Former Allscripts CEO and Livongo founder now heads Transcarent, touted as a comprehensive platform for employees of self-insured employers.
Glen Tullman is a serial entrepreneur in the digital healthcare business.
After leaving the CEO's position at Allscripts in 2012, he founded Livongo, a diabetes monitoring and remote monitoring company acquired last year by Teladoc for $18.5 billion.
Now, Tullman is on to the next startup, Transcarent, which uses technology to improve how consumers engage with top healthcare providers. The platform is focused on employees of self-insured employers.
Tullman recently responded to HealthLeaders' questions about how his latest startup intends to help self-insured employers navigate the virtual-care-dominated world of the COVID-19 pandemic.
HealthLeaders: What is consumer-directed healthcare, and how does it differ from healthcare as practiced in the U.S. today (other than concierge care)?
Glen Tullman: Consumer-directed care is a completely different way of experiencing health and care than what we’re currently used to. Despite the massive amount of innovation that’s happened over the last few years, and especially over the last 18 months or so, health care is still more confusing, more complex, and more costly than ever before. When’s the last time you heard someone say they loved their healthcare experience? It doesn’t happen often, and it’s a shame because there are hundreds of companies, providers, payers, and PBMs working within the ecosystem to solve healthcare’s challenges, but no one’s cracked the code on genuinely improving the patient experience. At Transcarent, we want to correct that by creating a new and different kind of health and care experience that puts people back in control of their healthcare decisions and makes it easier to stay healthy.
The consumer-directed model is actually a lot closer to how we approach other experiences in our lives, like booking a trip or purchasing a new pair of running shoes. Right now, if I were to go on a site like Amazon and type in the kind of shoe I’m looking for, I would get information about all kinds of shoes from all sorts of brands. Some would be more expensive, some might be specific to the type of exercise I want to do, but I would have all the information right there in front of me to choose the right pair for my needs – I am in control.
At Transcarent, we are redefining the relationship that people have with the health care system by giving them the same kind of unbiased, transparent information about the care options available to them, providing trusted guidance where they know we will never choose what’s best for us over them, as happens today, and then letting them make the decision that’s best for themselves and their families. It’s an approach that puts employees and their families back in control of their own health, and we know that given the right information, people will make choices that lead to better health outcomes. We trust people.
(Glen Tullman is CEO of Transcarent. Photo: Courtesy of Transcarent)
HealthLeaders: Ultimately, do you have more faith in private enterprise's role to fix healthcare than you do in government regulation and oversight?
Tullman: I’ve said it often, but given the current state of affairs, I believe that employers will play a key role in driving real change within the healthcare ecosystem. We’ve already seen evidence of this. Three of the nation’s largest employers —JPMorgan Chase, Berkshire Hathaway, and Amazon — launched Haven in 2018 as a joint venture to lower costs and improve the quality of care for employees. They did that because they concluded that payers would never be aligned with their interests. When they spend more, payers make more.
We know now that Haven ultimately didn’t succeed, but I believe it was a wake-up call for the industry. Think about it. In any other industry, if your customer was so disappointed in the way you were doing business that they developed their own solution, you’d have a real problem. Self-insured employers have watched costs rise year over year, with no real correlation in the quality of care their employees are getting or alignment from a cost standpoint. On top of this, they’re being inundated with dozens of fragmented digital health solutions, each promising to address a specific part of care because the current systems don’t work well.
They’re desperate for change, and that’s why Transcarent was created. In fact, we were approached by several employers that had seen the success of Livongo in creating a health experience that people not only liked but loved, that measurably improved clinical outcomes (they were healthier) and that actually cost less. And these were people dealing with challenging chronic conditions. These large self-insured employers asked that we do the same thing for their employees, but across the full span of health care needs.
HealthLeaders: Despite much talk about healthcare becoming digital-first, many in the public are still not able to access their care digitally. What must be done to correct this?
Tullman: The digital-first push has been happening for a few years, but I would argue that maybe our scope of what we mean when we say "digital-first" has been too narrow. The place that I think we want to get to as an industry and as a society is putting the consumer first. To be clear, there are still real access issues when it comes to ensuring that people have the digital tools necessary for virtual care options, remote monitoring, and the like. But as providers, we also need to be willing to meet people on their own terms.
