Rob Andrews on Employer Led Health Care Reform and the Future of Health Plans

Summary

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Becker’s Healthcare Podcast

Episode: Rob Andrews on Employer Led Health Care Reform and the Future of Health Plans
Date: February 21, 2026
Host: Scott King
Guest: Rob Andrews, CEO of Health Transformation Alliance

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Episode Overview

This episode features a conversation with Rob Andrews, CEO of the Health Transformation Alliance (HTA) and former US Congressman, focusing on the evolution of employer-led healthcare reform and the future of health plans. Rob shares his perspectives on how the relationships between employers, payers, and providers are shifting, the growing importance of outcome-based competition, emerging technologies in personalized medicine, and the pressing challenges facing employer-sponsored health plans—particularly around drug pricing and transparency.

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Key Discussion Points and Insights

Rob Andrews’ Background and Perspective

• Rob’s career: Served for 25 years in the US House of Representatives (helped enact the Affordable Care Act), then practiced law and now leads HTA, a coalition of 80+ major employers seeking higher-value healthcare.
  • Rob’s experience spans being a legislator, lawyer, patient, and now industry leader.
  • Quote (01:06): "Our job really is to look for the highest value care, not the cheapest care, but the highest value care that produce the best results."

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The Changing Employer-Provider Relationship

• Providers and employers facing parallel challenges:
  • Providers under extreme financial pressure, shrinking reimbursements, and workforce shortages.
  • Employers experiencing ballooning healthcare costs (9%+ annual increases), but not commensurate improvements in quality.
• New Cooperation:
  • Shift towards greater collaboration, with less dominance by insurance carriers or pharmacy benefit managers (PBMs).
  • Quote (02:32): "More and more employers and providers are looking for a way to solve [critical problems] together. Not to the exclusion necessarily of carriers or PBMs, but probably with those groups playing a less important role and providers and employers playing a more prominent and primary role."
  • Quote (03:52): "If you've got an environment where employers are paying 9% more, but providers have seen their margins cut by two thirds or disappearing, the money is going in some cases to middlemen... Is it the right share? And I think the answer is usually no."

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Where Is the Biggest Gap? Carrier Competition and Quality

• Lack of true competition:
  • Carriers compete on price, not outcomes. Rob argues for competition to pivot towards results and health outcomes, not just discounts.
  • Quote (05:54): "Carriers should be competing on the basis of outcome, who helps to make people healthier, not on the basis of rates or discounts."

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The Next Big Disruptor: Personalized Medication with AI

• Pharmacogenomics and AI:
  • Technology will soon make it possible to match the right medication to the right patient, leveraging genetics and comorbidities.
  • Current formularies are economically, not clinically, driven; personalization will drive better outcomes and contain costs, especially as drug prices soar.
  • Quote (06:50): "I think you're going to see the market move toward more personalized formularies… That, I think, will lead to much better outcomes. Fewer cardiac incidents, fewer gastro incidents and so forth."
• Why it’s coming soon:
  • Drug cost escalation is a major pain point.
  • AI can synthesize data on drug interactions, genetics, and co-conditions.
  • Costs of these technologies are dropping rapidly.
  • Quote (08:19): "Pharmacogenomics which was fairly exotic and expensive a decade ago, will become a lot more common and less expensive. It'll be used by more providers and it'll lead to better outcomes."

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Regulatory and Industry Practice Changes: Transparency is Key

• Problem: Gag Clauses and Lack of Price Transparency
  • Gag clauses prevent true transparency in pricing between providers, networks, and PBMs, leading to confusion and inefficiency in the market.
  • Rob calls for legislative action to ensure all parties know “the real cost.”
  • Quote (09:21): "You can't have an effective market unless people know what the real cost is that they're being asked to bear and what the benefit of it is. So… let pricing be known, I think would disrupt the industry in a positive way."

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Most Pressing Issue for Employer Plans: Drug Pricing for GLP-1s

• GLP-1 drugs (for diabetes/weight loss) as immediate margin threat
  • Rapidly rising use and cost, but pricing inconsistencies between direct-to-consumer and employer plans is unsustainable.
  • Employers are considering workarounds—direct reimbursement to consumers, or pushing PBMs/manufacturers for price normalization.
  • Quote (10:40): "If a drug is being sold for $190 a month to someone who puts their credit card down, but it's $500 a month net of rebates for employer plan. Employers are going to do something to change that."

