Leadership and the Need for Change in Healthcare

Friends,

I’ve had the great privilege of interviewing and interacting with Glen Tullman a number of times over the past few years. The last time we spoke in a formal interview was episode #121, which was posted on Sept 22, 2021. That episode was entitled, “A master class in building a healthcare consumer experience company”. And it was exactly that – a master class. My experience is that this episode is a continuation of that master class in humanizing healthcare and in achieving markedly improved health outcomes.

Glen Tullman is the Chief Executive Officer of Transcarent and the former Executive Chairman, Chief Executive Officer, and Founder of Livongo Health. He previously ran two other public companies. During his time as

Chief Executive Officer of Allscripts, the Company was the leading provider of electronic prescribing, practice management, and electronic health records for physician practices. Prior to Allscripts, he was Chief Executive Officer of Enterprise Systems, the leading resource management systems for hospitals, which he also took public and then sold to McKesson/HBOC. Glen is also one of two Founding Partners at 7wireVentures, one of the highest- returning venture capital funds in Illinois. He is the author of On Our Terms: Empowering the New Health Consumer, in which he proposes new solutions to address the chronic condition epidemic facing our country.  A strong proponent of philanthropy, Glen was honored in 2019 with a Robert F. Kennedy Human Rights ‘Ripple of Hope’ Award for his career focused on improving the safety, empathy, and efficiency of our healthcare system. He also serves as a Life Director of the Illinois Chapter of JDRF, the leading organization advancing life-changing breakthroughs for Type 1 Diabetes. Glen has three amazing children and a new granddaughter who inspire him every day.

In this interview, we’ll discover:

1. Glen’s honest perspective on the current state of our healthcare system, and the core existential problems we must solve for.
   
2. Glen’s unique and generative perspective on a reimagined humanistic and consumer-oriented future for healthcare.
   
3. An in-depth explanation of the value propositions that his new company, Transcarent, is bringing to the market and to healthcare – and some of the great progress they’ve already made in working direct-to-employer – providing an alternative for self-insured employers who have relied solely on the large TPA (third party administrator) insurance companies.
   
4. What a platform business model is and how platforms are revolutionizing healthcare delivery and the healthcare market.
   
5. How Trancarent has built upon the traditional platform models (such as Amazon and Uber), but expanded it into a new (and uniquely healthcare) model that Glen calls “convener plus”.

Before we go any further, it’s important to briefly point out that Transcarent is inserting itself into the employer healthcare space as an alternative to the large BUCAH insurance companies that are acting as third party administrators (TPA’s) for self-insured employers – large, mid-sized and even relatively small employers. Transcarent is in what we refer to as the ‘direct-to-employer’ market. For those who are unfamiliar with the acronym, BUCAH stands for Blue Cross, United Healthcare, Cigna, Aetna (now CVS Health), and Humana. 

This episode is a master class in humanistic consumer-oriented care. In the previous podcast we recorded, Glen outlined 3 major needs people have when it comes to healthcare delivery. Briefly stated, these are: unbiased information, unbiased referrals, and support navigating the system. In this podcast he expands upon those to articulate five major value propositions that Transcarent is offering. These 5 are all embedded within the Transcarent app, and include:

1. Easy access to care (EveryDay Care)
   24/7 access, with almost instantaneous access to physicians and others who can assist in answering questions and navigating the system.
   
2. Low-cost pharmaceutical care – (Pharmacy Marketplace)
   Transcarent is working with alternative medication suppliers such as GoodRx, Mark Cuban’s Cost Plus Drug Company, Walmart and others to provide the lowest cost medication options for any given person.
3. Care@Home

Transcarent is partnering with home health companies, such as Dispatch Health, to deliver care into the home or directly to the individual via telehealth and digital options.

