In the world of payment models, getting providers to take on both upside and downside risk can be like pulling teeth.
But online specialty medical clinic Virta Health is daring to go where few providers have gone before, announcing plans to embark on an ambitious 100%-downside-risk model.
Under their new model, “every dollar is earned by meeting performance benchmarks, and the majority of payment is tied to health outcomes,” the company said in an announcement on Wednesday.
Virta claims it can reverse Type 2 diabetes in the majority of patients by placing them on an individualized meal plan similar to the keto diet and monitoring their progress via frequent virtual physician visits. The company also collects patient data using a wireless scale and a mobile app that tracks specific biometrics.
The company estimates employers and payers can save $9,600 per patient within the first 24 months of the program, making this "a unique opportunity for payers to bring diabetes reversal to their populations nearly risk-free."
The all-risk model is reflective of Virta’s confidence in its ability to deliver results, as evidenced by its clinical trial outcomes, said founder and CEO Sami Inkinen.
Virta can reverse diabetes—that is, bring blood sugar down to normal levels and eliminate all diabetes-specific medication—in 60% of patients, which is “beyond transformative” given that “the Type 2 diabetes reversal rate in standard care is about 0%,” Inkinen said.
While Inkinen declined to name the insurers who have signed on with Virta, he said that Purdue University, Nielsen, U.S. Foods and the Chickasaw Nation are among the employers that have joined the program.
As much as Virta is confident in its model, others are skeptical. Joel Kahn, M.D., a holistic cardiologist and proponent of plant-based diets, has criticized Virta for being “based on paltry science.”
He called the all-downside risk model “a bold move by a well-funded company,” but said the ketogenic diet has been “completely dismissed [within] most ongoing and academic research on nutrition, aging and reversal of disease,” Kahn said.
Kahn conceded that it’s “reasonable to suspect” Virta will save payers money in the short term, but he argued that patients’ health will worsen and ultimately rack up more costs over time.
Indeed, Virta’s clinical trials have only lasted for three years. However, the results Virta has shown so far are “unheard of,” Inkinen said, and the company is “laser-focused” on long-term results. And its clinical trial was just extended to five years, he added.
Virta will promote its services through e-mail marketing and in collaboration with employers, Inkinen said.
However, Kahn recommended that patients, payers and employers explore other app-based coaching programs, such as WellStart Health, a similar virtual program based on a plant-based diet.