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Where we share our weekly news debriefs and discussions with industry experts. These are lo-fi recordings aimed at giving our readers more opportunities to engage with our analysis and a view into some of the conversations that shape it.
Martin: Patrick, how are you today?
Patrick: I'm doing great.
Thank you guys for having me.
Martin: Uh, Patrick, is your
LinkedIn correct that you're in
the Greater Philadelphia Area?
Patrick: I am.
I'm in the suburbs of Philly.
Martin: I, uh, my wife is from
the suburbs of Philly and has
converted me into a, a big Wawa fan.
Patrick: Yeah, Wawa and all things, uh,
Eagles, and yeah, it's a, it's a great...
I'm, I'm a transplant here, but, but
we've, we've called it home for the
past, uh, 13 years, so we love it.
Martin: The Eagles are a bit
of a sensitive subject for
Kevin, who's a Vikings fan.
Kevin: We've, we've, we've had
some tough experiences against you
guys, but nonetheless, here we are.
Martin: So- Yeah.
Patrick- Yeah.
Kevin, you kick us off.
Kevin: Yeah.
I, Patrick, thanks for joining us today.
Excited to chat Belong.
Curious to hear a little more on the
model, how you think about planning
or partnering with plans, partners,
uh, and ACOs, uh, organizationally.
Patrick: Yeah.
So, you know, my background, I, I
started in the early 2000s actually
working, uh, for a company called
HealthSpring, which became a, a, a fairly
large operator of regional Medicare
Advantage plans across the country.
And so fast-forward to, uh, late 2020,
and we were thinking about starting
a company and reflecting back on
what, what I was operating individual
markets as a regional, uh, president
or a general manager, thinking about
the challenges that I had in standing
up, um, special needs plans as part of
the Medicare Advantage, um, offering.
And we really believe that to
compete at a, at a community regional
level, um, you have to have a full
suite of, of Medicare products.
And so, um, I, I knew from experience
that there were many great companies
that were offering, um, you know, very
targeted point solutions to health
plans, but there wasn't, um, a company
out there that was offering a platform
that a health plan could partner with to
stand up, um, a special needs product.
And so we launched Belong in
early 2021, uh, to do just that.
We had a, a initial very large
focus on dual special needs and
now, um, as well doing a lot of
work in chronic, uh, special needs.
So you can think of us as a, as a,
uh, a complement to what a health plan
already does well, and we try to then
help them either fill gaps where they
have it or, or, you know, differentiate
in, in, in the, the real integrated
care models that are needed to address
the, uh, special needs populations.
Martin: I was just gonna say, I'm
gonna ask a two-part question, but
they're a little bit unrelated.
So the first question is, what is
the, the sort of typical profile of a
plan that you're, you're working with?
Patrick: Yeah.
So, um, we...
A- again, based on my own personal
experience, in, in many cases, a community
health plan that has been in a community
for 30, 40, 50 years, they probably
started out initially, uh, providing,
um, employer, uh, sponsored healthcare of
some sort, and then they might have over
time, um, gotten into Medicare Advantage,
um, maybe via an acquisition, and then
they're probably starting to either think
about, uh, uh, Medicaid or, or maybe they,
they got into the Medicaid space as well.
And so the, the typical, uh, partner
for Belong i- is a, is a, a health plan
that, again, probably single region
or single community, um, and trying
to figure out how do they take all the
great work they do in being a real lean,
efficient, um, you know, great branded,
uh, lots of trust in the community, but
then how do they bring some of these
more sophisticated care models to special
needs populations and even general
Medicare Advantage populations they
don't have as much experience servicing.
Martin: And can you walk
through those different flavors
of, of special needs plans?
I think, you know, folks are-
Broadly aware that they exist, but
what's the, the difference between
a D-SNP and a C-SNP and an I-SNP?
Yeah.
Um, and then on the ACO piece, like
how do you, uh, work with MSSP players?
Patrick: Yeah.
So, you know, traditionally Medicare
has offered, um, a number of different
special needs, uh, components that would
go into the Medicare Advantage program.
So they could be additional
benefit offerings that a Medicare
Advantage plan would offer alongside
a, a general enrollment MA.
And so the largest is the dual
special needs, and that's for, uh,
you know, beneficiaries who are dually
eligible for Medicare and Medicaid.
And that has seen, uh, a lot of
growth since the early 2000s and,
and has like the lion's share of
special needs membership today.
The, the next largest segment is what
is, uh, called a chronic special needs
plan, and that has a number of different
chronic conditions that would qualify.
Um, you know, things that people are
aware of like, um, you know, uh, chronic,
um, kidney disease or, uh, diabetes,
but then it also offers the chance
to bundle a few of these together.
And so what's become very, uh, prominent
in the marketplace really over the last
two to three years are, um, these comorbid
bundles that allow you to, to really
treat a number of different conditions.
And then you mentioned the, the
institutional special needs or I-SNP
tends to be focused around, um, a
facility like a skilled nursing facility.
