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- [00:02]
A
R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 US health systems and handles over 270 million payer transactions annually. If you want to learn more about how you can transform your revenue cycle operations, Visit us at www. R1RCM.
- [00:32]
B
Hello and welcome to the Becker's Hospital Review Podcast. My name is Will Riley from R1. With me today is Brian Peters. Brian is CEO of Michigan Health and Hospital Association. Brian, welcome to the podcast.
- [00:48]
C
Thank you so much for having me on today.
- [00:51]
B
To start off, can you tell us a little bit about your role, your organization, and maybe what's on your mind heading into 2026?
- [01:00]
C
Absolutely. I have been blessed to work at the Michigan Health and hospital association for 36 years now, the last 10 as CEO, and we are an association based in the state capital of Lansing, Michigan. And we have the privilege of representing literally every hospital and health system, large and small, urban and rural, all ownership types, throughout the entire state. And we advocate for them primarily in the state capitol building on public policy issues, but also in the courts, in the regulatory arena. We have a number of other issues that we address as well. Through our MHA Keystone center for Patient Safety and Quality. We're very involved in quality improvement work and then also a for profit arm that is engaged with a number of services, unemployment compensation, data services and a host of other issues as well. But our real priority in this current environment, quite honestly, it's protecting access for patients. We're very concerned about that issue, what that means for us. Advocacy organization. First and foremost we need to advocate for fair and adequate funding. First of all at the state level with a Medicaid budget which we fortunately just protected. The state fiscal year just began October 1st and we approved all of the MHA board adopted priorities in that state budget. So good news there. But that's balanced by the real concerns we have with the passage of the reconciliation bill at the federal level and all of the the changes that that will entail down the road. But we have a lot of irons in the fire, as you can see.
- [02:41]
B
Excellent. Tell us. I mean, perhaps a good way to start might be as you think about all of the providers that you represent or that are part of your organization. You've talked about Medicare funding being probably one key thing. What are a couple of the other things that are on their minds that you're most concerned about?
- [03:04]
C
Well, in addition to Medicaid and Medicare funding, the 340B drug pricing program is a critical priority for a very large swath of our members, particularly our small rural hospitals. Many of the critical access hospitals in our state tell us that without the 340B program, they would be unable to continue to provide services to many of the residents of their respective communities. And that holds true as well for some of our large academic medical centers in the inner city of our state. The 340B program just critically important. And we're involved in that issue both at the state level, in the courts, and certainly at the federal level with our conversations with Congress as well. So that's a high priority, really, making sure that medical liability costs are reined in. We see a creep in those rates in the state of Michigan. Even though we have very significant medical liability reforms that have protected access to care for patients for many years, those are constantly under attack. We have a very strong certificate of need program in the state of Michigan, and every year we advocate to protect that con program because we really believe it goes a long way towards ensuring affordability of care, ensuring we're not duplicating services, ensuring that we have a rational approach to the care delivery system. So those are a few of the items that are front and center for us at the moment. And there's always the looming threat of cybersecurity. We know that the FBI has identified hospitals as one of the very top targets for cybercriminals globally, and that comes with it a lot of attention, a lot of investment of resources, both financial and human capital.
- [04:59]
B
On that point. That must be a challenge for many of your membership, who perhaps are smaller community hospitals that maybe lack resources to have robust cybersecurity initiatives and yet are just as vulnerable as any other provider. How do they provide adequate defenses in that sense?
- [05:22]
C
Well, you're exactly right. In fact, we have had several small rural hospitals in Michigan that have been the victims of successful cyber attacks, and it disrupted operations without any question. So you're spot on. The Michigan Health and Hospital association about a decade ago, saw this emerging threat, and we actually formed our own hsoc, a Healthcare Cybersecurity Operations center, along with a number of our members, and that is still in operation today. It serves as an early warning system so that if we detect an emerging threat, we can get the word out very quickly to our members so that they can take action quickly, unplug the system, so to speak, before a cyber attack becomes critically invasive. And so that's been a success for us. I think it's staved off some things that could have happened, and we're very proud of that.
- [06:19]
B
What kinds of resources are available then to smaller community hospitals through that program or through that initiative?
- [06:26]
C
And we're signing up more and more small hospitals. It began with large systems. I see. So now small hospitals have the opportunity to buy in at a very low cost, relatively speaking, so they have access to the resources that we've brought together, along with our endorsed business partner, Cyber Force. Q. They really are the backbone. They're the expertise. But this is very similar in my mind to the federal Patient Safety act years ago that allowed us to form a federally certified PSOs or patient safety organizations. The idea being we're going to collect information on adverse events and near misses and whether you're a large or small hospital, part of a big system, or a true independent. The PSO concept concept gave everyone access to the same set of information so that we can learn from each other in the benefit of patient care. So we're preventing future harms. And really, in the cybersecurity realm, the concept with the HSOC is very similar, and we're seeing it play out that way. We want to make sure that everyone, regardless of size, can do the right thing in terms of protecting data and protecting information and protecting patient care. Yeah.
- [07:41]
B
Okay. You mentioned the state level legislative agenda at the start of our conversation. What about the federal agenda? You talked about 340B, for example. But it's a very obviously pretty dynamic environment. What kinds of challenges or opportunities does that present for your members?
