Ep 38 | Rethinking Risk: How Employers Prepare for Cell and Gene Therapy

In this episode of the Only Healthcare Podcast, hosts Michael Navin and Randy Vogenberg are joined by Luke Prettol, benefits strategy leader at AT&T, for a deep dive into how employers are preparing for the growing impact of cell and gene therapies. The conversation focuses less on headline costs and more on the real risk employers face as utilization increases, therapies evolve, and benefit design struggles to keep pace.

Luke explains how AT&T defines success in benefits strategy, prioritizing patient outcomes while staying ahead of market trend. He walks through how large employers think about claim size, long-term value, and the growing complexity tied to treatment risk, provider selection, and fair pricing. The episode explores why rare disease therapies will no longer be one-off events, how proactive patient identification and centers of excellence can reduce risk, and why employers must plan several years ahead instead of reacting year to year.

Key Topics Discussed
• How employers define success beyond lowest cost
• Why cell and gene therapies create new risk challenges
• Treatment risk, provider risk, and financial risk explained
• Why rare diseases are becoming more common at scale
• Planning for 3–7 year benefit strategy horizons
• Proactive patient identification and care navigation
• Centers of excellence and site-of-care decisions
• Managing pricing certainty and outcome accountability
• Budget volatility, stop-loss pressure, and financial risk
• Structural challenges including ERISA erosion and data gaps

Episode Chapters & Timestamps
00:04 Welcome and episode overview
01:36 Luke Prettol background and role at AT&T
02:21 How employers define winning in benefits strategy
03:30 Claim size versus outcomes and long-term value
06:45 The three core risks employers must manage
08:30 Why cell and gene therapies change the risk equation
10:34 Rare disease growth and planning for 2030
13:19 Lessons from specialty drug adoption
15:24 Proactive patient identification and early intervention
19:50 Centers of excellence and treatment accuracy
22:03 Predictability, data, and risk reduction
23:26 ROI, retention, and member experience
26:22 The employer “triple pain” framework
32:35 Defining success and planning beyond today
36:06 Closing remarks

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Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.