Episode 100

Bridging the Payer-Provider Gap

with Steve Glass

February 16, 2023

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Steve Glass
CEO, Medical Mutual

Steve Glass is CEO of Medical Mutual and a member of the company’s board of directors. An experienced healthcare executive, Steve joined the Cleveland Clinic in 2002 and was named the organization’s CFO in 2005. In that role, he was responsible for the overall financial operations of the Cleveland Clinic and its subsidiaries worldwide. Mr. Glass earned a Bachelor of Science degree in Accounting from Towson University in Maryland and is a Certified Public Accountant. He is on the board of directors for the Greater Cleveland Partnership, as well as a member of the American Institute of Certified Accountants, Ohio Society of Certified Public Accountants and Healthcare Financial Management Association.


Episode Highlights


Key Insights:

Steve Glass believes that providers and payers can work together to minimize friction in healthcare.

  • The CEO Role. Stakeholders inside and outside of the company look to the CEO to be the voice of the organization, and establishing trust is key.
  • Managing Risk. Insurers understand the benefit of moving to value-based care, but it’s important to monitor and manage financial risk as health systems move in that direction.
  • A Capitalist Society. Steve remarks, “If somebody’s coming into your market, it’s because they see an opportunity.” Providers and Payers need to innovate to meet the challenge.

This episode was made possible by our partnership with Citi.

Relevant Links:

As we start to talk about where we want to go, what we want to do, let's be really clear about where we are today and how we're performing product by product today.



Dr. Gary Bisbee: Good afternoon, Steve, and welcome.

Steve Glass: Thanks Gary. It’s great to see you. Thanks for having me.

Dr. Gary Bisbee: First off, congratulations on your appointment as president and CEO of Medical Mutual. That’s exciting stuff.

Steve Glass: It is. Thanks. It wasn’t something a year ago I was anticipating. But I’m really excited to be in the role here of working with the team.

Dr. Gary Bisbee: You were a highly successful CFO at the Cleveland Clinic, a key executive there. So what was the backstory on for the all, for those of us on the outside saying, wow, this is a surprise. Steve went from health systems to health insurers. What was that backstory, Steve?

Steve Glass: I think I surprised a lot of people. I think most people that were around me expected me to retire at the clinic. And as Gary, I worked through Dr. Fred Lu is the c e o, Toby is the ceo, e o and now Tommy. And that last Tommy and I were have a great friendship and great relationship. It wasn’t something I was looking to move on from the clinic. But I did know quite a few of the board members at Medical Mutual and but a little bit more than a year ago, the CEO O here at l Steve was gonna retire. I didn’t think anything of it. Actually did get a call from the recruiter and my initial response was, Hey, I’m not looking to move on. But then the board members started calling me that I know. And as I started to think about it, it was an opportunity for me after 20 years at the clinic to really dig in and do something different and stay here in, in Ohio as well, which my kids are all in that high school age. So that was important as well. So I started to get really excited. Gary. Learning something new, and a as we continue to age in our careers I think we, many of us just want to continue to grow and continue to learn. And it was one of the things I really learned a lot from Toby Cosgrove. An individual who worked almost 80 years old and Toby looked at every day as an opportunity to learn. I want to continue to do that as well. So I looked at this as a great opportunity to step into a different industry or a different part of the military. And continue to learn and grow.

Dr. Gary Bisbee: You had some great c e O role models as you’re pointing out at the Cleveland Clinic for sure. What kind of reaction did you get from your CFO colleagues?

Steve Glass: Yeah, I think it was surprise. Most of them were just, as I said, Hey Steve, we expected you would be there until you retire. So I think that was the biggest surprise many of them. Why did you decide to go over to the dark side? Is they often. referred to it as well very similar surprise.

Dr. Gary Bisbee: Could you describe Medical Mutual for us please?

Steve Glass: Yeah, absolutely. Just as it says in the name, this is a mutual company, so it is a for-profit, but it’s not a shareholder company. And as I’ve come into the organization, I’ve realized this is as probably as close as a for-profit could get to a not-for-profit company. and given that it’s a mutual company, it has the same mission perspective that many or all of the healthcare organizations I’ve worked with over the last 34 have had. It’s largely regional with most of its business up here in the Midwest, but we do operate out of 40 states across the.

Dr. Gary Bisbee: Let’s go to just your role as the CEO and how that might be different than the role that you’ve had as C F O for many years. What differences have you noticed now that you’ve been CEO e for almost a year?

