Payers Trying to Differentiate Themselves by Working With Provider Organizations … or Not, With Jacob Asher, MD—Summer Shorts 5

It's hard for a payer to differentiate on cost or quality when it and all of its competitors are using the exact same PPO network. In this Summer Short, Stacey Richter talks with Jacob Asher, MD — a former ENT surgeon with Kaiser Permanente who spent 2008 to 2022 as a California commercial market medical director for Anthem Blue Cross, Cigna, and UnitedHealthcare — about why payers struggle to get providers to do anything special for their specific members, and why the "Dear Doctor" letters payers send to try to change that so often end up straight in the recycle bin.

WHAT YOU'LL LEARN

✅ Why providers contracted with multiple health plans have no real financial incentive to treat one payer's members any differently than another's

✅ Why standards of care between different payer policies rarely translate into actual differentiators in clinical practice

✅ Why the financial incentives providers face often don't reward standardizing or improving care in the ways payers want

✅ What kind of progress, if any, payers have made in getting providers more aware of the benefits available to their members

✅ Why providers are reluctant to hand off population health management to payers, even when it might make things easier

WHY THIS MATTERS

Payers keep trying to differentiate themselves through provider collaboration, but from the provider side of the desk, that collaboration usually looks like one more unopened letter in a stack of dozens from competing plans. Real differentiation, per Jacob Asher, would take genuine financial alignment and executional follow-through, not just clever messaging. Until that alignment exists, providers have little reason to treat any one payer's members differently, and patients keep experiencing the same fragmented care regardless of which plan is footing the bill.

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

✉️ Enjoy this podcast? Subscribe to the free weekly newsletter

🫙 Support the podcast with a small donation to the Tip Jar

🎤 Listen on Apple Podcasts

🎤 Listen on Spotify

📺 Subscribe to our YouTube channel

=== CONNECT WITH THE RHV TEAM ===

✭ LinkedIn ✭ Threads ✭ Bluesky ✭ X

00:00 Introduction

03:38 Why providers contracted with multiple health plans don't have a financial incentive to do something unique with one payer over another.

04:01 Why it doesn't make sense for providers to offer unique pathways for different payer organizations.

05:23 Why, broadly speaking, standards of care between payer policies aren't really differentiators in clinical practice.

06:47 Why financial incentives might not be aligned to make providers want to standardize their care.

09:16 What improvement has there been in plans making providers more aware of the benefits they offer?

11:47 Why won't providers off-load their pop health?