Maverick Magazine - Summer 2022 - Rethinking Chronic Care

INNOVATIVE BENEFITS SOLUTIONS FOR VISIONARY EXECUTIVES

A PAYTIENT PUBLICATION VOL. III • SUMMER 2022

A PERFECT STORM

Benefits challenges loom on the horizon.

Can your company weather the storm?

SMART DECISIONS

Artificial intelligence makes a real difference for Nayya’s customers.

BREAKING BARRIERS

Innovative companies are working to provide better access and affordable care.

At Omada Health, President Wei-Li Shao creates a “virtual-first” method of patient care.

Rethinking Chronic Care

FROM THE FOUNDER

A REVELATION ON EVERY PAGE They say the third time’s a charm.

In the case of Maverick, I’d say the third issue is quite charming. Our latest edition of the magazine is crammed with some brilliant folks working to change health care for the better.

As you saw on the cover of this issue, I was impressed with the story of Omada Health. What’s especially compelling about Omada is the engagement the company drives. This incredible company and president, Wei-Li Shao, demonstrate how the relationships between patients and providers are key to lifestyle changes that can bring improvements in mental and chronic conditions. To read more about Wei-Li and Omada Health, turn to Page 34.

I was also intrigued by the story taking a look at some of the innovations happening at LCMC Health and Northwell Direct. I felt like the sentiments shared by these health system leaders echoed a lot of the concepts at the heart of Paytient, including the need to educate patients on the economics of health care and the healthiest possible ways to pay for that care.

Paytient is all about eliminating barriers to care and empowering people to take charge of their health, so I suppose it was only natural that I was so drawn to their stories. You can learn more about the great work going on at both health systems on Page 28.

I was equally enthralled with Nayya and the way it uses AI-driven insights and year-round guidance to eliminate some of the confusion common in health

care and benefits enrollment. Although there have been other organizations that have helped support folks working through their decisions in health care, Nayya is blazing new trails by using incredible data analysis and personalized suggestions.

I particularly loved this quote from Nayya VP Aman Magoon: “When you personalize experiences by allowing employees to see things like what they’ve spent in the past, whether their favorite doctors are in-network, or how where they live impacts life insurance, you reduce the barrier to making smart decisions.”

Get the full story on Nayya by flipping over to Page 18.

Beyond those features, you can also find great profiles of companies like Beam Dental and Specialty Care Management. And for all the animal lovers out there, get an inside look at Embrace Pet Insurance.

There are plenty of other mavericks you’ll find in this third volume of the magazine. Please enjoy learning about all of these cutting-edge organizations and the great work they’re doing in the space. I know I did!

Brian Whorley, Founder brian@paytient.com

Summer 2022 • Maverick |

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CONTENTS

18

Nayya personalizes care with AI-driven insights.

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INNOVATIVE BENEFITS SOLUTIONS FOR VISIONARY EXECUTIVES

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ABOUT MAVERICK

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Maverick magazine is published by: Paytient Technologies Inc. 1601 S. Providence Road Columbia, Missouri 65211 (573) 206-9147 hello@paytient.com Founder Brian Whorley brian@paytient.com Editor Ryan Gauthier Content Strategist Morgan Williams

38

Art Director Carolyn Preul Copy Editor Sandy Selby Contributing Writers Lola Butcher Olivia DeSmit Pamela Dimmick Amy Wilder

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6

Groundbreaking companies are challenging the status quo in employee benefits.

26

Get to know Dr. Rachelle Scott of Eden Health.

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Can your company weather the benefits challenges heading this way in 2023?

28

Two companies are united in a goal to improve transparency in health care.

14

Beam Dental enhances dental health with data.

34

Omada Health takes a virtualfirst approach to chronic care management.

18

Nayya uses technology to guide consumers to smarter decisions.

38

Embrace Pet Insurance aims to reinvent coverage for our furry friends.

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Specialty Care Management changes the conversation about catastrophic claims.

42

Get to know Adriane Musuneggi of Accolade Inc.

Photographers CMJ Photography, LLC Juan Carlos Dominguez Rhonda Dumas Grace McConnell Walter Rachel Jessica Rudd Produced by Carriage House Publishers. Copyright Paytient Technologies Inc., 2022. 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.

Summer 2022 • Maverick |

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INDUSTRY BRIEFS

pharmaceuticals:

THE MARK CUBAN COST PLUS DRUG COMPANY

T

he Mark Cuban Cost Plus Drug Company aims to fundamentally change the way the pharmaceutical industry operates. As a publicbenefit corporation, its social mission of improving public health is just as important as the bottom line. The company transparently charges a standard markup on every drug it sells. With the launch of its online pharmacy’s first inventory of 100 affordable generic drugs in January 2022, establishment as a vertically integrated pharmacy benefits manager, and construction of a state-of-the-art pharmaceutical factory in Dallas slated for completion by the end of 2022, the company is well on its way to making medication affordable for all. For more information, visit costplusdrugs.com.

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prescriptions: fertility :

GoodRx is the first and only prescription drug price comparison tool created for consumers with prices from pharmacies nationwide. The company gathers current prices and discounts on medications to help members find the lowest-cost pharmacies for their prescriptions — all 100% free with no registration required. GoodRx’s founders are seasoned technology executives who were early employees at Facebook, Yahoo, and other successful companies. The company has received seed funding from Founders Fund, GRP Partners, Highland Capital, SV Angel, Lerer Ventures, and others. For more information, visit goodrx.com.

Carrot Fertility is the leading global fertility benefits provider for employers, built to support employees through their entire fertility health care journey.

Companies use Carrot to customize a fertility benefit that provides employees financial, medical, and emotional support as they pursue parenthood, resulting in better clinical outcomes. Carrot’s program includes egg freezing, in vitro fertilization, donor and gestational carrier services, adoption, and many other services. Founded in 2016, Carrot has raised funding from U.S. Venture Partners, F-Prime Capital, CRV, Precursor Ventures, Maven Ventures, Sound Ventures, and Uncork Capital. For more information, visit carrotfertility.com.

digital health: women’s health:

Hinge Health is building the world’s most patientcentered Digital Musculoskeletal (MSK) Clinic™.

It is now the leading Digital MSK Clinic, used by 4 in 5 employers and 90% of health plans with a digital MSK solution. Hinge Health reduces MSK pain, surgeries, and opioid use by pairing advanced wearable sensors and computer vision technology with a comprehensive clinical care team of physical therapists, physicians, and board-certified health coaches. Hinge Health’s HingeConnect integrates with nearly 1 million in-person providers and enables realtime interventions for elective MSK surgeries, driving proven medical claims reduction. Available to millions of members, Hinge Health is widely trusted by leading organizations such as Land O’Lakes, Salesforce, SelfInsured Schools of California, Southern Company, State of New Jersey, US Foods, and Verizon. For more information, visit hingehealth.com.

