I’ve recently gone through four “Request for Information & Proposal” processes with four different health plans/insurers. Here’s what’s happened. First, many of the RFP’s began with a description of what they want to accomplish and the wording in the RFP expresses an interest in a technology solution. They seem to want to integrate some tech solution into their website or some app they want to build. And they think Sherpaa could be a great fit. Therefore, only a few of the 150-200 or so questions in the RFP ask about the service we provide. And the majority of the questions ask for very detailed technical answers about our technology platform that powers Sherpaa. The questions made it very obvious these health plans were looking to somehow integrate or use or have access to a technology platform to enable their members to message with doctors. These were things like “Can your platform be white-labeled?” and “Do you offer support for single sign on?”
So here’s what we did. We answered the questions in detail around our Virtual Primary Care model— how and why it works with the 7 years of data we’ve collected showing that it changes care patterns and costs in a very meaningful way. And then we answered only a select few questions about our technology, mostly around privacy and security.
Of course we had to explain why we didn’t spend the time to answer 90% of the technical questions. Here’s what we said:
When you add a chain of urgent care centers to your network, do you ask them 100 questions about the EMR they use? Do you ask them if the EMR offers a patient portal and if that EMR enables single sign on for their plan members?
This helps them understand that Sherpaa is not really technology, but rather a service, just like an urgent care center, primary care practice, or retail health clinic. Then, it’s just a matter of them answering the questions:
“Does it make sense for us to cover the $100 Episode of Care for our members?” Is this less expensive for our plan than a fee-for-service urgent care center visit? Is this weird 7 year old “new” fixed-rate, value-based thing called an Episode of Care a better value for us than fee-for-service maximized billing shenanigans?”
By the way, if you haven’t read up on an Episode of Care, please do that. Once you do, this all makes so much more sense.
Sherpaa views ourselves as a service that solves problems. Because, honestly, that’s what patients have. They have problems and they come to us for solutions. We’re also a service that believes stripping out all the complexity of care and radically simplifying billing is the secret to financial sustainability for patients and insurers. Here’s the significant difference:
Sherpaa thinks doctors should get paid per solved problem, rather than per visit and per order.
That incentivizes our doctors to best solve problems with as few meaningful steps as possible, not drag problems out to maximize billing. That’s why we’ve leveraged our data from the last 7 years to answer these questions:
“How much should we charge to work through an average patient problem? What’s the amount that covers our overhead and gives us some margins to be a sustainable, profitable business?”
We’ve found that to be $100. Sometimes this online problem-solving lasts 3 days, 3 weeks, or 3 months. But we know, based on our data, that there’s a ton of 3 day and 3 week problems and far less 3 month problems. And, in the end, $100 per Episode of Care, ensures we’re a sustainable, profitable business.
Charging per Episode of Care is a variation on value-based care. It’s unique to Virtual Primary Care because of the way our doctors communicate and problem solve with you. Think of an Episode of Care like a Slack channel. Sometimes there’s 3 paragraphs written by you or your doctor. Sometimes it’s a quick one sentence update 3 days after you started your Episode of Care you send in response to your doctor’s “Hey just checking in…how’re things coming along?” Sometimes it’s a shared photo showing progress for your skin infection. The traditional CPT code for office visits and procedures offers no way to bill for all of the different types of communication used in Virtual Primary Care. Having one flat rate per Episode of Care is the simplest, most sustainable, and fairest way to deliver care and get paid for solving patients’ problems.
I talked with a benefits consultant the other day and, after learning about Sherpaa, he asked:
Why wouldn’t a company or insurer pay $100 for an Episode of Care?
There’s no per member per month fee. There’s no risk to insurers or employers. And it just makes sense.
It’s a great question. Why wouldn’t you when the alternative is fee-for-service billing shenanigans? If the answer is “it’s new and we’ve never done that before,” well…you can’t keep doing the same old thing and expect different results.