Maverick Magazine - Fall 2021

INNOVATIVE BENEFITS SOLUTIONS FOR VISIONARY EXECUTIVES

VOL. I • FALL 2021

GREEN IMAGING

Revolutionizes Radiology GREAT CARE + CLEAR PRICES

SimplePay Uncomplicates The Health Care Equation SIDECAR HEALTH

Gives Patients A Choice …

And Maybe Some Money Back

CHRIS SEVERN TURQUOISE HEALTH BRINGS CLARITY TO A CONFUSING MARKET

FROM THE FOUNDER

CHARTING A NEW COURSE Maverick is about people. Not point solutions, plan designs, PBMs, or policy. In our journey with this new magazine, we’ll find and introduce you to forwardthinking, mission-driven founders, innovators, and builders. These are men and women who have staked their reputations, careers and capital on a conviction, a belief with teeth, that is resonating with employers, plans, patients, and providers and redefining what we’ve all come to accept as the status quo.

Maverick was created to spotlight these founders, whether they’re in LA or Oklahoma City, and share their insights, backgrounds, and beliefs that are reshaping how Americans will access and afford care in the coming years.

We’ll introduce you to visionary founders creating modern, disruptive models of patient care that enable physicians to deliver better care to more people at a lower cost—a market-oriented approach to address economic disparities in access to care.

We’ll highlight a repeat founder and industry insider who is now building a next-generation patient experience, one that enables every employee on the health plan to see the actual cost of every treatment upfront, and helps them navigate to the highest quality provider in their market.

We’ll bring forward real-life profiles in courage with physicians who experienced a “Damascus Road” moment and decided to unhook from Medicare and step out of the machine of big box medicine to price and directly sell their talent on the open market to employers and patients.

Speaking personally, while I find the products, plans, and markets each maverick has created super interesting, it is the personal stories and struggle behind their successes that I find most inspiring: the mountains they had to climb just to get this far, the sideline critiques, and rocks thrown their way from obvious and obscure angles alike. In the world today, there’s no shortage of people who will post a complaint about health care, but there are few who have the confidence and conviction to launch into the void and build what they believe to be part of the answer.

They deserve to have their stories told, and we’re proud to share them with you.

Brian Whorley, Founder brian@paytient.com

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CONTENTS

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Knowality shares market wisdom and passion with health care startups.

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INNOVATIVE BENEFITS SOLUTIONS FOR VISIONARY EXECUTIVES

ABOUT MAVERICK Maverick magazine is published by: Paytient Technologies Inc. 1601 S. Providence Road Columbia, Missouri 65211 (573) 206-9147 hello@paytient.com

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Founder Brian Whorley brian@paytient.com Art Director Carolyn Preul

32

Copy Editor Sandy Selby Contributing Writers Lola Butcher Maja Majewski Sandy Selby Celeste Stewart Amy Wilder

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44

6 Meet six health care industry

32 Patients get a choice (and some

8 Joe Andelin and Lauren Dai are

36 Green Imaging offers a fresh

10 SimplePay combines high-quality

40 Sesame Care’s direct approach is

18 Paytient takes the worry out of

44 Surgery Center of Oklahoma is a

24 Turquoise Health solves the

48 The Health Transformation Alliance

28 Ro reinvents health care for the

50 Take a look inside the 2021 Free

innovators.

Mavericks You Should Know.

care with an easier way to pay.

health care with the swipe of a card.

mystery of health care pricing.

modern consumer.

cash back) with Sidecar Health.

approach to radiology services.

a win for both patients and providers.

pioneer in upfront pricing.

proves there’s power in numbers.

Photographers DeMorris Byrd Eric Michael Clarke Tulio Diaz Chance Jackson Mariola Hupert Scott Schaefer Robert Sheppard Nick Starichenko Copyright Paytient Technologies Inc., 2021. All Rights Reserved.

Production or use of any editorial or graphic content without the express written of Paytient Technologies Inc. is strictly prohibited. Postage paid at New Philadelphia, Ohio. Not responsible for omissions or information which has been misrepresented to this magazine.

Market Medical Association’s annual conference.

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INDUSTRY BRIEFS

benefits : Gravie is a health benefits company that continues to push the status quo, offering disruptive, consumercentric solutions such as Comfort, an innovative health plan that is changing the game for employers and their employees. Comfort provides 100 percent coverage on most common health care services, with no member cost-sharing for preventive care, urgent care, specialist visits, labs and imaging, generic prescriptions, and more. Employers save an average of 19 percent when making the switch to Gravie, and this year, so far, Comfort members have accessed more than 5,000 health care services without paying a dime out of pocket, putting them on a path toward better health and well-being. With competitive plan perks—online care, virtual fitness, and more—in combination with a unique customer service model and new flexible payment option powered by Paytient, Gravie offers a better health benefits experience that employers and employees love. For more information, visit gravie.com.

platform : Flume is the first ever platform built specifically to run plans in the modern, fragmented health care ecosystem. They make it easy for HR and financial leaders who are opinionated about their group’s health plan to build tailored benefit designs. Members have a single front door to all benefits and predictive care coordination (via the Flume Workflow Rules Engine®) that helps proactively drive utilization and mitigate risk. Employers have a single source of truth to monitor and control their plan.

From design through launch and reporting, all data and financials are cleanly available so they can make actionable decisions year-over-year. For more information, visit flumehealth.com.

mental health : Prairie Health is a mental health company delivering highly advanced, personalized care. Prairie Psychiatry, Prairie’s medication management service, offers individuals two options to get started: QuickStart and PrecisionStart. QuickStart allows patients who know what medication works best for them to start care right away. PrecisionStart provides patients with a free genetics test, delivered to their door, to personalize care and help individuals find the right medication, faster. Both options allow patients to see an expert psychiatrist online, with appointments, medication delivery, refills, and progress tracking made easy. Eighty-five percent of people experience fewer symptoms just weeks after starting. Greater than 60 percent of members indicate they’d be “very disappointed” if Prairie were not to exist. Prairie offers a modern mental health care experience that patients, providers, health plans, and employers love.

For more information, visit prairiehealth.co.

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pharmacy : Healthcare Bluebook, an industry leader in health care quality and price digital navigation is now tackling pharmacy costs with the recent launch of Bluebook RxSM, a new solution that helps employers and other health plan sponsors better understand and optimize their prescription drug spending.

Bluebook Rx is an integrated solution that analyzes millions of pieces of pharmacy claims data to guide customers toward savings. Now, health plans, employers, and members can: • Identify overpriced medications, • Find clinically effective, lower-cost alternatives, • Access personalized savings reports, • Access concierge services, including Bluebook’s licensed pharmaceutical team, to help guide decisions.

For more information, visit healthcarebluebook.com.

group health : In the United States, medical expenses cause nearly two-thirds of personal bankruptcies. In these cases, approximately 75 percent of individuals have health insurance. To combat this, Redirect Health has reimagined the health care journey. They design, broker, and administer end-to-end group health care plans that help Americans make informed decisions on how to find the best solutions to their medical needs. Redirect Health’s data-driven technology and experienced team navigates the uncertainties of the health care system, empowers primary care practitioners, and eliminates unnecessary administrative costs, anytime and anywhere. For more information, visit redirecthealth.com.

telehealth : Founded in 1996, Competitive Health builds virtual health solutions, including its own customizable platform, ShowBenefits. Utilizing award-winning digital health programs and more than 22 telehealth specialties, Competitive Health provides unlimited access and unprecedented savings to its clients and their members. Last year, Competitive Health saved employer groups, insurance carriers, third-party administrators, and affinity groups more than $100 million dollars. The ShowBenefits platform is 100 percent configurable. Clients can customize their benefit packages and load them directly into an app for their members. From telehealth to advocacy and chronic care, each implementation is completely tailored to fit the client’s business. From there, members can access medical ID cards, copays, deductibles, and other benefit information in one tool. For more information, visit competitivehealth.com. 

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Q&A JOE ANDELIN

CEO OF OLAVI GROUP

MAVERICKS

you should know

Tell us about the Olavi Group.

We do analytics, the simplest and most robust health insurance benchmarking, and offer unique data sets and tools for startups and brokers.

How does your company address the pain points of your customers?

Brokers need succinct tools and data to win prospects and to keep existing clients. “How good are my benefits?” is more nuanced than most think. Health insurance for employees is not a commodity; the coverage and cost to employees varies wildly and being in the top quartile is important in competing for talent.

Most people would be surprised to know that Olavi Group ... … works across personal finance and health care. The connection between health and wealth requires lenses and experience in both.

What would you say is the most transformational thing happening in your segment of the industry?

Skin in the game is growing and employees are more aware of the cost of care and need easier front door solutions.

Most care is episodic, so both fixed (premiums paid) and variable costs (card swipes) matter. The growth of health savings accounts presents a unique opportunity to promote investing and more rational plan selection.

What’s your favorite thing to do on weekends?

Cooking while listening to Spanish music.

What’s the best Netflix series you’ve watched?

“High Seas.”

Contact Joe Andelin: joe@olavigroup.com

Is there a great book you’d recommend to your colleagues or customers?

“Alchemy” by Rory Sutherland.

What’s something the market disagrees with you on?

Health care is highly shoppable. You can see by the way people choose their own coverage when it’s their own money. 

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Q&A Contact Lauren Dai: lauren@meetcocoon.com

LAUREN DAI

COO & CO-FOUNDER OF COCOON

Tell us about Cocoon.

Cocoon is the first full-suite software solution to remove the manual, heavy-lift from complex leave processes all HR departments must tackle. The Cocoon platform is designed to address every type of employee leave (i.e. parental, medical, bereavement, or any other type), across all 50 states, handling everything from compliance to claims management to payroll calculations. It factors in all state, federal, company, and insurance benefits to demystify, simplify, and streamline the leave experience for both employees and HR teams.

How does your company address the pain points of your customers?

Leave has long been one of the most antiquated aspects of HR, yet it is something every company has to deal with as nearly every employee will go on leave at some point in their career. Historically, the leave process has largely been managed by hand, with an HR representative sitting down with an employee to fill out stacks of paperwork.

Given all of the different variables involved, from insurance to government and corporate policies, this can result in a process riddled with human error that can yield significant, unnecessary costs to both employees and companies.

