‘Disruption’ of health care industry makes its way to WA as VMFH joins national network
A recent partnership announced with a local health system is the latest in a series of strategies taken to help shore up finances in an increasingly competitive marketplace.
San Francisco-based Transcarent in late September announced it was partnering with Virginia Mason Franciscan Health and nine other U.S. health systems to create the first national medical “ecosystem” for national self-insured employers and their employees.
“For the first time at a national level, members can access seamless virtual care that works in tandem with complex care services that are best delivered locally,” Transcarent said in its announcement.
Tacoma-based MultiCare, for its part, has partnered with Dispatch Health to offer at-home, on-call medical care.
Hospitals, primary care operators, retailers, even Uber are finding ways to reinvent methods of care delivery and to reach more patients.
At the same time, hospitals are facing worker shortages, rising costs of doing business and tougher financial outlooks.
It’s against this backdrop that new alliances are being announced and a wider medical “disruption” is taking hold, not just in Tacoma, but across the nation.
The ‘Big Six’
In an Oct. 7 online essay titled, “The health care disruptors are not coming. They are here,” Konye Ori, a health care finance professional in Indiana noted, “In 10 years, our traditional health systems could become obsolete when health care consumers have widely adopted the offerings of the Big Six and other entrants in the mainstream health care market.”
Ori listed the “Big Six” as Amazon, CVS Health, Walmart, Best Buy, Uber and Google, and added, “Taking our chances and hoping to fare better than Borders, Blockbuster, or Sears is no longer a safe bet.”
CVS, which owns Aetna, encourages that health plan’s clients to use CVS Health services and completed its acquisition of primary care provider Oak Street Health in May. An analysis in February 2023 by the American Hospital Association said the retail drugstore “could be the best-positioned retail primary care competitor today,” according to some analysts.
Walmart is set to double its number of health centers to more than 75 by next year. Best Buy has partnered with Atrium Health for “hospital at home” services, including wearable devices and virtual care. Uber Health has focused on medication and healthful food delivery along with non-emergency patient transport. Google is involved in intensive data-driven medical work, including partnering with the Mayo Clinic to expand use of A.I. in health care.
Amazon and its purchase of One Medical and its “concierge” services has many assuming it could soon represent a huge chunk of the nation’s primary care space.
Here’s a look at some of the other partnerships in this region.
VMFH-Transcarent
The VMFH-Transcarent partnership creates a newly established network for Transcarent’s customers, generally self-insured employers and their employees.
Transcarent told The News Tribune that more than 4.4 million people have access to Transcarent services across all 50 states, with more than 200 self-insured employer clients.
Self-insured is a type “of plan usually present in larger companies where the employer itself collects premiums from enrollees and takes on the responsibility of paying employees’ and dependents’ medical claims,” according to Healthcare.gov.
Self-insured employers can contract for insurance services such as enrollment, claims processing and provider networks with a third party administrator, or are self-administered.
Transcarent essentially acts as the third-party administrator for its clients, as a VMFH official explained recently to The News Tribune.
“They’ve already partnered with the best health systems that have the best overall value and outcomes,” said Thomas Kruse, senior vice president and chief strategy officer for VMFH and CommonSpirit Pacific Northwest Division. VMFH is part of CommonSpirit Health.
Transcarent directly contracts rates with the medical systems. As opposed to taking weeks if not months for reimbursement of services, Transcarent’s direct-to-employer platform “regularly pays providers on the same day the service is delivered,” according to the company.
That allows employers to gain competitive pricing “previously only reserved for narrow networks while maintaining access and choice for members,” according to the company.
Leslie Krigstein is Transcarent’s vice president of communications and government affairs. She told The News Tribune in response to questions that the new partnership with the 10 health systems gives employers a “regional anchor” for their health care.
“We’re beginning our partnership with surgical care services in early 2024. While the number of patients in need of advanced care such as surgery represents a segment of our supported Transcarent members nationwide, we entered this partnership with the intent to support all of our care services alongside our health system partners,” Krigstein said via email.
