Transcarent launches direct-to-employer solution in partnership with Advocate, Mount Sinai, other major health systems

Employee healthcare navigation company Transcarent unveiled Tuesday new partnerships with a network of major health systems to help its employer customers offer their workers access to high-quality medical services at lower cost, according to company CEO Glen Tullman.

The company's nationwide provider ecosystem sets the foundation for increased direct contracting between employers and health systems, something that has historically been a challenge to do at scale even for the largest of employers, according to the company.

With direct contracts for covered care services, Transcarent's model provides self-insured employers with competitive pricing while maintaining access and choice for members. The new solution will provide national employers and their employees with faster access to verified high-quality digital or in-person care and affordable and predictable costs with full transparency, Tullman told Fierce Healthcare. The partnerships will result in more personalized and coordinated care, he added.

Tullman, founder of Livongo, launched Transcarent in March 2021 to tackle the employer-sponsored benefits space. The startup uses a combination of software, technology and data science to provide members with health navigation, virtual care and bundled providers. The company now works with more than 300 employer clients plus health plan clients.

Transcarent has raised $200 million to date to scale up employer-provided healthcare. The company developed a personalized app to offer members "one place for health and care," Tullman said. It has expanded its services and solutions to include behavioral health navigation, pharmacy benefit tools, home health, chronic care management, cancer care and orthopedic consults.

"Everyone agrees that healthcare in America is too confusing, complex and costly. Our goal is to make it easy to access high-quality care, and, to do that, we’ve partnered with the people who deliver that care, the best health systems across the country,” Tullman said.

The 10 health systems that have joined the provider ecosystem are: Advocate Health, Atrium Health, Baylor Scott & White Health, Corewell Health, Hackensack Meridian Health, Intermountain Healthcare, Mass General Brigham, Memorial Hermann Health System, Mount Sinai Health System and Virginia Mason Franciscan Health.

"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," Tullman said in an interview. "We wanted to create close working relationships with the largest, highest-quality health systems across the country. A lot of people said this couldn't be done, which was to go to them and say, 'Look, we want to work with you on creating care pathways to make it more efficient. We'd like to get very cost-effective pricing, we'd like to have bundled pricing. We'd like people, when they come to you, to get a concierge healthcare experience.'"

As part of these partnerships, Transcarent directly contracts for rates upfront with health systems and guarantees same-day payment.

Through the care model, Transcarent members get preferred access to medical services across digital and in-person care. Each member will have a coordinated and personalized experience from the Transcarent platform directly through the care pathway of each health system, including scheduling and pre/post care. 

Some employees and their families benefit from perks like waived co-pays and co-insurance, depending on their plans.

According to Tullman, the Transcarent model simplifies the healthcare experience for employers, providers and employees. "It's a win across the board," he said. "It's a win for employees and their families because they get high-quality care. They get easy access to treatment in a concierge way. For employers, they have people who are satisfied with the care they received. And, for the health systems, they say, 'We have someone who's actually going to pay us when we do a great job.'"

The direct-to-employer platform regularly pays providers on the same day the service is delivered and includes value-based incentives, he noted.

The platform also closely integrates the digital experience with hands-on care. "It’s not an either/or, it’s both," Tullman said.

The company connects members via chat, phone or video to a personal health guide or a physician, expert second opinions, medication review and management, virtual physical therapy or full surgery management. Earlier this year, the company bought part of virtual care company 98point6. As part of the deal, it added 98point6's physician group and other elements to the fold to add Al-powered virtual care as well as an associated provider group with experience in delivering on-demand care.

"As an organization with a strong commitment to the affordability of healthcare, we are also excited that this solution allows us to take accountability for total cost of care, helping us keep costs down for our patients. We feel that this new model complements our existing value-based care approach and will be a promising choice to improve value opportunities for employers, and ultimately the people who choose us for their care," said Niyum Gandhi, chief financial officer and treasurer at Mass General Brigham, in a statement.

Transcarent recently partnered with digital health company ViewFi on virtual orthopedic rehabilitation and musculoskeletal care as part of its surgical care experience. The company made waves in the market when it announced a partnership with Walmart last year, marking the retail giant’s first collaboration to allow employers access to its prices for pharmaceuticals and healthcare services.

Last fall, Transcarent also launched a pharmacy benefit service for self-insured employers and health systems. The company joins a number of others trying to disrupt the current pharmacy benefit space including GoodRx and Mark Cuban Cost Plus Drug Company.

Tullman notes that what Transcarent and Mark Cuban Cost Plus Drug Company, which offers prescription drugs at transparent prices, are doing isn't brand-new or truly "innovative," but it just hasn't been attempted in healthcare.

"The main difference is that somebody is actually doing it as opposed to talking about it," he said. "In the healthcare space, we actually are doing things with companies to improve the quality, improve the experience and manage the overall cost."