On top of this, COVID-19 has created a more distributed workforce, which has forced employers to deal with leaves in many more geographies than they are used to, adding further compliance complexity.

It’s also becoming increasingly important to get employees’ leave benefits right because they are the new table stakes as many organizations face a talent crunch. Employers have to be competitive in their leave benefits if they want to attract and retain talent.

Cocoon was developed to address all of these issues, automating and simplifying leave with a platform that can be easily adapted at any time.

Most people would be surprised to know that Cocoon ... … was founded by three incredible women!

What would you say is the most transformational thing happening in your segment of the industry?

With COVID, leave matters now, more than ever. I think all of us have realized how it’s really these pivotal moments in life that matter, where it’s critical we see our companies step up to support us. Employers are recognizing this, and we’re seeing this be reflected in how companies build their employer brands— highlighting not just time and pay around leave, but also the employee experience with leave.

What’s your favorite thing to do on weekends?

Cook! I’m a huge foodie. I love hosting friends for brunch or dinner get-togethers.

What’s the best Netflix series you’ve watched?

“Lupin.”

Is there a great book you’d recommend to your colleagues or customers?

“Crossing the Chasm” by Geoffrey Moore.

What is your spirit animal?

All of us at Cocoon have a spirit animal! Mine is the Great Pyrenees dog.  Fall 2021 • Maverick |

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Easy does it.

SimplePay Health changes the health care insurance conversation.

BY LOLA BUTCHER // PHOTO BY ROBERT SHEPPARD

F

or the past six years, Ryan Murry, senior director of benefits for Essilor of America, has focused on a challenge that bedevils most U.S. employers: offering health benefits that make it easy to attract and retain employees while health care costs continue to rise. “We’ve been able to see a lot of great success in controlling our costs and improving the wellness of our population,” he says. “I have learned that is one of my passions.”

That’s how Essilor of America came to work with SimplePay Health (SimplePayHealth.com), an alternative health plan designed to steer patients to high-quality providers and simplify the way they pay for care. In a 2019 pilot, SimplePay was an option for employees at one Essilor location. That expanded to six markets in 2020, and throughout the organization this year.

Essilor of America is the U.S. arm of the Essilor Group, the world’s largest manufacturer of eyeglass lenses, with at least 40 percent of the worldwide market. Murry manages benefits for the 8,500 employees in the U.S.

SimplePay Health serves employers of all sizes that have self-funded insurance plans. It consolidates health plan services—wellbeing, navigation, and key clinical programs—with the goal of improving workers’ health and health care. “We hardwire them so they come together for a single, integrated, broad health plan management and insurance platform,” says Scott Schoenvogel, president of the Dallasbased company.

His success comes from targeting the three biggest drivers for health care costs: spine/joint issues, cancer, and diabetes/heart/lung problems.

“We have been very specific in trying to address those categories of spend and help our population to be able to be healthier in those areas,” he says. “And, when our workers need care in those areas, to make sure we have strategies in place to minimize our risk, and therefore minimize our cost increases.”

AN ATTRACTIVE OPTION

Of the 7,000 employees who receive health insurance through Essilor, 55 percent chose SimplePay. Based on his experience to date, Murry is saving at least 10 percent on the total cost of medical claims and administrative fees.

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Scott Schoenvogel is president of Dallas-based SimplePay Health.

“That’s pretty significant when you’re looking at a spend of around $25 million,” he says. “It delivers the results.”

Before co-founding SimplePay, Schoenvogel managed financial operations for Baylor Scott & White in Texas, and subsequently started Compass PHS, a health care navigation company that served nearly 2,000 employers’ efforts to lower costs and improve employees’ experiences while working through their existing health plans.

After selling Compass, he co-founded SimplePay with the goal of simplifying patients’ interactions with their health care providers while steering them to high-quality care.

“Employers want to create a great benefit that people value, but they need to be able to do that in a sustainable fashion,” Schoenvogel says. “Existing health care benefits and insurance suffer from cost and complexity problems.

SimplePay was built with the idea of reversing, on as many fronts as possible, both cost and complexity issues.”

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DECIDEDLY DIFFERENT

the doctor or go to the hospital, your insurance card says that the health plan is going to pay the doctor or the provider organization in full.”

The first is a plan design that does not include deductibles or co-insurance.

Rather, each category of health care service has a three-tier co-pay structure that incentivizes an employee to choose the high-quality provider. For outpatient surgery, for example, the employee can choose an out-of-pocket co-pay of $1,000, $1,500, or $2,000, while SimplePay covers the rest of the network-negotiated rate for the service.

SimplePay consolidates all the patient’s out-of-pocket costs—physicians, ancillary services, pharmacy, and hospitals—into a single monthly statement. The patient is then able to review their statement and make payment to SimplePay. The company offers health plans with flexible terms so that employees can pay their out-of-pocket costs over time.

He identifies two innovations that differentiate SimplePay from traditional health plans.

“If you have your $12,000 surgery at the highest quality place, it will cost you $1,000; if you have it at the lowest quality place, it’s $2,000,” Schoenvogel says. “The ability to price by provider is very unique, and we can have our own abilities and technology built around that.”

The second innovation is the payment model. “As a SimplePay member, you actually don’t pay your providers anymore,” he says. “When you go to

“So there’s a lot of going on behind the scenes,” Schoenvogel says. “By offering that fixed pricing upfront, we are trying to make it easy to identify and get to the highest quality providers so we can change the trajectory of care and get people healthier. And by changing the payment model on the backend, we are eliminating the complexities of the health care system that people have to figure out and overcome.”

At Essilor, SimplePay is one of three health insurance options available to

“Employers want to create a great benefit that people value, but they need to be able to do that in a sustainable fashion.”

– SCOTT SCHOENVOGEL

his workforce. Its premium makes SimplePay the middle option between a traditional PPO plan and a highdeductible health plan.

At the end of the first-year pilot, Essilor asked its employees: If you were offered another alternative to SimplePay, would you stay with SimplePay or would you change to the other plan?

“About 85 percent of those employees said that they would stay with SimplePay,” Murry says. “So that’s a demonstration that this is a good plan for employees. They see the value in it.”

BACK TO SCHOOL

The biggest challenge for SimplePay is the fact that it works so differently from the standard patient/provider/insurer relationship.

“Health care benefits are very sacred and sensitive for employers,” Schoenvogel says. “It takes a lot of trust to allow someone new to work with your health care benefit program.”

Although SimplePay is indeed simpler to use than traditional health plans, there is a learning curve.

“There’s education of members around their health benefits and how those benefits work,” Schoenvogel says. “The concepts are not super-difficult, but they are new. So, a certain amount of patience and persistence is required as we help people move from an old model to a new model where the employee is empowered to choose.”

Employees expect to pay out-of-pocket for their annual deductible and if they face a hospitalization, for example, they pay for their coinsurance. “But they don’t really know the exact amount that they’re going to be charged,” Murry says. “And they just are relying on the old system and hoping that what they’re told is accurate.”

SimplePay members go online before they choose a doctor or hospital to see the co-pay associated with each option. The hospital copay for labor and delivery, for example, will be $500, $1,000, or $2,000, depending on the hospital’s quality tier.

“But if an employee doesn’t check before they go, they may end up getting surprised with a $2,000 bill because they went to a Tier 3 provider,” Murry says.

“The principles of SimplePay work but people have to be invested and willing to educate themselves for them to truly recognize the value.”

SimplePay is easier for providers because the insurer pays them in full, and they don’t divide the bill between the patient and the third-party payer.

“If providers really understood it, they would be knocking on the door wanting to participate in the program because it basically takes the provider out of the collections business,” Murry says.

Schoenvogel, the son of a physician, believes SimplePay is a step toward fixing one of the many problems plaguing the health care industry. “No doctor got into the business to be a businessperson—they got into it to heal people,” he says. “But it’s hard to heal

people when you have to worry about whether you are going to get paid. And we’re reducing a lot of that risk so that ideally the health care system can realign around its strengths.”

Despite the challenges associated with introducing a new type of health plan, Schoenvogel is pleased with the progress to date. The company’s top-line goal is increased use of best-quality providers and its intended byproduct, a lower overall health spend for an employer.

“That has been our consistent experience to date, seeing significant increases in what we call Tier 1 provider utilization,” he says. “And likewise, we have seen, in many cases, double-digit percentage decreases on both medical and pharmacy costs.” 

WINNING BY LOSING For Essilor of America, SimplePay’s clinical programs support Murry’s goal of systematically tackling the biggest cost drivers. Staff members who choose SimplePay, for example, have access to Wondr Health, a digital behavioral change program design to help with weight management.

“It teaches people skills for not only how to lose weight, but how to maintain their weight,” Murry says. “If people lose just 2 percent to 5 percent of their body weight, a lot of the health issues that they are experiencing tend to be less prominent.”

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BY CELESTE STEWART

PHOTOS BY ERIC MICHAEL CLARKE/ ECLARKE PHOTO

STANDING UP FOR STARTUPS Knowality tackles health care with a passion for innovation and social impact.

Haesun Chang and Dr. Trent Haywood

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K

nowality, a boutique firm that specializes in accelerating market adoption for health care startups, is paving the way with innovation and knowledge. Dr. Trent Haywood, Knowality’s founder, and Haesun Chang, his business partner, combined their expertise to effect change through groundbreaking health care solutions.

Having earned both a medical and law degree, Haywood had to choose his path. “I ultimately had to decide whether to only be at the bedside or to have an impact more broadly.”

He chose the latter path, serving as the chief medical officer for Centers for Medicare and Medicaid Services (CMS) Region V, CMS deputy chief medical officer, and chief medical officer for the Blue Cross and Blue Shield Association. Currently, Haywood is chief medical officer for Zing Health and serves as an advisory board member for Paytient.

Chang’s journey to Knowality began in Bangladesh, where she witnessed a vast need in the developing world. “I believed America was leading history, creating the path for all these other countries to follow,” she says. “While in America pursuing my education to support the developing world, I learned there were many communities here that were ostracized. I didn’t need to travel out of America to make a difference.”

DOING GOOD TOGETHER Chang and Haywood’s paths crossed at the Blue Cross Blue Shield Association.