Midi is a virtual clinic that provides specialty care for women 40-plus. It uses video visits to connect people with clinicians trained specifically in perimenopause, menopause, and other aspects of female midlife health. The company collaborates with patients to improve their symptoms with a care plan personalized to their medical history, genetics, and approach to health. Midi care is holistic, which means it may include prescription drugs, supplements and botanical remedies, wellness therapies, and lifestyle coaching. Midi orders any blood work or imaging needed to track and treat patients’ unique hormonal transition, referring patients to regular doctors or specialists for any necessary in-person care. For more information, visit joinmidi.com.  Summer 2022 • Maverick |

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FACING THE GATHERING STORM

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A PERFECT STORM OF DEFERRED CARE, RISING COSTS, AND RECORDBREAKING INFL ATION IS GOING TO HIT EVERY EMPLOYER IN 2023.

HERE’S WHAT YOU CAN DO TO BE READY.

BY BRIAN WHORLEY

I live in a part of the country where, especially in the summers, the wise keep an eye on the sky.

Usually it’s just for the joy of watching the sunset, when the warm orange glow of day melts into the cool purple of night. But those with long memories keep a watchful eye out for certain gathering clouds; they understand that the right conditions can be quite dangerous. / Every year, somewhere within an hour’s drive of mid-Missouri, a tornado touches down. And every year, once the wind and heartache have passed, the affected community begins to rebuild. / As I look at the horizon beyond today’s headlines, I see a once-in-a-generation storm brewing — one that will touch down with damaging impact on employers in 2023 and 2024. Here’s what I see.

1)

There is still pent-up demand for health care.

If you’re an employer or benefits advisor, you know that insurance premiums have been rising annually for a couple of decades now. The primary pressure release valve has been to shift costs to the employee in the form of higher costsharing.

that 50% of Americans delayed care due to the COVID-19 pandemic, and patient volume has still not returned to pre-pandemic levels. The spike of virtual visits, while promising in concept, has abated. Health care, like life in general, is returning to in-person exchanges.

While this solved the immediate fiscal challenge for employers, it created an unseen issue: Many employees defer or skip care. By 2019, Gallup reported one-third of Americans had delayed medical treatment due to cost concerns.

Unaddressed health issues will worsen until they can no longer be ignored and will require serious medical interventions. Pent-up demand for care will eventually come home to roost in 2023 and 2024, which should worry every selffunded employer keeping an eye out for large claims.

Then came the COVID-19 pandemic. By May 2020, the Kaiser Family Foundation reported

2)

Inflation has roared into everyone’s lives.

While employers have plenty of reasons to worry about inflation driving up their costs amid global supply chain issues, they might not fully appreciate what it will do to the cost of health benefits for their employees.

With the Consumer Price Index up more than 8% from 12 months ago, the share of employees’ budgets available for health care costs has shrunk

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dramatically. The average employee making $50,000 annually has $4,250 less to spend on health care today than they did one year ago.

This will further increase the rate of deferred care except in the most serious of cases, which will worsen large claims and create a productivity headwind as employees become more absent, stressed, and sick.

3)

Our health systems are stressed.

The pandemic revealed the immense value and vulnerability of our medical professionals — particularly nurses — and our medical supply chain. Providers and health systems that compassionately cared for all of us during the pandemic silently struggled to keep their doors open, staffed with people, and stocked with supplies.

The Cleveland Clinic reported an operating loss for the first quarter of 2022 amid higher costs and lower overall admissions. Some hospitals are reportedly looking to increase prices by as much as 15% to afford nurses’ salaries. These higher prices will work their way through the system over the next two years and eventually wash ashore upon self-funded employers.

4)

Employers will continue to look for savings.

Facing higher interest rates, economic uncertainty, and the increasing likelihood of a recession, employers will be slower to hire and will look for savings to improve earnings. Tech giants like Meta have already begun to freeze hiring, though there are still more job openings (11.5 million at time of publishing) than available talent in the market.

Many who read this magazine are people leaders and benefits decision-makers who

recognize that health plans have been a source of significant savings over the past 20 years as employees have transitioned to plans with higher deductibles and lower premiums. At the same time, all people leaders know that a valuable benefits package is a key part of recruiting and retaining talent.

Economic challenges and ongoing employee turnover will put employers between a rock and a hard place in 2023 and 2024.

Summer 2022 • Maverick |

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With all of these factors combined, employees who can no longer delay care will be more exposed to the highest pricing for health care that this country has ever seen — at a time when they can least afford it.

The HSA is an insufficient answer.

We’ve moved en masse to consumer-driven health care plans without providing people the means to actually shop and pay for care. That’s especially true today, when people spend their savings from lower premiums just to gas up the car.

When I visit with employers, sometimes we wonder why, nearly 20 years after the inception of health savings accounts, there are only 32 million HSAs open in a country of 330 million Americans. That looks even worse when you consider that most HSAs are functionally empty (with balances well below their annual deductible).

An empty HSA can’t pay for care. About 20% of HSAs have $0 in them, and 20 million accounts have less than $1,000 at a time. In fact, 75% of HSAs have less than the average high deductible ($2,349).

The vast majority of dollars accumulated in HSAs ($64 billion of the $100 billion in all the HSAs in the U.S.) are held by savvy savers and investors who are banking those funds for later in life. (I’m one of them.) While we should care about everyone, those folks will weather the coming storm. Our most urgent attention, however, should be on the vast majority of folks who lack shelter.

There is shelter from the storm.

In the face of this gathering storm, helping employees access and afford care should be our first order of business. When we rebuild after each storm in the Midwest, we do so with better and more durable structures.

We are building Paytient because we believe credit (always free and without interest) is the simple and affordable way to give employees time to pay for care on their own terms. We take the stress out of the most painful part of health care: paying for it.

Provided without financial risk by employers to their employees, Paytient can give every employee access to $2,000 or more in health care credit on an Paytient Visa card for less than $4 per employee per month. The Paytient card works for medical, dental, vision, pharmacy, and mental health care — it even covers veterinary care for pets.

Paytient empowers our members to effortlessly avoid unexpected out-of-pocket expenses by giving them time to repay. Financially savvy employees often are the first users in any employer group because they use the pay-over-time feature to protect and grow their HSA accounts.

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We turn today’s patients into Paytients.

But Paytient is so much more than interest-free credit and a fix for next year’s challenges. The experience we’ve created is one that transitions a person from being a patient — beholden to the aches and pains of the current system — to one where they’re equipped with the resources they need and the dignity of control over their health care choices.

The word “patient” is a fascinating homonym.

While the Oxford dictionary describes the adjective as being “able to accept or tolerate delays, problems, or suffering,” the noun relates to “a person receiving or registered to receive medical treatment.” Why is it that those two definitions seem to be so inextricably linked?

Our vision is to turn today’s patients into Paytients — empowered consumers of care who can effortlessly access and afford care for themselves and their families.

This year, we’re proud that nearly half a million Americans now call themselves Paytients. With an NPS rating of 97, new providers and insurer partners — including Centene and LCMC Health — are beginning to take notice and use Paytient to empower their own patient experiences.

Whether you partner with Paytient or find other innovative ways to address these challenges, I hope you’ll take steps to insulate your organization and your team from the vicious cycle of deferred care amid rising costs in this inflationary environment.

