Chapter 8
Eight
AUGUST CURRENT DAY (TUESDAY)
T he eight of us are packed in the main conference room while Peter stands at the front of the room, talking through slides of the company vision and mission. It’s basically what I expected. They want to create an insurance company that only has value-based care contracts with providers. Most established health plans are slowly shifting their current fee-for-service contracts over to value-based care ones anyway. So, in some ways, it’s nice to start solely with that intention, but there are still plenty of providers that are hesitant to switch over.
The current fee-for-service payments are simple—one payment for one service, and the more services performed, the more payments they receive. Value-based care is trying to flip payment focus from quantity to quality based. These contracts can get extremely complicated and there are many different components to them, but essentially, they all, in some way, have a variable payment that’s tied to patient outcomes. For a primary care provider, that could mean managing chronic conditions so there are fewer ER visits. For a surgeon, that could mean fewer post-op complications.
It can require more management from providers, and since the payment is variable, if they don’t manage their patients well, they could end up earning less.
When I’m looking at developing our strategy for these programs, these are all pieces I have to take into consideration. And our programs get deployed by all health plans in our system; we don’t work exclusively with anyone—which is my main concern after reviewing the materials they sent ahead of time.
It’s why I start getting giddy when the financial slides pop up in Peter’s presentation. I have a lot of questions, and I don’t think they have the answers to them.
“Moving on to the financial projections,” Peter says, standing in front of the screen. He glances at Warren to make sure he’s prepared. “Are there any questions regarding the calculations sent over?”
“Yes, I have a few,” I chime in, and Warren looks up, weariness in his expression. This is his area, and as much as I don’t want to admit it, he knows how I am. I only smile though, because he should be weary. “I noticed that the only place you’re accounting for the impact we’ll have on the company is in the cost of healthcare savings. Are you planning on changing our company’s strategy away from consulting? Because I can’t help but notice that the savings projections are only a fraction of the revenue we currently generate.”
Warren clears his throat and sits up straight. “Yes, looking into the matter we found that it’s a conflict of interest for an in-house team to also consult out to other insurers.”
“Is there no way to keep it out-of-house then? So that you can still get the savings, but we can also keep our current business?” I push because this is important to me. I started working here because I truly cared and believed in what we were doing, and this feels like a fundamental shift in our core practice. “It seems like such a waste of all the expertise and the reputation we’ve built here over the years. Besides, if we do things the way you’ve modeled here, your savings projections are way too high.”
“What do you mean?” Peter asks, intently focused on every word I’m saying.
“I’m assuming you used the ten percent savings from our experience files?” I direct the question at Warren, and he nods. “Right, well we’re only able to achieve that level of savings because we have multi-payer alignment. With these programs, we’ve found that the providers are more engaged and attentive when, say, seventy percent of their members are part of a value-based care program, as opposed to if five percent are. And if they have five different sets of metrics to track from five different programs, they’ll end up only focusing on the one they believe will make them the most in return. As a result, they put more work into achieving the guidelines and striving to improve when they don’t have to change their practice for a few members. If you take away the consulting side of this business, you take away the buy-in of the physicians and the savings will not be what you’re expecting.”
Peter turns to look at Warren who’s shuffling through his papers. A smile pulls at my lips as he fidgets, searching for an answer—this part of the job never gets old for me.
“I haven’t been able to find a legal way for us to do that,” Warren says.
“Well, let’s keep looking,” Peter says to Warren, then looks at me. “Work with Miss Summers on this to make sure we’re capturing all of the nuances of the business.”
Warren nods and looks at me out of the corner of his eye. There’s not a single drop of frustration or resentment in that look, but there is something I know all too well—heat.
“Okay, moving—” Peter starts.
“Actually, I have one more question,” I cut in with a sweet smile that the men I’ve worked with in the past have learned to fear. “Assuming we’re able to find a way to make this work, that should generate enough additional revenue to keep our staff on. So the layoffs you have planned won’t be necessary, is that correct?”
Everyone in the room goes still. The people on my side look at Peter with confused and angry expressions. The people on their side look surprised and hesitant.
“Sorry if that wasn’t common knowledge,” I add, unfazed by the dead silence surrounding me. “But there’s no way that the expenses you projected here accounted for everyone we currently have on staff. Which is understandable considering the revenue projections that are here, but in the case that we keep the consulting side alive, we can’t make what we do work with only half our staff.”
