Transcarent, Changing the Way Employers Experience Healthcare

March 22, 2021

 – Episode #

56

Are you happy with your employers healthcare experience?

I’m not. I’ve never really been happy with it. I experience every silo, every failed handoff, every clunky technology tool that has been conceived in a vacuum. and… My cost goes up every year.

When people talk about broken healthcare, this is what they are talking about. This has to be solved across the Payer, Provider and PBM. It can’t be solved in any one silo.

The employer tries to solve it by knitting together a set of negotiated services with ever more sophisticated partners. But in the end their costs keep rising and the benefits meeting with the employees gets more contentious each year.

In steps the latest digital health startup, TranscarentGlen Tullman and team are back to change the self insured employers experience with healthcare.

They know healthcare, have a proven track record and have the funding.  In today’s episode we explore their model.

Hope you enjoy.

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Today in Health IT – The story is Transcarent, Glen Tullman and team are back to change the self insured employers experience with healthcare.
My name is Bill Russell, I’m a former CIO for a 16 hospital system and creator of This Week in Health IT a channel dedicated to keeping Health IT staff current and engaged.
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Here’s today’s story…
Transcarent is looking to transform the self insured employers experience with healthcare by empowering the employee and creating alignment with a new revenue model.
This comes from a host of different sources that have covered this. Just search for Transcarent.
Glen Tullman, coming off the Livongo success of changing the way Type 1 diabetes care is delivered, successful IPO and subsequent acquisition by Teledoc and formerly with Allscripts has taken on the founder and CEO role at Transcarent and this one is interesting.
You have to look at it as a whole to really see why this is different. Is it providing information to the healthcare consumer. Yes, it looks a little like castlight. Is it helping you navigate care, yes it is a little like Grand Rounds and Dr. on Demand merger objectives in terms of care coordination. But it is so much more than that because it closes the loop on the transaction like none of these have and the financial model changes everything. let’s take a closer look.
This is a play to the mid to large scale self insured employer market. This is a very lucrative market for health systems. They are a bolt-on, add-on to the existing model. The employer can keep their PBM, Payer and providers, Transcarent just weaves it all together around the experience that the employer and employee have with healthcare.
Providing consumers and their families with a set of information, tools and new choices that they didn’t have before.
  1. Unbiased information.
  2. Trusted Guidance
  3. Easy Access
Remember, this is about the experience. The self insured employer continue to bears the brunt of the rising healthcare cost. Payers, providers, PBMs make money every time the cost of healthcare goes up but the employers are left with a higher bill. That is one experience. The other experience is the employee who is looking for healthcare. If you’ve ever sat through one of these benefits meetings you know that the stories are not all that good. The employee is not empowered, information is scarce, choice is limited, and navigating the few choices you have is hard before you make a decision and after you make a decision you feel like you just strapped up to a roller coaster and you are hoping for the best outcome.
Transcarent. Let’s start with their revenue model. They align themselves with the self insured employer. Share of savings. Baseline, savings. Simple bill from Transcarent to the employer. The power is in the alignment. This is not about transactions, co-pays, this is about savings and experience.
The employer experience. I’ll assume we are looking at a digital tool. The unbiased information can be quality scores, costs and outcomes delivered straight to the employee. There is a trust that is given to the employee to make the right choice once they have the information in hand. Trusted guidance. They will provide access to someone 7×24 within 60 seconds who can help you to evaluate your choices. Those choices can be those negotiated rates within your existing plan or even options outside of your plan. They can look at local care, surgery centers or even centers of excellence that are just a short flight away.
Finally, they close the loop. They will line you up for care and provide an experience across your care journey to connect you with followups, rehab, and the like. This provides a powerful feedback loop that will make them smarter with each new employer they sign up.
You know I end each of these stories with a so-what. Why does this matter? This is a well funded startup, by a company that has deep healthcare experience and background, that has had proven success in doing this before. They are not trying to find a market. They are not going to spend a bulk of their time raising money. They are not going to have a hard time attracting the best talent and they know where the money is hidden in healthcare and how to find it. They will extract value at the point of waste. They will create a market at the point of frustration with the existing system.
This is yet another example of where next years margin pressure will come from for your health system. If I were a health system CIO today I would be waging war on inefficiencies, automating everything and working diligently to make our health system easy to partner with. Easy to plug into. I used to think that health systems would be able to stop this disintermediation that is occurring. The consumer decision is being influenced less and less by healthcare providers. This is a scary place to live.
If that is the future, quality matters even more than it does today. This will become true at the individual provider level. This is a hard place for the health systems to address. But as a technologist how I would be thinking about this is that you have to be an easy place to do business with. Think of your health system as a enterprise service bus or a set of APIs. Make it easy for them to plug their scheduling into, connect with your doctors for consults, and become a partner is cost savings.

That’s all for today.

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