In this episode of After the Chaos, Kandice and Angela discuss their conversation with Blair Childs, focusing on the macro and micro levels of healthcare, the implications of the Big Beautiful Bill, rural healthcare funding, and the challenges and opportunities presented by recent policy changes. They emphasize the importance of understanding the details of healthcare reforms and the need for proactive engagement from healthcare professionals to navigate the evolving landscape effectively.
Listen to the full length episode featuring Blair Childs and his take on the healthcare policy shifts that every leader needs to understand and action.
Full Transcript
AI-generated transcript. Accuracy may vary; please excuse any transcription errors.
Kandice Garcia, RN
Hi and welcome to After the Chaos. Angela and I just got done with our conversation with Blair Childs and ⁓ my gosh, I feel like I am seeing things for the first time. ⁓ I think we talked about this with David. It’s like the fish swimming through the ocean. Somebody’s like, how’s the water? And they walk by and they’re like, what’s water? I feel like finally I’m like, my gosh. ⁓ that’s what’s happening. my gosh. It just, he connected so many dots for me. I don’t know about you, Angela, but.
What a gift he is.
Angela Adams, RN
He really is. I think one thing that I’ve loved about him just for years and years now, like he has this macro and micro level view that I feel like we all crave it, but none of us get it, right? We would have to sit the hundreds and hundreds of hours in Washington, DC to like make our own bipartisan decisions. And that’s what I love about him is.
when he gives a presentation, like I’ve seen so many of his presentations, but he summarizes like, here’s everything that is happening in Washington in like an hour and a half presentation. But he does it in a way that there’s no politics to it. It’s like, if we go this way, here’s what it means. If we go this way, here’s what it means. Here’s where each camp is and here’s where each camp sits. And it’s so interesting when you listen to his presentations, because his are less about politics and more about like movement of the macro.
Kandice
Yeah.
Angela
like economics of healthcare. So when he broke down like, here’s our top three, like movement to value-based care, movement between a, you know, government owned to a privatized commercialized marketplace, fixing perverse incentives, whether, you know, he didn’t say it, but like there’s been some, yeah, there’s been some abuse of some of the incentives that definitely were checking.
Kandice
Yeah.
Angela
Consumerism, we’ve heard this over and over again, Candace, especially in our world, consumerism coming to the surface. So I think those macro level, like that’s what everybody kind of needs to understand. But what he’s saying is, man, if you don’t get into the details right now, you’re gonna be behind.
Kandice
Yeah.
Yeah, yeah, absolutely. And he kind of mentioned this data information transparency. I think that really speaks to the technology integration that we have been talking about kind of at the frontline level where we’re selecting technology and we’re trying to measure our performance and we’re trying to measure like the operations of our systems. If you don’t understand the context of those measurements to say,
hey, value-based care or like what is value and what is access? And if you don’t kind of dig down ⁓ and really understand those at the macro level, the micro level decisions on how those things are done, how they’re measured, how they’re communicated could be completely out of context and really ⁓ preventing you from actually doing what you want to do. So that massive telescope of macro to micro of what is the graph, what is the number is
I mean, that pathway is so critical to understand. I don’t know if I’ve really thought of it at that detailed a level before. ⁓ Super insightful.
Angela
Yeah, and I’m not sure about you, but like
I’ve heard a lot of like fear over the rural healthcare system. So we asked that question. Did you know that $50 billion were basically funded and it’s the state’s like basically right and decision-making power right now to kind of transform rural medicine in their state. I don’t know about you, but I haven’t heard much about it from my state. And I feel like, wow, we…
We need to understand this. Like how is this going to impact each and every one of our states? That’s something that I don’t think is being talked about.
Kandice
Yeah, and there’s going to be a lot of disparities across states and a lot of different approaches and a lot of different models that people are going to be using, which kind of brings us back to the voting opportunities that we have voting for our constituents to say, these are the ones who are going to be making decisions on the models. Let’s think about that. But to Blair’s point is, I don’t think there’s enough people thinking about that at a deep enough level to really kind of get on this as it starts to roll out.
Angela
Agreed. A couple of things he didn’t get to, which I thought were interesting points to like bring up here. These were like in notes that he had sent our CEO advisory group. ⁓ One was physician pay. The bill provided a two and a half percent increase for Medicare provider payments in 2026 only. So like that’s that’s kind of like for the providers on that are listening to us, like that’s good. There’s been nothing but cuts that have led up until this point.