“Yes”—Peter clears his throat—“that can be reevaluated after we hear your proposal.” He pulls off a good faux calmness, but I catch a slight shake in his voice that gives him away.
Clara, Serge, and Jason start grumbling amongst themselves—I’m sure they had no clue this was coming until I mentioned it. Warren is jotting down notes and Mac is looking through her materials in preparation for her part of the presentation that’s coming up. No one else sees it, but as I continue to sit tall, Peter watches me with interest, and I swear I see the corners of his mouth slowly turn up into a smile. I nod my head at him and his eyes light up as he returns the gesture.
I can tell just from the short time we’ve been in this meeting that Peter is a good boss. He listens to his employees and trusts them. He even trusted me with no reason to. I can see why Warren went to work for him; he’s everything our old bosses at Triniti weren’t.
* * *
“Damn, woman, are you gunning for my job or something?” Warren walks into my office towards the end of the day with a smile on his face. “That was brutal.”
“Did you expect me to hold back because I knew you?” He might’ve only worked with me for a little while, but even then I wasn’t afraid to be the one person with a differing opinion, or push back on what I thought was a stupid decision.
“No, I always knew that you’d grow to be a great leader, but that was something else entirely,” he says, with awe in his eyes. “You were clear and concise. You fought for your people, but you did it using logic, and you somehow tore down every counter argument we could’ve made before we could even say it. It was incredible . . . you’re incredible.”
“You’re only just realizing this?” I tease to cover the butterflies blooming in my stomach.
“Maybe I’m just now remembering what I’ve always known.” His voice is softer, more intimate, and my lungs forget how to breathe as my eyes stay locked on him. Time compresses, the size of the world shrinks, until there’s just us two and every moment we’ve shared together—real and imaginary, past, present, and future.
Someone coughs outside my office and I’m jolted back into reality. We both look around and catch Jason glaring at Warren through the open door as he passes by.
“He really doesn’t like me, does he?” Warren chuckles.
“He despises you.” I laugh and add, “He probably blames you for not being able to get a date with me, even though I’ve been turning him down since I started working here.”
I keep laughing but slowly realize Warren is silent. His jaw is tight, his lips pressed together, and his hands are gripping the seat so firmly I’m worried the armrests might snap right off.
“You okay?” I ask slowly.
He takes a few deep breaths before answering. “That hurt a lot more than I expected.”
My breathing stutters on the way in. I try to lighten the mood, but my voice comes out as a whisper. “That some douchebag guy is interested in me?”
“That you might’ve said yes,” he says, looking up at me. “If not to him, then to someone else. That you could’ve been moving on and I would’ve deserved every ounce of pain that brought me.”
I’m shaking my head before he’s even done. Tears well up but I try to keep them from spilling over because anyone could walk by at any time. “What are you trying to do to me?”
His eyebrows pull together. “I’m not trying to do anything.”
“But you are .” I barely let him finish his sentence before I start again. “ You left, Warren. You left and then you broke up with me. So you don’t get to sit here and say things that I wanted to hear six fucking years ago.”
“I know, but?—”
“No buts,” I say, trying to keep my voice at a whisper when I really want to scream at him. “I just want to know one thing. If I didn’t happen to be working here, would you have even told me you were going to be in town? Would you have tried to reach out? Because I don’t think you would’ve.”
“I—”
“Oh, there you are, Warren.” Peter appears in the doorway of my office, and I place a smile on my face. He glances between us. “Could you stop by the conference room when you’re done here?”
“We just finished up,” I say before Warren can speak. “I need to get going anyway. I’ll see you guys tomorrow.”
Peter smiles. “Have a good night, Analise.”
I just nod as my smile waivers, because with where I’m going tonight, it’s bound to be anything but a good night. “You too.”
Warren glances back before he leaves and I’m not sure if the look in his eyes is because of how our conversation went or because he could read the hesitation on my face about my night. It shouldn’t matter to me, but it’s all I can think about on the drive to the suburbs where I grew up.
I take a deep breath after I park in front of the familiar tan house before I work up the nerve to get out of the car. Even though I only come back once a year now, it doesn’t get any easier.
“Hello?” I call as I unlock the door with my spare key. I don’t even try to knock, it’d be useless.
The lights are off, but I hear noises coming from the kitchen, so I head in that direction. I flick on the lights as I move through the house until I reach the kitchen and there he is, digging through the liquor cabinet.