Steve Glass: I think the biggest thing I noticed, and this is something that is Dr. Maich took over at the Cleveland Clinic. He kept saying over and over again is The role as the ceo, the communication is you are the primary voice of the company. And even as the CFO at the clinic for well over a decade, I was constantly talking with internal and external stakeholders. But you’re doing it as the cfo, F o not as the individual in charge of the company. So I think that’s the biggest difference that I’ve noticed is both internally and externally people look at you as that one voice in the organization that they’re looking. Get a pulse off of and try to figure out are you an individual they’re willing to follow?

Dr. Gary Bisbee: There’s a lot of stories about following one CEO, following a predecessor who’d been in his job for a long time. Your predecessor was there, I believe, for more than 20 years. How did you prepare for that, Steve?

Steve Glass: Yeah. Rick was here probably a little over 30 years with 13 years of that as the c e o of the company. And this is something I did talk to the board about as I was interviewing the role. I’ve known Rick for quite a few years as well and realized Rick and I probably had different styles in managing the company and I think a lot of the conversation came back to what you often see in companies is different leaders for different times than the company as well. And when Rick took over as the c e o of the company, He had some significant financial challenges of trying to keep the company afloat. They were going through a difficult time period, and you may not know this Gary, but he jumped into a crisis because that his predecessor was actually killed in a plane crash. Brett, Rick Quinn from c f o to c e o in just a few days, and the organization so he was dealing with a lot of financial challenges. Rick’s put the organization on a very stable financial. So I come into it with a different approach where I’m trying to figure out how to grow the company. I don’t have to worry about the crisis that Rick had as the CEO here of trying to make sure financially they can continue. I have the luxury of a strong balance sheet and being able to figure out how do we continue to grow the company.

Dr. Gary Bisbee: You know as much about healthcare as anybody. You are more familiar with the provider side than the insurance side. When you come into a new position like this as a CEO, and it’s in a bit of a adjacent industry, I guess you could say. How do you think about setting priorities, Steve? What’s the timing like and how do you think about collecting the information to set the prior.

Steve Glass: The first thing I did is probably. Think a lot of CEOs do. Gary is go on listening tours, really start to get around the organization, listen and working at the clinic. We had a model of roundy. For everybody in the organization. You are constantly getting arou. And I’ve continued that here at Medical Mutual internally, but also getting out and talking to our customers and our partners that are out there and really trying to listen to what do they think Medical Mutual needs to do. The second thing I did was within probably a month of getting here I started talking to the team about how do we do a current assessment on where we. , how do we do a product by product, current state on where we are and how do we do a technology assessment on where we are? So to me, this is really, as we start to talk about where we want to go, what we want to do. Let’s be really clear about where we are today and how we’re performing product byproduct today.

Dr. Gary Bisbee: Longstanding executive in healthcare know as much about health insurance as anybody on a provider’s side, and probably more than most people, but what have you learned since you’ve been in Medical Mutual that maybe you weren’t aware of as a CFO on a provider’s side? Or maybe what surprised.

Steve Glass: A actually it’s probably less about the actual insurance business and. More about the differences in the specific industries. You know what I miss more than anything, Gary, and you’re very familiar with this because you played a big role in this across healthcare is I missed the luxury of the networks and the forums that we had on the not-for-profit side. Picking up the phone and calling your peers and so many of those peers, even when you’re competitors, your partner. and you could pick up the phone and, you could call Dennis Daylin at m Mayo and he would be more than happy to say, Hey, here’s how I’ve dealt with that experience. As I’ve come to the insurance cut side, that network doesn’t really exist, or at least I haven’t found it yet. That’s probably the biggest thing that I’ve realized. And I’ve called other executives and said, Hey, Am I missing something? And they do have, AIP meetings the American health plan insurance program. They do have those types of associations, but it’s not the network that we had on the not-for-profit healthcare side.

Dr. Gary Bisbee: Why do you think that is? Steve?

Steve Glass: My guess is it’s the competition. Guess is so many of these guys are competing in markets. . And as in healthcare, while we may be competitors it’s still a lot of it is still local. So even as I think about those national competitors for the clinic that still represent a smaller part of our business.

Dr. Gary Bisbee: how does the insurance industry look at value compare to fee for service, would you say?