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Notable Quotes & Memorable Moments

• On the employer-provider alliance:
  "Never let a good crisis go to waste." (02:32, paraphrased Rahm Emanuel, with attribution by Rob Andrews)

• On changing the game for PBMs and carriers:
  "The person...doing the actual healing work, that more of the money goes to the provider and less of it goes to the people in the middle..." (04:19)

• On the promise of AI in personalized medicine:
  "AI to understand the relationship among drugs, drugs with certain comorbidities, the genetic characteristics of the patient... will become a lot more common and less expensive." (08:19)

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Timestamps for Important Segments

• 00:50–01:45: Rob Andrews introduces his background and the mission of HTA.
• 02:15–03:55: New dynamics between providers and employers; middlemen under scrutiny.
• 05:54–06:42: Call for outcome-based competition among carriers.
• 06:50–08:19: Personalized medicine, AI, and pharmacogenomics as the next major disruptors.
• 09:13–10:22: Transparency and gag clauses as a root industry challenge.
• 10:40–11:57: GLP-1 pricing exposing unsustainable gaps for employer-sponsored health plans.

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Conclusion

Rob Andrews brings a rare and comprehensive perspective spanning legislation, employer coalitions, and patient advocacy. He sees a future where employers and providers forge stronger, more direct alliances, with technology and transparency as key levers for change. The rising costs—especially of breakthrough drugs—and a lack of price clarity threaten sustainability, but also present an inflection point for genuine reform in the health plan landscape.

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Transcript

[A]

This is where health insurance leadership comes together. Becker's 4th Annual Spring Payer Issues Roundtable brings together over 400 payer and health plan executives and more than 100 speakers to Chicago, April 13th and 14th. This year's event includes keynote conversations with the industry's top leaders and former President George W. Bush. For the full agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you here in Chicago.

[B]

Hello, everyone, and welcome to the Becker's Healthcare Podcast. I'm Scott King, thrilled today to be joined by a very special guest, Rob Andrews, Chief Executive Officer of Health Transformation Alliance. Rob, how you doing today? Thanks so much for joining us.

[C]

God. I'm doing great and it's nice to have a chance to be with you.

[B]

I appreciate your time and we, we have a lot of big topics to get into here with, with health plans and, and, you know, the health in general across the board. But before we, we dive into those, Rob, can you just tell us a little about your, your background and your career journey?

[C]

Well, I had the honor of serving in the US House of Representatives for about 25 years, during which time the Affordable Care act was enacted, and I was privileged to be a part of that, representing a district in New Jersey when, when I left the Congress, I started practicing law and was given the chance to represent a group of companies that were interested in binding together to form what became the hta, which is a group that combines the data and the purchasing power and the experience and judgment of a lot of major American companies. We're now up to over 80 companies. Our job really is to look for the highest value care, not the cheapest care, but the highest value care that produce the best results. So I've had a chance to experience healthcare as a dad, as a parent, as now as a grandparent, as a public servant legislator, and now as someone helping to lead the hta. So I feel very blessed.

[B]

That's certainly a lot of different perspectives with healthcare and appreciate you lending them to us for this podcast, Rob. And kind of the first topic I wanted to get to is how are your relationships with providers changing as both sides face cost pressure and workforce shortages?

[C]

I think they're changing for the better because both sides see the opportunities that come with the challenges that providers have. Look, everyone who listens to this podcast knows that healthcare providers are under extreme financial pressures. Reimbursements are lagging, in some cases being cut. Demands are growing, particularly with an increasingly elderly population. It's hard to find and retain talented men and women to work in healthcare fields. It's a really tough time to be running a provider system or contributing to running one. At the same time, employers are beset by a series of challenges. The costs keep going up 9% last year across the market. The quality isn't necessarily going up. The demands and challenges of the employees in the workforce are as high as they've ever been. So I think what you're finding is provider systems and employers are looking for ways to take advantage of was it Rahm Emanuel said, never let a good crisis go to waste. There's some critical problems have to be solved. And I think more and more employers and providers are looking for a way to solve them together. Not to the exclusion necessarily of carriers or PBMs, but probably with those groups playing a less important role and providers and employers playing a more prominent and primary role.

[B]

So Rob, you kind of think that because both providers and payers are both under, you know, different kinds of pressures and challenges, there's almost a united front in that relationship with like we're both dealing with a lot right now. Let's just try to work together the best we can. Is that kind of what you've been seeing?

[C]

I do. I think it's evolving in that direction. And the math tells you why. By and large, provider systems are either operating at a very thin margin or in non existent margin. They're operating in the red. Employers are paying in some cases double digits more than they paid in other years, but certainly in the high single digits. So where's the money going? Right, if you've got an environment where employers are paying 9% more, but providers have seen their margins cut by two thirds or disappearing, the money is going in some cases to middlemen who provide some important functions. I'm not in any way demeaning the work that some of those groups do. But is it the right share? Is it the right share? And I think the answer is usually no. So looking for a way to reallocate that money. So the person, you know, seeing triaging the patient in the emergency room or doing physical therapy with the patient or performing surgery or delivering the baby, or you're doing the actual healing work, that more of the money goes to the provider and less of it goes to the people in the middle, I think that's a common cause for employers and providers.