“We saw innovation occurring in the private sector,” Haywood says. “But once these companies got into the reality of health care, they struggled with structuring their product or service in a way that would align with how health care providers or health care plans purchase such products or services. And we thought that with our unique experience, we’d be able to support that. So, we targeted those entities that had a social impact component. That whole notion of doing well by doing good for others is a way that we continue to think about Knowality as a venture services firm.

“We didn’t specifically focus on diagnostic or drugs or devices, even though we have the background that would have made that an attractive opportunity. We chose to focus on those

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components that make a difference in the lives of health plan members but also have that social impact component.

So instead of focusing only on the capital, which is what the venture capitalists focus on, we focus on providing the services that we think help accelerate that adoption.”

Chang explains Knowality’s meaning: “You have to know your reality, which brings ‘knowality.’ So, we set our goals saying, yes, we’re going to support up-and-coming companies who might not understand how health care works or how to navigate through the health care world. We strive to be founder-friendly and work with them to figure out that nice balance so that we can bring our expertise while we grow with them on a longer term.”

“We call it venture services because while we’re not making a direct capital investment in the entrepreneurs, we are investing our resources and our expertise,” Haywood says. “There’s a limited amount of energy and time that we can spend with any founders. As a result, we are very selective about our approach. Our relationships are all designed to be multiyear.

We tell anyone that we work with that we’re going to be in this relationship for at least three years, which is why we try to be founder-friendly. Traditionally, they wouldn’t be able to afford a firm like ours early in their evolution, but we structure it in a way that makes it worthwhile.”

RELATIONSHIP COUNSELING “We’ve excelled at recognizing that it really is all about relationships,” Chang says. “We’re able to easily identify our clients’ missed opportunities and the most effective approach to reengaging with those opportunities.”

“And because a lot of this is built upon relationships, we also want to maintain a certain level of brand equity and didn’t want to do anything that we thought would tarnish or diminish the brand,” Haywood adds. “Managing that brand was critically important for us. From a challenge standpoint, we had to be able to come up with a structure and model that allowed for a substantial amount of engagement to further identify the right type of opportunities for the select entities that we want to work with.”

As a boutique firm, Knowality does not have outside financial backing. “This is us: Knowality,” Chang says. “You’ve heard the expertise that Dr. Haywood brings. He understands this place in and out, and I bring the structure to ensure the business runs smoothly and in a standardized way. We recognize the need. These entities have amazing solutions yet haven’t been able to break into the health care world.”

One of the company’s biggest challenges so far has been identifying the characteristics of Knowality’s ideal client.

Using a football analogy, Haywood says that Notre Dame and Stanford have the same issue.

“You have to be able to identify the student-athletes that actually believe that you have to be both a student and an athlete,” he says. “It’s kind of like that for us, where we have to identify which entities really want to have the social impact component and not just the financial impact component. Our biggest challenge is making certain that we have the right fit for what we do well.”

“Does a client intend to better the community?” Chang asks.

“Is it something that we believe we can support throughout the relationship?”

MEASURING IMPACT Knowality measures its success in several ways, including impact on social change and other metrics.

“Many of the metrics we follow are, for the most part, no different from others in this space,” Haywood says. “Yes, it’s high-risk, but then there’s high reward in terms of growth and valuations and things of that nature. We look at it in terms of social impact. What’s the impact that they’re having on the communities? Is it demonstrable? Can we see how many individuals they can help afford health care services?

That’s critically important for us, and we want to support that impact and know that our contribution made a difference at a community level.”

Haywood appreciates that client success is often measured and demonstrated in terms of increased membership or geographic distribution of health plans, private market valuation, social impact, and the revenue generated from that impact.

Haywood and Chang are excited about some of the trends they are observing, like the ability to identify innovative solutions that aren’t your everyday, run-of-the-mill solutions and achieving specific outcomes in a different way.

“While social determinants of health have been trending, we’re starting to see a shift in how entities are addressing the problem.

Entities are starting to think outside the box and become member-centric,” she says. “We’re also seeing a lot of movement in the behavioral health and women’s health setting. Given Knowality’s position on making a social impact, I would love to see a greater emphasis on not just recognizing that there is a need, but actually making it a priority to address the needs.”

: A CASE STUDY Dr. Trent Haywood shares a story that illustrates the positive effect Knowality’s clients have had on their members. He says Uno Health saw that while many people are eligible for government benefits, they often forgo opportunities such as utility assistance, lowincome subsidy support, and senior citizens program support due to the cumbersome nature of filling out all of the forms.

“Uno Health has been able to engage with those members successfully to the point where they’ve had members say, ‘I can finally sleep at night because I no longer worry about how I’m going to be able to pay my bills.’

On average, they put around $3,000 to $5,000 per year in those members’ pockets. We’re early on, but we’re pretty excited about the impact that some of these companies are already having.”

Speaking of priorities, Haywood and Chang get together weekly to reflect on why they do what they do. They say it’s easy to lose sight of why they started Knowality in the first place, so they make it a priority to recenter and refocus on their goals each week.

“What differentiates us is our emphasis on working with people who are going to impact our community,” Chang says.

“And make the world better. It sounds cliché, but we want to sleep well knowing that we were a part of impacting the community.” 

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No Worries Paytient makes getting sick feel better.

PHOTOS BY SCHAEFER PHOTOGRAPHY

“If you work in a hospital for a decade, you’ll see people experiencing life’s biggest moments. In one hall, it’s tears of elation as loved ones celebrate new life coming into their world. Down another, the somber remembrances of a life well lived.

And everywhere else is everything in between.”

B

rian Whorley, founder and CEO of Paytient, has seen firsthand the emotional hills and valleys that patients and their families experience in their health care journeys, and he has made it his company’s mission to make the journey easier. He is proud that his company helps people better access and afford care, and candidly shares his perspective on the future of health care.

THE CONFUSION OF CARE “In the early 2000s, the industry had this notion that as patients assume greater out-of-pocket responsibility, they would self-discover this ability to better navigate the health system since they were bearing first-dollar risk,” Whorley says. “I don’t know if that came true.

“Even for folks like myself who worked in health care most of our careers, the health system can be a hard thing to explain from the inside and an even harder thing to understand from the outside. There’s this uncertainty that is under the surface of the experience for patients. It starts from the first moment you feel unwell and you start wondering ... ‘Hmm, what’s wrong? Should I see someone? Who’s the best person to see? What will it cost?’ I think that’s why there’s this baseline level of anxiety or perhaps even frustration with the health care system as we know it.

Our ability to understand it, from a consumer perspective, hasn’t kept pace with our increasing responsibility of paying for it when we have to experience it.

“Give anyone—high-, middle-, or low-income—an unexpected expense that they feel like they didn’t have any voice or choice in creating and that’s just a super-frustrating experience.

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We’re so used to it that we just accept it as status quo. However, we’ve found leading employers who want to find ways to improve the employee experience without downsizing their current deductible.”

Employers pay a monthly subscription and Paytient gives employees a payment card pre-loaded with special purpose credit that the employee can use only for health care.

Employees tap the card (or use Google Pay or Apple Pay) at any provider and the provider is immediately paid in full by Paytient, giving the employee the ability to repay over time. The employee can even link their existing HSA or FSA in order to repay with tax-advantaged dollars when it makes sense, or, as Whorley suggests, “to help people preserve, save, and invest their HSA dollars for later in life.”

Whorley describes Paytient as a modern health payment benefit employers offer to their employees. It gives people the ability to pay for care over time, whether that’s medical, dental, vision, pharmacy, or even veterinary care.”

“We make every visit to the doctor’s office feel financially easier, better,” he says. “And certainly, providers love Paytient as they’re seeing patients come earlier and walk in the door with a ‘no worries’ attitude and a better ability to pay for care.

PAYTIENT BEGINNINGS Rewind to 2006. Prior to starting as an administrator at Boone Hospital Center in Columbia, Missouri, Whorley and a friend created a software platform that entrepreneurs from across the country used to build their own branded, on-demand delivery apps. It was the right place to be at the right time and by 2014, that company had grown to a few million users and was ripe for acquisition.

“NO MATTER THE AILMENT OR ISSUE OR SITUATION, THE ABILITY TO BETTER AFFORD AND ACCESS CARE IS TABLE STAKES TO BETTER HEALTH.” – BRIAN WHORLEY

After the sale, as Whorley continued to work at the hospital, he knew he had another mountain to climb. He’d lie awake at night thinking about how to repeat that experience but, this time, solve a much larger, more important problem.

“I called Daniel, my co-founder on our last business who is now Paytient’s CTO, and we started building again. The best ideas in health care are winwin-wins, where tangible value is created for payers, patients, and providers alike,” he says. “I felt we had the experience and insight to go all in, all the way, and build an iconic company to help people better access and afford care.

I had seen enough to know that the commerce of care happens outside the four walls of the hospital or physician office. It is shaped upstream, well over the horizon by parties often unknown to the providers who are at the end of the line with their heads down, rightly focused on taking good care of people.

I concluded that the best way to help people and enable better health was to go as far upstream and as close to the patient as possible, so that’s what we built.”

RIGHT PLACE, RIGHT TIME As employers found Paytient and began offering it to their employees, Whorley realized that they were once again in the right place at the right time and poised for high-velocity growth.

“We’ve been very fortunate to find early partners and employers who share our conviction for helping folks to better access and afford care,” he says. “These were leading employers who simply believed that every employee, young or old, high-

Paytient is a modern health payment benefit employers offer to their employees. It gives people the ability to pay for care over time, whether that’s medical, dental, vision, pharmacy, or even veterinary care.

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income or low-income, will probably have some sort of frustrating health care experience or annoying out-of-pocket cost at some point during the year and Paytient can help employees feel less stress when they’re ill.

“Most of the time, health care is unplanned. We built an experience to empower people to swipe, click, and split any medical, dental, vision, pharmacy and veterinary expense into bite-sized, interest-free payment plans of their own choosing. It’s peace of mind and a renewed feeling of control over one of the most frustrating parts of health care.”

Whorley understands that his focus on the right problem in the right way at the right time is meaningless without the right team. “Fortunately, just as we were able to find early employers and partners who realized the value in their employees having a ‘no worries’ attitude when it comes to paying for care, we were similarly lucky to find early investors who were passionate about that as well.