Steve Glass: Yeah I think I think in the insurance business, a lot of that value is looking for how do you manage the cost side of that? I think that becomes the rub between many of the providers that are out there. Part of the challenge, at least here at mmo, we’re very interested in expanding value-based agreements that we have with the providers. The challenge is, how those providers are prepared to manage the risk associated with that. And, Gary’s sitting in a place like the clinic with a lot of clinic. Involved in the management. Many of them say, Hey, Yolo, let’s go into value-based care, because they just think it’s the upside of that. And they don’t always realize that in managing that value-based care, you have to manage the downside risk of that as well. And I think that’s one of the things as we’re working here, how do we help our provider archers figure out how to manage in those types of environments that it’s, you have. there’s a lot of advantages to moving towards, paying for outcomes. It’s how do you manage the risk that comes along with that? And it’s, the financial risk comes along with that. And I think we all recognize this is a direction we have to shift into. We’ve gotta shift to models where we focus on paying for more that, or for outcomes than just for access.

Dr. Gary Bisbee: It seems as costs have become a bigger and bigger factor in healthcare, the friction between the health insurers and the providers has grown as well. How do you view that and is there a way out of that, Steve? Is there a way that we can somehow minimize that friction?

Steve Glass: Yeah, no, you’re absolutely right. And it was actually one of the reasons I didn’t decide to make this move, Gary, was I was always frustrated on the provider side with the friction between the two organizations. So coming over here, And being able to partner with many of my, former peers on the provider side in trying to figure out how we can manage some of that friction and particularly the administrative friction that exists. I’ve actually had a big project between Medical Mutual, my former employer, of tackling that exact task. And what I’ve recognized is so often we actually talk different languages about the same. The clinic would look at, this is what that friction is called. MMO would call it something different. But what I found is by getting those teams in the room together what happens is these people start to realize that they’re both trying to accomplish the same thing. And we’ve had great success over the last probably six. I’ve really tried to focus on improving that. Payers and providers have always been a little cautious about sharing information between one another, concerned about what’s gonna happen with that. I look at this as a way to start to build a deeper trust so that you could figure out what is the right information we can share to you have the right impact on the outcome of our patients. And step started some of those conversations with some providers as.

Dr. Gary Bisbee: On a bit of a more general or strategic question here, and that is that as baby boomers grow, as chronic disease continues to grow due to the baby boomers, as the federal dollars coming into the system through Medicare and other programs increases. , what do you see as the pressure on health systems and health? Sure. Health insurers. You could see on one hand point you were making, since everybody’s got that same issue, that might help draw insurers and providers together, or it just could be continued. Contention. What do you think about that, Steve?

Steve Glass: I think Gary, our ability to effectively serve the people. That we want to serve is gonna require us to, try to work a little bit closer together. There’s not gonna be enough money no matter how we look at this going forward. And this isn’t just, when you talked about Medicare federal funds for Medicare and Medicaid, we have redeterminations coming in this spring around Medicaid. Everybody’s wondering about how that’s gonna impact Medicaid enrollment to ACA enrollment to maybe unins. But this isn’t just a US problem either. I There was an article on the weekend about Perry Trudeau, trying to deal with the significant challenges they have in the Canadian system. Having spent the last several years at the clinic building the health system in UK on the private side, learned a lot about the challenges on the NHS side and what they’re trying to deal with as well. So I think this challenge of dealing with the growing cost of he. , it does have a lot to do with, the aging of the population the growth and chronic disease that we have, but also with the advances in healthcare. And there’s so many things that we treat today that we couldn’t treat before. So all of this comes back to, how do you have enough in order to really pay for all of this? I’ve actually had a couple of interesting conversations with some provider. That have talked about that exact thing of saying, Hey, we wanna figure out how we can better manage the outpatient utilization because they realize there needs to be more effective management there to help them manage the cost of when people do end up in an acute care set.

Dr. Gary Bisbee: Another trend is what do you think about the big cap companies, CVS, Walgreens and Walmart, Amazon, so on, elbowing their way into primary care. How do you think that’s going to affect health systems and how do you think that’s gonna affect health insurers? Steve?

Steve Glass: Yeah. Those conversations, when I was on the provider side, a lot of the concern was uh, disintermediation, right? I. The concern was somebody else getting in between, what is traditionally your patient and your relationship with your patient. However, this is, it’s a capitalist society. So we’ve got these companies are finding opportunities, they’re finding inefficiencies in the marketplace and they’re trying to address those inefficiencies, these private equity companies and for-profit companies. Typical. Don’t look to put their money in a place unless they see inefficiencies in that marketplace. So I think from one perspective it is an opportunity for providers to look at that same space and say, look, we have to innovate in that space. We have to think about how we do that. And I think it’s the same thing with the insurers in the marketplace as well. I think you have to look at that and say, if somebody’s coming into that piece of your market, , it’s because they see an opportunity, they’re looking to innovate in that space. And I think that is actually the beauty of, a capitalist society, that it brings that kind of innovation with it. I look at it from a perspective of that just means we have to step up and figure out how to compete. I do know, understand the worry of the disintermediate. The provider side of that, the segmenting of the healthcare component. There’s a lot of strong feelings about the inefficiency that can be created by that. But I think we have to address that and figure out if you want to keep that population together and manage it, from, a burst to the grave, you gotta figure out how to be as efficient as you can in each one of those.

