Jack Stoddard drops anchor at Eden Health as executive chairman and provides insight into a primary care model that he hopes will lead the way to a new model of care for Americans.
Haven, the once-promising venture between Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. that captured headlines when it was formed in 2018 with its mission to create a new approach to healthcare, has faded from the limelight. Most of its executives have left the company, including the notable departure earlier this year of CEO Atul Gawande, MD, MPH, who remains as chairman until his replacement is found.
While many hoped Haven would be a significant catalyst for change, other approaches emerging in the marketplace also show promise to create a more efficient, less costly approach to healthcare. Former Haven COO Jack Stoddard, MBA, is now focusing his energies on one of those opportunities. He was recently named executive chairman of New York–based Eden Health, founded as a small startup in 2016.
HealthLeaders spoke to Stoddard about why he chose to join the board at Eden Health. While he made it clear that his sights are only set forward, and declined to comment about Haven, what emerged from that conversation was a glimpse into a model that holds the potential for changing some of the challenging dynamics in healthcare.
Jack Stoddard, executive chairman, Eden Health (Photo courtesy of Eden Health)
1. Combine Primary Care with 'Insurance Navigation'
Eden Health is a primary care company operating in New York, New Jersey, and Connecticut, and offers services through 24/7 virtual care, medical offices, and pop-up clinics at worksites. A clue into the company's futuristic business formula lies in the way the company describes itself as "a primary care and insurance navigation company for employers, designed to elevate the health and wellbeing of employees everywhere."
"I believe primary care is probably one of the most essential levers that we have for improving experience and quality of care, and, ultimately, also lowering costs," Stoddard says. "Integrating benefits navigation with care delivery is novel. Combining those two is a recognition [of] how people experience healthcare.
When a physician prescribes a medication, for example, a patient might ask if it will be covered by insurance; whether it's a tier one, two, or three formulary drug; or how much the copay will cost.
"Most physicians can't answer those questions because they don't have any insights into the benefits," says Stoddard. But, Eden Health can because benefits information is incorporated into the same system clinicians are using, he explains, and there's a benefits navigator on the team. The team also can guide patients to lower-cost options, for example, explaining that a generic substitute will reduce the copay or pointing out that a 30-day mail order prescription will save money.
These endeavors enhance the patient experience and lower their own out-of-pocket expenditures. He says. "But there's also a savings that accrues to the employer who's paying the balance of the bill."
Combining primary care and benefits navigation may be the most unusual aspect of Eden's business model, but there are other distinguishing factors.
2. Change the Payer Dynamics to Deepen Patient-Physician Relationships
Today's approach to primary care is "very transactional in nature because of the economics," Stoddard says. "It's paid on a fee-for-service model and the whole model gets attuned to how fast can you get somebody through and how many people can be seen in a day." As a result, medical care is less proactive and relationship-oriented.
Eden contracts directly with employers who are charged a membership fee. This gets the provider out of the high-churn, fee-for-service mindset, yet it is not true value-based care because the Eden is not accountable for "all of those downstream costs that would incur at the hospital system," Stoddard says.
"By being able to capture a [membership] fee from the employer … it allows you to do what the market's not doing, which is being longitudinal, proactive, and relationship-oriented," he says. As a result, physicians are able to spend more time with patients, better understand their needs, and focus on preventive measures. This approach, he says, results in a better patient experiences and unlocks downstream savings.
This approach to primary care has an ancillary benefit, Stoddard says.
"We have a deficit of primary care physicians," he says. "Part of the national challenge is that we've continued to invest [more in] specialists than we do in primary care. I'm hopeful that new primary care models like Eden's [will drive] more people to realize that there is a more compelling career—the kind of medicine that people want to go into because they get to have relationships and help people over time, which seems to be missing from traditional fee-for-service primary care."
3. Play Quarterback to Reduce Costs
Retailers like Walmart, Walgreens, and CVS are launching or expanding their primary care offerings, creating more competition in the market. Their strategy focuses on creating greater convenience and access for consumers. Yet to have a significant impact on reducing costs, Stoddard says something is missing from the equation.
Primary care represents only about 7%–10% of total healthcare costs in a commercial payer population, he says. "The other 90%–93% is driven from people trying to self-navigate the rest of the healthcare system." This includes hospital care, emergency department and urgent care visits, diagnostic tests, and more, as well as specialist care.
"There's a lot of bouncing around that goes on and a lot of waste when you don't have a quarterback who's putting it all together," says Stoddard.
The principal way Eden's model can help reduce costs is by coordinating patients' care, he says. This includes referrals to high value, in-network specialists, keeping patients out of the ER and urgent care, and coordinating hospital stays, as well as post-discharge care.
"That takes waste out of the system that normally happens when somebody is trying to self-navigate through it on their own," Stoddard says. Spending more time with patients to address their concerns reduces the need for care outside the practice.
Eden Health CEO Matt McCambridge earlier shared with HealthLeaders that while most primary care physicians refer patients to specialists 33% of the time, Eden Health's rate is 10%.
4. Build Care Delivery From the Patient Backwards
Stoddard shares one key innovation lesson from his past that he says is essential to meet the needs of today's patients: "Build from the end-user, backwards." In healthcare, this means the patient.
"That just doesn't happen enough in healthcare," he says. "That's one of the real opportunities for innovators to map the journey, understand the hassles that people go through, and solve real problems for them."
He acknowledges that the complexities of healthcare present additional challenges. "Once you get the product right for the consumer, you also have to get the business model right. That's always the hard part in healthcare because often the person who experiences it, isn't the one who's paying for it. You have to get both of those to work in unison."
One of the reasons Stoddard was attracted to Eden Health is that its model is designed to meet patient's needs first.
While the company currently serves 30,000 patients, in five years, Stoddard would like that number to be a million. "The goal is to get this care model to as many people possible; to have a positive impact on as many lives as we can."
Yet Stoddard also has loftier goals. "Over time, I hope that the success that Eden has begins to change how others provide care [so Americans can get] personalized, accessible care on their own terms. My real dream is that others would say, 'They're onto something.' I'd be delighted if others were trying to replicate the Eden model in five to 10 years, because it means that we led the way, and we 'got' the way that care should be delivered to Americans."
“I'd be delighted if others were trying to replicate the Eden model in five to 10 years, because it means that we led the way. ”
Jack Stoddard, MBA, executive chairman, Eden Health
Mandy Roth is the innovations editor at HealthLeaders.
Combining primary care with benefits navigation offers a novel way to improve the patient experience and reduce costs.
A membership model with employers creates a revenue stream that changes the fee-for-service mindset.
Coordinating care and reducing specialist referrals has an impact on reducing overall healthcare costs.