In years past, the world of health care often seemed to be populated by a number of entities that were having a difficult time working together. Like an orchestra that was made up of musicians who were each playing parts of different symphonies, there seemed to be little order – and certainly not much harmony.
What would happen if a good conductor stepped up, handed out the right musical parts, and began to conduct and coordinate everything? What would happen if all those different players began to play in harmony?
And what would happen in the world of health care if that same kind of conducting organization stepped up and coordinated what all those different players were doing? What kind of experience would all those players have? And what about the people in the audience?
Something similar is worth working for in health care.
Leverage Health Solutions describes itself as, “The market leader in health care growth services focused on health care strategic business development. We concentrate on delivering best-in-class solutions by way of our Portfolio Companies to the health care marketplace, with an emphasis on payers and health plans, based on unique and unparalleled industry experience. Our team excels at understanding the needs of health care payers as well as emerging trends in the vendor community. All health care constituents are experiencing significant change and we are ideally positioned to offer proven results to dynamically impact all aspects of the industry. Our efforts result in measurable results encompassing profitable revenue, operational savings and market facing enhancements for payers delivered from our best-of-breed vendor solutions.”
If that statement makes Leverage Health sound like the Swiss Army Knife of health enterprise, that is not inaccurate. Richard and his team do not specialize in just one aspect of health, but aim to improve processes and experiences for care providers, insurers, employers, health systems, pharmacy benefit managers, as well as end-users.
Here are some excerpts from a recent conversation between Richard and myself.
Kevin Pereau: What led you to start your unusual, innovative company?
Richard Lungen: I was working for a health and life insurance agency in New York state, where I learned the importance of dealing with local employers and their employees about their health care plans. In 1992, I was on the ground floor of a small, local third-party administrator who administered self-insured benefits for local employers. We went on to create a national provider network called National Preferred Provider Network. That organization was my entry into the provider network industry, which is still a big part of our passion at Leverage Health. Several of our companies are attached to the network side of health care, which we believe is the most important asset owned by health plans.
I founded Leverage Health in 2007 to enable highly qualified, innovative vendors to accelerate their growth into the health care marketplace. My co-founder and I saw an opportunity to become an integrated partner to highly promising companies, which we call our Portfolio Companies, and to help them grow their revenue and client base faster than they could have done themselves. And we have been doing that for over 11 years.
Kevin Pereau: What kind of companies do you work with?
Richard Lungen: All our portfolio companies provide some form of innovative and unique solution, service or technology – predominantly to health plans, but also to health systems, members and other stakeholders. Sample solutions include member and provider engagement tools, data modeling and analytics, administrative simplification, and provider network solutions.
Kevin Pereau: How are business agreements and partnerships changing the role that health care companies are performing today?
Richard Lungen: That is an important question, since collaboration and cooperation is critical to success. The user of any service, whether a consumer or a provider, doesn’t want to have to go to multiple places to accomplish the same or similar task. They value and demand the ease of use of a more streamlined workflow.
There are many examples of that throughout the country. Payers and providers are joining together to create mutually agreeable risk models, and to create co-branded products. That is a critical integration, and we are active in that market trend. Health plans are seeing hospitals and physicians more as partners, and not just names in a provider directory. Providers are becoming more critical partners and stakeholders in health plans.
Kevin Pereau: What new trends have you seen emerge over the last 10 years or so? What do you think the future will be?
Richard Lungen: I would say that many major changes are impacting the industry today. Trends are impacting consumers by enabling more effective use of the health care system, trends are impacting the overall cost of health care, and trends are enabling health plans and medical providers to better collaborate.
However, based on the stakeholder, the priority of how to invest in these trends can differ. The goal is to give consumers new tools to better use the health care system and incentivize providers to deliver effective care.
For consumers, there are new and innovative solutions being provided, whether on their phones or via their employers or insurers that provide tools to transparently explain the cost of a medical event the same way a consumer shops for any other product. Consumers can find different care providers, just like they’d use Yelp to find a particular merchant. Plus, there are tools to better understand the quality of care those providers deliver.
For example, one of our Portfolio Companies enables those things to happen right now, in the consumers’ phones, providing important information for the consumer to choose high-value and highly rated providers. It’s no different than consumers being steered toward Amazon Prime merchants when shopping online.
Another significant trend is to offer incentives to providers to transition from a fee-for-service model to a value-based arrangement. Increasingly, the mindset is that outcomes are not just billables. There is a substantial trend toward incentivizing with outcomes and creating real financial and risk-sharing partnerships between payers and providers.
Where are things going? I wish I knew the answer. But we could talk about consolidation and integration of care delivery systems. For example, the Aetna/CVS deal will enable 10,000 retail pharmacies to serve millions of Aetna members, using a yet-to-be-created, integrated product.
Another trend, which is only going to gain momentum, is the integration of health plans, providers and other provider stakeholders to increasingly become one vertical stack. What Kaiser has done in various markets is clearly working, and there are examples across the nation with other companies such as Geisinger, UPMC, Intermountain Healthcare and new insurer entrants who are tightly aligning with providers such as Bright Health, Melody, and Clover. It’s also worth noting that insurers are acquiring provider groups (like Optum has done) in critical markets, which is creating vertical stacks that allow care to be delivered in a more cost-effective manner.
Future Opportunities and Trends as Connected Care Evolves
Health care may be going through massive transformation, but it can sometimes seem like we have only taken baby steps toward achieving the changes that will produce fundamental, meaningful results.
Millennials are already driving change and will continue to do so. They are collecting data on themselves. They tend to accept the premise that data should be available both to themselves and to their care providers. They want to connect and share information when it benefits them to do so. And they are impatient with the way things are and eager for the situation to change. Thanks to millennials, the old myth that the consumer doesn’t want to get involved with managing their own well-being is beginning to go away. And millennials are teaching that mindset to members of other cohorts.
That change will begin when health care reorients to prevent disease and keep people healthy – not only treat them when something goes wrong. When that change happens, everyone wins.
As this evolves, a wider range of businesses will be drawn into maintaining health and offering preventative, not remedial, care. Nutrition companies, nutritionists, fitness clubs, psychologists and other care providers will migrate from their current position on the sidelines of “mainstream” health care and move toward the center alongside physicians, hospitals and insurance companies.
Richard Lungen is Founder and Managing Member at Leverage Health Solutions, which describes itself as, “the market leader in Healthcare Growth Services focused on health care Strategic Business Development. We concentrate on delivering best-in-class solutions by way of our Portfolio Companies to the health care marketplace, with an emphasis on payers and health plans, based on unique and unparalleled industry experience.”