At this time, RamaOnHealthcare talks with Steven Nelson. Contigo Well being creates new methods for clinicians, well being programs and employers to work collectively supporting a standard objective for all stakeholders: to extend entry to high-quality care, improve affiliate engagement, management prices, and get associates again to work and life sooner. Contigo Well being delivers complete providers for optimizing worker well being advantages.
RamaOnHealthcare (ROH): Welcome, Steven, to our thought management collection. Are you able to inform me about Contigo Well being’s mission and sport plan and the way you’re aiming for achievement?
Steven Nelson (SN): The most important expense employers cope with is wage. Worker advantages – primarily pushed by healthcare prices – is the second largest expense employers incur. We additionally know that almost all of Individuals get their medical health insurance by way of their employer making it a crucial and addressable marketplace for our nation. Our mission is to liberate suppliers, employers, and sufferers to speed up optimistic change in our present healthcare system.
The most important expense employers cope with is wage.
Contigo Well being is relentlessly centered on bringing collectively employers and suppliers to offer entry to the very best care and enhance the standard of life for workers and their households throughout the nation. Now we have seen that by and huge, employers need extra management over the standard of care their workers obtain. Contigo Well being offers them the ability to do that by arming them with knowledge analytics and direct reference to excessive worth suppliers who ship high quality care.
Moreover, Contigo serves because the conduit between those that ship care and people who pay for it, simplifying and bringing transparency to an usually overly difficult course of.
ROH: Trying again, how have you ever seen the employer advantages house evolve?
SN: The pandemic crystalized the concept that the well being of workers is a strategic asset for employers. This realization, coupled with the nice resignation, is main employers to supply a few of the extra strong compensation packages now we have seen in latest reminiscence. It’s broadly understood that workers – total – have gotten extra savvy healthcare customers, and advantages that embrace fertility protection and behavioral well being choices assist with recruitment and retention.
The pandemic crystalized the concept that the well being of workers is a strategic asset for employers.
Now we have additionally began to see employers suppose extra concretely about well being fairness – guaranteeing ladies and associates from traditionally underserved populations are cared for.
Now we have additionally began to see employers suppose extra concretely about well being fairness….
One other a part of the evolution we’re seeing offers with the getting old of sure components of the American workforce. As Individuals start to work from anyplace, for some, this interprets to a delayed retirement. That is resulting in employers needing protection for well being conditions they might not beforehand have had publicity to regularly.
ROH: Fascinated about the medical health insurance house, why does direct to employer matter? Why is that this disruptive strategy being adopted?
SN: Traditionally, the worker advantages house has been an intermediary-dominated trade. Those that pay for care and people who delivered it had been hardly ever, if ever, in communication with each other. What we consider as medical health insurance corporations have acted as monetary conduits, maintaining the consumers and sellers siloed and the well being plan member excluded from the dialogue. This phenomenon has been eroded in areas exterior of healthcare over the past decade or so with the introduction of platform corporations which have created marketplaces the place consumers and sellers can work together instantly. Supplier direct to employer – the house that Contigo operates in – brings this idea to healthcare.
Once I inform individuals what I do for a dwelling, one of many extra widespread questions I get is, “Why is it higher for my employer to be concerned in my healthcare than the insurance coverage firm?” First, I clarify that having insurance coverage corporations concerned in medical choice making is a comparatively new aspect of American healthcare. Previous to that, well being plans centered on community entry, charge negotiations and claims cost. However as healthcare prices, supplier reimbursements and premiums continued to rise, payors demanded extra accountability; thus, medical health insurance corporations turned increasingly concerned in makes an attempt to regulate prices of healthcare. Then I ask, “So why are insurance coverage corporations who concentrate on actuarial science extra certified to help an organization’s well being plan members in navigating and financing their healthcare than the retail or healthcare firm that employs you?” I level out that their firm in all probability presents a 401K however doesn’t inform them what to put money into. As an alternative, they assist navigate and supply incentive for workers to avoid wasting for his or her retirements.