While funnel clouds can be incredibly destructive, they’re also somewhat fragile. A slight shift in the wind, a slight warming of air temperatures, and they evaporate into thin air. Let’s apply those mitigating pressures and save our teams from the worst of this economic turmoil. If we can help in any way, please get in touch. 

Brian Whorley is the founder and CEO of Paytient, a company dedicated to helping people better access and afford care. Paytient works with employers, partners, brokers, and health systems to provide a healthier way to pay for out-of-pocket care expenses.

Summer 2022 • Maverick |

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Beam Dental co-founder and CEO Alex Frommeyer

BEAM DENTAL ADDS DATA TO DENTAL HEALTH.

smart smiles

BY AMY WILDER | PORTRAITS BY JESSICA RUDD

Summer 2022 • Maverick |

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industry at large: How do you get people to adopt healthy habits? Can you incentivize behavior that leads to a healthier population?

BEAM DENTAL IS DISRUPTING THE DENTAL INSURANCE MARKET AND PIONEERING SMART NEW WAYS TO PROMOTE WELLNESS AMONG ITS SUBSCRIBERS. The company, founded by three engineers, wasn’t originally an insurance provider. Alex Frommeyer, Alex Curry, and Dan Dykes thought insurers could provide better coverage options for consumers if they had access to data about people’s dental hygiene habits. The founders had family members who were dental professionals and realized there was a data gap in this field.

“The company really started around what we think of as a dental wellness program,” Frommeyer says. “The brush for sure is the star of the show.”

A DENTAL BENEFIT THAT CUTS COSTS BY REWARDING HEALTHY HABITS

The Beam toothbrush connects to the user’s smartphone app and records their daily use. Program participants receive rewards like free replacement brush heads, dental hygiene products, and Amazon gift cards simply for brushing their teeth. The Beam team developed the brush to address a problem faced by the health care

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“The idea is that by building and maintaining good daily dental care habits, you could now prove that you’re taking great care of your teeth every day — whether it’s to yourself, to your dentist, or to Beam — and you actually get credit for it in the form of rewards,” Frommeyer says. “Which we think is really fun and helpful from a population health perspective.”

The company’s initial brush has evolved into a full-scale dental insurance product that operates as a PPO provider working with more than 400,000 access points nationwide.

“We thought it was a fascinating market,” Frommeyer recalls. “It was a really big market, and really nobody was working to try to modernize it or digitize it and take it into the future. We thought it would be really interesting to try and solve the big meaningful problems that we saw in dentistry.

That’s really what led us to start Beam and craft it into an insurance business.”

The response from employers and their team members has been overwhelmingly positive, especially

when they get that first Amazon reward and realize there’s no catch.

And employers love the way good dental hygiene helps bring down their dental insurance rates.

FLEXIBILITY BY DESIGN

Nathalie McManamon, vice president of Filice Insurance Services, says her company started out as a broker for Beam. But McManamon was so impressed with Frommeyer’s presentation on Beam’s value proposition that Filice decided to enroll as a customer. She counts Beam’s perks, stellar customer service, and the product’s ease of use as some of its best qualities.

“In terms of working with Beam, one of the things that really stands out for us and for our clients is the flexibility in plan design,” McManamon says.

“We have the ability to set levels for coinsurance, out-of-pocket maxes, out-of-network reimbursements, what services are covered in basic versus major categories, and the ability to offer multiple plans to a single employer group. These are all things our clients are excited about.”

As a broker, McManamon says Filice rigorously evaluates the companies it works with in terms of the services it provides, both for her company and to its clients.

The company’s initial brush has evolved into a full-scale dental insurance product that operates as a PPO provider working with more than 105,000 dental practitioners nationwide.

“Beam places a high level of importance on delivering good service and maintaining that level of good service,” she says. “They reach out to us for feedback — and when we provide feedback, they take action on it.”

Beam has built this exceptional approach to employee benefits with a few key attributes in mind from day one, according to Frommeyer. Ease of use, smarter data, and a focus on wellness are at the heart of its mission.

They noticed that health care, insurance, and financial services sometimes lag behind other consumer areas in that they tend to be more analog, labor-intensive, and old-school industries — with many regulatory barriers. In short, they’re not always user-friendly.

Beam exists to tear down those barriers and provide positive consumer and user experiences “regardless of who that stakeholder is,” Frommeyer says. And it does it in a way that encourages people to want to understand more about how to use their insurance because they like interacting with Beam.

The big challenge for health care companies across the board is getting consumers to develop and maintain healthy habits. Better personal habits lead to better health outcomes overall, which reduces the financial burden on consumers, employers, medical providers, and insurers alike. Everyone wins when everyone is healthier.

“This is not a Beam challenge. It’s not a new challenge. It’s just the challenge of health care,” Frommeyer says. “It’s the challenge of a multitrillion-dollar industry. Even though everyone in the world will agree with you that eating healthy is good for me and it’ll elongate my life and keep me looking and feeling fit and allow me to do more stuff, man that junk food tastes good. And I still slip and eat it all the time. And that’s the challenge of health care.”

A BRIGHT FUTURE

Beam’s model directly rewards people for taking healthy actions. That not only differentiates Beam, but it’s also essential to the company’s identity.

The data the company receives back from users allows it to offer a more fair and flexible pricing model for customers.

There hasn’t been a lot of effort put into understanding dental risk, Frommeyer says, and one-size-fits-all options treat small businesses unfairly.

Distinct types of companies, from marketing firms to manufacturers, have different kinds of employees and unique needs and budgets.

“And yet they’re all treated like they’re the same company by large insurance businesses,” he says.

Beam decided to generate a product that is customized for each company that adopts it, which means coverage and price are more appropriate and can improve over time as groups adopt healthy behaviors that decrease their overall risk.

Beam continues to expand rapidly, and there are more innovations on the horizon — and not just in the dental market. Beam already offers vision and group life insurance products.

It’s also looking into other products employers might want.

“There’s a lot out there that we think deserves to be a unified, really wonderful experience for employers of all sizes,” Frommeyer says. “But especially the small ones.”  Summer 2022 • Maverick |

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DYNAMIC DECISIONMAKING NAYYA, A BENEFITS DECISION-SUPPORT COMPANY, is reinventing the way consumers choose and use their benefits. Through personalized, AI-driven insights and yearround guidance, the New York-based company is helping to reduce the opacity surrounding health care and the benefits enrollment process.

The result: Employees with greater physical, mental, and financial well-being.

BY OLIVIA DESMIT PHOTOS BY JUAN CARLOS DOMINGUEZ | @JUANCHOPEDIA

Aman Magoon, vice president of product and founding team member of Nayya

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“Our mission is to give Americans peace on their best days and confidence on their worst as it relates to health and finances,” says Aman Magoon, vice president of product and founding team member. “There is an inextricable link between one’s physical well-being and financial well-being. The decisions we make at the intersection of our health and our benefits have meaningful impacts on our financial security, so Nayya has built two software products that look to improve this decision-making process for employees.”

CHOOSING AND USING HEALTH CARE Nayya consists of two product options: Choose and Use. With AI technology, Nayya can create a highly personalized benefits enrollment experience.