If it's the middle of the night and a mom doesn't want to bring her sick child into the urgent care center, she can connect with a provider through Transcarent in an average of 60 seconds. If a person is on the go and prefers to text a doctor about their symptoms, rather than taking time to do a video call or go into an actual doctor's office, they can do that as well. The increased utilization of virtual care has been paramount during the pandemic, but digital tools don't mean anything if an individual doesn't want to use them in the long term. The future of healthcare has to be focused on providing multiple avenues for consumers to access care on their own terms.
HealthLeaders: Much of what ails healthcare is cost. What is the ultimate tonic for high costs: true competition, price controls, care rationing, or something else?
Tullman: To drive down healthcare costs, we must provide consumers with three things: broad unbiased choice (like Amazon does); trusted expert guidance (like Travelocity does), and high-value care (already provided by many of our health systems but we have no way to differentiate). Transcarent’s surgical solution is a prime example of this. When a Member comes to Transcarent in need of surgery, our first step is to immediately get them an expert second opinion. Oftentimes it turns out that surgery may not even be medically necessary, and we’ve saved a person from having surgery that they didn’t really need. Most importantly, that’s a safer option for the person. A better option. And it saves them and their employer money.
Let’s say, though, that they do end up needing the surgery. Transcarent will ensure that the member has the option to receives the surgery at the highest quality and most appropriate site of care, and we’ll even fly them there to get it if necessary. In the past, the CEO would go to the best place. The janitor was told where to go. Now they both get access to the same exact, high-quality choices and without co-pays or co-insurance. That’s kind of magical and it happens to be much more equitable. Everyone gets high-quality care they can afford. Again, this kind of access to high-quality providers and Centers of Excellence has traditionally been reserved for those that could afford it or people with influence, but it’s open to everyone with Transcarent. And on an overall basis, because it eliminates unnecessary surgeries and medical errors by going to top-quality health systems, it results in an average savings of 25-50% per procedure. For back surgeries, which are historically very ineffective and very expensive, it’s even greater.
HealthLeaders: Are there superior business models that have yet to be tried, or to be implemented successfully, and how can we get there?
Tullman: At Transcarent, we’ve taken on a full-risk model, meaning we’re fully aligned with the employers and completely focused on making the health and care experience easier for their employees and their families. Our success is based on whether or not we improve the health and care experience for our Members and their families, measurably improve clinical outcomes, and lower overall costs for the Member (no-copays or co-insurance) and their employer. This concept is very different than the traditional navigator models deployed by companies like Accolade, Grand Rounds, or Castlight Health, where employers pay upfront for access to the solution. Ultimately, the full-risk model ensures alignment among stakeholders, a necessity if we’re going to fix the current system and have better alignment with the employer and health consumer (all of us). We don’t want to “navigate” a broken system . . . we want to fix it.
HealthLeaders: What are you hearing from leading health systems relating to digital health, and more specifically, what specifically about the rise of digital health reminds you of the early days of hospitals and doctors' offices adopting EHRs?
Tullman: While many health systems are embracing digital health, the explosion of new services that both helps and sometimes competes with them definitely has them overwhelmed, at times. It’s not too dissimilar to the plight of self-insured employers who are also overwhelmed with countless digital health services pitching them every day, something I discussed with The Wall Street Journal. However, they understand that if they are going to compete with tech-savvy upstarts and other industry giants, they’re going to have to drive adoption really quickly and offer a new and different consumer experience.
There are a few parallels to the adoption of EHRs years ago – namely the challenge of driving adoption and usage internally. The clinical staff is already under tremendous stress, and every time you add new technology, it can be met with resistance because it seemingly adds more work. That’s why it’s up to digital health vendors to do a better job making the experiences seamless, but also working together to create integrations that are aligned and drive ROI at scale both clinically and financially. That friction is something that plagues the EHR community still to this day. This is not easy but it’s doable with the right leadership and the right focus, which brings us front and center to where we started . . . putting the health consumer back in charge or, said another way, consumer-directed care.
Scott Mace is a contributing writer for HealthLeaders.