Those pro- that probably has the smallest,
um, uh, you know, penetration right now
a- across the country, but lots of focus
today in, uh, chronic special needs,
which has been the highest, uh, growth
engine over the past couple of years,
and then, uh, dual special needs as well.
And then for Belong, the way that it
relates to ACOs with Belong is that part
of our, um, model and how we work with
health plans is we also take a, a, a
leading role in going out and, and working
to, uh, uh, to enable the primary care
network within that community to enable
that commu- that, that network to work
more seamlessly with the health plan.
So again, one of the ways that we
differentiate is we try to help, um, form
a deeper relationship between the health
plan and the primary care community.
And so in doing that, we have been
using, um, ACO structures, whether
it be MSSP or others, um, as a way to
kind of get started or even broaden
the, um, percentage of the physicians'
panel size that we work with.
Kevin: Patrick, as I think about C-SNP
market growth over the past couple
years, that, that seems to be one of
the kind of dominant narratives in the
Medicare Advantage market 2026, right?
On the whole market, not a
ton of growth, but C-SNP is a
pocket seeing a lot of interest.
In my head, part of that is
because- Of the, the P&L dynamics.
As I understand it, C-SNP plans look
pretty different than traditional MA
plans, where if you're getting twelve
hundred bucks PMPM in an MA plan, C-SNP
plans, you might be getting two X, three
X, or more of that, and that allows
you to better manage that condition.
Could you...
I-am I, am I generally
right in that understanding?
Could you sketch for me, like, what
is the, what does the C-SNP plan
look like in Enable financially?
Why are we seeing so much interest
from plans in getting into C-SNPs?
Patrick: Yeah.
So I think the, the first part of your
question probably relates back to what
has been a, a really challenging, call it,
three to four years in the Medicare space.
It's been one of the more,
um, I think challenging times
that I've seen in my career.
And so what that really means is that
there have been utilization upticks, and
then there have been reimbursement changes
specifically re-related to the risk
adjustment model in Medicare Advantage.
And those two things have combined to
just make it more and more difficult
if you're an insurance company
and you're maybe, maybe have a PPO
offering in Medicare Advantage.
It's just very difficult to get
the accurate, uh, risk capture and
then, um, the engagement level at
the beneficiary and provider, uh,
side to manage medical utilization.
And so when you think about then a,
a dual special needs or a chronic
special needs, the, I think the biggest
benefits of those is that it allows you
as a health plan to really tailor the
offering to meet the, the needs of the,
of the members that you're going after.
And then likewise, you can provide more
tools, uh, enhanced benefits and, and
different things like certain models
of care that work with the physician
community to then help, um, wrap around
and, and help them, um, you know, do a
better job of managing the risk profile.
And so to your point, Kevin, we've
always felt like if you're doing the
right thing clinically, the, the, the
risk adjustment or, or, or the, um,
the, the, you know, the revenue side of
things, it, it, it will match, uh, the
clinical work that you're doing, and
that's be-becoming all, all the more
important because of the changes that have
been made in the risk adjustment model.
So that's how you start to see, um, the, I
guess the, uh, the, the, the differential
in terms of a higher reimbursement.
It would...
It, it's really just an indication that
you're, you're able to more accurately
capture what's going on with that patient.
Specifically in the case of C-SNP,
where the patient is, is actively,
um, opting in to a health plan that
works with their chronic conditions,
they're much more, um, active in terms
of going to see primary care and then
a-and participating with the health
plan in terms of care, um, coordination
and care management activities.
Martin: In hearing you describe, you
know, who you're partnering with, one
of the things we've been tracking pretty
closely is the financial challenges for
the regional nonprofit health plans.
Yeah.
It's been a rough year for all
insurance companies, but scale tends
to be pretty helpful in these things.
Yeah.
At the same time, we're hearing a,
like, special needs plans is a huge
focus area from the big nationals.
Yeah.
And we, you know, the, the McKinsey
Profit Pools report, they're saying
most of the profits in the industry
are gonna come from special needs
plans over the next couple years.
Um, I'm curious what you're seeing on the
ground as you're going out and talking
to plans on appetite for investing in,
in special needs plans and how they're
sort of thinking about their Medicaid
and MA plans as part of, you know, like,
bringing them together, integrating them,
and, and working with someone like you.
Patrick: Yeah.
So it really...
It, it probably is, um, from a strategy
perspective, it's very different when
you think about w- you know, what
you're hearing publicly, um, through
the, the publicly traded, you know,
nationals versus what's happening
in the, the, you know, the, the
not-for-profit, um, regional plans.
And so, uh, from, from a national's
perspective, um, they can, you know,
they can take kind of a portfolio
view of these product offerings.
And so in many cases, I think they're
using C-SNP as an example, as a way
to really drive, um, you know, a
differentiated benefit offering in a
set of zip codes or counties and then
try to use that to grow membership,
which has been, um, you know, a, a
very successful approach for them
over the past, um, couple of years.