Nayya’s decision-support product is called Choose and helps consumers enroll in benefit programs through a simple, guided enrollment process. By using Choose, consumers can make intelligent, data-driven decisions during open enrollment, new employee onboarding, and qualifying life events.

Nayya’s health care financial planning application, Use, helps drive benefits engagement throughout the year. With proactive reminders and nudges, Use enables consumers to make the most of their benefits, actively helping them to understand their benefits, how to use them, and ultimately, how to save money.

“Nayya Choose does a great job of helping employees feel good about picking a plan, but health care questions continue throughout the year, not just once,” Magoon says.

Nayya Choose helps employees decide which doctors to visit, determine which digital health care options are covered, and learn how to pay for unexpected medical bills.

The software analyzes an individual’s medical history, current benefits enrollment, and claims data to help manage health care costs and ensure they are prepared for all scenarios. For example, a member

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may have linked visit history into Nayya, including OB-GYN visits.

If that visit history indicates the member is pregnant, Nayya can send information to the member about their employer’s family leave policy, what their insurance covers for labor and delivery, and more helpful information.

FOUNDED IN INSURANCE While Nayya aims to help members improve their physical and financial well-being, the company was originally founded as a tool for insurance firms.

In 2019, Sina Chehrazi and Akash Magoon founded a startup that provided insurance companies with detailed insights about members, such as salary, level of physical activity, etc.

“During their tenure, they had great success improving underwriting,” Aman Magoon says. “But what if their model was flipped upside down, and instead of empowering the underwriter with information about the member, you gave the member more information on their benefits? Once they realized that, it was obvious they needed to start an organization based around this mission.”

Aman Magoon joined Chehrazi and Akash Magoon in 2020, when Nayya’s software was under development. The first prototype was launched at the end of that year.

In 2021, Nayya was named the most promising U.S. insurtech company by Insurtech Insights Future50 Awards.

“For Nayya, success isn’t measured in terms of awards,” Aman Magoon says.

“The number of Americans engaging with the software and adhering to the advice and guidance we are giving is our No. 1 success metric. Even if we’re generating revenue, the ultimate truth lies in consumer adoption.”

In March 2022, Nayya secured a Series C round of funding, which will enable the company to distribute its software more widely.

“As we move into the next phase of our history,” Magoon says, “we are primarily focused on thinking about building products in the most consumer-centric way.”

A STELLAR USER EXPERIENCE When it comes to barriers to entry, the biggest challenge for Nayya isn’t convincing employers that their

A LIFE-CHANGING REMINDER One case study that demonstrates the power of Nayya involves a client who adopted Nayya Choose and Use for its employees. One employee, who had used Nayya Choose during open enrollment, suffered a tragic skiing accident, was flown to a nearby hospital, and rushed into emergency surgery.

After recovery, this employee needed extensive physical therapy. During this time, Nayya Use notified them that they were covered by supplemental hospital indemnity insurance and could use this coverage to pay for medical and physical therapy costs.

Nayya was able to relieve significant financial stress for this employee during a particularly challenging time.

“The moral of the story is that it isn’t enough to help employees choose what benefits to enroll in,” says VP of Product Aman Magoon.

“We are there throughout the year to make sure benefits are used and used wisely.”

software is useful and necessary — it’s demonstrating that the user experience doesn’t bog down HR teams.

“As an HR professional, one may be required to interact with half a dozen unique systems to perform day-to-day activities,” Magoon says.

“The primary challenge we face is creating a solution that has the best user experience and streamlines the HR and employee journey.”

To solve this issue, Nayya has formed partnerships with HR tech platforms, most recently ADP, to embed the software directly into its management platform.

Decision support in the health care field isn’t new; it has existed for more than a decade. But Nayya has a leg up on its competition due to its data analysis and personalized suggestions.

“The primary differentiator between Nayya and incumbent technology in this space is that our product philosophy centers around personalized decision support,” Magoon says.

One company Nayya took inspiration from was Amazon — specifically its homepage.

“When you personalize experiences by allowing employees to see things like what they’ve spent in the past, whether their favorite doctors are in-network, or how where they live impacts life insurance, you reduce the barrier to making smart decisions,” Magoon says. “What Nayya centers around is solving a problem that is ubiquitous. Nearly all of us have experienced or know someone who has experienced financial issues with managing their health. There are a ton of tech solutions out there, but never has a software existed that holistically personalizes financial planning around health care. Solving that issue is where we get a lot of our moxie.”  Summer 2022 • Maverick |

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Q&A

DR. RACHELLE SCOTT SENIOR MEDICAL DIRECTOR OF MENTAL HEALTH, EDEN HEALTH Tell us about Eden Health.

Eden Health is a new kind of primary care that helps simplify the complexity of today’s health care system. We unite primary care, mental health, care navigation, and more under a Collaborative Care model to simplify the complexity that patients typically face. Eden works directly with employer groups and health plans to provide this exceptional, 24/7 virtual and in-person care that builds trust, engagement, and satisfaction.

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

Eden Health is the best at creating long-term, trusted provider relationships that have a tangible, positive impact on employee health.

By ensuring employees experience consistent, positive, and meaningful interactions over time with the same care team, Eden builds trusted relationships that lead to greater engagement, increased adherence to care plans, happier employees, and improved health outcomes. This helps employers keep employees healthy while lowering health care costs.

Most people would be surprised to know that my company …

Responds to every patient message in under seven minutes, 24/7.

What are the most exciting or transformational things happening in your segment of the industry right now?

I am incredibly encouraged by the increased focus on mental health. Enabling virtual mental Contact: rscott@edenhealth.com

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MAVERICKS you should know

health services has allowed more access and greater compliance with mental health services.

It has also allowed us to reach typically difficultto-reach populations. At Eden Health, we take it one step further by delivering care in a Collaborative Care model. In our Collaborative Care model, the patient has a team that is made up of a PCP, a therapist, and a psychiatrist. The PCP screens the patient and refers them to a licensed therapist for talk therapy if needed, or consults with a psychiatrist for medication therapy if needed.

This is an evidence-based approach; our PCPs are trained in mental health assessment, triage, and treatment and connect patients to the resources that they need. It is also an effective use of resources. Given the nationwide shortage of mental health services, it helps increase access to mental health treatment.

What’s your favorite thing to do on weekends?

I keep it simple! I love spending time connected with loved ones and usually catching up on shows I missed during the week.

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

I absolutely love Chef’s Table. I am hooked once I hear the music, but what I love most is hearing about the chefs’ stories: their challenges and triumphs. A good story always captures my attention.

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

A little recency bias here, but I loved the most recent book I read, which was actually recommended to me by a colleague and friend: The Forty Rules of Love by Elif Shafak. It is a story of relationships and transformation.

What are you most passionate about?

Sports! But besides that, I would say helping people feel connected and listened to. 

Specialty Care Management provides health cost solutions.

AVERTING PRICE CATASTROPHES

BY OLIVIA DESMIT | PHOTOS BY CMJ PHOTOGRAPHY, LLC

A

risk management company in Pennsylvania is setting the standard for controlling catastrophic claims.

Specialty Care Management provides an à la carte solution to self-funded health plans, with offerings ranging from outpatient dialysis to oncology.

