Client Profile: Embedded Healthcare & Their Work to Change the Way that Providers Make Decisions

Keith

December 2020 – Onpoint was recently selected by Embedded Healthcare, a fast-growing health IT start-up based in Washington, DC, to support its back-end data integration and analytic-services needs. Embedded Healthcare is focused on lowering the cost of care by leveraging behavioral economics models to change the ways that providers make decisions. We sat down with Keith Florance, Embedded Healthcare’s President, to learn more about the solutions that they have developed, their progress to date, and the role that Onpoint is playing in their go-to-market strategy.

Onpoint: Could you offer a snapshot of Embedded Healthcare and the work that you’re currently doing?

Keith Florance (KF): Embedded is using behavioral economics models to change the way that providers make decisions, encouraging them to engage in high-value care and high-value decision-making that is simple and rewarding for both them and their patients. At our core, we are focused on fostering behavioral change among providers through both macro-incentives around their pricing structure and micro-incentives around point-of-care decision-making.

Essentially, we offer a platform that makes it easy to engage and motivate providers to make decisions that deliver better care at lower costs. We help payers set up innovative payment models and deliver targeted nudges and incentives to providers using turn-key solutions that require neither new investments in IT nor disruption of a physician’s practice to make it easier to give the most effective and efficient care to their patients.

Onpoint: How would you describe Embedded’s core product offering and value proposition?

KF: Our core product offering is our analytics platform, which is built on much of the infrastructure that Onpoint is helping us to provide. This platform allows us to ingest a large amount of historical utilization and payment data to evaluate and develop an optimized model for primary care capitation that will have the greatest uptake from both providers and purchasers to set the right incentives.

Our value proposition is to be as unobtrusive as possible as possible for our payer clients, our provider clients, and their members while also rewarding all of the right decisions within that model.

The shift from fee-for-service (FFS) payments to value-based payments has happened so incredibly slowly, and much of the reason for that is the lack of a solution that allows providers and payers to make the change easily and in a way that is built on evidence-based methodologies. Embedded Healthcare is building systems that we can plug in to a payer’s situation so that they can begin making that shift a lot more quickly without large investments and in a way that is very attractive to providers.

Onpoint: How do payers access the analytics component of your platform?

KF: We help them design, administer, and manage their solution. When you think about what we are doing with Onpoint today, we basically put our models, our methodology, and our code on Onpoint’s infrastructure to intake all of that information and inform the design process based on a range of configurations to arrive at the best model for each client’s market and its nuances. This includes the management piece that allows the payer to ask, “How am I performing against the metrics that I had set out and the goals that I had hoped to achieve?” Essentially, we’re hosting the applications for them in Onpoint’s cloud, and they are coming in and proactively managing and reconfiguring the model over time to optimize for different factors, including types of incentives.

Onpoint: What do you think differentiates Embedded Healthcare’s approach?

KF: Part of what makes us special is that we’re built on evidence-based models with published studies that demonstrate how our hypotheses have worked. Based on our partnership with the University of Pennsylvania, its Healthcare Transformation Institute, and our founders – Zeke Emanuel, MD, PhD; Amol Navathe, MD, PhD; and Simeon Schwartz, MD – we have a lot of credibility to be able to go to the market and say that our methodologies are sound. While we have actually published our findings in peer-reviewed studies that confirm that this is the right model, we are still the only ones that really know exactly how to recreate and replicate that model. Our advantage in the market is taking that secret sauce and productizing it in a way in which we can say, “Do you want what we did in State X? Well here it is in a package. We will modify it and create the nuance that fits your situation, but you should expect to achieve the same results that were achieved there and elsewhere because we’ve developed this product in a way that mirrors how that methodology achieved its own success.”

Onpoint: Can you speak to some of the challenges that you’re facing today and how you’re addressing those?

KF: The provider buy-in challenge is always a problem, but these are significant times with the pandemic, particularly for independent primary care where they are looking at the changes that are happening around them related to the impact of COVID and saying how do I maintain my independence and how do I make sure that I’m doing it in a model that’s going to provide stability in my payments that is not going to set me on a path that I couldn’t have achieved through FFS.

The models and methodologies that we have developed address of a lot of those concerns and are very progressive. There’s an accuracy level achieved based on member-level economics as opposed to large-population economics. Providers feel very comfortable that the amount that they’re getting under capitation reflects their panel and their risk, which is something that they don’t always feel that they get from a lot of the versions of capitation that they see in other markets.

For payers, I think that there’s a lot of comfort in knowing that this is just moving them to primary care capitation – at least with the Lynx product that we’re building – and no further than that, allowing them to make an incremental step toward something that’s much broader and more global to say, “I can take my primary care spend – which is 7% to 10% of my overall spend and probably doesn’t have the opportunity for massive variation because primary care doctors aren’t going into the hospital and doing large, expensive surgeries – so I can start moving my business towards a more capitated model and I can do it at the point of management where I know that better primary care management results in great total cost of care impact.”

Onpoint: What drew you to work with Onpoint in terms of services and attributes?

KF: Part of our value proposition is around the specific configurability to apply our solution to a client’s market. That specific configurability is not something that our clients necessarily have in mind when they first partner with us. They don’t know exactly what they want it to look like but recognize that they need historical data and analysis around that data to be able to make the core decisions around questions such as: How do I set a base PMPM? Which primary care doctors do I include? What incentives can I put on top of this – for engagement, for quality, for total cost of care – if I don’t understand what’s in my market?

Those decisions historically have been driven by finger-in-the-air intuition. Part of our value to clients is providing a much more foundational, analytical view of how to make those decisions. To do that, we need to ingest a significant amount of data so we needed a partner able to help us deliver that quickly. That partner also had to have a very high standard for both privacy and security as well as experience in taking a raw claims file and turning it into something useful because that is not an easy task by any stretch of the imagination. That’s where Onpoint comes in.

We needed a partner that we could work with that wasn’t just a random “cloud.” We needed somebody who has the technology, has the methodologies to clean the data, and the knowledge to support the data in a way that puts it into a structure that can be very quickly turned around for use in our scripts and in our own models – somebody that we could trust to do it right with experience. This is why we chose Onpoint.