EP316: Unexpectedly Talking About Employers, With David Carmouche, MD, From Ochsner, a Large Health System

In Episode 316, Stacey Richter talks with David Carmouche, MD, executive vice president of value-based care and network operations at Ochsner Health, about what a large provider organization actually wants and needs from commercial payers and self-insured employers.

WHAT YOU'LL LEARN

✅ The four things that have to come together for meaningful value-based care creation

✅ Why payer-provider-employer partnerships may be the most important collaborations for value

✅ Why health systems want to grow their commercial market share

✅ Whether competition among health systems is moving upstream

✅ Why collaboration skills are essential to any organization's transition away from fee-for-service

WHY THIS MATTERS

Dr. Carmouche flips the usual script on this show: instead of employers explaining what they need from providers, a large health system explains what it needs from commercial payers and employers to make value-based care work. His four ingredients — willingness to change, the ability to affect payment, access to data, and some control over steering patients — put employers and payers squarely at the center of provider transformation. The broader lesson applies well beyond Ochsner: no organization can transition to value without knowing how to collaborate and share the rewards with everyone else in the ecosystem.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

🔗 Healthcare Industry Acronyms and Terms

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00:00 Introduction.

04:15 Who needs to be working together to create value-based success?

04:31 "I think the most important partnerships that are likely to lead to value are those between payers or purchasers … and providers."

04:45 What four things have to come together for meaningful value?

06:02 "We're focusing specifically on payer employers today. We think that's where there's the biggest opportunity."

07:23 What's the overarching reason for health systems to want to grow their commercial market share?

14:00 Is the competition moving upstream?

16:20 "In all honesty, we're competing for pieces of the business."

16:23 What's the ultimate competition?

18:36 "There is a consumer experience that is available inside these … collaborative efforts."

20:53 "We really haven't changed the paradigm of benefit design as it comes to drugs."