Strengthening Independent Medicine and Rethinking Employer Health Benefits with Scott Hurst

Summary

Episode Summary: Becker’s Healthcare Podcast – "Strengthening Independent Medicine and Rethinking Employer Health Benefits" with Scott Hurst Date: March 13, 2026
Host: Scott Becker
Guest: Scott Hurst, CEO and President, Large IPA, Dallas, TX

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Overview

In this engaging episode, Scott Becker sits down with Scott Hurst, a seasoned healthcare executive leading a major Independent Practice Association (IPA) in Dallas, Texas. Their conversation centers on the challenges and innovations in independent medicine, the impact of health insurance costs, and the creative solutions IPAs can leverage—particularly the development of Multiple Employer Welfare Arrangements (MEWAs). Hurst also offers candid insights on value disparities, strategies for survival in the current healthcare landscape, and advice for emerging healthcare leaders, especially in an AI-driven age.

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Key Discussion Points & Insights

Introduction to Scott Hurst and IPA Innovations

[00:51 - 01:40]

• Scott Hurst introduces himself as CEO and president of a large Dallas-based IPA with nearly 600 providers.
• The IPA supports members in contracting, credentialing, group purchasing, value-based care, and now a MEWA (Multiple Employer Welfare Arrangement) offering health insurance to practice members and their families.
• Hurst expresses pride in the MEWA's development, highlighting substantial growth from 50 initial participants to almost 250 by 2026.

What is a MEWA and Why Does it Matter?

[01:40 - 02:54]

• Hurst explains MEWA as "Multiple Employer Welfare Arrangement," designed to provide a fully insured health insurance product to IPA members, their staff, and families—addressing soaring health insurance costs.

• Stresses that the escalating costs are a "remarkable threat" to independent practices.

  “The increasing cost of health insurance I viewed as a remarkable impediment or remarkable threat to my offices.”
  — Scott Hurst [02:22]

The State of Independent Practice Associations (IPAs)

[02:54 - 04:35]

• Discusses challenges IPAs face, including difficulty in gaining payer recognition and educating employers on available resources to lower costs.

• Notes major disparities in provider reimbursement—independent doctors are paid much less compared to large health systems, with higher costs being shifted to employers.

• Employers largely unaware of these cost drivers, which are "almost shameful disparities".

  “...money's not going to the doctors in those systems, it's just going to cost in those systems. And that cost is being transferred down to the employers and the employers are not being told what's really driving their cost increases.”
  — Scott Hurst [04:11]

Fixing Cost and Reimbursement Disparities

[04:35 - 06:30]

• Hurst relays a constructive conversation he had with a large employer about direct contracting with his IPA to drive employees to lower-cost, high-quality independent physicians and share the savings.

• Points out that disparities in payment rates—some at Medicare rate, others at up to 250% of Medicare—are real dollars, especially in professional, surgical, and labor/delivery charges.

• Calls for small, pragmatic steps to improve the landscape for independent practices to survive and thrive.

  “If my doctors are being paid right around Medicare… and then other doctors are being paid 190, 200, 250 of Medicare, that cost differential is real dollars…”
  — Scott Hurst [05:37]

The Future of Independent Medicine & Need for Scale

[06:30 - 08:37]

• Notes a declining share of truly independent doctors ("9% are employed by United, 7-8% by private equity"), with Texas as a rare stronghold.

• Advocates consolidating revenue cycle management and EHR systems to improve efficiency and viability without sacrificing individual autonomy.

• Strongly criticizes payer practices like downcoding (automatic reduction of billing levels), calling it insurers "practicing medicine".

  “The days of an independent organization… having 200 different approaches to rev cycle and 46 different EHRs… that has to go away. Right? We have to move to where we have one unified rep cycle.”
  — Scott Hurst [07:24]

  “We received documented notification from major payers that they were going to take 99214s and 215s and down code them one level automatically. That's them practicing medicine. That's not their job.”
  — Scott Hurst [08:12]

Current Focus and Excitement for 2026

[08:37 - 10:06]

• Hurst’s top priorities:

  • Continuing to expand the MEWA, which provides creative and cost-saving insurance options with meaningful benefits (zero copay, zero deductible, reasonable out-of-pocket).

  • Helping independent physicians understand that achieving scale is crucial to survival, but must be pursued without surrendering all independence.

    “The plan that we offer our members does two things. One, it's a zero copay, zero deductible, 5250 out of pocket max plan. At the same time, it pays my doctors fairly well, above what I get from the bucas.”
    — Scott Hurst [09:16]

Advice for Emerging Healthcare Leaders

[10:06 - 11:41]

• Hurst urges new leaders not to blindly trust AI to "fix everything," warning that overreliance without critical understanding can amplify errors.

• Advocates for critical thinking, accountability, and active questioning, warning of a generational decline in educational rigor due to overuse of generative AI.

