Jessica Zeaske is director of healthcare investments for GE Ventures, the venture capital subsidy of General Electric. In this role, she focuses on healthcare IT, health IT-enabled services, and non-invasive medical technology. Zeaske’s previous roles include investing, launching healthcare startups, and writing software. At Convergence, Zeaske will describe how GE Ventures assesses investment opportunities that support provider-payer convergence initiatives.
Why is it important for the healthcare industry to take the emergence of payer-provider convergence seriously? What do you see in your work that makes this important to you?
I have had numerous questions over my career how a PhD in public health ended up with a career in private equity, and most are surprised when I reply, “But I never left public health.” I explain that in order to create healthcare that is accessible and efficient, we must change the business models inherent in the industry and venture capital can be the fuel for that change.
By “following the money” and the business models all the way back to payer or to Centers for Medicare & Medicaid Services (CMS) policies, we can understand what impacts the delivery of care in this country. With convergence and new models of value-based payment, public health issues of efficiency, access, and affordability can be addressed and innovation can be welcomed into the system.
Which stakeholders need to be at the table when strategic conversations about convergence take place?
When we think about who needs to be at the table, we often think of the various parties paying the claims and signing the contracts. Who we often leave out of the conversation is the one ill-equipped to face the behavior change, the individual patient or member.
We look at business models with acronyms like B2B, B2B2p (patient) or B2B2m (member), but often leave the one on the end of value chain in lowercase. We need to make the patient or member bold, all caps, and in big letters so we’re focusing on that individual.
In these major market shifts, we’re asking the patient to make fundamentally different decisions about care, about spending, about how they manage their own illness, about how they keep themselves healthy – yet they lack a stakeholder seat at the table. How to include patients and members up front is challenging, but they deserve a voice.
Are you prioritizing convergence of data ingestion, analytics, care management, or patient engagement? Which of these key area(s) are you focused on?
At GE Ventures, there are four main investment themes that we prioritize in our healthcare practice: Enhancing the payer-provider experience, accelerating diagnosis and treatment, optimizing healthcare and life science operations, and enabling the transition to value-based care. They all hit on the fundamental shift to convergence, and we have investments in each of these areas.
On the analytics side, GE Ventures has invested in Arcadia, Apervita, and Aver Informatics. All three address the fundamental data and analyses needed to be able to drive change in this market. In addition, GE has invested in:
- HealthReveal uses evidence-based clinical models and a unique analytic platform to help preempt avoidable consequences of chronic diseases. HealthReveal brings together multiple streams of patient data to assess risks for an individual, propose interventions, and change the trajectory of care.
- Iora Health is a tremendous example of how new models care delivery can produce health outcomes at a lower cost. Iora’s team-based approach and collaborative care platform are changing how many see the role of primary care in the convergence trend.
- Omada Health is a pioneer in behavioral intervention that is changing individual’s lives using digital therapeutics, enabling people to change their habits and improve their health.
In these major market shifts, we’re asking patients to make fundamentally different decisions about care, about spending, about how they manage their own illness, about how they keep themselves healthy – yet they lack a stakeholder seat at the table. How to include patients and members up front is challenging, but they deserve a voice.
Do you think the roadblocks to broader acceptance of convergence are more strategic, tactical, operational, or cultural in nature? What are some of the roadblocks you’re encountering?
All of the above, but one roadblock we often underestimate is the unknowable timeline and sequential order of fundamental market changes. When we look at the shift to accountable care organizations (ACOs), we realize ACOs often didn’t happen in the order of that acronym:
- First, many hospitals bought other providers and became an organization. That’s the O.
- Shortly after, they signed the accountable contracts. That’s the A.
- Then they’re figuring out how to deliver the care. That’s the C.
So sequential O, A, C, systems were developed over time, not fully-formed ACOs. This timing has significant adoption implications because selling a big data analytic solution to guide (C)are as hospitals were still focusing on their (O)rganization stage created a mismatch between the readiness of buyers and sellers. In other words, we were offering population health management (PHM) solutions to a provider that wasn’t managing a population yet. Deciphering these timelines of adoption rates during major industry changes is extremely challenging.
As we look at convergence, we are still determining the order of market adoption. We should be asking … How do we put a data cleansing solution in place before the analytic solution so we don’t have garbage in/garbage out? How do we do reorganize care before the risk contract is put in place? It’s not so much of a roadblock, but when working with portfolios and entrepreneurs, we have to think about when to sell solutions as much as what they need and be cognizant of the sequence and timeline.
Convergence and value-based care are closely linked. What will it take for the industry to accelerate the shift toward value-based care?
To track the acceleration, we again need to follow the money. Federal, state, and local governments account for over half of all healthcare spending in the United States; when Washington, D.C. speaks, providers sit up and take notice because of the amount of funding that comes from that source. When it comes to value-based care, self-insured employers may be ahead of Washington, but the biggest accelerant is going to be CMS in the long-run.
What are the major non-technical barriers to achieving convergence?
When convergence is defined as the collaboration of providers, employers, and payers to achieve better population health, we can all get behind that mission at a high level. But stakeholders have typically operated in their silos, serving consumers/patients/employees/members in a different way, typically without crossing into each other’s domains. Changing decades-old patterns of behavior and silos is going to be the greatest challenge and opportunity.