At least he’s off the couch. That’s a good sign, right?
“Did you bring bourbon?” he grumbles out in a slur of words.
Maybe not.
“Hi, Dad,” I sigh. “Nice to see you too.”
“Whatever, do you have bourbon or not?”
“No.”
“Useless fucking bitch,” he grumbles loud enough for me to hear, and I flinch, even after all this time. I still hope that one of these times I’ll walk through that door and find my old dad—the kind, sweet man who showed up to every volleyball game I played in growing up. Instead, he grabs a bottle of whisky and drinks it straight from the bottle. “Just like your mother.”
My teeth grind together in frustration. “You didn’t start drinking bourbon until after she died.”
“No one asked you.” His voice raises.
Why do I still come here? Why do I put myself through this each year?
My eyes shift to their wedding picture still hanging on the wall. She’s why.
“Could you not drink for one night?” I plead. “If not for me, then to honor her memory?”
It’s the five year anniversary of her passing, and I don’t think I’ve seen him sober once in that time. He stares me in the eyes as he lifts the bottle he just found to his lips and takes a long swig.
“She’d be so disappointed in who you’ve become.” I try a different route, anything that will make him put down the drink even for a minute.
His eyes flare with anger, and before I can register what’s happening, the glass cup on the counter is flying at my head. I manage to move out of its direct path, but it shatters on the wall behind me and I’m close enough that shards of glass fly toward my face. As the sound of glass stills, I press two fingers to my stinging cheek, pulling them away to find a line of blood.
“How dare you tell me what she’d feel,” he spits at me. “She fucking left us; she doesn’t get a say anymore. Fuck her and fuck you. Get out of my house.”
“Dad—”
“Get the fuck out,” he screams as he reaches for another glass.
I turn and walk out before the contents of my stomach end up on his kitchen floor, and heave in a breath when I step onto the front porch. My eyes widen when the handle on the door turns, and I run down the driveway to my car. He must be really drunk if he’s following me out here. He usually forgets about me once I’m out of sight.
I stop to catch my breath in the car, but he starts stomping down the driveway, so I put the car in drive and go. I call Ali over Bluetooth on the way home with a tight voice and one hand pressing a napkin to my cheek and ask if she can meet me at my place.
She must’ve heard the distress in my voice because she shows up with an overnight bag and immediately comes over to comfort me where I’ve been since I got home: curled up in a fetal position, sobbing, on my couch.
“What did he do to you?” she whispers as she strokes my hair. She takes the damp towel from my hand to wipe the skin around the cut and I wince.
“Threw a glass at me,” I choke out between sobs.
“Analise,” she says, voice cracking, “I don’t think it’s safe for you to go there anymore.”
“She wouldn’t want him to live like this.”
“But she wouldn’t expect you to fix it.” Ali met my mom a lot before she passed. My mom loved to meet us for lunch in the city and dotted over Ali like a second daughter. “She would tell you that you can’t help him unless he wants to help himself.”
My eyes close—she’s not the first person to tell me that. But what if he never wants to help himself? Am I supposed to just stand back and let him keep hurting himself?
Ali puts on a rom-com, and once my tears ease up, she helps me take care of the cut on my cheek then grabs us the emergency ice cream we have on hand for occasions like this.
“He blames her for leaving, and he can’t get over it,” I say once my tears have stopped and I’ve had some time to think. “He pushes everyone away because of it. Did . . .” I bite my lip, considering my words before I finish the sentence. “Did I do the same thing with Warren?”
She looks taken aback by the direction of the conversation. “You have more right to be angry than he does. Warren chose to leave, your mom didn’t have a choice.”
“But I just keep holding onto this anger,” I say. “I won’t let him explain, even though he’s tried to multiple times now. And no matter what I still feel for him, I won’t let him get close to me.”
“You have to decide if there’s any explanation he could give that would make you forgive him,” she says. “But if there’s no chance of you forgiving him, then you need to acknowledge that for yourself, and you need to tell him. Because from what I saw, he’s looking for your forgiveness.”
Could I forgive him? For leaving, for not giving any explanation, for not reaching out for six years. Is it possible to forgive that?
I already know the answer.
But the real reason I won’t hear him out is because I’m scared of how easily I’ll forgive him. How quickly I’ve already handed my heart back over to him, even if he doesn’t know it.
I’m scared of how easy it is to love him, and how much I still do.