“We look for distinctively talented, mission-driven people who are passionate about building something that’s making a difference in people’s lives. As a remote-withroots company, we’re able to screen for talent rather than geography and give people looking for purpose a place to work no matter where they live. That’s been so helpful to our growth.”

Naturally, one of the tools Paytient uses in recruiting is a top-notch benefits package that includes its own product. “We give everyone $5,000 on their Paytient card because we want everyone in the company to be able to easily access and afford care, no matter their HSA balance, no matter if they choose the high-deductible or low-deductible plan,” Whorley says. “Every employee deserves an anxiety-free care experience where they just can focus on feeling better. The last thing you want to think about when you’re sick is paying for care; that’ll make you sick on its own. We make that easy.”

His company, like the companies Paytient serves, sees a tangible, financial benefit with the program. “We’ve been able to increase enrollment in lower cost health plan designs without the worry of negatively impacting our employees,” Whorley says.

“It’s a Do No Harm approach to the health plan design. You can increase enrollment in your higher deductible plan and save $40 member per month without harming employee access to care. There’s also an element that I can’t quantify and that is people work best when they are less stressed. From an employer perspective, offering Paytient was an effortlessly generous thing we could do for our own employees, and people love using it. It’s not just the large expenses, it’s for everyday life. It’s for the team member who considers her dog as a family member, and it helps her take him to the vet; that’s totally fine.

“Every day we receive emails and comments from members about how Paytient helped them. The other day someone simply sent in a note that said, ‘Lifesaver.’

Seeing those coming in, unsolicited … it is inspiring.”

With access to nearly $100 million in outside capital, Whorley feels momentum building as the company is pulled into discussions with larger employers and partners.

“I think we have the opportunity to establish Paytient as a trusted, iconic brand that people will rely on to better access and afford care,” he says. “I wake up every morning thinking about how we deliver on that promise, how we make decisions all day long to reinforce that promise and earn our way up to that, as quickly as possible, in a durable and sustainable way.” 

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PAYTIENT’S PET PROJECT Paytient’s Visa cards can be used to pay for the categories of health care most people would expect, but there’s one category they may find surprising: veterinary care. And for that, they have CEO Brian Whorley’s sister to thank.

“We were programming Paytient back in the day,” he says. “My sister has a basset hound named Baxter, and he’s definitely a part of their family, but unfortunately he had a serious eye issue. She asked, ‘Could Paytient someday work for vet care?’ I was like, ‘We could do that today!’ and it’s been such a crowd pleaser.

Easily 20 percent of our employee transactions are vet-related. Their pets are part of their family. Just being able to turn a $400 vet visit into $20 over 20 checks—we’re basically turning that unexpected visit into an easy, effortless subscription payment.”

SCAN QR CODE & COMPLETE FORM ONLINE or complete the Reader Service Card inserted in this issue for a free subscription.

Fall 2021 • Maverick |

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Turquoise Health

HEALTH CARE PRICING FOR ALL Chris Severn launches Turquoise Health to bring clarity to a confusing market.

Whether you’re buying a new pair of socks, a used car, or a flight to Paris, you expect to be able to shop around.

The ability to compare options before making a purchase could be considered the right of the modern consumer.

Most industries have had no choice but to embrace a more informed, more empowered consumer—one who has more information at their fingertips than ever before.

The health care industry has, until recently, been excused from this demand for price transparency, leaving patients at the mercy of a confusing, unpredictable, outdated, and expensive system. Chris Severn, founder of Turquoise Health, explains the unique challenges associated with increasing price transparency in health care.

BY MAJA MAJEWSKI | PHOTOS BY MARIOLA HUPERT

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THE PUSH FOR TRANSPARENCY The demand from consumers for pricing transparency in health care isn’t new, but the need for providers and payers to comply is, as Severn explains.

The challenge itself is fascinating. For one thing, the economics of health care are controlled by contract agreements that live on scanned PDFs and scattered fee schedules. Many haven’t changed since the ‘90s and have never faced the scrutiny of consumer transparency.

Regulatory changes forced the hands of health care providers. The Hospital Price Transparency rule took effect Jan. 1, 2021, requiring all hospitals in the U.S. to publicly disclose their payernegotiated payment rates. The rule also requires hospitals to provide a tool that allows consumers to search and view the prices of 300 shoppable medical services.

Hospitals that don’t comply face a penalty of up to $300 a day, and penalties are expected to increase over time.

Providers (and starting in 2022, payers) have no choice but to increase the transparency around their rates. This doesn’t have to be a bad thing for them, Severn says.

The new regulations represent an opportunity, as Turquoise Health sees it, to get providers and payers to buy in and see the value of empowering patients to be rational consumers of health care.

Providers and payers can view price transparency as a competitive advantage, not a regulatory burden.

It’s a challenge that the young, venturefunded company (with a total of $5.3 million raised between two rounds) is uniquely positioned to address.

HUNGRY FOR DATA Severn created Turquoise to be the solution for health care price confusion.

“We’re building software to enable price transparency.”

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Turquoise guides providers and payers to simpler agreements, resulting in clearer prices. (Payer, in this instance, refers to any entity that purchases health care on behalf of groups—insurance companies, co-ops, and employers that buy health care on behalf of their employees.)

The company’s website (Turquoise. health) shows a glimpse into the future when every provider and payer website will need to have the capabilities that Turquoise Health enables.

It’s a tall order. Building the software is, in theory, the easy part. To facilitate price transparency, Turquoise needs data— data that, until the new regulations came into effect, was not readily available.

And although thousands of hospitals have since released their transaction data to comply with regulations, it’s not necessarily presented in a consumerfriendly format.

Severn describes the health care landscape as a muddy river, dirtied by inaccurate, incomplete, or unavailable data. Cleaning up the river requires accuracy and transparency at the source—from providers and payers.

When hospitals began releasing batches of this data in early 2021, the Turquoise team set out to scour the

internet and turn the data they found into something useful.

Severn instructed the team to think of this process like a video game, where each new data source was a level to unlock and beat. So far, the team has aggregated data from more than 3,100 hospitals and counting—enough to launch the beta version of their website, which anyone can use to find and compare prices of health care services in their area.

Later this year, the team looks forward to what Severn describes as “the biggest thing happening in health care that no one knows about,” when payers will also be required to release their pricing data.

With each new data set, the team gets closer to being able to offer what Severn calls a “... full fidelity shopping experience.”

A BLUE OCEAN The opportunity is immense—but surprisingly, the competition in this space has not been. A few widely used electronic health record, or EHR, solutions have shown signs of wanting to enter the transparency data space but are limited by their existing relationships with providers and payers. “They can’t risk alienating their customers,” Severn says.

A large EHR tool with long-standing relationships with hospitals and payers isn’t exactly incentivized to broadcast transparency data that might put their customers at risk.

But someone has to do it: Hospitals and insurance companies have no choice but to comply with new regulations.

In the short-term, they risk having to pay fines, but soon, simply complying with the legal requirements won’t be enough. As price transparency becomes the norm in health care, patients will demand better, more user-friendly experiences. Price transparency, but even more broadly, value transparency (where patients can consider access to and quality of health care in addition to price) will be the standard.

And so, providers and payers face a critical choice: Turn value transparency into a competitive advantage or face the consequences. Whether they are ready or not, providers and payers are entering a race to offer the most transparent, userfriendly patient experience.

Turquoise Health is ready to help them compete. “We welcome them all,” Severn says.

“It’s like being invited to a wedding that you don’t want to go to,” he says with a laugh. “These hospitals and insurers know they have to come to the party … so they might as well find a way to make it enjoyable.”

There are several ways that Turquoise Health is currently working with its B2B customers to help them comply with and embrace the new regulations. One large revenue source for the company is the data they have painstakingly collected.

Turquoise offers “... one of the biggest data sets of cleaned up, structured hospital rate data,” Severn says. Providers use this data to gain a better understanding of how to compete with those around them.

The company also sells a white labeled version of its software to providers and payers to use on their own websites.

Hospitals can become fully compliant with transparency regulations while

offering patients a simple browsing experience. Non-hospital providers can also list cash rates for services and become a Turquoise-verified provider.

Turquoise is also launching another product soon: a rate negotiation platform to help providers and payers act on and renegotiate pricing data. This will help payers meet compliance requirements, and drive value-based care decisions for members.

FULL-FIDELITY SHOPPING Turquoise Health’s vision is to make shopping for health care as simple as buying a plane ticket is today—so that consumers of health care know exactly what they are getting, how much it will cost, and what their options are before they step foot in a provider’s office.

The company’s vision is a not-so-distant future where prices have menu-like clarity at a fair market rate. It’s a shift that will take time, but it is happening.

And Severn and the Turquoise Health team are ready for it. 

Turquoise Health’s vision is to make shopping for health care as simple as buying a plane ticket is today—so that consumers of health care know exactly what they are getting, how much it will cost, and what their options are before they step foot in a provider’s office.

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Ro’s Zachariah Reitano is determined to make quality health care accessible to everyone.

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HOUSE CALLS

reinvented

BY SANDY SELBY PHOTOS BY NICK STARICHENKO

Z

achariah Reitano’s mission for his company, Ro, is to build a patient-centric heath care system. It’s an ambitious mission that seeks to unravel decades of mind-boggling complexity, but Reitano has demonstrated to patients, providers, and investors that he is the right person at the right time to make it happen.

Reitano launched Ro, initially called Roman, in 2017, to focus on men’s health. With a promise to discreetly deliver treatment for men’s health concerns through a virtual platform, he proved that the public was ready for a different approach to health care. Reitano shortened the company name to Ro and began adding verticals. One year after the launch of Ro, Reitano started Zero to support smoking cessation, and the expansion has continued with Rory for women’s health care, Ro Pharmacy, Modern Fertility, Plenity for weight loss, Workpath for in-home health care, and Kit for in-home diagnositics.

“We offer products and services for mental health, weight management, women’s health, men’s health, fertility, skin care, and have a generic cash pay pharmacy with over 1,000 medications for just a few dollars a month,” Reitano says.