4. Surgeries

Transcarent is partnering with the Cleveland Clinic in offering literally world-class 2nd opinions when an individual has been recommended to have surgery. The reason being that a significant percentage of recommended surgeries are unnecessary and potentially harmful. And once the 2nd opinion is rendered, Transcarent can provide options for the best surgeons and hundreds of sites across the country to have the procedure.  One thing to note here is that Transcarent is working with employers to provide surgical care without any payment or co-payment to employees. The way this works from a financial perspective is that by reducing inappropriate surgeries and suboptimal outcomes, Transcarent plans to save employers enough money to provide the needed and appropriate surgeries for free. 

5. Cancer Care

Glen quotes a stat that nearly one quarter of all cancer diagnoses and cancer care in this country is being done without the latest information or being provided at the lowest cost high quality sites. Transcarent’s platform approach utilizes state-of-the-art information and expertise to assist employees in obtaining the best care and the best value option.

Transcarent is utilizing a relatively new business/tech model, which is called a platform. Examples of well known platforms include Amazon, Uber and Airbnb. The model is different from the typical business model in that the platform doesn’t necessarily build, create or produce products and services. Instead, it hosts or convenes them in one place and provides highly consumer-oriented services to make them accessible to the consumer.  Platforms are, essentially, virtual digital marketplaces, but they provide customized and personalized information and convenient access that isn’t available in brick & mortar market places. For example, the well-known, “people like you bought” or “people who bought this also bought…”  The customers on the Transcarent platform are self-insured employers, with the ultimate consumer being employees. The vendors supplying the products and services would include healthcare systems, provider practices, and digital health companies. 

One of the lessons I’ve learned from this conversation with Glen is that Transcarent is not only a platform but it’s a platform plus, or what Glen calls a “convener plus”. Glen explains that unlike Amazon, Transcarent not only provides the product or service, but it assists the customer in navigating through the experience. As he eloquently puts it,
“It’s not just to, it’s through”. For example, Transcarent not only provides a 2nd opinion of whether to have a specific surgery, the platform will also recommend the highest quality, highest value option, and it will also make the referral. Not only that, it will follow up in the surgical as well as post-surgical care. 

And, one advantage of this platform approach is that the services that any given employer is looking for can be accessed on the platform without having to purchase the entire bundle of services.  It’s a truly ‘choose your own journey’ type of business model – highly customized for any given employer customer.  Another related advantage of the platform model is that if an employer has a product or service they like, Transcarent can place that on the platform instead of forcing the employer to switch. As Glen states, most vendors require that you “rip out and replace” the current product or service you’re using. Transcarent’s platform and approach avoids that.

What I’d like to conclude with is an issue that is, in my opinion, the most root cause in healthcare today. In Glen’s own words:

“What I’m looking for in healthcare is more leadership – that’s what we need…  And, when I think about leadership, I think about creating systems that put the healthcare consumer front & center – improving the quality and experience of care, and reducing costs.”

I’ve written extensively about Glen and about Transcarent in my recent book – Beyond The Walls – and for good reason. Glen is one of the most accomplished healthcare leaders in the world. But, even more than that, he is a humanistically disruptive and consumer-obsessed healthcare leader. There are very few leaders I’ve met who possess his unrelenting focus on the actual experience of care from the point of view of the individual healthcare consumer. Glen is brutally straightforward on his take of the American healthcare experience. He calls it like it is. As he states so clearly – “healthcare is more confusing, more complex, and more costly than it’s ever been before… [and the situation] is getting worse, not better”. He also makes the point that a major cause is “maximizing profits over care”. It’s Glen’s objectively truthful sensibilities and his integrity which has fueled his incredibly disruptive and positively advancing achievements.

When I asked Glen what message he would want to share with healthcare leaders and employer leadership, he responded with two questions. First – what are you doing now that is really different and better – actually innovating rather than incrementally improving?  Second – why would you not at least try this new approach – given the reality that the current approaches we’ve been rehashing for decades is clearly not working and in fact, is making things worse? 

I’ll leave you all to ponder and respond to those two questions.

Until Next Time,

Zeev Neuwirth, MD