When Prominence Health Plan announced its partnership with Vera, they became the first insurance carrier in Nevada to provide transformative primary care access through dedicated care centers.
With members in rural communities across the state, Prominence was looking for a partner who could provide better access and a higher quality of care for their members, including a large Medicare Advantage population.
We sat down with Prominence CEO, Kamal Jemmoua, to talk about their decision-making process and what led them to choose on-site clinics and Vera as an innovative healthcare delivery partner.
Q: Why would a carrier get into the business of care delivery?
Kamal: From our vantage point, the health plan business is essentially underwriting access to care. We are in the business of working with employer groups, senior populations (i.e., Medicare Advantage), and self-funded employer groups to underwrite a product that enables their access to care. The problem is, we don’t always get to control the quality of that care. That paradigm becomes even more challenging when you start to look at narrower, more rural markets where you don’t have as many options from a provider standpoint. Getting into the business of care delivery is an effort to enable better access to higher quality, highly coordinated care.
On the Medicare Advantage side, there are other considerations. Because senior populations have utilization rates 3-5 times higher than typical populations, we find that a higher frequency of engagement with a primary care doctor translates into better care and better documentation, which allows us to do a much better job of care coordination and management.
Q: What were you looking for in a partner?
Kamal: First, we wanted someone with the right experience. Specifically, we wanted someone with established experience partnering with employer groups, who understood benefit structure challenges, and who knew what it would take to coordinate care with other providers in the community.
Second, we wanted someone with a proven ability to drive results in quality care, member satisfaction, and in bending the cost curve. As a part of that, we looked for a partner invested in the technology, platform, and culture needed to provide a higher quality of care.
Finally, it was important to us to have a partner so confident in their ability to drive those results that they put their money where their mouth is, so to speak.
Q: What questions and answers were most important to you as you went through the process of determining a partner?
Kamal: What’s the motivation behind the partner? Why are they in this space trying to do this? The answer needed to focus on an intent to change healthcare from the traditional fee-for-service model to a much more value-based orientation. In other words, we wanted someone who wasn’t interested in strictly seeing as many patients as possible. We needed someone who was willing to be rated in their ability to provide coordinated care and a quality experience.
We also asked, "Is the partner nimble and creative in their partnerships with employer groups?" When it comes down to it, we’re all in the business of serving the same mutual client, the patient. We needed a partner with the ability to adapt to different regions, employer needs, and patient needs.
Q: What are the unique needs of your members?
Kamal: Maybe not unique, but our biggest need was access. In rural communities, we find that members can’t seem to get into their primary care doctor within less than 6-8 weeks unless we are jumping in and heavily coordinating that conversation.
We needed accessible providers who have time to care for the patient. We’ve all had the experience of a 10-minute appointment with a provider who spends most of that time staring at a screen. We believe our members need a much more holistic experience, with an emphasis on preventive care and an appreciation for their psycho/social well-being, as well as their physical health.
Better coordinated care, direct access to prescriptions, and an environment that shifted patient attitudes away from sick care were also top needs on our list. We wanted patients to know that coming to see your primary care doctor is a good thing. Solutions for all of these issues were important to us. I wouldn’t describe them as unique. They’re a prevalent problem in rural communities everywhere.
Q: What makes Vera a unique fit?
Kamal: Vera provides solutions to all the problems I just listed: more accessible care, quality experiences with providers, better care coordination, and an environment that promotes good preventive care practices.
But the other thing that makes Vera a unique fit is the leadership team and the culture within the organization. They embody the spirit of their mission. It’s very evident in their commitment to working through any challenges that arise.
Q: Was there anything that felt scary or risky when you initially decided to take on a new partner? How has Vera overcome those fears?
Kamal: Whenever you go into something that goes against the norm, it’s always a little disruptive and scary. The first fear is that there’s an economic assumption you have to make that’s fairly significant. You will spend more on primary care than ever before, and there is a substantial capital investment. Understanding the ROI takes some time. But, Vera assuaged these concerns with proven results and a money-back performance guarantee.
The second fear for us was the potential disruption and reaction of the community. But, again, we looked at past stories of Vera entering markets. What we saw was a tremendous opportunity to join Vera in educating and partnering with the community, rather than disrupting it.