The public response shows that patients are eager for an alternative. “Since 2017, Ro has facilitated more than six million digital health care visits in nearly every county in Fall 2021 • Maverick |

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the United States, including 98 percent of primary care deserts,” Reitano says.

RELIEF IN THE DESERT For rural residents who must choose between driving for hours to see a doctor or tolerating whatever is afflicting them, having easy access to quality care is as close as their phone. The Ro system works for everyone, as even those in well-served cities find modern health care to be inconvenient and unnecessarily complicated.

“Patients should be in control of their health care,” Reitano says. “Unfortunately, that’s not the case today. It seems every stakeholder in the health care system, except patients—from insurance companies to PBMs (pharmacy benefit managers)— are determining what’s best for patients. But we learned during the pandemic with the rapid adoption of virtual care that patients are no longer going to wait for the current health care system to catch up with their needs. They’re no longer willing to take off work and travel across town for a 13-minute doctor’s appointment that took a month to schedule and costs over $100.

“We’re thrilled to see the rise in a direct-to-patient approach to health care that makes accessing care easier, costs more transparent, and unburdens providers from insurance-related tasks to focus solely on patients’ needs. This model has also become especially important for the millions of patients across the country who may not have existing or adequate health insurance. We owe patients a health care system designed with them at the center, and frankly, it is one that will be expected and the standard in the future.”

CHALLENGE ACCEPTED COVID-19 wasn’t on any company’s radar, and the chaos it created touched everyone, but Reitano acknowledges that the pandemic was a catalyst for innovation. “The impact on Ro is hard to quantify as we’re still in it,” he says. “But one of the brightest spots of the pandemic has been getting to watch Ro’ers constantly work to leverage the technology we’ve built to help patients through it.”

In March 2020, as infections increased and shutdowns began, Ro was the first company to launch a free nationwide telehealth assessment for COVID-19 triage. “People could come online, enter their symptoms, enter their exposure or travel history, and then if appropriate, they would get connected to a provider to speak to for free,” Reitano says. “Eventually, we partnered with over 70 companies nationally to give their employees or consumers access to this tool, including Uber, who rolled this out to all of their drivers.”

That was just the beginning of Ro’s commitment to helping the public navigate the pandemic. Last December, the company acquired Workpath, and that acquisition put them in a position to deliver vaccines to New Yorkers in need. “[Workpath] unlocked a new capability for us: the ability to send health care professionals to a patient’s home to deliver care and support more chronic and complex conditions through Ro’s platform. Workpath’s capability also enabled us to launch our COVID-19 Vaccine Drive, a first-of-its-kind in-home vaccination program facilitated with New York State’s Department of Health. We helped thousands of vulnerable New Yorkers who could not access vaccination sites, including the elderly, disabled, and homebound, by dispatching health care professionals directly to patients’ homes to administer the COVID-19 vaccine.”

BRINGING HEALTH CARE HOME Reitano knows that Workpath’s in-home care delivery will continue to be valuable post-pandemic.

“Over time, Ro will integrate Workpath with our most recent acquisition, Kit, an at-home diagnostics company,” he says. The integration of Workpath and Kit will facilitate in-home care and diagnostics that might include self-administered test kits or inhome visits by a provider. “Ro can help patients more effectively manage their health, detect health issues earlier, and ultimately improve their health outcomes.”

According to Reitano, Workpath’s nationwide network now reaches 95 percent of the U.S. population, giving them access to providers who can perform services such as blood draws, vaccinations, and other primary care services. “Since its launch, Workpath has powered over 100,000 in-home care appointments for clinical trial operators, Fortune 100 companies, and the nation’s largest diagnostic laboratories.”

The addition of Workpath strengthens a company that was already offering a comprehensive list of services. “What makes Ro unique is that we’re entirely vertically integrated,” Reitano says. “We’re the only health care company in the entire country to seamlessly integrate a nationwide telemedicine practice, a nationwide pharmacy network (we own and operate eight pharmacies distributed throughout the country), our own CLIA-certified

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and CAP-accredited lab, at-home lab tests, and an in-home care platform that can send a health care provider to the home of 95 percent of the U.S. population. Ro’s infrastructure, which gives us the ability to make high-quality affordable health care available where and when patients need it most, is one of one.”

INVESTING IN CHANGE After four years, it is clear that Ro is a success, but the earliest investors in the company made the leap based on their faith in Reitano and their disdain for the status quo. In March, the company completed its Series D round of fundraising, which brought the company’s total funding to $876 million.

“We’re lucky to have investors who have supported us pre-launch through Series D,” Reitano says. “The reasons are straightforward: They’ve recognized the incredible value we provide to patients across the country, we’ve grown extremely quickly, and there is no obvious limit to the impact we can have.

Our investors are mission-driven, take the longest view in the room, and are in support of challenging the status quo in service of helping patients. We couldn’t ask for more.”

There is no reason to believe Ro’s growth is going to slow down. “When we think about adding new capabilities and services to the Ro platform through acquisition, we think about partnering with incredible teams that can help

accelerate our ability to add value to patients’ lives and advance our mission of building a patient-centric health system.”

ALL TOGETHER NOW Ro’s robust multipronged platform may be best exemplified by its COVID-19 Vaccine Drive in New York. Reitano takes pride in how the entire Ro team came together for that effort. “This initiative required every ounce of technology and operations Ro has built over the last three-plus years. It required our synchronous and asynchronous telehealth services, our pharmacy distribution network, our in-home care platform Workpath, and our team of pharmacists, doctors, nurses, engineers, designers, and operators working relentlessly to serve patients.

“We owe patients a health care system designed with them at the center, and frankly, it is one that will be expected and the standard in the future.”

– ZACHARIAH REITANO

“We helped more than a thousand elderly, homebound New Yorkers receive the vaccine from the convenience and safety of their homes and also got to learn their stories. We helped a woman who was 107 years old and homebound, and convinced she otherwise wouldn’t have gotten the vaccine. We also helped a 92-yearold grandmother get vaccinated so that after a year, she could finally see her grandkids and attend her granddaughter’s wedding. These powerful moments were only possible because of the platform we built. And we have so much left to build.

“It’s just the beginning.”  Fall 2021 • Maverick |

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Turning Patients into Purchasers of Care Sidecar Health gives patients a choice and maybe even some money back.

BY CELESTE STEWART

PORTRAIT BY TULIO DIAZ / IMAGESBY2.COM

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H

ealth care in the United States remains elusive, with many people struggling to afford it or skipping it altogether. Those with employersponsored plans increasingly face high deductibles and narrow networks. Patrick Quigley and Veronica Osetinsky, CEO and COO of Sidecar Health, want to change that by empowering consumers to buy care with cash and, at the same time, leverage their knowledge of what health care should cost. This combination has never been seen before.

“Sidecar Health is turning patients into purchasers of care for the first time,” Quigley says. “We enable people to buy care when they need it using a Visa card that pulls money directly from our claims account. We tell our members what everything in the U.S. health care system costs and what our benefits are, enabling them to shop for care.”

COMPARISON SHOPPING “It’s all about access to insurance and to the doctors they want to see,” Osetinsky says. “Sidecar Health tackles those issues, and our plans are affordable. Members can see any doctor. And since we give members transparency on the coverage, they can shop around smartly.”

“Our product is a bit mind-blowing in that we pay a fixed rate for every service you can receive in the U.S. health care system,” Quigley says. “And that fixed amount is based on the average market price. So conceptually, 50 percent of doctors will be more expensive, and 50 percent will be less expensive, but our members know that all upfront.”

Members can ask for pricing when scheduling appointments and compare costs to the market average and Sidecar Health benefit.

“Let’s say you were shopping for chicken,” Quigley says. “You could go to Whole Foods and pay $8 per pound, or you could go to Safeway and pay $4 per pound.

With Sidecar Health’s product, we say,

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look, we’ll pay $6, and you decide where you want to go. Some people will choose Whole Foods—maybe they like the freerange chicken—and they’ll know upfront that their portion will be $2.”

Quigley prefers buying his chicken at Safeway and getting $2 cash back. “By giving them all the information and the control, they can shop around. If they shop smartly, they can get care and get money back.”

This happened with the company’s first expense where they paid a previously uninsured family $20 cash back after their first well-child visit. “When we saw that, we realized, ‘Wow, we’re really on to something,’” Quigley says.

“It’s more than anecdotal evidence. It’s real hard-core data around our members using the platform and choosing providers that charge less,” Osetinsky says. “The biggest measure of success is member satisfaction. We measure that through surveys, Trustpilot reviews, and ratings of our member interactions. Our product is based on cash prices, so we’re always watching the market prices. We gather all of the data around consumers shopping for care, medical services, and prescription drugs. We compare that to the average cash prices out in the market.

We’ve seen that consumers are shopping, and they’re getting prices that are much less. They’re often getting money back, and that’s super exciting to see.”

Quigley adds, “And it’s absolutely fascinating because, at this point, over 60 percent of our members are choosing providers or pharmacies that are charging less than the market, resulting in cash back. It’s really exciting to see the power of consumers being fully engaged in their health care to make the decisions that work for them. That’s never been done before in the U.S. health care system.”

A WINNING TEAM Although Sidecar Health is a new company, it’s the third one that Quigley

and Osetinsky have worked on together.

Their previous collaborations include QuinStreet Inc., a pioneer in directto-consumer marketing, and Katch, a company that helps major insurance companies market their health plans directly to consumers.

With an extensive background in health care marketing, digital technology, finance, strategy, and building companies together, the Sidecar Health co-founders understood the importance of finding the right partners. “Veronica and I wanted to make sure that we chose correctly. We put our own money in initially to get enough runway to choose the right institutional investors,” Quigley says. “Since then, we’ve raised $175 million of outside capital from tremendous investors to facilitate our growth.”

Sidecar Health currently operates in 17 states (Arizona, Ohio, Michigan, Indiana, Utah, Texas, Florida, North Carolina, South Carolina, Kentucky, Tennessee, Georgia, Alabama, Arkansas, Maryland, Mississippi, and Oklahoma).

Members include everyone from young adults who have aged out of their parents’ coverage and want a more modern approach to health insurance to pre-Medicare seniors who’ve been frustrated with traditional plans and their lack of choice.

