RamaOnHealthcare July 21, 2022

Today, RamaOnHealthcare talks with Steven Nelson. Contigo Health creates new ways for clinicians, health systems and employers to work together supporting a common goal for all stakeholders: to increase access to high-quality care, enhance associate engagement, control costs, and get associates back to work and life faster. Contigo Health delivers comprehensive services for optimizing employee health benefits.

Steven Nelson, President, Contigo Health

Steven Nelson, President, Contigo Health

RamaOnHealthcare (ROH): Welcome, Steven, to our thought leadership series. Can you tell me about Contigo Health’s mission and game plan and how you are aiming for success?

Steven Nelson (SN): The biggest expense employers deal with is salary. Employee benefits – primarily driven by healthcare costs – is the second largest expense employers incur. We also know that the majority of Americans get their health insurance through their employer making it a critical and addressable market for our country. Our mission is to liberate providers, employers, and patients to accelerate positive change in our current healthcare system.

The biggest expense employers deal with is salary.

Contigo Health is relentlessly focused on bringing together employers and providers to provide access to the best possible care and improve the quality of life for employees and their families across the country. We have seen that by and large, employers want more control over the quality of care their employees receive. Contigo Health gives them the power to do this by arming them with data analytics and direct connection with high value providers who deliver quality care.

Furthermore, Contigo serves as the conduit between those who deliver care and those who pay for it, simplifying and bringing transparency to an often overly complicated process.

ROH: Looking back, how have you seen the employer benefits space evolve?

SN: The pandemic crystalized the idea that the health of employees is a strategic asset for employers. This realization, coupled with the great resignation, is leading employers to offer some of the more robust compensation packages we have seen in recent memory. It is widely understood that employees – overall – are becoming more savvy healthcare consumers, and benefits that include fertility coverage and behavioral health offerings help with recruitment and retention.

The pandemic crystalized the idea that the health of employees is a strategic asset for employers.

We have also started to see employers think more concretely about health equity – ensuring women and associates from historically underserved populations are cared for.

We have also started to see employers think more concretely about health equity….

Another part of the evolution we are seeing deals with the aging of certain parts of the American workforce. As Americans begin to work from anywhere, for some, this translates to a delayed retirement. This is leading to employers needing coverage for health situations they may not previously have had exposure to on a regular basis.

ROH: Thinking about the health insurance space, why does direct to employer matter? Why is this disruptive approach being adopted?

SN: Historically, the employee benefits space has been an intermediary-dominated industry. Those who pay for care and those who delivered it were rarely, if ever, in communication with one another. What we think of as health insurance companies have acted as financial conduits, keeping the buyers and sellers siloed and the health plan member excluded from the dialogue. This phenomenon has been eroded in areas outside of healthcare over the last decade or so with the introduction of platform companies that have created marketplaces where buyers and sellers can interact directly. Provider direct to employer – the space that Contigo operates in – brings this concept to healthcare.

When I tell people what I do for a living, one of the more common questions I get is, “Why is it better for my employer to be involved in my healthcare than the insurance company?” First, I explain that having insurance companies involved in clinical decision making is a relatively new element of American healthcare. Prior to that, health plans focused on network access, fee negotiations and claims payment. But as healthcare costs, provider reimbursements and premiums continued to rise, payors demanded more accountability; thus, health insurance companies became more and more involved in attempts to control costs of healthcare. Then I ask, “So why are insurance companies who specialize in actuarial science more qualified to assist a company’s health plan members in navigating and financing their healthcare than the retail or healthcare company that employs you?” I point out that their company probably offers a 401K but doesn’t tell them what to invest in. Instead, they help navigate and provide incentive for employees to save for their retirements.

Employees should feel valued and cared for. They should be able to believe that their employer wants them at work (whatever that means, these days), living their best lives (as my kids would say) and in the best health possible. At companies who are doing this best, it feels to employees like the organization has their back from health and finance perspectives and that human resources will ensure they don’t get hit with an absurd bill they shouldn’t receive.

Employees should feel valued and cared for.

ROH: What gaps does Contigo Health solve for?

SN: So many patients in the U.S. end up not receiving the care they need or receive unnecessary care that doesn’t lead to better outcomes. We are very focused on reducing the frequency of both of these gaps while simultaneously ensuring a higher quality of care is delivered.

When patients look in a directory for an orthopedist, it’s all but impossible for them to see who specializes in treating patients “like them.” Provider directories may include photos and notations around provider practice style or languages spoken but not enough detail to really connect providers to the special healthcare interests and needs of prospective patients. We can do better. We know which orthopedists specialize in hip replacement for women, for example, and can guide them accordingly.

We are also in the midst of a transition for employers as they move from the “old” way of navigating employee benefits. It used to be that a company would look to a consultant or a broker to advise them on their health benefit program design and execution – that platform we discussed before has disrupted everything. Brokers and consultants are still highly valued, especially for both small and large organizations, but human resources (HR) benefit executives now have more skin in the game as they work to moderate corporate overhead expense and the need to recruit the best and brightest talent. More frequently, benefit decision makers within employer groups are becoming active participants in seeking out benefit innovations.

Separately, it is also worth talking about a trend that we are seeing conclude – and that is around individual point solutions. The days of having a dozen or so vendors for individual issues (e.g., an app for diabetes, different from the one for weight loss and different from behavioral health) are over. We are seeing a rise in demand for comprehensive solutions that can “do more” than one thing.

