The Centers for Medicare and Medicaid Services aims to have all Medicare beneficiaries in a value-based arrangement by 2030. But achieving that will be a difficult undertaking, with just 12% of providers ready to take on value-based contracts.
Atlanta-based Syntax Health, which launched Thursday, aims to accelerate the process through its new platform. The two-sided software-as-a-service solution allows payers and providers (as well as actuaries, network managers and analysts) to collaborate in creating a value-based contract. A network manager is usually responsible for creating reimbursement models, including value-based care programs.
Transforming Patient Care: The Role of AI-Powered Assistants
The progress in artificial intelligence (AI) is reshaping patient care, across various dimensions, from facilitating faster discharge to curating treatment plans and suggesting lifestyle changes.
“It takes up to six to nine months to get a [value-based] contract done, just to come back to the table six months later to start all over again,” said Rachael Jones, CEO of Syntax, in an interview. “Oftentimes those conversations are drawn out because it’s an imbalance of data, imbalance of information. It’s kind of that black box mentality that happens when the health plan isn’t able to share efficiently what the contract terms mean. So the provider is nervous to sign on. Syntax is solving that directly by creating that platform that both the health plan and the provider can access together and collaborate in the design of the contract from start to finish.”
The current process for creating a model for a value-based contract is done in a “conveyor belt mentality,” Jones said. It’s done through Excel tools, PDFs, Tableau and other software products.
“You have actuaries and analysts doing something and then translating it to the network manager, then passing it on to the provider,” she said.
Syntax’s platform brings all this together in one spot and allows all the players to design a contract using the company’s contract templates. Then, once they’re ready to share the model with the provider, they just press a button. The provider is able to see descriptions of the terms and the math used to create the model. There is also a chat option so the different players from payer and provider organizations can easily communicate with one another while collaborating.
Reducing Clinical and Staff Burnout with AI Automation
As technology advances, AI-powered tools will increasingly reduce the administrative burdens on healthcare providers.
“All the things that typically make folks intimidated about signing on … we expose that and show the math and show what the language, these complex terms actually mean for [providers’] take-home revenue,” Jones said. “Then more importantly, empower them to know what levers they can influence and change as they’re taking risks on a population.”
Syntax’s initial go-to-market strategy is to focus on the modeling part of value-based contracts. But it aims to also help measure performance of the contracts over time and help organizations manage several contracts at once.
“We know value-based care contracts are not one-size-fits-all. Most providers are dealing with multiple different versions of contracts from payers. Definitely payers have multiple different versions of provider contracts,” Jones said.
The company will make revenue by selling its services, mainly to payers, in a software-as-a-service licensing model. It plans to initially focus on smaller, regional health plans — particularly Medicare Advantage plans that have more of an appetite for value-based payment models.
Syntax was formed at Redesign Health, a healthcare innovation company, and has raised $7.5 million in seed funding through Redesign.
Jones declined to name competitors, but other companies that support value-based arrangements include Yuvo Health, which is tailored for federally qualified health centers, and Aledade, which supports independent clinical practices. Syntax differs from other companies, however, by focusing on the modeling of value-based contracts and by allowing providers and payers to collaborate, Jones said.
In launching its platform, Syntax aims to reduce the amount of time it takes to adopt value-based arrangements, as well as improve physician trust, Jones said.
“We believe part of that breakdown of trust is a lack of transparency and a lack of really being clear and making the process a lot less burdensome. We talk about administrative burnout and all those things,” Jones stated. “I think a tool like ours can really address that and bring physicians into the equation and have ownership and accountability in a very meaningful way.”
Photo: atibodyphoto, Getty Images