America's Most Powerful Hospitals... The Game Show

This video, presented in a "game show" format by Dr. Eric Bricker of AHealthcareZ, provides a critical overview of America's most powerful hospital systems across the 10 largest metropolitan areas. The core purpose is to equip employee benefits professionals, HR leaders, and CFOs with the knowledge necessary to understand where their healthcare spending is directed and to empower them to engage directly with healthcare providers. Dr. Bricker emphasizes that knowing these dominant hospital systems is as fundamental for employers as knowing major sports teams for a football fan, given the substantial financial outlay involved.

The video systematically goes through the top 10 largest U.S. metropolitan areas, starting with New York City and progressing to Phoenix, identifying the approximate population and the leading hospital systems within each. For instance, New York City features Northwell, Mount Sinai, New York Presbyterian, and NYU, while Los Angeles includes Kaiser, Providence, Common Spirit, and Cedar Sinai. This segment highlights the regional fragmentation and concentration of power within the hospital sector, underscoring that employers often deal with a diverse set of powerful providers across different geographies. The speaker's approach is to make this often-dry financial information engaging and memorable through the game show structure.

Beyond simply listing powerful hospital systems, the video's central thesis is a call to action for employers to bypass traditional insurance carriers and establish direct relationships with healthcare providers. Dr. Bricker argues that employers, as the ultimate payers, possess significant leverage ("the gold") and can dictate terms. He cites examples of large corporations like Disney and eBay, and even smaller employers, successfully negotiating direct contracts with major hospital systems or specialized facilities like ambulatory surgery centers (ASCs), endoscopy centers, and imaging centers. The underlying message is that the current carrier-centric system is not working efficiently, and proactive employer engagement can lead to "win-win" relationships and better deals for employees and their families.

Key Takeaways:

• Identify Major Healthcare Spenders: Employers, particularly employee benefits professionals, must be intimately familiar with the largest and most powerful hospital systems in the metropolitan areas where their employees reside, as these are the primary recipients of their healthcare spending.
• Regional Dominance: The video highlights that powerful hospital systems are highly regionalized; knowing the dominant players in one major city (e.g., New York) does not translate to another (e.g., Los Angeles), necessitating a broad understanding of the national landscape.
• Top 10 Metro Areas & Key Systems: The presentation details the major hospital systems in the 10 largest U.S. metropolitan areas, including New York City (Northwell, Mount Sinai), Los Angeles (Kaiser, Providence), Chicago (Advocate, Northwestern), Dallas-Fort Worth (Baylor Scott & White, Texas Health Resources), Houston (Memorial Hermann, Houston Methodist), Miami (Baptist, Jackson), DC-Baltimore (Inova, MedStar), Atlanta (Emory, Piedmont), Philadelphia (UPenn, Thomas Jefferson), and Phoenix (Banner, Common Spirit).
• Employer Leverage ("The Gold"): Employers hold significant financial power as the ultimate payers in the healthcare system, a position that grants them the ability to influence terms and negotiate directly with providers.
• Direct Contracting is a Best Practice: Forward-thinking employer-sponsored health plans are increasingly adopting direct contracting with hospital systems and other healthcare providers as a strategy to optimize costs and improve care quality, bypassing traditional insurance carriers.
• Precedent for Direct Deals: Examples like Disney's direct arrangement with Orlando Health, eBay's with a Salt Lake City hospital system, and a Dallas furniture retailer's local agreements demonstrate the feasibility and benefits of direct employer-provider relationships.
• Accessibility for Smaller Employers: Even smaller employers, who might not have the negotiating power for major hospital systems, can pursue direct contracts with specialized providers such as ambulatory surgery centers, endoscopy centers, and imaging centers, which are often eager to offer special deals outside of insurance networks.
• Provider Willingness for Direct Deals: Many healthcare providers, especially smaller and specialized centers, are keen to work directly with employers, as it allows them to avoid the administrative complexities and reduced reimbursements often associated with insurance carriers.
• Critique of Carrier-Centric Model: The video implicitly critiques the current system where employers rely solely on insurance carriers, suggesting that this model is "not working" and advocating for a more proactive, direct approach to healthcare purchasing.
• Actionable Advice: Build Relationships: Employers are encouraged to move beyond simply writing "blank checks" to providers via carriers and instead establish direct relationships, fostering common ground for "win-win" outcomes.