How Haven’s hires hint at the healthcare organization’s larger ambitions

According to a CNBC report, Haven’s latest executive addition is Sandhya Rao, who will serve as the organization’s VP of Clinical Strategy.

Haven, the recently announced name of the healthcare collaboration from J.P. Morgan, Amazon and Berkshire Hathaway, has been on a bit of a hiring spree to fill out its executive team.

According to a CNBC report, Haven’s latest executive addition is Sandhya Rao, who will serve as the organization’s VP of Clinical Strategy.

Rao comes to Haven from her previous position as the senior medical director for Partners Population Health where she helped lead the Boston-based health system’s efforts to advance value-based care through avenues like alternative payment models.

She joins an experienced team that includes CEO Atul Gawande and  COO Jack Stoddard, a former executive at Optum, Comcast and Accolade.

The organization has also brought on BCBS IT exec Dana Gelb Safran as head of measurement to provide a data-driven foundation to track outcomes and cost savings.

Haven was formed out of a frustration from the member companies about the continual increase in employer healthcare costs without any corresponding improvement in health outcomes. Collectively, the companies spend around $4 billion annually across their combined 1.2 million employees.

Accolade, which serves as a benefits aggregator for employers that focuses on building relationships with employees and steering them towards lower cost and higher quality care, could provide one model which Haven may follow.

“What data do we have, what insights can we glean from that data around cost and quality of care so that we can help then make that available as we think about helping patients choose doctors that are going to help them get better outcomes on the quality side at the best price,” Stoddard said during a testimony in the legal fight between Haven and Optum over the hire of former Optum executive Dave Smith.

One important step on that journey would be building out a national integrated clinical network made up of those providers deemed by the organization to fit into that framework. Rao’s experience building out in value-based payment systems as part of Accountable Care Networks could be central to that effort.

Setting up their own clinical network and contracting directly with providers in value-based arrangements could circumvent traditional payer organizations who have often served as third-party administrators for self-funded employers responsible for establishing provider networks and processing claims.

The core expertise of the Haven member companies in payments, insurance and data analysis (as well as their sheer size and national presence) would make the establishment of this kind of network possible. It also fits in with larger trends of employers looking toward direct relationships with providers as a potential cost-control method.

One Willis Towers Watson survey conducted in 2018 found that while only 6 percent of employers were currently contracting directly with providers, the proportion of employers considering direct contracting in 2019 has ballooned to 22 percent.

One company ahead of the curve has been Walmart, which has been working with providers for the past few years through a Centers of Excellence program for specialized and expensive treatments like knee replacements and heart surgery. Reimbursement for these procedures are in the form of bundled arrangements where the contracted providers are responsible for the entire episode of care.

In 2019 the company started requiring plan participants to travel to one of eight chosen providers around the country in order to have their spine surgeries covered, after the company found that around half of participants who traveled to these locations were about to avoid the surgery altogether.

A recent Harvard Business Review case study pointed out the example of one employee who was flown out to Geisinger Medical Center for a spine surgery only to be diagnosed with Parkinson’s disease instead.

The company has also developed ACO arrangements with select providers in certain geographic areas that handle all routine primary care for employees. That could provide a potential framework as Haven moves forward with its own plans, which including increasing access to primary care services.

Picture: Getty Images, Lisa Lake