[B]

I think you're right, Rob. And you know, you discussed real allocating that, that money. But where do you see the biggest gap today when you look at you know, payer strategy and operational execution.

[C]

I think the biggest gap is the lack of meaningful competition among carriers. I think carriers should be competing on the basis of outcome who helps to make people healthier, not on the basis of rates or discounts. Now, discounts are important. No one wants to overpay for something. But I don't think anybody wants the cheapest mammogram for their daughter or their wife, or the cheapest cancer screening for their husband or their brother. I think if we could create a world where carriers competed on the basis of delivering great outcomes and providers were a part of that in a fair way, then I think employers and consumers would benefit.

[B]

What's one investment or initiative you believe will most reshape how health plans operate over the next two to three years?

[C]

I think it will be the emergence of technologies that can match the right drug with the right patient, which doesn't really happen very often. Now, formularies are written frankly with economic considerations in mind. But we know from looking at genetic studies and we know from looking at comorbidities, some drugs are incredibly beneficial for a patient. Many of them are. Some are expensive but ineffective. And a few can even have a harmful impact, particularly if mixed with other drugs that the patient's taking. So I think you're going to see the market move toward more personalized formularies where physicians and others writing prescriptions are privy to information that would help understand whether this is the right drug for the person. And that, I think, will lead to much better outcomes. Fewer cardiac incidents, you know, fewer gastro economic gastro incidents and so forth. I think that's something that's on the horizon and could be very positive.

[B]

I think it's really interesting, Rob. You know, we talk about a lot of ways to use emerging technology in the patient journey and personalize things more. But having that specific, that right medication for a patient, you said it's on the horizon. Do we think that it's something that could happen sooner rather than later with all the emerging tech we're seeing?

[C]

I think it will happen sooner rather than later for two reasons. The first is in an economy where health care costs are burgeoning, drug costs are growing the most. It's the biggest pain point, whether it's GLP1s or the immune system, autoimmune drugs. So there's a lot of attention being focused in the area. And then second is the advance of AI, the ability of AI to understand the relationship among drugs, drugs with certain comorbidities, the genetic characteristics of the patient. I think pharmacogenomics which was fairly exotic and expensive a decade ago, will become a lot more common and less expensive. It'll be used by more providers and it'll lead to better outcomes. That's something I think is on the pretty near term horizon.

[B]

If you could change one regulatory or industry practice tomorrow to improve affordability and access, what would it be and why?

[C]

Gag clauses in agreements between providers and network builders and drug PBMs. In the case of drugs markets, I think markets fundamentally work and markets work when there is meaningful transparency for people who are buyers in that market. We have erratic transparency right now. A lot of payers, whether they're employers or health plans or individuals, don't really know what they're paying. There's this vast difference between the, you know, the, the charge that's on your bill, the charge rate, and what's really being paid. You can't have an effective market unless people know what the real cost is that they're being asked to bear and what the benefit of it is. So I, I think a legislative approach that would, you know, open the kimono, let, let pricing be known, I think would disrupt the industry in a positive way. And I think it's coming.

[B]

The last thing I wanted to ask you, Rob, what's, what is the issue you think is putting the most pressure on health plan margins right now? And how are you going to respond differently? Or have you even started to respond differently in 2026?

[C]

When you say health plans, do you mean employer sponsored health plans?

[B]

Yes.

[C]

Yeah. I think what's putting the most pressure now is GLP1s in the short run. Many more people are taking these drugs. They're still very expensive, they have good benefits. I mean, they do work for a lot of consumers in a lot of situations. So I think that what you're going to see is employers looking toward creative ways to take advantage of some of the direct pricing that's being offered by the drug manufacturers. You can't read Becker's any day and not read a story about a drug company that's offering a price for GLP1 through its consumer portal. That's like less than half of what employers are paying in their health plans. Well, that's just not going to sustain itself. If a, if a drug is being sold for $190 a month to someone who puts their credit card down, but it's $500 a month net of rebates for employer plan. Employers are going to do something to change that. They're going to work around it and try to reimburse the consumer or they're going to insist that the PBMs and the manufacturers normalize that price. So I think that's what's putting a lot of pressure on, and that's the direction in which you'll see it go.

[B]

Rob, thanks so much for joining us on the podcast. It was a great conversation. Look forward to having you speak in the spring at our Pay your Issues Roundtable.

[C]

Scott I'm sure Chicago will be a great experience, and thank you for making it so.