And then further to your point, because
of the, the, the mix of, um, of, of
risk and, and the care model work that
we talked about previously, they can,
they can probably generate a higher
margin on that than just a traditional,
uh, general enrollment MA product.
On the, on the flip side of this,
though, if you think about the
mandate or really the promise that
a community health plan makes to
the community that they're in, they,
they can't take a portfolio approach.
I mean, they're fully
rooted in that community.
They're not going anywhere.
And so- It has been a really challenging
time for them, as you alluded to,
over the past couple of years because
they've seen a lot of pressure, um,
not only in their Medicare business,
but they've seen pressure across
even their commercial business.
And, and so there might be an
instinct to say, "Well, let's go,
let's go more narrow around what
we offer and try to stem losses."
But the conversation that we have with
these health plan executives is that
how, how do you really fulfill your
promise to the community where, you
know, you, you have been there, in many
cases 50 or more years in the community,
and you're, you're, you're telling the
community, "Okay, well, we're gonna be
there for certain lines of business,
but we're not going to be there, um,
for, for Medicare lines of business."
And I think that's a challenging,
um, approach to take.
And so what, what we try to do is work
with them to say, "Okay, how do you
turn this into a sustainable, you know,
profitable, uh, line of business?"
And then, you know, to your last, uh,
question about Medicaid, in the states
that are very much pushing for full
integration of Medicare and Medicaid, um,
it's, it's, it's really not a question of
if, it's just, like, how quickly can you
get to a sustainable structure that...
And I think every state has had a
slightly different, um, timeframe there.
But we, we again fully believe that
if you're a community health plan,
you know, operating, um, in a single
community or a single region, that it
strategically is very important for
you to have that full suite of, um,
of offerings for, for the community.
Kevin: Patrick, one of the things that
I'm curious about in C-SNP plans, you
mentioned this on the website, you talk
about product sales and marketing, driving
year-round awareness on behalf of plans.
The enrollment cycle seems different
for C-SNPs given that year-round-
Patrick: Yeah
... Kevin: uh, enrollment process.
We've also been hearing a lot about the
dislocation in the broker market the last
few years and some of the issues- Yeah
that has caused.
I, I'd be interested to hear your
perspective on- How are you, how
are you thinking about relationships
with brokers in the market?
Because it seems like there's
more awareness that needs to
happen and people coming into
C-SNP plans, uh, in particular.
How does that work?
How are you thinking about it?
How are you helping plans with that
year-round, uh, enrollment cycle?
Patrick: Yeah, no, great question.
So again, I think it, it, it's, um, there,
there are different approaches, again,
based on the type of plan that you are.
And so I think the, the nationals
are able to take a, an approach
that is probably the one that, that,
that gets written about most, um, in
the, in the, in the, in the press.
But, but at a local level, you
are trying to build, again, what's
going to be really a, a multi-decade
relationship with your broker community.
And, um, knowing that there are going
to be times when you might not be the
most, um, competitively priced offering
or, or your benefits might not be,
um, you know, as good as a national
that's offering a plan in the space.
You're trying to develop this, this,
this very much, this holistic approach
with the, with the broker community,
and then with any, you know, kind
of independent or captive, um,
distribution partners that you have.
And, and really working with them
to say, "Okay, we want to give you
options to work with us, not only
during, you know, open enrollment,
but also all throughout the year."
And so a D-SNP is a way to do that.
A C-SNP is also a way to do that.
But then most importantly with those
products is saying, you know, "Hey,
you, you're going to have a relationship
with somebody in the community as
a broker that probably starts, uh,
even before they turn 65 years old."
And then you're gonna try to nurture
that relationship all throughout,
um, the, the, the period that that
person ages as a Medicare eligible.
And so you want to be able, um, again,
to give them the confidence that they can
trust the offering that you're putting
out on the table as, as a community plan.
And so we think with the C-SNP
specifically, a lot of that trust just
gets down to the most active and highly
engaged primary care community that's
gonna be actively wanting to work with
the, with the patient once they enroll.
And then the, the, the, the most
comprehensive set of, um, you
know, supplemental benefits to help
address the, the, the chronic needs.
And then probably last is just knowing
that they have, um, a, you know, a
brand and a community health plan that
they can trust and who's going to kind
of be there for, for them, you know,
year in and year out, and they're not
gonna have to go shopping, um, you know,
one or two years after making a health
plan change, which is sometimes what
happens when you have maybe a national
come in for a few years, and then
they, they pull out a few years later.
Martin: Patrick, we are at time.
Thank you so much for
your time this morning.
We really appreciate it.
Where can folks learn more about Belong
Health, um, if they are, they're curious?
Patrick: Yeah, definitely,
um, on our website, which is,
you know, belong-health.com,
and then, um, can, can find contact
information there, and we would love
to talk, you know, um, directly and,
and one-on-one with anyone who's
interested in, in working with us.
Martin: Thanks so much for your time.
Really appreciated the overview.
Patrick: Yeah.
Thank you.
Take care.
Kevin: Yep.
See ya.