Dr. Gary Bisbee: Yep. Steve, what do you think about consolidation? Of course, we’ve seen consolidation on the health insurance side. We’ve seen it on the health system side. Will that continue, do you think? What’s been driving that and will that continue?

Steve Glass: It’s an interesting conversation, and particularly given the fact that consolidation between the insurers payers looks very different. I know there’s a lot of criticism of consolidation on the provider side. . But I always find it interesting that, Gary, what is HCA a’s national market share? 3% maybe. And they’re one of the deep biggest, if not one of the biggest healthcare providers. But then you compare that to UnitedHealthcare, what is UnitedHealthcare at 15% market share. Big looks very different between where you’re a provider and where you’re a payer. I think on the provider side with these economic challenges we’re talking about in a number. Hospitals that are really strained by the significant increase in cost over the last several years. You would likely assume that’s gonna drive to more consolidation. However, it’ll probably also create the problem of more of the haves and the have nots, right? Because, the systems that are looking to grow are properly gonna merge with systems that are doing okay and not take on those that are more stressed in that situation. So that could create some challenges from that perspective where, community hospitals maybe continue to struggle because they can’t find those partners with them as well. I think on the insurance side, it at least the focus seems to be more of adding capabilities, that they can deliver rudder obviously. In a recent announcement about Edna cvs Edna acquiring Oak Street is just another one of those examples, right? And we’ve seen this from Optum getting into the provider space, and I think they’re trying to broaden their capabilities. There’s diversification in there and I think we’ve seen this from some of the large health systems of starting to look at how did they more diversify their revenue model.

Dr. Gary Bisbee: Yeah, you’re right about all of that. Steve, there’s another question. There’s a lot of discussion during Covid about how the kind of expense side and disruption side hit the. Provider side more than the health insurance side. And that would, that, those discussions could be pretty impassioned, but how do you view that from your current chair?

Steve Glass: Absolutely. Have I got, have had the advantage of seeing it from both church, right? The last, you previous two and a half years of covid at the clinic and seeing the significant challenge of not having enough resources many of our hospitals being over, not overwhelmed, but getting close to that point. With a number of covid based patients. And on the health insurance side, as I’ve come in here, you’ve definitely seen that. Is that an impact on claims, but slowing those claims down? To your point, as a result of that, now different insurance companies I think handled that differently. I know here they were working on how did they help give some of that money back? And they actually had four grants where they said, Hey, we’re gonna do the right. And actually partner back with either the providers or the customers, some of that as well. But it’s also identified I think we saw this with some of the healthcare providers that had health plans. That health plan became a way of balancing that now. But as we also know, many of these health system provider plans haven’t been at SU as successful. So that maybe hasn’t created as much of a mitigation as some of those that have been in the industry 10 to 15 years. So it’s definitely created an imbalance on that side of it. And it’ll be interesting to see how that continues to play out.

Dr. Gary Bisbee: Steve, this has been a great interview as we fully expected it would be. We appreciate your time. I have one last question. If I. For those among our audience who are up and coming leaders and I’m not being specific to providers or health insurers, just up and coming leaders, what advice would you have for them?

Steve Glass: Gary as certainly as I’ve stepped into this leadership role as a ceo. I’ve recognized that in leading teams, the importance of the soft skills is more needed today than it ever has been. So I think if I were in front of groups of young, up and coming leaders, we all have to have the technical expertise in order to do the jobs that we’re gonna take on in the future. But I think in today’s environment, the soft skills are far more important than the, were just five years. And I think focusing on how you continue to develop those soft skills, and I think many of those skills come with time. They’re not something you can just read a book in, in, three months develop. You have to practice those skills. So I would strongly encourage people to focus on the development of those soft skills.

Dr. Gary Bisbee: Steve, I love this interview. Thanks so much for being with us and hopefully you’ll let us come back a year from now and I think things will be different in in healthcare and in let us interview you again. Well

Steve Glass: I’d look forward to that conversation. Gary, it’s been great seeing you again.

Dr. Gary Bisbee: Thanks Steve.

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