⁓ Health savings account, the bill restored health savings accounts or HSAs provisions included in the House reconciliation bill, which I think was important. There was a big one too that we didn’t get to that I really wanted to the supplemental nutrition support program or SNAP. ⁓ States are required to chip in now for SNAP beginning in fiscal year 2028. So it will become a state responsibility. ⁓
if they have a payment error of greater or equal to 6%, which they’re holding them to those metrics, which I think is good, right? States will pay between 5 % and 15 % depending on the error rate. So to your point, we’re no longer gonna be willy nilly on like, oh, well, we have a 25%, 30 % error rate and we think that the government should just kind of help pay for that. It’s gonna be very much like, no.
Kandice
Okay.
Angela
If you have a error rate over this amount, you’re not accurately running your program. So there’s going to be like incentives there. And then I think he got to most of the other things. Like he didn’t talk much about provider taxes, but that’s another big part of the bill freezing existing provider taxes at current rates. ⁓ But yeah, he he’s got such a good view. For those of you who are listeners, like we’re going to post this with his
email and things for you to be able to get in touch with Blair, but for executive teams that really want that macro and micro and like, what do we need to be doing for our teams? If you feel like you don’t have a resource, Blair is amazing for executive teams.
Kandice
Yeah.
Yeah.
Yeah, you you were saying I don’t have a book, read the bill. And I was just thinking, oh my gosh, I need a bill club. need to like, I want to like sit down with people and be like, what do we think this means? You know, it is so hard to, I can see where the fear mongering can come from, right? Like these people in politics. Yeah, you don’t want to go through it line by line with me. I mean, you were going to be my first invite. It wasn’t like, let’s read this. Let’s, let’s understand.
Angela
Nothing sounds more painful to me than-
So I’m just like,
yeah, to be me, can you summarize the big, beautiful villain?
Kandice
You know, let’s get some coffee. Let’s get some snacks. ⁓ But you know, there is so much fear out there. It’s easy to see that like, hey, we’re going to make, you know, I’m in change. Change is hard. Change is super scary because where we are today, we know it isn’t working. It is absolutely a disaster. We call it chaos, but like it’s not working. The models, the payments, the roles, you know, how things are managed, you know, now we’re going to be making this these big shifts. And like that is also super scary because
Is it gonna be good? Is it gonna be better? Can we trust our states? know, clearly the federal government wasn’t doing a great job. Now we’re gonna kind of put that power into the states and is that going to be better? I don’t know. People are really scared that it’s not going to be. And I think those are real, real fears. And I think that when we look at the context of the world around us, we can do a lot from these operational levels, from these executive levels in each healthcare organization.
to understand, interpret, and take advantage of the new model in a way that really serves our patients and our staff. But it comes from deep understanding. Like we said, no problem can be solved without deep, deep understanding, and that’s where we all need to start.
Angela
Yeah, I think you’re exactly right. I’ve said this for a long time. I feel like in the health system, we’re really good at being like, I am mad about what’s happening to me. And it’s like, well, then let’s take back that control, the controls now being given across the states. And if you’re a large health system, you have a lot of ability to impact what happens at that state level. Now, it doesn’t feel so far away. And it’s like, are you doing it?
Like don’t complain next year when you haven’t done your duty and gotten into the details and like really defined this for your state. Don’t complain next year about all of the bad things that are being done to you. Like now is our shot and I feel like everybody needs to step up and take it.
Kandice
Transition is hard. Transition is so hard. But with every transition, with every change comes real opportunity. And we can do better. We’ve been trying to do better. And if we allow this shift to redesign the way that we interact with each other, our patients and our staff, I mean, we could end up in a much better place for everyone.
Angela
So.
Yeah, the last time he spoke, think it was maybe in the spring. was before Big Beautiful Bill was definitely on the table, but nothing was decided quite yet. And when you asked that book question, I literally thought he was going to say there’s like a Trump biography that he recommended because he’s like, you need to understand where this man is coming from. He’s coming from a business mindset and everything that he does.
is from this mindset. And so he actually recommended this book last time. That was like a biography of Trump. And I can’t remember what the name of it was right now. But essentially he was like, if you want to truly understand what’s going on in Washington, read this book because it’s going to help you understand how this man thinks. And I think that there’s like an important aspect to that, you know, like know who you’re dealing with and know why they’re making these decisions. I think it’s going to take us a long time to look back at this administration.
pick through the chaotic pieces that maybe some were manufactured to be that way and be like, what truly just happened there? So, but at least in the big, beautiful bill and what we have represented at the state level, I think there’s a lot of opportunity, like you said.
Kandice
Yeah.
Hmm, can we take advantage of it? Can we do it?
Angela
Yeah, this.
right. Thank you guys for joining us and tune in for our next episode.
