How Bright Health is changing the payer-provider dynamic 

Close-up of handshake between person in suit and person in business shirt.
Bright Health's co-founder discussed disruption at the World Health Care Congress this week. (Getty Images/FS-Stock)

WASHINGTON—When talk turns to disruption or innovation, the first thing one might consider is new technology. 

But for startup health plan Bright Health, it begins with the underlying business case, said Kyle Rolfing, the company’s co-founder, during a panel discussion at the World Health Care Congress. 

“I think the best transformation is to leverage a business model and support it with tech,” Rolfing said. 

Case Study

Across-the-Board Impact of an OB-GYN Hospitalist Program

A Denver facility saw across-the-board improvements in patient satisfaction, maternal quality metrics, decreased subsidy and increased service volume, thanks to the rollout of the first OB-GYN hospitalist program in the state.

Bright Health currently operates in 12 markets and partners directly with a provider for its plans. It co-brands the insurance plans with the providers—“this is their health plan,” Rolfing said—to launch the coverage. 

RELATED: Kyle Rolfing—Provider partnerships will be key to Bright Health’s success 

A co-branded insurance plan allows for a more high-touch experience for members, Rolfing said, as well as a more coordinated and cost-effective approach to care. 

However, one key challenge is filling in the gaps in the services provided, he said. There’s no health system that checks all the boxes, so Bright works with its partners to identify the best referral partner to address services that may not be offered otherwise. 

Bright Health’s plans begin with an upside-only financial risk agreement, which works to attract new partners as the company continues to grow its market share. But the providers that signed on first are now looking to grow their footprint in the plans by moving into additional counties or regions locally. 

Rolfing said the Bright Health team assumed they would be pushing providers into this growth, and they were pleasantly surprised to find them taking the initiative. 

RELATED: Bright Health sets sights on expansion with new $200M funding round 

Once these partnerships are established, the technology is built on top of that foundation, Rolfing said. The company designed internally multiple tech platforms, some of which failed, with the goal of finding what works best on a larger scale. 

“We wanted to ensure that what we ultimately build is scalable,” he said. 

Rolfing said rethinking these relationships and dynamics has been slow going, as the current healthcare industry isn’t built for this type of innovation. An example? The insurance premium, which uses the savings from the most efficient providers to subsidize the least efficient providers. 

“It’s like giving everyone a B and wondering why they’re not doing any better,” he said. 

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