A MATH LESSON Sidecar Health’s first product focused on those with the most need: the uninsured

“It’s really exciting to see the power of consumers being fully engaged in their health care to make the decisions that work for them.

That’s never been done before in the U.S. health care system.”

– Patrick Quigley

and underinsured. Sidecar Health has also set its sights on the Affordable Care Act’s health care exchanges, offering individuals a new choice.

“What many people don’t know is that paying for care with cash is actually dramatically cheaper on average than traditional insurance negotiated rates,” Quigley says. “Most people think that the traditional insurance companies are negotiating better deals on behalf of their members. But in fact, when you pay for care with cash, on average, it’s actually almost 40 percent cheaper than what your insurance company might pay because there aren’t all the administrative costs.”

By eliminating costs, Sidecar Health’s new approach translates into lower premiums. “Insurance is just a boring math equation. It’s the cost of a claim times the likelihood of a claim plus a margin,” he says. “We’re able to provide a product that’s much cheaper than traditional insurance because our claims

cost are lower. At the same time, we provide better access because it turns out everybody takes cash.”

Sidecar Health’s first employersponsored plan will launch in the first quarter of 2022, a move that offers employers a new way to provide health benefits for their employees. Quigley and Osetinsky believe this innovative approach will change how health care is bought, sold, and delivered in America today.

A NEW DAY “Some of what HHS (Health and Human Services) has done has been outstanding,” Quigley says. “They’re pushing transparency regulations and making it a requirement for hospitals to publish their negotiated rates and further pushing on insurance companies to inform consumers about what their portions of the bills are going to be.

There’s also lots of legislation around surprise billing. If you put these things

together, it’s really going to change and empower consumers for the first time.

We feel like that is exactly what we’re all about.”

“Technology is finally allowing health care to move into the 21st century,” Osetinsky says. “We’re seeing a move toward electronic medical records, more accessible telehealth, new payment platforms, a rethinking of medical billing, and enabling transparency.

Thinking about where the on-demand transportation industry was 10 years ago and where we are today with the ease of Uber and Lyft, I think health care can become similarly seamless for people to use.”

Sidecar Health’s vision and digital platform represent a new approach to health care that is more affordable and provides better access. As the company grows, it may only be a matter of time before all U.S. residents can gain control over their health care.  Fall 2021 • Maverick |

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• • •

A CLEARER IMAGE Dr. Cristin Dickerson transforms her field with Green Imaging.

BY AMY WILDER

PHOTOS BY DEMORRIS BYRD / LIFESTYLEVISUALZ

F

or more than a decade, Dr. Cristin Dickerson of Houston has been disrupting the way radiology services in the U.S. are provided and billed.

By doing so, she has helped create a better payment landscape for employers, patients, and even for radiologists in the markets her company serves.

BUILDING ON A BRAINSTORM Dickerson, a well-credentialed radiologist with a background that includes training at the MD Anderson Cancer Center and a degree from the University of Texas Medical School in Houston, is founder and CEO of Green Imaging PLLC, a pioneer in self-pay and imaging.

She conceived of Green Imaging when Houston’s uninsured rose to 21 percent of the patient population, while at the same time radiology services were moving

toward centralized departments within hospital systems.

The rates for imaging began to skyrocket, and in turn led to more bad debt for medical providers.

With these combined factors, Dickerson saw a need for affordable alternatives for patients and employers, and at first, she thought about opening her own imaging center. “I had developed an imaging center when I was president of a multispecialty group,” she says. She helped digitize that group practice in 2005, so she had the right background to start building. But she hit a roadblock almost immediately.

“By the time we priced it out, it was going to be several million dollars and I wasn’t going to be able to save anybody any money,” she says, “but Travelocity and some other shared models were starting to emerge.”

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Oddly enough, this provided a great cross-industry starting point for Green Imaging’s initial blueprints.

Radiology was an ideal industry for a self-pay model, as Dickerson notes.

“In the Stark Laws, which are the self-referral laws, radiologists have an exemption,” she says. “We’re considered consultants for imagining centers, and so we can actually do per-click lease arrangements with imaging centers.

Typically, in an outpatient imaging center, the center pays the radiologist a flat fee for their professional service, and then they bill the patient globally.

In hospitals, it’s split-billing: The radiologist group bills for one service and the hospital bills for the other.”

Dickerson developed an unprecedented model—to buy the scan directly from the imaging center and hire internal radiologists to provide the interpretation. “And then we would bill globally,” she says. This limited the need for overhead and even for a large initial investment, and Green Imaging continues to operate as a virtual company.

By following such a model, she could offer lower imaging rates for the employers and patients she sought to serve, while simultaneously filling an income gap for radiology centers that have chronic unfilled time slots on their imaging machines. “I had a radiology group and I was reading for all these imaging centers that were at only 50 percent capacity,” Dickerson says, “so I got the idea to offer to buy time on their scanners at a discount. If I could buy time on the table, this would be icing on the cake for them.”

The first imaging center Dickerson approached was run by one of her former MD Anderson professors. “I said, let’s give this a shot—let’s see if we can get some more volume your way,” The center agreed, and volume increased.

“We just needed to find a different way to tap into resources that were being under- or not utilized, and create savings, and that’s what we did.”

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NO MORE MYSTERY Laura Turcotte, who has done contract work as an external design consultant for Green Imaging and other providers in the health care industry, had an experience about 10 years ago that will sound familiar to many American families with high-deductible plans. Her daughter unexpectedly needed an MRI for a sports-related injury.

Turcotte remembered that high-deductible plans were beginning to dominate the insurance marketplace and employers were starting to worry about skyrocketing health care costs across the board. Her family carried a high-deductible plan, with a family deductible at $10,000 and an individual deductible at $5,000. “As a relatively healthy human being with a relatively healthy family,” she says, “it never impacted me because all I did was pay my premium, went to the doctor, paid my copay, and everything was great.”

Until it wasn’t.

The hospital sent the family to their inhouse radiology department for imaging.

“And we’re sitting in the financial counselor’s office, and she said to me, ‘We think that your patient pay is going to be this amount,’ and I said, ‘What do you mean you think my patient pay is going to be this amount? Tell me what my patient pay is.’”

Although Turcotte had the knowledge and skill to calculate her patient pay herself, the financial counselor refused to provide her with the necessary contracted insurance information, telling her that it was “privileged information.”

Incredulous, Turcotte pointed out that as the one paying the bill, she should have access to the information used to calculate it.

“So, I just looked at her and I said, ‘I’m going to pay you $1,800 today, and then I don’t know how much more I’m going to pay later? I just want to make sure I understand that correctly,’ and she said, ‘Yes,’” Turcotte says. “I looked at her and

said, ‘You do realize that that’s like me going into Pottery Barn and them telling me that the shelf I want is going to be about $50, and then I buy it, and when I take it home, they may or may not send me a bill for an additional amount,’ and she looked at me and started laughing, and said, ‘Yeah, that’s pretty much it.’”

That’s when it hit her that Green Imaging offered a solution for this sort of situation. “I thought, this is precisely why Cristin Dickerson built her business the way she did. So I called Green Imaging,” and asked for a quote from their patient concierge. It was in the vicinity of $350 all in, unlike the hospital, which would have sent at least

Dr. Cristin Dickerson shares her success story with attendees at the Free Market Medical Association Conference.

• • • also have two huge clients in Florida— we have a school district, and we have the Rosen Hotels & Resorts.”

Green Imaging has worked with the School District of Osceola County in Florida for nearly two years. In 2019, employees had their entire wage increase wiped out by their insurance premiums, and the teacher’s union petitioned the school board for solutions. Enter Green Imaging. The board contracted Dickerson’s company for zero out-ofpocket costs for their employees. The employees are clearly benefitting, but so is the school district.

PHOTO BY CHANCE JACKSON

two billing statements. “So we’ve been using them ever since,” Turcotte says.

“It’s so simple that you can’t believe it.

One thing I didn’t realize the first time I used them is that you can use your health savings account for it. So I go to Green Imaging, and I just give them my HSA card.”

Green Imaging makes every effort to make the process as easy as they can for patients. The process is simple. A patient reaches out, by phone or secure text message, and contacts an actual human who can connect them to a local service provider within minutes, assuming the patient has their imaging order from their physician on hand, and their other

needed personal information. If the patient agrees to the rate, he or she pays up front and then goes to the imaging provider for the scheduled appointment.

And that’s it—no surprise bills.

EVERYBODY WINS Green Imaging has grown from its initial local contract a decade ago, to more than 1,400 centers across the U.S. today. Dickerson says the company determines when and how to enter a new market through research. “We read the studies, when there are enough employees or covered lives in an area to justify that. The first five years, we were just in Texas, and we have a very mature Texas network,” she says. “And then we

Carolyn Grant, a Health Rosetta benefits advisor, met Dickerson at a conference a couple of years ago. She immediately saw the potential cost savings for teachers and their employer. “When you pay the price of an MRI at $450 compared to $1,500, it’s a big difference to the group,” Grant says. “It’s a triple win, right? It’s a win for the employer, it’s a win for the employee, and it’s a win for the plan. It’s so easy and the concierge behind it is just beautiful.”

“We had predicted that we would save them $1.3 million, based on our existing network,” Dickerson says. “We were actually able to leverage that large number of employees, get them better pricing, and we actually saved them $1.5 million in 2020, and we’re on target to save them $2.5 million this year.”

“Dr. Dickerson is a highly credentialed radiologist herself,” Grant says. “All providers and all doctors are not equal.

There are some crappy specialists and some really great specialists. In her field, she is top-notch. It’s great to know that. She’s running this very creative business, but she’s also this really great radiologist.”  Fall 2021 • Maverick |

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THE DIRECT EFFECT

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By Sandy Selby

PHOTO PROVIDED BY SESAME CARE PORTRAIT BY DEMORRIS BYRD/ LIFESTYLEVISUALZ

SESAME CARE’S RADICALLY SIMPLE HEALTH CARE MODEL PUTS CONTROL BACK INTO THE HANDS OF PATIENTS AND THEIR PHYSICIANS.

D

avid Goldhill’s career began to shift in an unexpected direction as he sat vigil in a New York City hospital room.