ROH: How do you define “quality care?”

SN: Quality is about creating the best possible outcome using the least possible resources. Quality care is multi-dimensional, and the key is finding balance among all those aspects, like a four-legged stool.

First, we need to achieve a good outcome for the patient from a clinical standpoint. There are the basics like mortality and infection prevention, but also return to daily activities and quality of life measurements. Second, I think of appropriateness of care. Was that surgery the right approach? Was surgery needed at all? Was there a more conservative approach that would have been more effective? Should you have ordered that imaging or lab? Cost is the third leg. You don’t buy a car without knowing the value, but in healthcare, we don’t talk about cost versus value. Patient experience is the fourth and final leg – was their need met? Did they get the concierge or bare bones treatment? Just like any other product or service, people want different things – individual preference in healthcare is a real thing. Beneficiaries (or employees) need to be able to make purchases based on their values which evolve throughout their lives. What’s mandatory in care at one phase of life is not needed at another point in time.

ROH: Can you talk to me about how you approach working with employers and providers?

SN: We like to say that if you’ve talked to one employer, you’ve talked to one employer. We do a lot of listening at Contigo Health. We hear about the vision for their health plan, their philosophies, objectives and needs. At the end of the day, employee benefits are an investment in a company’s biggest asset – their people. It’s incumbent upon everyone to make sure it’s a smart investment.

…employee benefits are an investment in a company’s biggest asset – their people.

Contigo gets involved in the early stages of co-creation, bringing different parties into the mix, and having them talk to each other to find innovative solutions that are a win-win for all parties involved. If we need to educate the buyer (employers), that means the first thing we need to do is bring the sellers (providers) to the table to create that dialogue. We educate on the value of primary care, that is how to analyze and think about short-term versus long-term costs.

With healthcare, you are dealing with a societal good – we are ultimately trying to lower the risk pool for everyone. We understand that turnover is inevitable, but what we’ve found is that your likelihood of dealing with a high-cost claim won’t be any lower. Think of health plan benefits as paying forward for the benefit investments other firms are making in the employees you recruit away from them and vice versa. We always have that adage in the back of our minds – what happens if you don’t invest in your people’s health, and they stay?

ROH: How are self-insured employers navigating a post-pandemic – or at least endemic – environment? What issues do you see them running into? What are the pain points? How are you helping them organize and chart their path forward?

SN: We see behavioral health playing an outsize role in employee benefits going forward. The pandemic did a number on people’s emotional well-being. We don’t think this can be solved overnight, but we know how significant an issue this is for employers going forward. Part and parcel with this are substance abuse and helping our colleagues who are struggling.

Another issue we see playing out related to pandemic involves delayed care. We know women delayed mammograms and everyone delayed colonoscopies. That means, in addition to the backlog of screenings we are working through, we are inevitably going to catch diseases later in their progression. That is something that employers are going to have to deal with head on. Similarly, we know that childhood early interventions were delayed or done virtually – we’re going to see increased demand for occupational and speech therapy.

Another issue we see playing out related to pandemic involves delayed care.

Lastly, between inflation and the pandemic ripples, we’re going to be seeing some of the biggest rate increases in a decade heading into 2023, 2024 and 2025. Unfortunately, from what we are hearing, this isn’t translating to increases in the bottom lines of providers.

ROH: How does Contigo help these employers forecast and plan for the future?

SN: Contigo offers employers the data analytics to make informed decisions, putting them in the driver’s seat when it comes to making decisions about their health benefits and who they partner with. We also bring in our parent company – Premier® and its PINC AI™ platform to help provide benchmarks and understand market trends and which trends are actionable.

Analytics is not just knowing your numbers but understanding them and diving into their meaning to drive action, it is one of the most important aspects of managing an employee health plan today. We break it down into a series of dashboards that help HR benefit leaders understand some of the activity and leading indicators around where, how, and why care was delivered. That rolls up into a financial performance dashboard that gives plan managers the big picture and the detail they need to identify potential areas of opportunity and design solutions. It’s also important to be able to monitor and measure any changes you make. For every plan change you make, your team should be working with you to identify the objective and key results you plan to measure. Are you putting in a telehealth option to reduce emergency department (ED) utilization? Are you adding a capitated primary care plan design to encourage preventative care? Your analytics department — whether internal or external — should be measuring and reporting those results to you. And using that, you can start to project future performance and trends. Nobody has a crystal ball, but thoughtful analysis can help you spot trends early and put in amplifiers or mitigation strategies.

…thoughtful analysis can help you spot trends early and put in amplifiers or mitigation strategies.

About Steven Nelson

Steven Nelson leads the Contigo Health team as President and was one of the leaders who initiated the strategy behind Contigo Health within Premier, Inc. Before joining Premier, Nelson was a leader at Anthem Inc. where he served as Vice President of Strategy and Planning and COO of Anthem’s diversified business group. Prior to joining Anthem, Nelson led strategy, product and marketing at Highmark Blue Cross Blue Shield and helped to build Allegheny Health Network. Nelson has a deep and personal commitment to giving back to his local community as well as the global community, including leading charity work in Haiti. He holds a bachelor’s degree from the University of Pittsburgh and a master’s degree from Ohio University. He and his family reside outside of Pittsburgh, in Gibsonia, Pennsylvania.

Topics: Insurance, Interview / Q&A, Self-insured, Trends
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