  “Don't assume or 100% accept the idea that AI is going to fix everything… if all we do is throw more junk on top of junk, it's gonna get real messy.”
  — Scott Hurst [10:41]

  “Take a breath. Take time to really evaluate this, study it, understand it, ask good questions, demand accountability from your teams and your people. But don’t be rude.”
  — Scott Hurst [11:07]

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Memorable Quotes

• On value disparities:

  “It's a remarkable disparity, in fact almost shameful disparity.” — Scott Hurst [03:47]

• On the reality of scaling:

  “Scale is the name of the game today. And we have to find a path to scale without sacrificing all of their independence.” — Scott Hurst [09:05]

• On leadership and AI:

  "AI plus people, AI plus specialists to make this work in the long run." — Scott Becker [11:35]

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Notable Moments & Timestamps

• What is a MEWA? — [01:50]
• IPA challenges and inequality in payments — [03:16, 04:11]
• Direct contract model for employer health costs — [05:03]
• Need for scaling and standardizing in independent practice — [07:17]
• Payer downcoding practices criticized — [08:12]
• Advice to new leaders about AI use — [10:41]

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Conclusion

Scott Hurst offers a pragmatic yet hopeful view of the independent healthcare landscape—recognizing deep-rooted challenges but highlighting innovative paths like MEWAs and collaborative contracting. He emphasizes the unglamorous realities facing small practices, the urgent need for efficiencies, and the importance of thoughtful, critical leadership in an era of technological change. This episode is a must-listen for those interested in the future of independent practice and healthcare innovation.

Transcript

[A]

This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.

[B]

This is Scott Becker with the Becker's Healthcare Podcast. I'm thrilled today to visit with Scott Hurst. And Scott's had a tremendous leadership career. He's going to talk to us a little bit today about where he's most focused today, what he's doing, and a lot more. Scott, can you take a moment and introduce yourself?

[C]

Sure. I appreciate the opportunity to rejoin you on the podcast. I was telling you, one of your colleagues that I, I'm pretty certain we did this about three years ago, but if it doesn't feel like that long ago. So. I am currently serving as CEO and president of a large IPA independent practice association in the Dallas, Texas area. We've got just short of 600 providers that trust our organization to assist them in contracting, delegated credentialing, group purchasing, value based care operations, and most recently, and one of the things I'm most proud of, the creation and development of a MEWA offering for health insurance to our practices, their members and their families.

[B]

And tell us what a MEWA offering is. I'm sure I should know, but talk to us about what that is. I've seen the term but don't really understand.

[C]

It's a relatively emerging term or I think. Well, let me me back up. I think it's been out there for a while. I don't think many people implement it in the space that we exist in. So MEWHA stands for Multiple Employer Welfare Arrangement. And there's very specific things you do. And we had to work with lawyers to check all the boxes, you know, for lack of a better term, to get granted the ability to run this through the Texas Department of Insurance. So we offer a fully insured product to all of our member offices for our members, their staff, members, family, so on, so forth. And we did that in large part because the increasing cost of health insurance I viewed as a remarkable impediment or remarkable threat to my offices. And that was three years ago when we started it. We started with just short of 50 participants and then this year coming into 26, we got almost 250 people participating on the plan.

[B]

Fantastic. And tell us about IPAs today. It seems like at one time everybody was building an ipa. Then it seems like not so much. Give us a sense of where do IPAs sit today and how is that going and what's the trends. I know in some markets bigger than others. But tell us what you're seeing with IPAs today.

[C]

I think it's a challenging time for IPAs, unless you're an IPA beer. But I think independent medicine in general is remarkably challenging. And it's largely because the payers are not recognizing the value that independent doctors can bring to the table. And probably most importantly, because employers don't realize the resources available to them to lower their cost. In the Dallas Fort Worth market, 80% of the major employers are self insured entities. And just yesterday I was talking to an individual from a large employer at an event and we were talking about the rates that my doctors get from the Bucas, you know, Blue, United, Cigna, Aetna, comparative to what the big vertically integrated systems get. And it is a remarkable disparity, in fact almost shameful disparity. Now what my doctors get comparative to vertically integrated systems and the sad reality is that money's not going to the doctors in those systems, it's just going to cost in those systems. And that cost is being transferred down to the employers and the employers are not being told what's really driving their cost increases.

[B]

Thank you. And how could that change at all? How does this change? It seems like we've got this crazy situation in healthcare that between the government, the big payers, money's moving around, but costs are going up. And then the flip side is we're not producing enough doctors and nurses. We're getting better on nurses, but it seems like on doctors, a disaster. How do we fix this? Is there any way to fix some of this?