While the company offers three different product service lines, President and CEO Craig Clemente says its bread and butter is outpatient dialysis risk management.

Within its unique approach, the company offers two options: Dialysis Plus and Prime. Plus is a full administrative and legal carveout of the benefit, allowing the plan sponsor more autonomy and freedom. Prime is a more traditional setup with a TPAbased vendor relationship.

Other offerings include cancer management and transplants.

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But SCM’s plans don’t start and end with purely medical coverage. It also provides clinical underwriting consulting and negotiation services. Whether one or all its offerings apply is up to each plan sponsor and its risk management strategy.

involves a lifelong treatment plan.

As an organization, SCM’s mission is to minimize these types of claim costs.

“Our programs look to remove outof-pocket expenses for members, so there is no copay, coinsurance, or associated deductibles for the benefit of outpatient dialysis,” he says. “While we enhance value for members, the employers are getting charged a flat, fixed-cost rate.”

“One of the things we look to do is identify and manage emerging risk upstream as much as possible,” Clemente says.

Municipalities, government agencies, and unions are some of the most common partnerships.

SCM’s various solutions, including chronic kidney disease case management, provide care and support throughout the entire process — not just at the beginning of dialysis treatment. The company takes this approach because its plans involve conditions that require treatment. Dialysis is not an elective service and typically

LAST DOLLAR DOWN Specialty Care Management has been providing innovative catastrophic claim coverage for two decades. Its mission has stayed the same in that time: managing risk from the last dollar spent down.

What does this mean? Typical cost containment companies

Craig Clemente, president and CEO of Specialty Care Management

PLAN PROVIDER BENEFITS HOW SPECIALTY CARE MANAGEMENT BENEFITS DIFFER AMONG PLAN PROVIDERS.

THIRD-PARTY ADMINISTRATORS TPAs benefit most from SCM’s integration processes (which save time and reduce complexity), cost savings, and increased plan retention and membership.

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MANAGING GENERAL UNDERWRITERS MGUs have shown higher profitability and decreased risk exposure, helping to increase persistency.

BROKERS

CARRIERS

Brokers can reduce high-dollar claims and engage in partnerships between networks due to SCM’s flexible policies.

Predictability from fixed-rate costs, ease of use, and flexibility enable carriers to increase profits and satisfy partners.

“Our programs look to remove out-of-pocket expenses for members, so there is no copay, coinsurance, or associated deductibles for the benefit of outpatient dialysis.” – CRAIG CLEMENTE

tackle risk from a first dollar up approach, meaning the emphasis is on what discount is being achieved. Instead, SCM focuses on the comprehensive nature of financial risk.

“We don’t classify ourselves as cost containment, as that is from a first-dollar approach,” Clemente says. “We’re looking to provide something with a larger scope and more tangible value by managing claims with a costup approach in pricing strategy.”

Aside from its approach to coverage, SCM differentiates itself with a flat rate and fixed costs. The goal of SCM isn’t just to make health care more affordable for members; it also wants the plan to be affordable for employers.

to all self-funded insurances, its niche offerings create some challenges.

“Our No. 1 challenge is the rarity of the risk,” Clemente says.

“Dialysis outpatient care is not something that every plan experiences, which is actually a good thing for the market.

But our biggest obstacle to overcome is finding where those risks are happening.”

The other, Clemente says, is the amount of time and effort that goes into customized solutions.

“Our plans are tailor-made solutions, which is part of the expertise we bring, but it takes a lot of review and analysis on our end.”

“Any product or service that is based in nuance is going to have values that pile up to create a truly unique value proposition, and that’s how SCM has been built since Day One,” Clemente says. “We want to make sure we’re providing a true risk management tool through predictable, quantifiable costs.”

QUANTIFIABLE SUCCESS When it comes to success, SCM takes a bilateral approach. The main measurement is whether the health plans can preserve funds in a way they weren’t able to do before. And ideally, those funds can be allocated in a more impactful and meaningful way.

The quantifiable measurement, though, is the volume in which that value is provided.

SCM’s plans apply to the entire spectrum of self-funded health plans, from more traditional insurance networks to small out-of-network companies.

The only other requirement is a minimum of four members in the plan. Although its plans apply

“As we’re able to provide that value on a larger spectrum across someone’s block of business, we maximize results every time on first dollar and the final payment process,” Clemente says. “It’s really special when we have an opportunity

to provide that over time and across multiple beneficiaries.

That’s the exciting part for us — knowing what we’ve built really provides value through a sustainable risk solution.”

Dialysis, in particular, is in the worst quadrant of risk for selffunded health plans because of its cost, volatility, and ongoing nature. SCM’s dialysis plan includes 33 months of exposure for financial risk. A partner of SCM with a member undergoing dialysis recently saved 89% of costs associated with that member’s care. Before enrolling in SCM’s dialysis plan, the member’s treatment was running about $2.4 million annually; this was trimmed to around $264,700 through SCM’s Renal Re-Pricing Program.

Looking ahead, SCM might expand into other niche health coverage plans. In March 2022, Argosy Healthcare Partners purchased a majority of SCM, paving the way for greater resources moving forward.

“We’re looking at expanding both inside of our outpatient risk management dialysis market and different ways to deliver that to market and assume risk,” Clemente says. “But outside of that, we want to diversify our top line through some existing programs like data analytics and oncology — and perhaps other verticals.”  Summer 2022 • Maverick |

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Innovative companies are removing barriers to health care.

Access

28 | Maverick • Summer 2022

Granted

BY PAMELA DIMMICK

While management teams wonder why their health care rates increased again and how much they’ll need to pass on to employees in the form of higher premiums, deductibles, and copays, some truly innovative leaders in the health care space are embracing bold solutions to reduce costs, improve care, and increase access to care.

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Nick Stefanizzi, CEO of Northwell Direct in New York, says the current system has become unsustainable.

“Rates continue to go up and access to care diminishes,” he says. “Meanwhile, traditional insurance carriers have disincentivized employers from thinking differently. They use a lack of transparency and control of data to their strategic advantage.”

Northwell Direct has more than 22,000 providers and more than 50 hospitals in its network. It serves as a direct-to-employer alternative to traditional carriers and providers, operating as a subsidiary of Northwell Health.

Down south, LCMC Health is grappling with similar problems. The nonprofit hospital system is focused on providing the best possible care it can to every person and parish in Louisiana. LCMC Health provides a continuum of care from its Children’s Hospital and primary care to its Level I trauma center, geriatrics, and senior living.

While they’re thousands of miles apart, LCMC Health CFO JoAnn Kunkel echoes Stefanizzi’s sentiments regarding transparency in health care.

“There’s really no industry where you pay premiums to an insurance company that sits in between and contracts facilities for fees,” Kunkel says. “It’s not very transparent.”

A PERFECT STORM OF RISING COSTS The trend lines are moving in the wrong direction, Stefanizzi says. Every year, employers get another year-over-year increase from the traditional carriers when their renewal comes up. And every year, they are forced to pass along those costs.

“The carriers have created structural barriers to care because the cost gets passed on,” he says.