“Over time, that will include advanced primary care, oncology care, and additional categories to cover 90% of our employer’s average health care spend,” Krigstein wrote.
Transcarent touts its “concierge level” services, including access to virtual care “in 60 seconds.”
Krigstein explained how it works.
“Everything starts in the Transcarent app. From there, Transcarent members can find the solution that best fits their needs, virtually, in-person, or at home, and understand the cost upfront.”
“We route members directly through to the right care, the notes are consistent across every touch point, maintaining a medical record that is consistent. ... Whether it’s a surgery or a consultation for cancer or managing a chronic condition we can track the journey the entire way and make sure that we close each communication loop and get to the next best action.”
Kruse of VMFH noted that “it’s not a discount shop. They actually work with the best systems so that they get the best outcomes, which in the end actually improves the total cost of care by getting people to the best care.”
Transcarent CEO Glen Tullman told Fierce Healthcare news site in a recent interview, “What we found when we were dealing with some of our largest self-insured employers, they said they’d like a national network, and only big payers have national networks. We wanted to create close working relationships with the largest, highest-quality health systems across the country.”
VMFH CEO and CommonSpirit Health PNW Division president Ketul Patel also recently spoke with The News Tribune about the announcement.
“You have very prominent organizations like Transcarent choosing us to be their partner to really represent the destination, if you will, for health care, west of the Rockies. It’s a very, very significant statement,” Patel said.
“After the merger of CHI Franciscan and Virginia Mason, we’ve focused on many different initiatives in this region ... our partnership with Transcarent is just another step in that direction,” he said. “I think that all of us have obviously learned many things during the days of the pandemic. One of those was to ensure that we’re finding better and more effective ways to connect with people that need care.“
The other nine health systems and the states they are based in within the provider network are Advocate Health (Illinois), Atrium Health (North Carolina), Baylor Scott & White Health (Texas), Corewell Health (Michigan), Hackensack Meridian Health (New Jersey), Intermountain Healthcare (Utah), Mass General Brigham (Massachusetts), Memorial Hermann Health System (Texas) and Mount Sinai Health System (New York).
VMFH-Optum
Optum, a UnitedHealth Group subsidiary, also is partnering with VMFH in a “strategic alignment” to make Virginia Mason Medical Center in Seattle its preferred acute care provider for its Seattle Polyclinic patients. Optum, in turn, will “provide in-network continuity and co-management of 25,000 Medicare Advantage patients.”
Optum operates both The Everett Clinic and The Polyclinic, which are set to be rebranded as Optum clinics next April.
Optum has been a UHG subsidiary since 2011 when UHG merged its pharmacy and care delivery services into one brand. UHG reached a 10-year agreement with Walmart in September 2022 to start serving a handful of Walmart Health locations in Florida and Georgia, growing over time to serve seniors and Medicare beneficiaries through Medicare Advantage plans.
Plans were filed Oct. 4 with the City of Tacoma for a new $3.5 million Optum Tacoma space at Point Ruston’s Building 5, 4924 Main St., with construction tentatively to start in February.
Costco-Sesame
Around the same time as the VMFH-Transcarent announcement, New York-based Sesame, a “direct-to-consumer health care marketplace” announced it was partnering with Issaquah-based retailer Costco to offer discount pricing for virtual or in-person care for Costco members.
A virtual visit is priced at $29, while “Health check-ups (a standard lab panel, plus a virtual follow-up consultation with a provider), just $72,” according to its announcements, and a virtual mental health therapy session priced at $79.
“The Sesame marketplace is comprised of primary care doctors and nurse practitioners, more than 40 health specialties, labs and imaging centers, and is inclusive of both virtual and in-person care,” Sesame said in its release.
“Sesame doesn’t accept health insurance, making it ideal for Costco members that prefer to pay cash for their health care, whether it is because they are enrolled in high deductible insurance plans, are uninsured, or simply appreciate the price, quality and convenience of Sesame,” it added.
This story was originally published October 23, 2023 at 5:00 AM.