- [08:01]
C
Well, it's incredibly concerning that even though the president did sign the OBBBA earlier this year, and we know what that's going to mean from an economic perspective in the healthcare ecosystem. It's concerning that even though that's already teed up, we have a number of other conversations that are front and center right now on Capitol Hill that could add insult to injury. And what I mean by that is if the premium tax credits actually expire at the end of this calendar year and Congress and the administration don't act to renew those, we know that we're going to see a rise in the uninsured rate in the state of Michigan and elsewhere throughout the country, we know that translates to uncompensated care for our member hospitals, and ultimately that translates to a lack of access, because at some point you have to talk about staff layoffs, you have to talk about diminishing or eliminating service lines and perhaps even closing entire hospitals. We've seen this movie before, right? This is what led to the passage of the Affordable Care act in the first place? So the premium tax credits, that's the primary issue. There are other considerations. Site neutral payment continues to be under discussion at the federal level. We believe that hospitals play a very unique role and have justified the need to have a higher reimbursement for the services they provide. Because we're open 24 7, 365, we take the most complex patients, we take everyone, regardless of their ability to pay. There are reasons why we have that this reimbursement scheme in place to begin with. So site neutral payment reforms deeply concern us. And then the last thing I'd lift up at the federal level, did you know that if we assaulted a flight attendant on a commercial airline flight today, that's a federal felony offense? But if we assault a nurse in a Michigan hospital or a hospital anywhere throughout the country, it's not. What's wrong with this picture? We really believe that Congress should pass a law that equates those two, that makes assaulting a frontline hospital worker a federal felony offense. Because unfortunately, we see this violence against healthcare workers on the rise. It's not getting better. And that's really getting in the way of our efforts to recruit and retain an adequate number of clinical staff. In this era where we have so many people aging into retirement, that pipeline becomes incredibly important. So these are a few of the things that we're talking about routinely with our congressional delegation about.
- [10:43]
B
Thank you. You mentioned challenges around reimbursement. Medicare, Medicaid reimbursement. Can we broaden that out? And can you talk a little bit about the broader picture of reimbursement in general through commercial payers as well? What's that environment like right now in Michigan?
- [11:03]
C
That environment has changed dramatically over time, predominantly because the population demographics have changed. So in a state like Michigan, have about 10 million residents. And 30 years ago in the state of Michigan, Medicare and Medicaid was only a small sliver of that 10 million. Today it's north of 50%, trending towards 60%. But what it means is that the private insurance sector, starting with Blue Cross Blue Shield in Michigan, which is by far the largest private insurer in our state, they've moved into that public arena, meaning they provide Medicaid managed care plans and they provide Medicare Advantage plans. And so when you talk about those public services, Medicare and Medicaid, now you have the private sector insurers that are fully engaged as well. The other thing that's really changed over time is the fact that we are moving dramatically towards a value driven reimbursement. So that the new contracts between private insurers in Michigan and our member hospitals and health systems, more and more those come with value driven metrics, value driven design. And it really means that rather than just giving a Michigander a card, an insurance card that says you have open access to every hospital, every doctor, and we treat them all the same, we're really starting to steer those patients and incentivize those patients to go to the high value, high quality, low cost providers, whether that's hospitals or physicians. Now, that's not a new concept. It's been around for some time, but we're really seeing that start to escalate given all of the other financial pressures that exist.
- [12:52]
B
I see. And the relationship between payers and providers in many states, many regions, has been contentious and difficult over the last couple of years. Is that true in Michigan? I mean, perhaps with so much Medicare, Medicaid, maybe it's different, I don't know. And how is technology playing a role in facilitating some of those relationships between payers and providers?
- [13:16]
C
It's a great question. I think in Michigan we tend to have a better relationship between the health insurance community and the provider community than you see in most other states. And there's a long history to explain that. But we do have a formal relationship, for example, with Blue Cross Blue Shield of Michigan. That allows us, the association and our members to sit around a formally sanctioned table with the health insurer and their team and at least have open conversation about the issues that we need to address together. It doesn't always mean that we agree or that the insurers are going to do what we'd like to see them do. We still argue about things like prior authorization and payment denials and the same conversations you would see about elsewhere around the country. There's no question. But I think in Michigan we have a good enough relationship that we're addressing a lot of those things, at least in a better way at the macro level. Now, having said all of that, we were successful just a couple of years ago in passing legislation at the state level. It doesn't touch the ERISA plans, of course, and doesn't touch Medicare and Medicaid. But for everyone else, this was related to prior authorization. So the legislature saw that we needed to do a better job, treat patients and providers more fairly in that realm. So there's going to be ongoing conversation between our members and the insurance field as we go forward. But again, it's going to revolve around this emphasis on value driven care. Yeah.
- [14:50]
B
Okay. As we wrap it up, Brian, anything else on your mind as you look at 2026 that we haven't touched on?
- [14:58]
C
Well, I'm a big believer that technology can be a game changer. And when it comes to our workforce, you look at at the advent of artificial intelligence, the advent of virtual nursing programs. These can be what I like to call force multipliers for our workforce. They're challenged as it is, no question. But this technology really does have an opportunity to help in terms of the care that we deliver every single day in Michigan hospitals and hospitals throughout the country. I'm excited to see what the next phase in this evolution will be.
- [15:32]
B
Brilliant. Brian, it's been a pleasure talking to you. Thank you so much for spending time with us today.
- [15:37]
C
Thank you for the opportunity.
- [15:38]
B
Thank you.