Workers ought to really feel valued and cared for. They need to be capable of consider that their employer needs them at work (no matter which means, lately), dwelling their greatest lives (as my youngsters would say) and in the perfect well being potential. At corporations who’re doing this greatest, it feels to workers just like the group has their again from well being and finance views and that human assets will guarantee they don’t get hit with an absurd invoice they shouldn’t obtain.
Workers ought to really feel valued and cared for.
ROH: What gaps does Contigo Well being clear up for?
SN: So many sufferers within the U.S. find yourself not receiving the care they want or obtain pointless care that doesn’t result in higher outcomes. We’re very centered on decreasing the frequency of each of those gaps whereas concurrently guaranteeing a better high quality of care is delivered.
When sufferers look in a listing for an orthopedist, it’s all however unattainable for them to see who makes a speciality of treating sufferers “like them.” Supplier directories could embrace pictures and notations round supplier apply model or languages spoken however not sufficient element to essentially join suppliers to the particular healthcare pursuits and wishes of potential sufferers. We will do higher. We all know which orthopedists concentrate on hip substitute for ladies, for instance, and might information them accordingly.
We’re additionally within the midst of a transition for employers as they transfer from the “previous” method of navigating worker advantages. It was once that an organization would look to a guide or a dealer to advise them on their well being profit program design and execution – that platform we mentioned earlier than has disrupted every thing. Brokers and consultants are nonetheless extremely valued, particularly for each small and huge organizations, however human assets (HR) profit executives now have extra pores and skin within the sport as they work to average company overhead expense and the necessity to recruit the perfect and brightest expertise. Extra ceaselessly, profit choice makers inside employer teams have gotten lively members in searching for out profit improvements.
Individually, it is usually value speaking a couple of development that we’re seeing conclude – and that’s round particular person level options. The times of getting a dozen or so distributors for particular person points (e.g., an app for diabetes, completely different from the one for weight reduction and completely different from behavioral well being) are over. We’re seeing an increase in demand for complete options that may “do extra” than one factor.
ROH: How do you outline “high quality care?”
SN: High quality is about creating the very best end result utilizing the least potential assets. High quality care is multi-dimensional, and the secret is discovering steadiness amongst all these points, like a four-legged stool.
First, we have to obtain an excellent end result for the affected person from a medical standpoint. There are the fundamentals like mortality and an infection prevention, but in addition return to each day actions and high quality of life measurements. Second, I consider appropriateness of care. Was that surgical procedure the appropriate strategy? Was surgical procedure wanted in any respect? Was there a extra conservative strategy that might have been simpler? Ought to you might have ordered that imaging or lab? Value is the third leg. You don’t purchase a automotive with out realizing the worth, however in healthcare, we don’t discuss value versus worth. Affected person expertise is the fourth and last leg – was their want met? Did they get the concierge or naked bones remedy? Similar to every other services or products, individuals need various things – particular person desire in healthcare is an actual factor. Beneficiaries (or workers) want to have the ability to make purchases based mostly on their values which evolve all through their lives. What’s obligatory in care at one part of life will not be wanted at one other cut-off date.
ROH: Are you able to speak to me about the way you strategy working with employers and suppliers?
SN: We wish to say that in the event you’ve talked to at least one employer, you’ve talked to at least one employer. We do loads of listening at Contigo Well being. We hear in regards to the imaginative and prescient for his or her well being plan, their philosophies, goals and wishes. On the finish of the day, worker advantages are an funding in an organization’s greatest asset – their individuals. It’s incumbent upon everybody to verify it’s a wise funding.
…worker advantages are an funding in an organization’s greatest asset – their individuals.
Contigo will get concerned within the early levels of co-creation, bringing completely different events into the combo, and having them speak to one another to search out progressive options which might be a win-win for all events concerned. If we have to educate the customer (employers), which means the very first thing we have to do is convey the sellers (suppliers) to the desk to create that dialogue. We educate on the worth of major care, that’s how you can analyze and take into consideration short-term versus long-term prices.
