New tech startup Syntax Health launches 2-sided platform to accelerate value-based care

As buzzwords like “holistic care” and “patient-centric” have solidified into value-based care models and total capitation contracts, providers and payers still face a lot of friction to align incentives and find contract blueprints.

Syntax Health launched a new platform designed to smooth out the value-based care contracting process using analytics, infrastructure and a collaborative virtual workspace. The solution allows payers and providers to model contract scenarios with increased transparency while foreseeing performance trends.

Founder Rachael Jones told Fierce Healthcare that Syntax aims to promote transparency and consistency in value-based care contract negotiations in order to create trust in the new model of reimbursement and between disparate players in the healthcare industry.

“Value-based care has been defined as all these different things, but at its core value-based care is both a clinical care delivery model that focuses on preventative care and long-term health outcomes and a payment model,” Jones said. “Syntax provides transparency into what is available for both sides to succeed and facilitates collaboration that breaks down this sort of friction and distrust that's natural when you start talking about money.”

To date, Syntax has raised $7.5 million in seed funding. The New York-based company was built at healthcare startup creator Redesign Health by a founding team including Jones who have spent a combined six decades on all sides of healthcare contract negotiations.

Jones says the hardest part of value-based care is adoption via relationships that serve all entities with the shared goal of improving patient outcomes. Despite the hurdles to transform a fee-for-service system, value-based care is on the path to becoming a central model of reimbursement for the U.S. healthcare system.

The Centers for Medicare & Medicaid Services (CMS) pledged that all Medicare fee-for-service beneficiaries must be “in a care relationship that accounts for quality and total cost of care by 2030.” CMS stated that the model allows for the coordination and de-siloing of healthcare entities.

However, for smaller entities, adjusting to a new model with months of contract negotiations and data analytics is no small feat. CMS’ Innovation Center stated it aims to specifically engage providers who have not previously participated in a value-based care model while ensuring that rural and underserved populations are not left behind.  

“The Achilles heel of value-based care is adoption,” Jones said. “You have 85% of health plans saying that their biggest barrier to value-based care adoption is simply inefficiencies in contracting. It takes six to nine months today to negotiate a value-based care contract. That’s time wasted, going back and forth, fighting over numbers, doing version control over papers, getting lawyers involved, that's all lost time preventing the outcomes that you want in the first place.”

A lot of that back and forth, Jones said, is negotiating parties getting comfortable with what they’re signing up for. If both sides are confident about the payment model they’re settling on, the next step is hurdling technical challenges including data acquisition and analysis. What ties it all together? Trust. “Trust is built over time through partnership, through transparency and through seeing that both sides can work together to produce results,” Jones said.

The goal of the SaaS-based solution is to allow healthcare actuaries, network managers, analysts and providers to meet on the common ground of a shared data set to compare savings, revenue, quality metrics and trends.

Syntax’s initial target is smaller regional health plans, especially Medicare Advantage plans, that see the advantages of the model but don’t have a deep analytical or actuarial bench to implement it. MA populations also provide stable populations with fewer shifting pockets of data.

The longevity of MA groups helps bolster predictive performance. But for less stable data pools, partners don’t need to jump into full capitation models. Instead, shared risk can be a place to start. There are different places along the reimbursement model spectrum to jump on, Jones said. “The longer we make it hard to join, the harder it's going to make for providers to get excited and see a path to their own revenue and improved patient outcomes,” she said.

She sees an advantage for new providers entering the field with new models of care, providers like Cityblock Health or Zocalo Health, which aren’t repairing something that’s broken but starting from scratch. Whatever the starting point, transparency is key, Jones said.

“Today, the provider receives the output from a health plan's internal team and has to translate what that means for their own bottom line,” Jones said. “In a lot of ways, it's a black box. What if we allow that provider to see the same deep detail, data, language, costs and terms side-by-side to the financial projections at the same time the health plan is seeing it. So, you have this one-to-one solution that removes the guessing game, removes the 'gotchas' and both sides can be transparent about the math.”