EP373: How to Kick a Big Hospital Out of Your Network, With Cora Opsahl

How One Union Health Fund Cut a Major Hospital From Its Network, With Cora Opsahl. Why 32BJ Health Fund Decided a Major NYC Hospital System Wasn't Worth the Price. Episode 373.

Stacey Richter continues her conversation with Cora Opsahl, director of the 32BJ Health Fund, about the data-driven decision to remove NewYork-Presbyterian from the fund's network—and what it took operationally to actually pull it off.

WHAT YOU'LL LEARN

✅ Why 56% of 32BJ Health Fund's total spend goes to hospitals, making hospital pricing the highest-impact place to focus

✅ How the same procedure, like a CABG, can cost 10x more at one hospital than another in the same market with no quality difference

✅ Why 32BJ concluded it could not be sustainable without directly tackling hospital prices, since "you can't reduce spend by benefit design alone"

✅ Why claims of "razor-thin operating margins" don't hold up for large, consolidated health systems that received billions in COVID relief and posted record profit growth

✅ Why 32BJ repriced its claims using Medicare rates to reveal how far commercial prices had diverged

✅ What the HEAL Act is, and why 32BJ Health Fund supported it as part of asserting more control over its own benefit design

WHY THIS MATTERS

Removing a major hospital system from a network is disruptive and politically fraught, but Opsahl's account shows what it looks like when a fiduciary actually acts on what its own data reveals about price versus quality. For other employers and unions weighing whether a similar move is possible, 32BJ's experience is a rare real-world case study rather than a theoretical argument.

MENTIONED IN THIS EPISODE

EP368 with Ashleigh Gunter: Apple Podcasts | Spotify | Other Apps

EP366 with Kevin Schulman, MD: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

07:02 What motivated the decision for 32BJ to cut NewYork-Presbyterian out of their network?

09:14 How did 32BJ compare their spending at each hospital in their network?

13:01 "We cannot be sustainable as a health fund … without really tackling the challenge of hospital prices."

13:38 "It is one of the challenges as a self-funded plan that, even having this data, there's not a lot we can do with it."

16:10 What is 32BJ Health Fund's maternity program?

19:34 What is the HEAL Act, and why did 32BJ Health Fund support it?

21:39 "For us, we just don't feel it's right that anyone gets to dictate our benefit."

23:34 Why did 32BJ Health Fund reprice their claims using Medicare rates?

24:58 "It really goes to show you how high the commercial prices are in comparison to Medicare."