With healthcare, you’re coping with a societal good – we’re in the end attempting to decrease the chance pool for everybody. We perceive that turnover is inevitable, however what we’ve discovered is that your chance of coping with a high-cost declare received’t be any decrease. Consider well being plan advantages as paying ahead for the profit investments different companies are making within the workers you recruit away from them and vice versa. We at all times have that adage at the back of our minds – what occurs in the event you don’t put money into your individuals’s well being, and so they keep?
ROH: How are self-insured employers navigating a post-pandemic – or no less than endemic – atmosphere? What points do you see them working into? What are the ache factors? How are you serving to them arrange and chart their path ahead?
SN: We see behavioral well being taking part in an outsize position in worker advantages going ahead. The pandemic did a quantity on individuals’s emotional well-being. We don’t suppose this may be solved in a single day, however we all know how important a problem that is for employers going ahead. Half and parcel with this are substance abuse and serving to our colleagues who’re struggling.
One other situation we see taking part in out associated to pandemic entails delayed care. We all know ladies delayed mammograms and everybody delayed colonoscopies. Meaning, along with the backlog of screenings we’re working by way of, we’re inevitably going to catch ailments later of their development. That’s one thing that employers are going to must cope with head on. Equally, we all know that childhood early interventions had been delayed or performed just about – we’re going to see elevated demand for occupational and speech remedy.
One other situation we see taking part in out associated to pandemic entails delayed care.
Lastly, between inflation and the pandemic ripples, we’re going to be seeing a few of the greatest fee will increase in a decade heading into 2023, 2024 and 2025. Sadly, from what we’re listening to, this isn’t translating to will increase within the backside traces of suppliers.
ROH: How does Contigo assist these employers forecast and plan for the long run?
SN: Contigo presents employers the info analytics to make knowledgeable choices, placing them within the driver’s seat in relation to making choices about their well being advantages and who they companion with. We additionally herald our mother or father firm – Premier® and its PINC AI™ platform to assist present benchmarks and perceive market tendencies and which tendencies are actionable.
Analytics is not only realizing your numbers however understanding them and diving into their that means to drive motion, it is likely one of the most essential points of managing an worker well being plan immediately. We break it down right into a collection of dashboards that assist HR profit leaders perceive a few of the exercise and main indicators round the place, how, and why care was delivered. That rolls up right into a monetary efficiency dashboard that offers plan managers the massive image and the element they should establish potential areas of alternative and design options. It’s additionally essential to have the ability to monitor and measure any modifications you make. For each plan change you make, your workforce ought to be working with you to establish the target and key outcomes you propose to measure. Are you placing in a telehealth possibility to cut back emergency division (ED) utilization? Are you including a capitated major care plan design to encourage preventative care? Your analytics division — whether or not inside or exterior — ought to be measuring and reporting these outcomes to you. And utilizing that, you can begin to challenge future efficiency and tendencies. No person has a crystal ball, however considerate evaluation may help you notice tendencies early and put in amplifiers or mitigation methods.
…considerate evaluation may help you notice tendencies early and put in amplifiers or mitigation methods.
About Steven Nelson
Steven Nelson leads the Contigo Well being workforce as President and was one of many leaders who initiated the technique behind Contigo Well being inside Premier, Inc. Earlier than becoming a member of Premier, Nelson was a pacesetter at Anthem Inc. the place he served as Vice President of Technique and Planning and COO of Anthem’s diversified enterprise group. Previous to becoming a member of Anthem, Nelson led technique, product and advertising at Highmark Blue Cross Blue Defend and helped to construct Allegheny Well being Community. Nelson has a deep and private dedication to giving again to his area people in addition to the worldwide group, together with main charity work in Haiti. He holds a bachelor’s diploma from the College of Pittsburgh and a grasp’s diploma from Ohio College. He and his household reside exterior of Pittsburgh, in Gibsonia, Pennsylvania.