RED HOT Contributors

 

Episode 9 – A Successful Pivot…60 Million Lives

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Prevention and management programs for chronic disease, though well intentioned, often fall short of member engagement and ROI for payers. One healthcare maverick founded a unique solution to these challenges. She raised $12MM in funding and created a national care network that now carries more than 30 million lives.

Brenda Schmidt is the CEO for Solera Health – an identification, prevention and management network for chronic disease. Their technology smartly matches members with thousands of best-in-class network partners and community organizations, to deliver services resulting in better outcomes, lower care costs, and greater member control for their quality of life.

A SHORT SNIPPET FROM THE INTERVIEW:

STEVE: “Rather than being another player in heavily-commoditized chronic disease prevention and management vertical, you stepped back to make Solera an actual network for all of these smaller chronic care programs. You added in best-of-breed monitoring, better analytics, improved technology, more capital, and better payer leverage.

A lot of what is missing in these individual programs….do I have this right?”

BRENDA: “That’s exactly right. There’s a lot of organizations in the chronic disease prevention & management space looking to make incremental improvements. The payers, providers and community organizations were really clear that they wanted to cover these powerful programs…but there wasn’t this integrator role in connecting all of the technology needed.

As we saw the literature coming out and the opportunity for it, there was a lot of interest in the model. No one had ever operationalized it, and that’s what we saw as the opportunity. To pivot and leverage community resources – and more recently, digital providers into a high-access, lower-cost network as an adjunct to primary care.”

So for the payer, they wanted ONE contract with an organization that could meet their compliance and data/privacy security requirements at a single price point, that would offer their members choice to access a wide and diverse network with chronic care prevention and management.

They also didn’t want to spend the time and resources to evaluate and evaluate all the digital technologies, to see which one was the best. Especially since there is new digital technology coming out every day.”

STEVE: “I see”

BRENDA: “The other interesting thing that it did was to redefine the relationship between the payer and the physician. In a lot of instances, a very large percentage of people that go to the doctor, the physician advice is ‘lose a few pounds, eat better, and exercise more’ — and they send those patients out into a world where that’s not very easy and it’s not paid for.

So now payers can go to their physicians and tell them that they now have a program covered at 100% that covers patients to do exactly what the physicians are telling them to do.

For the consumer, they get member choice. They get to pick [from different care programs]. For the community-based organizations and digital providers, they get to connect and deliver the program…and they don’t have to worry about the back-office technology and integration to stay in the payer network.

CONTRIBUTE & INFLUENCE

 I have had the privilege and pleasure of working with Steve Ambrose on a podcast that covered a range of topics in healthcare information technology. The podcast logistics – communications, interview questions, scheduling and production – were every well managed.
A great experience that I would do again in an instance.

Dr. John Glaser
SVP, Population Health at CERNER

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