“Employees ration their own care based on things like plan design and out-of-pocket costs. It’s not good. It’s not healthy. And it’s not sustainable.”

The pandemic has exacerbated rising costs and caused nearly half of Americans to delay care. A study from the Kaiser Family Foundation found that 48% of U.S. adults or their household members skipped or delayed medical care due to the pandemic.

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Byron Stockstill, the AVP of business development with LCMC Health, says the health system sees quite a bit of variation in who gets care based on insurance coverage.

“What influences these decisions to delay or not seek care really rests with whether the person is insured,” Stockstill says. “The uninsured are most likely to delay care, but data shows insured people delay care, too, likely because they can’t afford their out-of-pocket responsibility.”

And all of that delayed care has a cost, Kunkel says, with other issues piling on top of an already difficult situation.

“Now we’re facing inflation, labor shortages, and supply chain issues,” Kunkel says. “And when you’re in a hospital providing care and surgeries, supplies are critical every day. We’ve seen prices increase astronomically. Masks that previously cost a few cents now cost dollars each. The same is true of labor — not only with registered nurses but also technical support.”

OVERCOMING OBSTACLES Rising costs certainly pose a barrier to care, but Stefanizzi says they also contend with issues like the lingering stigma of behavioral and mental health care as well as access issues such as distance and lack of coverage.

“As a culture and society, we’ve made progress,” he says. “However, there’s still a stigma, and employees remain concerned about what it means when they ask for that kind of help. How do we meet those individuals where they are in their comfort level, and how can we best protect confidentiality and privacy while making these services more broadly available?”

He explains that the New York metro area has a dense representation of health care providers.

However, people living outside the city have to travel to see specialists, which makes access a challenge.

“In communities of color and economically disadvantaged communities, there are issues just accessing care, whether it be because of availability of providers or due to the fact that individuals may

Northwell Direct’s CEO Nick Stefanizzi

not have access to coverage,” he says.

“We are driven to address these issues and have tried to be thoughtful about constructing a network of providers that’s bigger than Northwell Health that provides adequate, fair, and equitable access across our service area.”

Northwell Direct offers a tiered network strategy, with the tier-one network for an employer’s benefit plan in the Northwell Direct network consisting of more than 22,000 providers, 50 hospitals, and other sites of care. National supplemental networks are available to broaden the plan’s reach, allowing employees to access local providers outside of the New York metro area.

Kunkel notes that access can also boil down to not knowing what kind of care to seek or being unable to get an appointment.

“It’s really about being able to serve the patients and meet them where they need to be met, whether it’s a community clinic, a facility, or a virtual option,” she says.

“The ability to do a video or phone visit has opened opportunities to reach patients and will continue to be built upon, regardless of whether we’re in a public health emergency or not. This will help improve access to some of the harder-to-getto types of services.”

BRIDGING THE MIDDLE There is no shortage of red tape in health care. But by working to eliminate middlemen, Stefanizzi says Northwell Direct has been able to strengthen the patient and provider relationship and remove some of the hassles typically associated with insurance companies (e.g., billing issues, costs).

“The rates that we’ve negotiated with providers have, on average, given employers the ability to save up to 20% compared to traditional BUCA plans,” Stefanizzi says. “After two years of pandemic-related financial and business disruption, we’d be remiss not to talk about the cost. A 20% savings opportunity is something that everybody should take very seriously.”

A direct-to-employer relationship makes it relatively easy for an organization like Northwell to offer other strategic advantages, Stefanizzi says. There’s no middleman between the employer and the provider, and nobody second-guesses the clinical judgment of a provider about what’s in the best interest of each patient.

“Our care management programs get higher levels of engagement than those rolled out by traditional carriers,” he says. “Why? I can send a nurse to the bedside to meet with you before you’re discharged from the hospital to make sure your transition care plan is set up and organized, that you understand it, and have a resource to help you navigate it as you leave the hospital. When my nurse practitioner calls, it’s on behalf of the provider about your care and not about an insurance billing issue. It’s a differentiated experience in addition to the pure financial savings.”

The team at LCMC Health is also focused on providing great patient experiences. Kunkel says Summer 2022 • Maverick |

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the health system aims for an experience that is “beyond extraordinary.”

focus on food and nutrition, ongoing health coaching, and some unique navigational capability.

“We work with employers and several of the other payers in the market and have developed narrownetwork products,” she says. “We are beginning to work through some of those strategies, but as we develop as a system, there’s a huge opportunity for ensuring that the employees are getting care in the right place. For example, going to the right kind of a physician or specialist or having an outpatient procedure versus inpatient. Population health opportunities include managing the whole patient experience.”

“We can do that because we’re a provider organization that sits right across the table from the employer as the client and as the partner. You don’t get that from a traditional carrier’s middleman sitting between the two organizations.”

Stefanizzi notes that working directly with a health care system makes it possible to take the specific needs of an employer’s workforce into account.

For example, Northwell Direct customized a unique primary care experience for Whole Foods.

“As you can imagine, food and nutrition as an organizational culture and value factor pretty heavily into Whole Foods’ thinking,” Stefanizzi says. “We worked with our primary care providers to create a more extensive primary care visit type with a greater

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THE BOTTOM LINE Kunkel admits the cost of health care is on everybody’s mind and is often the biggest barrier to patients seeking care. People might not understand the total cost of treatment — or what the patient’s share will be.

In these cases, health care leaders must help educate patients on the economics of paying for care, she says.

“Once you understand the financial piece, you can just worry about your health and not about how to pay for it,” Kunkel says. “Likewise, employers can work directly with the health care facilities to ensure that they treat your employees as special patients, every time they walk through the door.”

The pandemic has exacerbated rising costs and caused 1 in 5 adults to delay care.

RHONDA DUMAS | PIE FACE PHOTOGRAPHY

From left: LCMC Health’s CFO JoAnn Kunkel and AVP of Business Development Byron Stockstill

Stockstill says LCMC Health is partnering with Paytient to help its patients better access and afford the care they need. LCMC is subsidizing the cost of the benefit for employers in the region, empowering people to turn out-of-pocket care costs into affordable payments.

“It was an easy decision for LCMC Health,” Stockstill says. “Paytient allows our patients to pay for services at LCMC Health locations without any interest or fees via payroll deductions through their employers.”

Patients who are able to afford their care are more likely to get treatment earlier, Stockstill says, with earlier treatment leading to better outcomes.

“This helps them stay healthy, which in turn takes the strain off our healthcare system to provide care for those individuals who are uninsured or underinsured,” Stockstill says.

LCMC Health has teams that focus on population health, managing people’s care and ensuring they get to the doctor. Kunkel says sometimes the hardest part is encouraging patients to call in and ask questions they might have.

“How do we educate patients, ensure patient satisfaction and quality, and make sure that we’re communicating at every level?” she says. “That’s something we do every day that helps differentiate us.”

Kunkel stresses that nonprofit health care systems require funds to stay afloat and to reinvest in upgrading facilities, technologies, and treatments.

“To reinvest in the community that we serve, we must ensure that we’re spending our resources and investing in the right things,” Kunkel says. “Everyone has great ideas! How do you choose? For me, it’s always what’s best for the patients, how do we improve patient care, and how do we make it easier for our doctors, nurses, and staff every day? What things can we do to help them?”