Goldhill was enjoying success at the helm of the Game Show Network and never envisioned a future in the health care industry, but as he sat helpless, watching his father succumb to a hospital-borne infection, observing systemic inefficiencies, and struggling with the opacity of hospital bills and codes, his anger gave way to action.

In 2019, Goldhill founded Sesame Care, a business that prescribes “radical simplicity” as the antidote to the overwhelming complexity of health care in America.

“Sesame is a marketplace with a full range of health services designed for value-conscious patients and patients who pay all or a lot of the health care directly out of pocket,” Goldhill says. “Sesame is a marketplace where provider doctors, nurse practitioners, physician assistants, labs and outpatient clinics can offer services directly to those patients for fixed prices. Patients have the opportunity to do some shopping around and get to know the provider.”

THE RESULT: “TERRIFIC SAVINGS AND MUCH GREATER CLARITY FOR THE PATIENT.”

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FIXING WHAT’S BROKEN Sesame offers both in-person appointments and telemedicine, but the hallmark of the service is the fixed prices, which are clearly stated up front. The patient pays directly for a consultation, test, or treatment, often at a price far less than would be billed to their insurance because of the savings providers realize when burdensome red tape disappears.

“Most practices find administrative and credit costs to be so high that having a direct patient relationship saves a meaningful amount of cost; some of those savings can be passed on to the patient,” Goldhill says.

The company launched in Kansas City and was poised to expand to Houston.

Then came COVID-19 and Sesame’s telemedicine platform, SesameCare.com, became more than just an added convenience.

“When the pandemic started, most of Sesame’s physicians listed in-office services and of course, because of the lockdowns around COVID and its impact on health care providers generally, much of the consultation work in health care became virtual,” Goldhill says. “That immediately changed what we were doing. We built a telemedicine platform immediately so the doctors working with us could continue to see patients through Sesame. We opened that to any of our doctors who wanted to hang out their own telemedicine shingle. We had something like a thousand physicians join in a few weeks.”

“TO ME, THE MOST IMPORTANT METRIC IS THE CUSTOMER REPEAT RATE.” – DAVID GOLDHILL

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It would be a mistake to call Sesame a telemedicine business, though. “We’re not really a telemedicine business as much as a platform that a lot of medicine business gets done on,” he says. “A lot of care can only be done in-person. Our business remains an effort to be full-scope with primary care, specialist consultations, pharma, labs, testing, and procedures. And we expect that as people get more comfortable, that will be the bulk of our business.”

Sesame untangles the confusion of health care by modeling itself after traditional business paradigms where service providers interact directly with customers. While a direct-pay relationship

is the norm in a few medical businesses, notably areas such as sexual health and cosmetic procedures, it remains a rarity in medicine overall. “What we’re doing at Sesame is taking the core part of health care appointments with physicians and tests and procedures, and moving that to a direct marketplace,” Goldhill says. “It’s a pretty radical approach and something we think has worked in every other consumer-facing business.

We should think of health care as a consumer-facing business instead of an industry that feels stuck in a previous century.”

It’s a broken system, in Goldhill’s view, that allows obstacles and inefficiencies to be placed between patients and their physicians. Sesame aims to give control back to the people receiving the care and the professionals providing it.

Sesame isn’t an either/or proposition for its providers, though. “It gives physicians the opportunity to choose how much they want to devote to the cash-based market and how much they want to do in the traditional insurance-based market,” Edwards says.

“We’re about high-value health care,” Goldhill says. “Not just lower price health care. There’s no question that price is a very big motivator. The fixed price is important, too.”

Goldhill adds that providers who gravitate toward Sesame are those who are comfortable with being reviewed and rated by patients. “They want to be accountable. We have designed with our chief medical officer a proprietary system for rating every single provider. We use it now and use it in discussions with our doctors. We intend to publish them when we get to a scale that we feel is representative and fair.”

THE BIG SWING Goldhill’s ideas for simplifying American health care first grabbed national attention with his 2009 essay in The Atlantic: “How American Health Care Killed My Father.” That essay put him at the front of a national debate about health care and, when he went decided to launch Sesame, he found like-minded investors who were ready to put their money behind his bold approach. Goldhill brought in $24 million in investor financing for his startup, and investors continue to see the value in the company as it expands.

“We were very fortunate that our initial investors and General Catalyst as our lead investor were very supportive of the broader vision,” Goldhill says. “This is obviously a big swing at a big problem. There are investors who like big swings.”

Once funded, Sesame began recruiting physicians and found plenty of highly qualified care providers who were ready to break away from the status quo. Sesame is quite selective about the physicians it invites to join the platform. “The doctors are vetted, and every transaction is rated for quality and service metrics. We vet as well on customer service and patient relationships.”

Dr. Allison Edwards, Sesame’s chief medical officer, was eager to join the team. She was already part of a direct-pay primary care practice in Kansas City, and a fan of Goldhill and his book, “Catastrophic Care: Why Everything We Think We Know About Health Care Is Wrong.” She asked Goldhill, “How can I get involved?”

In her role, Edwards helps medical providers move away from the dysfunctional system they thought was unavoidable. “You do have to market yourself and you don’t have the assembly line of insured patients coming through your door, but it’s not an unsuccessful model,” she says. “We’ve had great success!”

According to Goldhill, Sesame will have more than 6,000 physician affiliates by fall, and as the service expands to more cities, those numbers will continue to climb. “Physicians want to be listed on Sesame,” he says. “They have to be genuinely willing to fix their prices. None of the surprises. There’s no point in listing on Sesame as a provider unless you’re providing a special package or a value to the patient better than they can receive on their own.”

GROWTH POTENTIAL The greatest challenge, according to Sesame’s founder, is getting known and understood by the people who would benefit from the service the company provides. Once consumers try the Sesame way of accessing health care, they like it and often become repeat customers.

“We’ve benefitted because we’re doing something different and we’re growing organically,” Goldhill says, and adds that recently they have seen strong interest from employers and even from some insurance companies who are recommending Sesame for the portion of health care that insured people are financially responsible for. “At the end of the day, we launched this into a pandemic and it’s just a matter of getting known.”

Goldhill and his Sesame team know that if they are going to rewrite the book on American health care, they must keep the needs of the patient and the needs of the provider in balance.

“We can bring this to health care today and it can be a win-win for both sides of the marketplace,” he says.

Goldhill is, at heart, an optimist, and it would be difficult to look at the early indicators and see anything but a bright future for Sesame.

“Sesame is growing very, very quickly,” he says. “There are high satisfaction scores from patients and providers. We have exactly what you would look for: huge numbers use us more than once and lots and lots and lots of providers are asking to join the platform. We have a high repeat rate for patients and a high retention rate for doctors and the goal is to maintain that level of satisfaction.” 

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Surgery Center of Oklahoma is the standard-bearer for upfront health care pricing.

LEADING THE

change A hysterectomy costs $8,000; a tonsillectomy/adenoidectomy, $3,100. A bone marrow biopsy is $5,800. Total knee replacement: $15,499. Those prices—which include pre- and post-operative services, surgeon(s), anesthesia, pathology, facility fees and, in the case of joint replacement, physical therapy and home health— are all offered by Surgery Center of Oklahoma, which has operated outside the traditional health insurance system for nearly 25 years.

During that time, the number of surgeons and the range of procedures provided at the Oklahoma City facility has increased dramatically. More broadly, Surgery Center of Oklahoma has inspired the development of a true market for cash-price health care services.

“This movement is much further along and much bigger than most people will acknowledge,” says Dr. Keith Smith, an anesthesiologist and the center’s co-founder with Dr. Steve Lantier, also an anesthesiologist.

BY LOLA BUTCHER PHOTOS PROVIDED

BY SURGERY CENTER OF OKLAHOMA

44 | Maverick • Fall 2021

A few physician-owned businesses and at least one huge health system—UCLA Health—have followed Surgery Center of Oklahoma’s model: publicly posted cash prices for bundled services, with payment due at time of service. Beyond that, Smith says, many other hospitals and physicians, when asked, will offer cash-price services to keep from losing patients.

“A lot of people are doing this in the shadows because they know it’s inevitable,” he says. “The self-funded buyers are increasingly aware of what is possible, and they are going to make all providers do it, or they will send their employees elsewhere.”

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from idea to ideal Surgery Center of Oklahoma has six operating rooms and one minor procedure room. Its infection rates, which are much lower than industry averages, are posted online at SurgeryCenterOK.com. The total cost of procedures is generally at least 50 percent less than standard insurancecovered operations at other hospitals.

When Smith and Lantier opened the center in 1997, 10 surgeons were on staff. That number has grown to 115.

“We are just one of the places they work, although every one of them wishes all of their surgeries could be performed at our place,” Smith says.

At the 2021 Medical Freedom Conference, Smith recounted the surgery center’s first week of operation in 1997, when an uninsured patient who had a breast mass called to ask how much it would cost to have it removed. Smith put her call on hold while he quickly called his friend who is a general surgeon to ask what his fee would be; called a pathologist friend to get a quote for his services; and estimated the anesthesia costs, based on his own time and supplies required. He returned to the patient’s call to say the total cost would be $1,900.

“She said, ‘That’s funny. The hospital down the street from you wanted $19,000 for the facility fee alone,’” Smith says. “I knew we were on the right track when, after this case and the supply cost was tallied, we’d made a profit.”

Originally, Surgery Center of Oklahoma served uninsured people who could afford to pay for procedures out-of-pocket, people with high-deductible health plans and health savings accounts, individuals in cost-sharing ministries, and patients from other countries, such as Canada, who preferred to pay their own way rather than wait for their government-subsidized care.

In the past decade, however, Surgery Center of Oklahoma has increasingly treated patients covered by self-funded insurance plans that incentivize employees to use the surgery center’s low-cost, high-quality services. Today, at least 40 percent of the center’s revenues come from self-funded plans.

The surgery center predates the centers of excellence concept, in which major employers such as Walmart and Boeing direct their employees to a specific facility for a specific procedure because of its quality performance for that service.

