Accolade CEO: Where Glen’s Model Is Wrong; Glen Tullman: You can’t navigate a broken system

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Rajeev Singh, CEO of Accolade, and Glen Tullman, CEO of Transcarent, both agree on one thing: the healthcare system is broken.

The way they go about trying to solve the problem is where their visions diverge sharply. This was evident in a recent interview with Singh at the HLTH conference in Boston. He sees navigation in care as essential in helping to curve the cost curve of healthcare for self-insured employers by leveraging data, technology and people. Meanwhile, at the same conference, Tullman spoke with the always-chatty Jonathan Bush in a discussion of the future of healthcare and essentially described the navigation of care with derogatory terms in any industry. : the man in the middle.

But first a bit of context and background.

It’s fair to say that among the wide range of companies looking to sell their software solutions to predominantly self-insured employers and help their employees navigate the world of healthcare, Accolade stands out.

Rajeev Singh, President and CEO, Accolade

The Pennsylvania company and others targeting employers have a simple proposition: Managed care businesses and insurance companies haven’t been able to stem the ever-growing cost burden that large self-insured employers have. support to provide health care benefits to employees. With the consumerization and digitalization of healthcare, this group of beginners aims to combine technology, data and the power of human relations to not only reduce the cost curve, but also deliver exceptional clinical experience and outcomes for employees. .

Accolade went public amid the pandemic and enjoyed a successful IPO. The stock is currently trading at around $ 40, just below the 52-week high of $ 65.25. However, 10 of 11 Wall Street analysts recommend buying the stock. The navigation care company has around 400 customers, Singh said in the interview with the top four customers being Comcast, State Farm, American Airlines and Lowe’s. Accolade also made major acquisitions this year that enabled it to offer services such as second opinion and virtual primary care and mental health consultations.

The Accolade Care product integrates virtual primary care with mental health care. Accolade One is the full suite of services offered by the company where employees have access to care providers, mental health care and care navigation services, while also enjoying second opinion and support services. expert tools to help manage chronic disease.

Here’s how Singh described his vision for improving healthcare with a light dig at Teladoc, the telehealth company that bought Livongo, Tullman’s chronic disease management startup, in a mind-boggling deal from $ 18.5 billion:

You need navigation teams. They have to be fed by primary care doctors and mental health specialists who can actually deliver the care and we did that in a virtual model that says, “You go to a primary care doctor, they are going to stay with it. you through your journey. It is not transactional, like a Teladoc, for example. If you need expert consultation, it will be human. There will be a mental health professional on each of your care teams. So we’re going to be people-focused, data-driven, and measurable.

So how is Accolade paid? Singh said the company charges employers for their entire population, whether or not all employees use the care navigation benefit provided by Accolade. And this is precisely a starting point between the two men.

Tullman launched Transcarent earlier this year with the goal of entering into risk-based agreements with large employers to steer their employees to better, lower-cost care facilities. In an episode of MedCity’s Pivot podcast, Tullman didn’t call any company by name, but was broadly critical of other companies that weren’t taking risks and just charging a monthly fee per employee, regardless of employee usage. of the benefit provided. When asked about Tullman’s perspective at HLTH, Singh didn’t hold back.

I think what’s wrong with Glen’s model of only charging people who need help is that people don’t know where to go when they need help. Glen’s model is an afterthought, and this model after the fact, call me if you need me, has proven time and time again that it doesn’t improve outcomes or control healthcare costs. We charge for the entire population. Models like Glen’s say, “I’ll give you a better result on this episode of care” [but the employer is thinking] “I bought all of these services to improve my episodic care and yet my trend line is increasing” and it has been true for buyers for 25 or 30 years.

Singh added that having that relationship with employees and using data to guide them to better care at lower cost is what sets Accolade apart. He explained that when employees receive insurance ID cards from their employers, the phone numbers on the back all go to Accolade.

“When I say I’m going to take all the numbers on the back of your health insurance card, that means if you lose your ID, I’ll take that phone call,” he said. “And someone might say, you’re wasting your time, why are you taking that phone call. The insurance company should take that call. I’d say you need that ID because you’re about to to go see the doctor … “

Singh later pointed out that “a third of our costs are threatened by performance guarantees with our customers” and that Accolade has shown that it can reduce healthcare costs for employers by 4-6% over the course of time. of the first year and even more. reductions in the second and third year. The company-commissioned Aon study of six customers provides more details on those savings, he said.

After that in-depth interview, it was off to watch a live chat featuring Jonathan Bush of fame from athenahealth, now at Zus Health, and Tullman, moderated by reporter-turned-VC Christina Farr, with OMERS Ventures.

“I know Transcarent is not a navigator,” Bush said, turning to Tullman. “But to merge navigation with childbirth in a way where the doctor – wouldn’t it be nice if the doctor was your navigator?” Didn’t we all sort of assume that back then? And now there are these shipping companies, which I have invested in, so proud of them. What I see happening is not a navigation in the middle, but an establishment around the perimeter of very interesting and technology-driven care alternatives that have essentially understood how to deliver care in a business model that responds to the singularity. which will actually become cheaper and faster and more efficient every year.

Glen Tullman, CEO of Transcarent

Tullman, as expected, was less charitable towards the idea of ​​navigation in care.

“I’m not that nice to browsers because I think browsers are yet another step in this process and you can’t navigate a broken system. When we were in Livongo and [employers] would say, “We have a browser” and instead of going straight to our people, you go through the browser. OK, when we went live we would get 35% 40% of people to opt in and when we went through the browser, it was like 12%. So it was just one more step and people want it simple.

So the first thing is that you cannot navigate a broken system. If you break glass in a room, if you are in a health care facility, you would say, “I want to free up some space,” then [I] hire someone when I want to cross the room, they can remind me of the way. Most of us outside of health care would simply sweep the glass and so we have to sweep the glass.

Compared to health care providers, hospitals are not the problem, providers are not the problem. They provide care. I don’t know about you. I would not like to have heart surgery at home at this time. I prefer to go to the hospital. We need both sides of the equation. We are the health consumers and we are the real payers. It’s us and the people we work for. Then, on the other side, there are the suppliers. This is all that is needed.

Good software takes the middle. This is where the friction is. This is where the challenges are. This is where all the cost is. And that absorbs all the profits today.

The HLTH conference has been a wonderful avenue for bringing together top thought leaders and future healthcare innovators after 18 months of isolation to celebrate healthcare successes and chart a course for equity, the inclusion, lower costs and better results. [Disclaimer: MedCity News is a partner of HLTH]. But dig deeper and you will discover that behind the inevitable note of complacency at such gatherings, there are substantive debates to be had about the future of health.

Photo: HAKINMHAN, Getty Images, Accolade, Transcarent


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