Relentless Health Value
Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn't a Marketplace, With Jacob Asher, MD
Relentless Health Value
•February 19, 2026•34 min
0
Relentless Health Value•Feb 19, 2026
Why It Matters
Understanding why the commercial health insurance market is effectively a non‑market reveals systemic barriers to cost control and quality improvement that affect employers, employees, and patients alike. This insight is crucial for policymakers, employers, and health‑care leaders seeking to break the status quo and foster genuine competition in a sector that impacts billions of dollars in spending.
Key Takeaways
- •Employer inertia prevents carrier market share shifts.
- •Brokers and consultants favor discounts over quality.
- •Carriers trade commercial rates for Medicare Advantage gains.
- •Uniform provider networks limit competition and pricing pressure.
- •No true marketplace exists; strategies rely on volume discounts.
Pulse Analysis
In this episode, host Stacey Richter revisits a three‑year‑old conversation with former health‑plan CMO Jacob Asher to explain why the commercial carrier market feels stagnant. The core argument is simple: there is no genuine marketplace. Employers rarely switch carriers because changing plans triggers costly administrative disruption, a phenomenon Asher and guests label "employer inertia." This inertia keeps the top three California carriers—Anthem, Blue Cross, and Kaiser—in fixed rank order, making the market appear boring despite underlying financial maneuvering.
The discussion uncovers several structural forces that cement this status quo. Benefit consultants and brokers, who wield significant influence over employer decisions, are incentivized to chase discounts rather than quality, reinforcing price‑focused negotiations. Carriers also exploit a strategic lever: they accept higher commercial rates to secure lower Medicare Advantage reimbursements, effectively shifting risk onto self‑funded employers. Meanwhile, most plans draw from a near‑identical provider pool, especially Kaiser’s integrated network, which erodes any competitive pressure on network affordability or clinical outcomes. The result is a market driven by volume discounts and negotiated leverage, not by genuine competition on value.
For business leaders, the episode signals both a warning and an opportunity. Relying on market forces alone will not drive cost containment or quality improvement; proactive strategies are required. Companies can break the inertia by demanding transparent quality metrics, exploring emerging third‑party administrators, or partnering directly with providers to bypass traditional carrier structures. As Asher notes, no employer has ever purchased a plan solely for quality, highlighting a massive untapped lever. Recognizing these dynamics equips executives to negotiate smarter contracts, reduce waste, and ultimately improve employee health outcomes in a market that, while seemingly boring, holds significant room for innovation.
Episode Description
The Non-Market Reality of Healthcare Carrier Marketplaces with Dr. Jacob Asher. In this episode of Relentlessly Seeking Value, host Stacey Richter introduces the 'No Market' series focused on the healthcare sector's lack of competitive market dynamics, which affects cost and quality.
The episode features a conversation with Dr. Jacob Asher, who has extensive experience as a Chief Medical Officer at major healthcare plans. They discuss the stagnant nature of commercial carrier marketplaces, particularly in California, and the various factors contributing to this stasis, including employer inertia, the influence of employee benefit consultants, and the strategic focus of carriers on Medicare Advantage over commercial business.
They also explore how carriers' dependence on existing provider networks and contractual negotiations based on member volumes contribute to a lack of meaningful competition. The episode highlights the challenges faced by plans attempting to innovate or differentiate on quality and the systemic issues that perpetuate the current equilibrium.
=== LINKS ===
🔗 Show Notes with all mentioned links:
https://cc-lnk.com/Take2-EP398
✉️ Enjoy this podcast? Subscribe to the free weekly newsletter:
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🫙 Support the podcast with a small donation to the Tip Jar:
https://relentlesshealthvalue.com/join-the-relentless-tribe
🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1
🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b
📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue
=== CONNECT WITH THE RHV TEAM ===
✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/
✭ Threads https://www.threads.net/@relentlesshealthvalue/
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00:00 Introduction to the episode.