“The self-funded employers treat us very much like a center of excellence, except that, unlike the centers of excellence, they know with me what a treatment is going to cost beforehand,” Smith says. “People from all over the country started buying from us when they realized the price differences were so

46 | Maverick • Fall 2021

“People from all over the country started buying from us when they realized the price differences were so stark that they could cover all of the travel expenses for their employees, waive all deductibles and copays, and pay for all of the care at 100 percent.” – DR. KEITH SMITH

stark that they could cover all of the travel expenses for their employees, waive all deductibles and copays, and pay for all of the care at 100 percent.”

the premier league The turn to self-funded plans came when Smith met Jay Kempton, president and CEO of The Kempton Group, a third-party administrator in Oklahoma City. Seeing the Surgery Center’s prices made Kempton realize that his clients could benefit from directing their employees there.

Kempton approached a couple of his clients to explain the opportunity. “We were able to look at 40-plus years of claims data, and I could show my employers that the pricing here was a sixth or an eighth of what they were normally buying these medical procedures for,” he says.

His company created a new enhanced benefit tier, in which employees incur no copay, deductible or co-insurance if they choose Surgery Center of Oklahoma as the provider. All of Kempton’s self-funded plans jumped on board to offer the new premier benefit tier to their employees.

Kempton is the third-party administrator for about 200 employers who cover about 30,000 lives, mostly in Oklahoma and Texas. As patients covered by those plans started choosing Surgery Center of Oklahoma for their procedures, other physicians and facilities in the market took note. One of them called Kempton to find out why he was losing business.

“And I was able to explain that there is a competitor of his with a very compelling value proposition—upfront pricing, guaranteeing their outcome, and ‘I can tell you what the price is and it’s a lot less than yours,’” Kempton says. “This particular medical provider said, ‘Well, we’re going to try to compete for those patients as well ... and we also do a few things that they don’t do.’”

Thus, a market for health care services in Oklahoma City was born. Soon, an inpatient cardiac hospital started offering bundled cash prices, followed by imaging centers and oncology

Dr. Keith Smith and Dr. Steve Lantier

practices. All are premier-tier providers with prices posted on Kempton’s website. The price sheet for Surgery Center of Oklahoma includes more than 500 procedures, detailed by their CPT codes.

“We are doing business with probably over 150 providers that have adopted Surgery Center of Oklahoma’s business model,” Kempton says. “Surgery Center of Oklahoma is consistently in the top three in terms of volume for our clients, but we now have thousands of procedures that are available on a cash basis.”

destination health care At this point, at least 40 percent of Surgery Center of Oklahoma’s patients travel from out of state to receive care.

“Most come from states that border Oklahoma, but more and more come from Wisconsin, Minnesota, Oregon, Washington state, Florida, very, very far away,” Smith says. “The price differences are so stark that, for a total knee replacement or a total hip replacement, the employers are more than willing to pay for the employee to stay in town for a week or longer because they still are coming way under the bar of what they would have paid elsewhere.”

Smith also serves employers whose workers do not travel to Oklahoma City for procedures. He owns Atlas Billing Co., operating in Oklahoma, Washington, Georgia and Arizona, which “curates” bundled-pricing deals with other providers.

If a self-funded plan in Georgia needs to buy a procedure for a patient, for example, Atlas Billing contacts a surgeon in that market. “I say, ‘This patient really doesn’t want to come to Oklahoma, but they are thinking about it. Why don’t we work together—you, your anesthesia team and a hospital or facility and let’s see if we can help this patient,’” Smith says.

With the bundled price determined, the employer and patient can compare it with the price offered at Surgery Center of Oklahoma and choose the best option. Regardless of the location chosen, Atlas invoices the employer, collects the full payment and pays all providers and facilities involved in the episode of care.

“One of the reasons they [hospitals] are fearful to do business in this way is they are afraid that they will offer pricing that conflicts with the contracts they have with carriers,” Smith says.

“But Atlas’s involvement cloaks them and insulates them from that threat, so it actually works beautifully.”

Smith expects to see other “clearinghouse” competitors to Atlas emerge.

“When you start to see that, and you start to see big-name hospitals using a clearinghouse to create and collect for bundledcare episodes, then you will know the dominoes are starting to fall,” Smith says. “I’m seeing it right now, and I’m very optimistic that the big purchasing gorilla—the self-funded world—has already started this movement in such a way that it won’t stop.”  Fall 2021 • Maverick |

47

U.S. health care system, at times, could be better aligned with the interests of patients. “Simply put, providers are still mostly paid for volume rather than value,” he says. “This will continue to change.”

Andrews knows the U.S. health care system well. Before the HTA, he served as a member of the United States House of Representatives for nearly 24 years. President Barack Obama praised Andrews’ service as “an original author of the Affordable Care Act ... and a vital partner in its passage and implementation.”

Power in Numbers The Health Transformation Alliance uses its leverage to improve American health care.

BY CELESTE STEWART

E

mployers are in a unique position to improve the health care system and make it more affordable.

Still, they need access to data and a coordinated strategy to make change happen.

The Health Transformation Alliance (HTA) is a nonprofit cooperative of leading U.S. self-insured employers that uses the companies’ aggregated health care data and collective buying power to provide higher quality health

48 | Maverick • Fall 2021

benefits for their employees at the same or lower cost. Fifty-seven member organizations from the financial services, banking, manufacturing, retail, health care, energy, agriculture, insurance, transportation, technology, oil and gas, consumer products, food and beverage, communications, and packaging industries have banded together to fix the broken health care system.

According to HTA’s CEO Robert Andrews, the financial incentives of the

HTA’s members believe they have a bright future in the shift to valuebased health care. “Our core belief is that employers are stronger together,” Andrews says. “Even a very large company’s leverage is fairly small when it acts alone. But when we join forces, we have the leverage needed to get what is essential: data, better contract terms, and the ability to take action.”

Andrews emphasizes that HTA obtains its patient data with consent, and that data is aggregated and anonymized. “We don’t know—and don’t need to know— that Sally had a cesarean section, how much it cost and what the outcome was for her and her baby,” he explains. “We just need to know how many women on a plan had C-sections, the cost range, and the outcomes.”

However, accessing the data patients and employers need to make informed decisions about health care and benefits isn’t easy. “Insurers, PBMs, and TPAs largely control the data and they would prefer that patients and employers don’t have it,” Andrews says. “I’ve said this

Want to know more about the companies featured in this magazine?  Cocoon, Lauren Dai PAGE 9

“WHEN WE JOIN FORCES, WE HAVE THE LEVERAGE NEEDED TO GET WHAT IS ESSENTIAL: DATA, BETTER CONTRACT TERMS, AND THE ABILITY TO TAKE ACTION.” – ROBERT ANDREWS many times: getting data out of these organizations is like getting raw meat away from a caged lion. Even with the collective influence of our members, it took the HTA three and a half years to get data on 3 million people our members represent.”

Safety and quality data combined with aggregated data on millions of employees’ health and health care claims enable employers to negotiate and enforce payment strategies and contracts that reward providers for the best patient outcomes. Not only does this help save lives, but it also saves billions of dollars in health care costs. In the five years since HTA’s formation, the cooperative has saved employer members $1 billion in health care costs.

Access to data empowers patients to choose the best hospital or surgery center for their needs and incentivizes providers to make improvements.

“We also partner with innovative companies to offer our members pharmaceutical, medical, and consumer engagement solutions that provide the care they deserve at more affordable prices,” Andrews says. “Examples include pharmacy plans that save money, proprietary provider networks incentivized by outcomes, not volume,

and technology that empowers consumers.”

The U.S. health care system may be in a crisis, but HTA’s members are motivated to make it better.

“Every one of the employers in our cooperative is taking on the health care system in America. That takes courage,” Andrews says. “For example, telling employees that you’re going to change how they get health care sounds easy. But people get used to doing things a certain way, and even if they don’t like how they access health care now, many will not like it when things change. That takes courage.

“There is also the risk of damaging relationships employers have with companies in the health care field.

Health care is 20 percent of the U.S. economy. Anytime you take business away from a company in the health care field, you risk your relationship. That takes courage.”

When it comes to improving the health care system, U.S. employers are wellpositioned and highly motivated to make the changes necessary for a healthier America. In the tug-of-war between fee-for-service and fee-for-value, HTA member employers are united in a push for value-based health care. 

 Free Market Medical Association PAGE 50  Green Imaging PAGE 36  Health Transformation Alliance PAGE 48  Knowality PAGE 14  Olavi Group, Joe Andelin PAGE 8  Paytient Technologies Inc. PAGE 18  Ro PAGE 28  Sesame Care PAGE 40  SideCar Health PAGE 32  SimplePay PAGE 10  Surgery Center of Oklahoma PAGE 44  Turquoise Health PAGE 24

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Fall 2021 • Maverick |

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2021 FREE MARKET MEDICAL ASSOCIATION

ANNUAL CONFERENCE

PHOTOS BY CHANCE JACKSON

M

ore than 300 representatives from the health, insurance and benefits industries attended the 2021 Free Market Medical Association Annual Conference, Aug. 5-7, 2021, at the Hilton Dallas/Plano Granite Park hotel in Plano, Texas. The conference featured a variety of panel discussions, keynote speeches, and case studies highlighting the growing movement of patients, providers, and self-funded employers working together to change the way health care is bought and sold in the United States.  Mitigate Partners’ Co-founder Carl Schuessler, Jr. leads a panel discussion on employer health plans with representatives of The Gasparilla Inn & Club from Boca Grande, Florida.

More than 20 companies exhibited their products and services at the 2021 FMMA Convention.

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Steve Forbes delivers the keynote message on the successes of free market approaches to health care delivery at the 2021 FMMA Conference.

Left: Oklahoma State University Professor Dr. Per Bylund discusses the impact of health care regulations on entrepreneurship.

Below: Conference attendees network while enjoying lunch at the Hilton Dallas/ Plano Granite Park hotel.

Dr. Adam Wheeler, founder of Big Tree Medical, participates in a panel discussion with Freedom Healthwork’s Co-founder Adam Habig and Dr. Lee Gross, president of the Docs 4 Patient Care Foundation.

Elaine Parker, president of the Job Creator’s Network Foundation, shares the story of her own personal health battle while highlighting the work being done by her organization.

To learn more about the Free Market Medical Association, visit fmma.org.

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Paytient Technologies Inc. 1601 S. Providence Road Columbia, MO 65211

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