The concept of “centers of excellence” has been around for a few decades. Surely sending health plan members and self-insured employers’ employees to the best and most effective providers should improve health outcomes and save payers’ money? Sach Jain is CEO of Carrum which has been working on this problem, partnering with the best providers and aggregating that demand from employers…and putting it all on a state of the art platform. As you might suspect, it’s not as easy as it looks. Carrum raised $45m from Omers Ventures a few weeks back, on top of a decent raise from Tiger Global a couple of years back. So are they getting it right? Sach told Matthew Holt that they are for sure on their way….
Our Healthcare System Needs More Than Policy Overhaul: It’s Time for Private Sector Innovation to Kick into High Gear for Our Health’s Sake
By SACH JAIN
Last year I was heading to a meeting on a Fortune 500 business campus and stumbled upon a bake sale. It was odd to see someone selling cupcakes and breads on the grounds of a major corporation, so I inquired. As it turns out, Judy, an employee, was selling baked goods to finance her insurance deductible for spinal fusion surgery.
“Is this what our system has come to?” I asked myself, “Fundraisers for fusions?” If so, our health system is broken.
No matter how you slice it, Americans spend more on healthcare than any other advanced economy, with households responsible for 28% of that spend according to CMS. The Affordable Care Act (ACA) attempted to address long-standing deficiencies inherent in our fractured healthcare system. However, creating an insurance marketplace hasn’t solved the problem of affordability or the reality of limited access to quality providers. The concept is great, but without private sector buy-in it will never succeed.
President Biden is taking long-overdue steps to address some of the ACA’s shortcomings with Executive Orders. During his campaign, he suggested other actions, like capping marketplace premiums at 8.5% for all income levels with the goal of spurring enrollment and strengthening the ACA with an affordable public option. The recently passed $1.9 trillion stimulus package also incorporates an increase in government subsidies to health insurers for covering workers laid off due to COVID-19 and those purchasing their own coverage.
This is a start. But it’s not enough. We can’t afford to waste time waiting for policymakers to negotiate rules that may be overturned when a party majority flips.
Continue reading…Local Doctors Get the “Centers of Excellence” Treatment: Embold Health’s CEO on Data-Driven Quality
By JESSICA DaMASSA, WTF HEALTH
Apparently, self-insured employers hot on better managing their healthcare spend are finding truth (and dollars) in Embold Health’s mantra that “quality is the best, most sustainable way to control costs.” This health tech startup is applying the old “Centers of Excellence” framework to the individual physician level; helping identify high-performing primary care docs and specialists in local markets for employers who not only want to offer their employees better quality care, but also improve the healthcare system in the communities in which they live and work.
Daniel Stein, Embold Health’s co-Founder & CEO, explains the company’s model, which is being perfected with one of the most demanding-yet-coveted “health activist” employers out there: Walmart. In this particular case, Walmart is actually incentivizing its employees to go to the providers ranked highest by Embold’s assessment, which looks at physician performance along three categories: 1) appropriateness of care; 2) outcomes; and 3) cost-effective compared to peers in-market. Backed by the robust national BlueCross BlueShield dataset, the information Embold Health is collecting, analyzing, and doling out to employers can definitely cause some health systems to take pause — and their docs to bristle. So, how does Embold Health diffuse potential blowback? Here’s where the competitive nature of local healthcare, particularly in the world of primary care, becomes clutch. Tune in to hear the details, including some very interesting stats, as well as Embold’s latest endeavors to help docs make better referrals to specialists.
