If there are two certainties in today’s health insurance world, it’s that the individual market is a tough place to do business and that it's difficult to break into an industry primarily dominated by a handful of entrenched giants. Yet even with those challenges, some enterprising startup companies still see an opportunity to disrupt a system long set in its ways.
One such company is Bright Health. Starting next year it will offer plans on the Colorado public exchange in the wake of a retreat from major players UnitedHealth and Humana. Bright Health will work with a financially aligned provider partner, Centura Health, to manage members’ care, hoping to build a model that is “really all about the individual,” as co-founder and President Kyle Rolfing put it during a panel at this year’s AHIP Institute.
FierceHealthPayer sat down with Rolfing in Las Vegas to find about more about Bright Health’s plans.
FierceHealthPayer: What strategies does Bright Health hope to use to succeed on the Colorado exchange, where other plans have struggled?
Kyle Rolfing: First of all, we’re not just an exchange company. We’re very focused on the consumer as the customer--that is in our DNA. And we stepped back and said, “What do you really need in order to be successful in this new market?” It comes down to two factors in our mind: The first is affordability and the second is a great experience. Affordability is the cost of care, and that’s delivered through the health system, not through the health plan. So we needed a cost-efficient, high-quality integrated healthcare system that we could solely partner with in a market.
With our partnership with a health system, we’re able to invest in technology in a different way by building a data hub where we share data between us. We’re investing heavily in that, and part of the reason we’re able to do that is we have financial alignment with our provider partner. We both want to gain market share so we want the pricing to be right and cost-effective, but also we have profit-sharing with our care partners.
And then the last piece where we’re investing in technology is to really change the whole experience for the consumer. That’s easy to say as a health plan, but if you’re dealing with multiple systems out there in the healthcare market, you’re almost limited to administrative factors such as ease of enrollment and allowing consumers to check out their bill. With one partnership that we have in place, now we can lean into the care side--for example, it’s virtual care that’s connected to that care partner, getting an appointment online, fast-tracking, forms already filled out. Those are the types of factors we’re talking to Centura about.
FHP: Is your financial alignment with Centura an upside-only agreement?
Rolfing: To start with, typically providers like the upside only option. And we’re fine keeping it upside-only. For care partners that want to lean in and take on additional risk, we’re open to that as well, but it’s not a requirement. We feel like the desire to get market share, in which you want to price competitively, and profit sharing is enough alignment to then provide for transparency of information, data--to use that in different ways.
FHP: How does Bright Health plan to keep care costs down for patients with chronic conditions and invest in population health?
Rolfing: It all comes back to the partnership with our care partner. Most providers have actually invested quite a bit in population health management, so we take a very different and customized approach. With Centura, we have various work teams that are looking at everything from care management, disease management, the patient experience, how to market together--all aspects of how we work together. We like to leverage what they bring to bear in those areas to help those patients stay healthy who are healthy and for those that aren’t, get healthy as quickly as possible.
For other potential care partners, there’s a different level of readiness in each one of those areas, and we’ll take on as much of that as they aren't ready for, or that they don’t want to take on.
FHP: What are some of the data analytics capabilities you’re building?
Rolfing: We’re building a system where we’ll take the data provided by the health plan, and we marry that with the traditional data from the health plan as well as traditional consumer data. It’s really the blending of those three--and gathering insights on how we can best serve that member/patient together--that the magic of the data is really going to come to life. Those have been very separate.
FHP: What are Bright Health’s plans for expansion beyond its partnership with Centura Health?
Rolfing: For the Denver market, starting Jan. 1, 2017, we’ll sell to consumers younger than 65. By Jan. 1, 2018, we’ll add Medicare Advantage and we intend to add one or two additional markets. We’re in discussions with many right now--very interesting discussions--and we have not had anyone slam the door on us and say "we’re not interested."
FHP: So when planning to enter the Medicare Advantage market, what will you do differently to serve that population?
Rolfing: There are differences, but we really don’t look at it that way. Our care partner deals with both of those populations. In addition, our focus is on individual consumers--not employers--and both markets are individual consumers; they’re making their own value choice and the playbook on that is very similar. Now how we do that, and what they actually want and need, has some differences, but we have the capability through our partnership to deliver whether under or over 65.
FHP: The insurance market is notoriously difficult to break into for startups, especially if you look at struggles of the CO-OPs. What is different about Bright Health that will allow it to succeed and allow it to disrupt the industry?
Rolfing: It comes down to people, talent and experience that are brought forth, and business model. If you have that right, your team can execute. We have yet to prove that, but we have that in spades with a lot of folks that were in Minneapolis with UnitedHealth Group, and others, including myself, with experience with healthcare startups. We also have people outside of healthcare, on the customer experience side coming from the technology and marketing sectors.
FHP: Looking even further into the future, what role does Bright Health play in some of the big-picture changes overtaking the healthcare system?
Rolfing: We feel that we’re right on the verge of the next generation of how healthcare will be delivered. None of this is rocket science, but we feel the absolute critical understanding is to know where healthcare happens--with the individual consumer and with their care partner. We really understand that as the foundational underpinning of how we’re going to fix the system, and a health plan should recognize that and bring tools to bear to make that connection happen for the best health of the individual. And if we do that, healthcare will be more affordable, and it’s going to be a way better experience for people.
Editor's Note: This interview has been edited for clarity and length.