00:42 The "No Market" series.
01:51 Why is the carrier market boring?
04:26 A breakdown of what follows.
05:48 Six reasons why a marketplace doesn't actually exist.
10:04 Upcoming episodes in the "No Market" series.
10:41 The conversation with Dr. Jacob Asher.
11:01 What is the competitive picture of California's health plans?
11:03 Understanding the California health plan market.
12:28 What the competitive landscape looks like to get market share in California.
12:55 Challenges in market competition.
13:14 What are micro markets and market drivers?
15:14 How brokers and consultants shape the marketplace.
15:49 Why is it difficult to take market share?
16:56 Who was Dr. Asher pitching to and why?
18:56 How is Kaiser's position in the marketplace unique?
19:29 Did employers ever buy plans for quality?
23:23 What does this look like from the payer perspective?
27:42 What improvements have there been to engagement in health plans?
29:47 Have plans gotten better at communicating with employers?
31:19 Why is it hard to compare the Kaiser world to the non-Kaiser world?
31:19 Dr. Asher's final thoughts and reflections.
33:40 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD.
Show Notes
The Non-Market Reality of Healthcare Carrier Marketplaces with Dr. Jacob Asher. In this episode of Relentlessly Seeking Value, host Stacey Richter introduces the 'No Market' series focused on the healthcare sector's lack of competitive market dynamics, which affects cost and quality.
The episode features a conversation with Dr. Jacob Asher, who has extensive experience as a Chief Medical Officer at major healthcare plans. They discuss the stagnant nature of commercial carrier marketplaces, particularly in California, and the various factors contributing to this stasis, including employer inertia, the influence of employee benefit consultants, and the strategic focus of carriers on Medicare Advantage over commercial business.
They also explore how carriers' dependence on existing provider networks and contractual negotiations based on member volumes contribute to a lack of meaningful competition. The episode highlights the challenges faced by plans attempting to innovate or differentiate on quality and the systemic issues that perpetuate the current equilibrium.
=== LINKS === 🔗 Show Notes with all mentioned links: https://cc-lnk.com/Take2-EP398
✉️ Enjoy this podcast? Subscribe to the free weekly newsletter: https://relentlesshealthvalue.com/join-the-relentless-tribe
🫙 Support the podcast with a small donation to the Tip Jar: https://relentlesshealthvalue.com/join-the-relentless-tribe
🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1
🎤 Listen on Spotify https://open.spotify.com/show/6UjgzI7bScDrWvZEk2f46b
📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue
=== CONNECT WITH THE RHV TEAM === ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/ ✭ Threads https://www.threads.net/@relentlesshealthvalue/ ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social ✭ X https://twitter.com/relentleshealth/
00:00 Introduction to the episode.
00:42 The "No Market" series.
01:51 Why is the carrier market boring?
04:26 A breakdown of what follows.
05:48 Six reasons why a marketplace doesn't actually exist.
10:04 Upcoming episodes in the "No Market" series.
10:41 The conversation with Dr. Jacob Asher.
11:01 What is the competitive picture of California's health plans?
11:03 Understanding the California health plan market.
12:28 What the competitive landscape looks like to get market share in California.
12:55 Challenges in market competition.
13:14 What are micro markets and market drivers?
15:14 How brokers and consultants shape the marketplace.
15:49 Why is it difficult to take market share?
16:56 Who was Dr. Asher pitching to and why?
18:56 How is Kaiser's position in the marketplace unique?
19:29 Did employers ever buy plans for quality?
23:23 What does this look like from the payer perspective?
27:42 What improvements have there been to engagement in health plans?
29:47 Have plans gotten better at communicating with employers?
31:19 Why is it hard to compare the Kaiser world to the non-Kaiser world?
31:19 Dr. Asher's final thoughts and reflections.
33:40 EP390 with Gloria Sachdev, PharmD, and Chris Skisak, PhD.
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