In today’s world, payers are facing challenges, and they’re looking for innovative solutions. Recently, we sat down with Jennifer Sargent, Chief Commercial Officer at Vera, for her thoughts on how payers can strengthen their market position.
Q:Why is the Vera Whole Health model the right fit for payers?
A: When payers integrate care delivery by partnering with Vera, we can quickly support the needs of their members and community. There are three main ways our model supports them:
Primary care access: Many payers are facing access issues in their markets, there aren’t enough primary care providers to meet the needs of their population. Our model solves this.
Better control: By partnering with Vera on a primary care solution, they are able to have more control over the care model. Without a partner like Vera, payers struggle to influence how care is delivered and how utilization is managed in a typical fee for service primary care setting.
Aligned Incentives: With more control and a value-based model, the payer can ensure that incentives are aligned and appropriate for what they are trying to accomplish and the populations served.
Q: How is Vera helping payers gain a competitive advantage?
A: Differentiation is the key to gaining a competitive advantage that drives business growth. And by partnering with Vera, a payer gains a turn-key primary care solution to accelerate their growth strategy.
Payers are hearing from both commercial customers and members that the current care delivery system is broken. Commercial customers face escalating premiums and employee populations that aren’t getting healthier in a production-based sick care system. Members are frustrated that they can’t get a primary care appointment when they need it, their out-of-pocket costs are climbing, and when they do see a provider, it’s for 15 minutes.
We’re hearing that commercial customers are going to their payers and asking , "What are you doing about this? I need a solution to curb my costs and improve the health of my workforce."
A primary care solution opens the door for payers to add value for clients and, ultimately, differentiate and grow their business.
Q: Are payers that serve the Medicare Advantage (MA) segment looking for something different?
A: Payers that serve Medicare Advantage members have additional challenges. MA members typically have complex needs and limited access to primary care. They’re trying to navigate all of the referrals they’re getting. The members, and their family members who are influencing those decisions, are looking for a better place to get care. Payers are looking to a primary care solution — a differentiated solution — that’s focused on Medicare Advantage, which creates a competitive advantage.
Ultimately, payers are working to achieve higher quality for members and improve the STARS ratings they get from CMS, which influences plan purchase interest and reimbursement rates.
Q: How has Vera's experience with Employers translated to the Payer market?
A: We’ve delivered population health for our employer clients for 10+ years; better managing appropriate healthcare utilization, delivering strong outcomes and driving down total cost of care. Our model has third-party validation for its impact on population outcomes. Our experience with that market segment gives payers confidence about what our model can do for their population. Remember, most of their clients are employers, so we have that in common.
Q: Can you speak to the importance of alignment between Vera and payers?
A: Alignment between Vera and payers is critical. We start by identifying the mutual success factors and then build aligned incentives into our partnerships that will deliver the needed goals. Health outcomes are only possible if you build the model and the incentives right.
For example, we can build a care delivery approach for specific care centers to serve the biopsychosocial needs of a Payer’s Medicare Advantage, or a commercial population, each with different needs.
Q: What drives the faster pace of the payer segment?
A: Two things: The first is that they have already been thinking about how to drive change in the way that care is delivered. They are really close to the problems that the system faces with their current network partners, so better primary care has already been on their radar.
They’ve already been asking themselves key questions: What can we do? How can we get closer to care? When we meet with them, they’ve considered various strategies and we can get right to: "Okay, you know you need to do something. What's the right thing for you to do? Where should we start? What populations should we serve?"
The second is that partnering with an organization like Vera becomes very visible at the highest levels of the organization. So the C-suite is engaged and relationships progress more quickly than with other market segments. The CEO, Chief Medical Officer, and the head of business development are thinking about these types of partnerships.
As they explore how to better control how care is delivered, they're paying attention to what some of their peers are doing, including three of our current clients: Blue Cross and Blue Shield of Kansas City with their Spira Care solution, Premera with their Vivacity Care Centers in Spokane, as well as Prominence Health Plan in Reno.
There's momentum around this approach — they're thinking about it, they're talking about it. Therefore, the decision process is faster than what we would typically see in a standard employer sales cycle.
Q: What should payers be looking to accomplish in 2020?
A: Regardless of whether they implement the Vera advanced primary care model , or another primary care solution, I think they really need to be focused on getting closer to the member experience and how care is delivered. That can be done in lots of different ways. It can be done by partnering with local primary care groups and trying to drive value.
But I believe they really need to focus on how they’re going to drive value and how to drive better patterns in care, so they need to pay attention to shifting towards value-based care. Everybody's talking about that, right? I think if a payer is not thinking about how they can do that quickly, they're really going to be left behind by their competition.
Q: Any closing thoughts on payers and the Vera advanced primary care model beyond 2020?
A: There’s a lot that really resonates with payers about this model, particularly the empathy-driven approach to care. Yes, they're getting into care delivery as a disruption strategy and to lower total cost of care, and yes, it’s a very metric-driven approach. But it's also important that people understand that payers really care that the members they're serving have a fulfilling experience that improves their health.
We speak with payers about the Vera Whole Health values of empathy and outcomes, which are the focus of our care delivery. And that's ultimately what we deliver. It's not just about cost. It's not just about the data and the metrics and the utilization. Payers are really looking for the right model to provide members a healthcare experience that makes a difference. And that’s what Vera brings.