s really what the value attack is, is recommending that, that our BPD POV on it, which is how do you better share the stories of the impact you’re having in communities?

How do you better paint that emotional picture of when a child is sick and a parent and a family is going through this? They need all the things, all the things. They need the research behind it. They need the, you know, pharmaceutical, um, landscape. They need the, the space to get healed in. They need all of the things.

And so asking where cuts can be made is a very difficult and very emotional question. And yet one that we’re all facing right now. So [00:42:00] maybe we’ll just wrap on that, the, the hard truth. Well, thank you, Kate, so much for joining us. I really, really appreciate your words of wisdom and your experience.

Um, thank you.

Kate Caverno: It was fun.

Stephanie Wierwille: And thank you, Des, as always, for sharing your viewpoints, um, and what you’re seeing here. Um, thanks for joining.

Desiree Duncan: Yeah, love to give the kind of random tangents and hopes for a better world.

Stephanie Wierwille: The important tangents, um, the important, you know, sidebars as everyone is thinking. So for everyone listening, thank you. Thank you for joining us. Um, let us know if you have a take on these things, what you’re doing in your organizations. We would love to see you subscribe to our newsletter, The NoNormal Rewind, where you can get even more, um, behind these discussions.

And also, as we mentioned, the blog, Things to Expect from the Second Trump Administration, which you can find at bbdhealthcare. com slash insights slash blogs, um, and make sure you share the show. with your friends and colleagues. And until next time, don’t be satisfied with the normal. There’s nothing normal about what’s happening right [00:43:00] now.

So we have to be willing to walk into the no normal, unafraid, um, unpolitical and unemotional to the best of our abilities. Uh, and we’ll talk to you next time.