Stefanizzi says some large employers have begun carving out pieces of their benefit plans by creating centers of excellence around orthopedic surgery or cardiac care or partnering with specific provider organizations to incrementally chip away at the cost/ quality dilemma that employers face.

“We’re happy to work with employers in this way and certainly have all of the specialties and capabilities that would allow them to try some innovation without totally throwing out the traditional insurers,” he says.

“But we have the opportunity to go bigger together and do something that can be truly transformational and a model for the country in how health care can be organized and paid for in the future.

“Why not? The conditions over the past couple of years coupled with the trend lines have created an environment where employers are finally ready to say, ‘You know what, let’s take that big swing, and let’s take on this problem in a fundamentally transformational way.’ That’s what we’re really excited about.”  Summer 2022 • Maverick |

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rethinking chronic care Omada Health’s Virtual-First Care is rewriting the playbook for chronic care management.

BY LOLA BUTCHER PORTRAITS BY WALTER RACHEL

S

ome 133 million Americans live with diabetes, hypertension, or other chronic conditions, and the traditional health care model does not always serve them well.

“For such a long time, people believed that the battle against chronic conditions was fought in the doctor’s office,” says Wei-Li Shao, president of Omada Health.

“We believe the battle, unfortunately, is most often lost in the vast amount of white space between doctors’ visits. People are left to their own devices, making decisions — some good, many bad — that affect their near-term and long-term health.”

Omada Health provides “virtual-first” care, integrating the expertise of dietitians, behavioral therapists, physical therapists, coaches, and others via digital tools that allow constant communication between members and their designated care team. Care plans are rooted in the science of behavior change, empowering people to embrace evidence-based habits that will help them meet their health goals.

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A New Concert of Solutions to Combat Comorbidities

O

mada Health’s four programs — prediabetes, diabetes, hypertension, and musculoskeletal care — can be deployed in concert, reflecting the prevalence of comorbidities.

“The unfortunate reality is that most Americans who suffer from one chronic condition suffer from another condition as well,” Shao says. The Centers for Disease Control and Prevention estimates that 74% of adults with Type 2 diabetes have hypertension; 90% are overweight or obese.

“And if you’re overweight or obese, you’re likely to have back pain or joint pain,” Shao says.

Omada Health serves more than 1,700 clients, including 18 national and regional health plans, and dozens of employer entities across industries including Costco, Bacardi, NovoNordisk, and the State of Alaska.

All told, about 18 million U.S. adults have access to Omada Health through their insurers or employers; more than 640,000 have enrolled in an Omada Health program.

That includes a group of American Eagle Outfitters (AEO) employees.

AEO chose Omada Health’s diabetes prevention program in 2019 because the company wanted to offer a personalized program that was easy to implement and promoted strong engagement and sustainable results, according to an Omada Health case study.

36 | Maverick • Summer 2022

Omada provided each participant with a digital scale to track progress, matched them with a professional health coach and peer group for around-the-clock support, and offered interactive lessons via smartphone or laptop.

“Omada’s marketing includes some of the most engaging collateral that I have seen,” Anthony Jarusinski, AEO’s former benefits manager, said in the case study. “Our associates responded well to their various communication materials and were eager to enroll in the program.”

Indeed, 83% of targeted staff members enrolled. On average, participants in the program engaged with Omada 28 times every week and completed 76% of their lessons. A full 70% of employees who stuck with

the program for at least 16 weeks lost weight, and 33% of participants lost 5% or more of their body weight.

BELIEF IN A BETTER WAY

When Omada was created 11 years ago by Sean Duffy and Adrian James, the San Francisco-based company was founded on the premise that the traditional U.S. health care system fails people who are overweight or obese.

“There was a belief in a better way,” Shao says. “And that belief was that things can be done, as Sean likes to say, ‘from afar.’ Things that don’t require a face-to-face visit but are proven to be effective without having a physician or other health care professional lay hands on a patient.”

Its original program focused on diabetes prevention. In 2018, Omada

health symptoms of anxiety and/or depression. That insight comes from validated mental health screening tools used as part of the intake protocol for all four Omada programs.

Of adults with Type 2 diabetes,

74% have hypertension;

90% are overweight or obese.

became the largest provider, in-person or virtual, to achieve full recognition from the Centers for Disease Control and Prevention for its diabetes prevention program. The recognition reflects the CDC’s approval of Omada’s curriculum, the level of participant engagement, the average participant weight loss, and other factors.

As the company has added programs and members, it is constantly learning about what works best to help members achieve their health goals.

“With every person who comes in, we utilize that data to hone our insights and our interventions more precisely for our new and existing Omada customers,” Shao says.

Indeed, Omada has amassed more than a billion actionable health data

points and adds another 25,000 data points every half-hour. They come from members who, on average, generate 31 data points each week from activity tracking, meal tracking, weigh-ins, log-ins, and group messages.

“We take all that, and we surface a set of care insights that drive customized interventions,” Shao says. “We know that when members experience those customized interventions delivered by a human care team, they are 2.5 times more likely to achieve positive outcomes.”

ADDRESSING THE MENTAL SIDE OF HEALTH

One insight pulled from Omada’s vast reservoir of data: 47% of its members show elevated behavioral

Shortly after closing on a new $192 million funding round in early 2022, the company announced plans to integrate mental and physical care in all its programs more thoroughly.

Addressing depression and anxiety for people with medical conditions can improve treatment compliance, enhance overall health outcomes, and lower costs.

In addition to assessing mental health systems, Omada staff screen members for food insecurity, access to health care, and other social determinants of health; address specific behavioral challenges by providing sleep and stressmanagement lessons; and triage high-risk situations that require immediate intervention.

Every Omada member is assigned a care team that includes a health coach and the appropriate clinical specialists, such as certified diabetes educators and hypertension specialists.

“We can also pull in licensed clinical social workers who have special training in behavioral health,” Shao says. “And all individuals in our care teams are trained in behavioral health to the various degrees that match their licensure, so they can work not only on things such as dropping weight or dropping blood pressure, but also those signs and symptoms that impact the mental part of behavior change.”  Summer 2022 • Maverick |

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EMBRACE PET INSURANCE INNOVATES COVERAGE FOR FURRY FRIENDS.

Protecting Our Pets …

BY OLIVIA DESMIT

…

For most people, health insurance involves a card that gets scanned at the doctor’s office, and it usually means paying a small copay for a standard visit.

That’s well and good for humans, but what about our furry friends? While pet insurance has been around for more than a century, the North American Pet Health Insurance Association reports that fewer than 3.5 million pets in the U.S. were insured in 2021. This might sound like a big number, but it’s a drop in the bucket when you consider that there were an estimated 135 million canine and feline pets last year. “There’s a lack of awareness of pet insurance,” Embrace Pet Insurance President Brian Macias says. “It’s a very nascent industry where most people haven’t heard of it or don’t understand it fully. The job to create awareness and educate consumers falls on us.”