[C]

I wish there was a single snap in the finger that can fix healthcare, but I'm afraid that's not. That wouldn't be a true statement, let's put it that way. Small steps can be taken to fix it. First and foremost. You know this conversation I had yesterday with this major employer, he suggested that we write a contract between PPN and the employer for provision of care from my network and that he would write the contract at this value and then drive his employees to see physicians in my network and take the savings from using that network comparative to using large integrated health system and share it with his employees. And I was like, that is an outstanding plan of action. But too many Employers don't sort of think through that. They don't understand that if you're, if my doctors are being paid right around Medicare, which is unfortunate, and then other doctors are being paid 190, 200, 250 of Medicare, like that cost differential is real dollars in terms of professional fees, in terms of surgical fees, in terms of labor and delivery fees, all of those things. Now it doesn't address some of the really big charges inside of hospitals. And that's not my job today. Is it something that'll have to be addressed also? Absolutely. But right now my concern is just trying to create a path by which independent medicine can survive and thrive.

[B]

Thank you. And where do you see that? It seems like not enough doctors. You know, 9% are employed by United, 9% are employed by private equity, 7%, 8% by private equity. Truly independent. Less and less. Too complex a payer situation to be truly independent. Very hard unless you're really big. Where is it going in terms of independent practitioners? And Texas is one of the last bastions of a decent amount of independent practice. What do you see?

[C]

Yeah, I had to tie up my horse before I got on the phone for today's call. But you know, I think independent medicine has a place. I do believe, and I've been very active and honest with my board of directors about this, that the days of an independent organization like PPN having 200 different approaches to rev cycle and 46 different EHRs and 5 or 10 different clearinghouses, that has to go away. Right? We have to move to where we have one unified rep cycle. We have to move to where we have no more than three or four enterprise level EHRs and probably target getting to one because then we can let people be independent. I don't want to tell them when to practice, where to practice, how to dress in their practice. I don't want to do any of those things. But what I do want to make certain is that they're being as efficient and as effective as possible. The thing that lets them do the thing they want to do, which is practice medicine. And there's way too many instances where doctors are being denied, delayed, underpaid, where they're being down coded right now. I mean we, we received documented notification from major payers that they were going to take 99214s and 215s and down code them one level automatically. That's them practicing medicine. That's not their job. And so yeah, 100 is going to have to fix that.

[B]

And talk about on the opposite side of all this, lots of challenges. What are you most focused and excited about this year?

[C]

This year, two things. One, continuing to grow the mewa. I really do think that that's a remarkable value for our members, but it's also a learning experience. You know, I've talked to dozens of practices where, you know, they, they call their broker every October and they say, hey, we need to renew our insurance. And the broker says, okay, let me get back to you in a couple days. And then the broker calls back and says, well, you know, we can keep you here, we can go here. It's going to be 10% increase. But it's tough market out there. The brokers very rarely talk about new and creative ways to approach this business. And you know, the plan that we offer our members does two things. One, it's a zero copay, zero deductible, 5250 out of pocket max plan. At the same time, it pays my doctors fairly well above what I get from the bucas. And so the, the reality is that's one thing I'm really focused on. Another thing I'm really focused on is this idea of kind of bringing my doctors together to let them understand that scale is the name of the game today. And we have to find a path to scale without sacrificing all of their independence. Because those that run out to the edge, they're being forced to move into employment because they don't have any other options right now.

[B]

No, I love your perspective on, and you're absolutely right about being forced to go into groups, into health systems, into every place else because there's no other option. So I love your perspective, and I love your perspective on the growth of multi employer welfare plans too, is fantastic. Scott, you've had this great career in healthcare. Any advice that you would give to emerging leaders.

[C]

Well, I won't imitate a lot of my doctors who tell their kids don't practice medicine. We need good people in healthcare. It's going to take good people working together to solve this. I think the biggest piece of advice I would give right now is don't assume or 100% accept the idea that AI is going to fix everything. Because unfortunately I'm already seeing too many instances where people are 100% on the train of AI, but they don't know enough about what they're asking AI to, to populate or create or design to then identify the errors. And if all we do is throw more junk on top of junk, it's gonna get real messy. So I think I would counsel new leaders. Hey, take a breath. You can take time to really evaluate this, study it, understand it, ask good questions, demand accountability from your teams and your people. But don't be rude. There are generations coming up right now through the schools because I've got kids who really aren't learning per se. They're just repopulating documents. And it's a problem that's going to catch up with us if we're not careful.

[B]

Well, it's so interesting you say that because we have a really close colleague who teaches advanced math in high school and he is saying that the rigor of the students minds is the worst he's seen in years because they're doing exactly what you're talking about. They're more repopulating, they're actually thinking with rigor. And I think that is a really fascinating perspective. And in healthcare, I could not agree with you more. It's gotta be AI plus people, AI plus specialists to make this work in the long run. I could not agree with you more. Thank you so much, Scott. I want to thank you for joining us today on the Beckons Healthcare podcast. I love getting a chance to visit with you. You've got just this most realistic view of the world and what you're seeing, you don't sugarcoat it. It's a real ple. Thank you so much for taking the time to join us today.

[C]

Hey, thank you for giving me the opportunity.