MedCity Influencers

Why navigating a broken healthcare system requires a nuanced approach

A blended navigation model that includes a transformed pharmacy benefits offering is the industry’s best opportunity for overall cost reduction in an employer space that desperately needs it.

What happens when you take a simplistic view to a pointed discussion? In the case of care navigation, you get polarizing opinions in a sector that’s not accustomed to sharp debate.

Recently, Glen Tulman, CEO of Transcarent, and Rajeev Singh, CEO of Accolade, exchanged blows on the right approach to care navigation. Glen proclaimed navigation as an obsolete “middleman,” and described it as paving a way through shattered glass rather than working to pick up the pieces. Rajeev came at this from a different perspective, as the leader of the care navigation incumbent, he believes navigation teams led by clinicians are critical to fixing the broken system.

Two leaders with fundamentally different viewpoints to improving healthcare. What happens if they are both right to a degree, but neither presents the winning model?

At Rightway, we believe that certain parts of healthcare need a complete overhaul while others simply need optimization. But superlatives and generalizations aren’t catalysts for change; you have to dive deeper into what’s happening in healthcare and consumerism to identify what’s key to navigating our fragmented system.

Navigation with mobile-first technology, clinical teams, and the right data can help consumers effectively traverse the broken system, and has been proven to reduce healthcare spend. It can steer members to high-quality providers and reduce the roughly 30% of healthcare that’s wasteful or preventable. But navigation fails to work in the world of prescription drugs — the most recurring part of healthcare and the one with the highest frequency of interactions between a consumer and the system. Guiding members through the world of prescription drugs is where consumers are constantly stepping on those shards of glass Glen mentions.

What is it about pharmacy benefits that is so broken that optimizing isn’t an option? Simply put: everything.

By design, the current pharmacy benefit manager (PBM) model has created a steel cage around consumerism in pharmacy, making it impossible to navigate. From their twenty-plus revenue streams, subpar treatment of their members, and opaque contracting, PBMs have made it so that consumerism can’t exist; in fact, most people can’t even name their PBM. The success of companies like GoodRx exposes the immense weaknesses of the consumer experience prevalent in pharmacy benefits.

Pharmacy spend has become the fastest growing contributor to healthcare costs, raising public scrutiny to an all-time high. The issues that PBMs present can’t be solved by Rajeev’s vision; this is where Glen’s approach gets called in from the bullpen. PBM is the ultimate “middleman,” no layer or guide can fix what is irreparably broken.

It’s time to blow up the current model and rethink what it means to be a PBM: no rebates, no spread pricing — and with the type of pharmacy navigation that GoodRx hasn’t touched. It’s time to put the consumer at the center of the healthcare experience, align incentives, and go fully at-risk through guarantees and agreements.

The future of enterprise healthcare will take pieces from both Glen and Rajeev’s visions, executing care navigation in the right component parts. A blended navigation model that includes a transformed pharmacy benefits offering is the industry’s best opportunity for overall cost reduction in an employer space that desperately needs it.

As we head into the final inning, I’m calling my friend Owen Tripp at Included Health up to bat to tell us what he thinks.

Photo: Bulat Silvia, Getty Images


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Jordan Feldman

Jordan Feldman founded Rightway to solve some of the biggest challenges across the medical and pharmacy landscape. Growing up with a physician for a father, Jordan saw first-hand how having a dedicated, expert advocate could simplify healthcare, improve quality, and lower costs. At Rightway, his mission is to provide every member with the same experience by combining clinician-led support with a modern, intuitive app that guides consumers towards the highest-quality, most cost-efficient options. Jordan is a graduate of Harvard University where he received his A.B. in Government and Economics.

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