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Brian Macias, president of Embrace Pet Insurance

REINVENTING PET INSURANCE

…

Based out of Cleveland, Ohio, Embrace Pet Insurance is changing the pet care coverage game.

But what exactly is pet insurance? At Embrace, it means coverage for accidents, illnesses, and chronic conditions for cats and dogs. Coverage costs range depending on the pet’s species, breed, location, and age. Covered events could be anything from ear infections to emergency surgery. What it doesn’t cover are preexisting conditions and standard vet visits, including vaccinations and pregnancy care.

According to Macias, “insurance is for the unexpected and instantaneous.”

However, Embrace does offer a Wellness Rewards program that budgets for those routine appointments and procedures. Within the program, pet owners can purchase different yearly allowance amounts and set those funds aside. While pet owners pay for that coverage monthly, they have access to the plan’s total funds immediately.

Although pet insurance has a few differences from the human variety, it is similar in that plan costs, coverage, and underwriting times can vary. While Embrace is not the lowest-priced offering on the market, that’s for a reason.

“There is an argument to be made for affordability,” Macias says, “but Embrace has an all-inclusive, robust policy. That means the claims are going to be paid — and paid on time.

“With insurance, we make a promise that we will be there for you. Anyone can do that and enroll people; the hard part is keeping the promise. When people need you, you have to be able to respond with a sense of urgency and fairness.”

Part of that needed sense of urgency is due to how the claims side of pet insurance works. Pet owners with Embrace pay for the vet bill out of pocket and are then reimbursed. That’s why Embrace prioritizes processing and paying claims as quickly as possible; the average is eight days from filing to reimbursement.

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GIVING BACK

…

Part of Embrace’s mission is giving back both locally and nationally. The Embrace CLE Challenge, an annual community fundraising competition, helps Cleveland-area nonprofits raise money. Since it was founded in 2020, the challenge has raised more than $380,000. Embrace also matches employee donations to nonprofits 100%. These initiatives together have resulted in more than half a million dollars for charities.

THE ORIGINS OF EMBRACE

…

GRACE MCCONNELL

Technically, Embrace Pet Insurance existed before it was even named. Company co-founders Laura Bennett and Alex Krooglik won the 2003 Wharton Business Plan Competition with the concept of a pet insurance company, though it was pitched as PAWS Pet Health Insurance. While Bennett and Krooglik are no longer with Embrace, their legacy lives on.

The Embrace team is growing rapidly, with plenty of pet expertise present; at least 20% of Embrace’s employees are licensed or registered veterinary technicians. These vet techs are essential because they review the medical records, qualify for preexisting conditions, and decide which events are covered.

Although Embrace’s policies cover unexpected accidents or illnesses, preexisting conditions can complicate matters. While preexisting conditions like cancer and hip dysplasia are technically not covered, there is some flexibility when it comes to curable conditions.

“Some preexisting conditions only have a temporary non-coverage period,” Macias says. What this means is that once a pet does not display symptoms of that condition for a certain period of time, coverage can be reinstated. For example, if a dog displays symptoms of repeated stomach issues, like vomiting, at the original time of coverage but then has no symptoms for a year, they would be eligible for coverage for that condition.

The category of pets is broad, with people keeping anything from a snake to a parrot as a pet. Embrace only insures cats and dogs, however.

“There are 135 million cats and dogs in the U.S., which is where the bulk of pet expenses lie,” Macias says. “We

want to get really good at insuring cats and dogs, but that doesn’t mean someday we won’t expand to cover other pets.”

Because of this focus, Embrace has been able to finetune its policies and processes. Embrace was rated the No. 1 pet insurance on the Forbes list of America’s Best Insurance Companies in 2022. Macias is quick to note that awards never lead to something; they follow what was already accomplished.

“In our internal Teams channels, we post different testimonials we receive and we really geek out about it,” he says. “A recent testimonial praised Embrace for creating one less thing for the customer to worry about and received around 50 likes and comments on an internal-facing board. Things like that just show the passion our employees have and what we mean to folks.”

Embrace is currently the top affinity distributor of pet insurance, leveraging partnerships with companies like Allstate and Geico to offer co-branded and whitelabeled insurance policies. When someone purchases Geico’s pet insurance plan, for instance, they’re actually working with Embrace.

Now that Embrace has gained widespread distribution through those channels, the company is focused on stepping up its direct-to-consumer strategy to become the primary product on the market while creating the best experience for pet parents.

“To understand Embrace is to understand that it isn’t what we do — it’s who we are,” Macias says. “I get to tell the story of Embrace, but there are hundreds of people who are empowered every day to find those small wins and take care of our clients. That’s really the secret sauce.”  Summer 2022 • Maverick |

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Most people would be surprised to know that my company....

Has an office in Prague.

Q&A

What are the most exciting or transformational things happening in your segment of the industry right now?

There are a few including, but not limited to: • Providing personalized, clinically integrated solutions and ecosystems to companies that enable people leaders to effectively offer their employees a comprehensive strategy that supports all aspects of their members’ and their families’ overall well-being.

• Building in health equity into clinical and engagement models, solutions, technology, and artificial intelligence to help every person live their healthiest life.

• Shifting greater patient numbers to remote care and the rise of on-demand health care.

MAVERICKS you should know

ADRIANE MUSUNEGGI VICE PRESIDENT OF PRODUCT & USER EXPERIENCE, ACCOL ADE INC.

Contact: adriane.musuneggi@accolade.com

Tell us about Accolade.

Accolade provides millions of people and their families with an exceptional health care experience that is personal, data-driven, and value-based to help every person live their healthiest life. Accolade solutions combine virtual primary care, mental health support, and expert medical opinion services with intelligent technology and best-in-class care navigation.

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

Accolade’s personalized health care approach puts humanity back in health care by building relationships that connect people and their families to the right care at the right time to lower costs and deliver improved health outcomes.

42 | Maverick • Summer 2022

What’s your favorite thing to do on weekends?

You’ll often find me taking a long run outside on the weekends. In addition to running being great exercise, it also provides me clarity and peace of mind.

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

One of the best series I’ve ever watched is on Hulu. It’s called Taste the Nation, and it’s produced and hosted by Padma Lakshmi. Lakshmi takes viewers on a journey to explore the rich and diverse food culture of immigrant groups across America. I enjoy traveling immensely, and during the height of the pandemic lockdown, this series provided me the opportunity to travel virtually while learning about the numerous food cultures across the U.S. Is there a great book you’d recommend to your colleagues or customers?

Why We Sleep: Unlocking the Power of Sleep and Dreams by Matthew Walker, Ph.D. This book explores and explains why sleep is such a critical component of our health and well-being. Walker, a neuroscientist and sleep expert, leverages data to exhibit how too little or poor sleep quality can impact our overall health and how harnessing the power of sleep can have a transformative impact. This book fundamentally changed my perspective on the importance of sleep and how I prioritize it in my daily life.

What is your favorite smart device?

My Oura ring. Oura monitors sleep quality, daily activity, and body stress signals to provide daily sleep, activity, and readiness scores. One of the first things I do every morning is check these scores to influence how I am going to approach taking care of myself that day. The personalized data this device tracks has had a profound positive impact on my daily habits. 

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