Sean Schantzen of Health Rosetta discusses how Direct Primary Care is a proven strategy to reduce healthcare costs and why it is so important to incorporate direct primary care into employer health plans. This was a long talk with a lot of great Q&A. Watch the full session here: http://video.hint.com/sean-schantzen-the-role-of-dpc-in

1. Sean Schantzen
Health Rosetta
The Role of
DPC in Next-
Gen Health
Plan Design

2. Health Rosetta
Infrastructure for a
New Health Ecosystem.
Highly Confidential.
Do not share without permission.
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3. What is Health Rosetta?
The Foundation for High-Performance Unbundled Health Plans
Platform
Open Framework & Taxonomy
Ecosystem
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4. Value-Based Primary Care
Independent, Active Plan Admin. & Oversight
High-Perf. Plan Design, Docs. & Risk Mgmt.
Transparent Open Networks
Major Specialties & Outlier Patients
Transparent Pharmacy Benefits
Individual Stewardship
Health Rosetta Inside Platform
EnablingTech
Transparent,AlignedAdvisors
Taxonomy Summary Framework
4

5. 20k+ in 16 months
BOOKS SOLD
How we source our insight
Building a self-perpetuating movement & market intelligence
Hundreds of
contributors
HEALTH ROSETTA
Plan sponsors
Benefits Advisors
Industry Experts
Clinicians
Technologists
40,000+ followers
TRADITIONAL & SOCIAL MEDIA
REACH
65 articles in H2:18
3.7 million
CERTIFICATIONS
110 advisors
37 states
Largely
mid-market
100’s of sources
Broad goal is to drive decentralized, grassroots action
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6. How Plans Work
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7. Types of Plans
Partially self-funded
Fully-insured Level-funded
Fully self-funded
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8. Types of Self-Funded Plan Administration
Independent TPA Fully-bundled Carrier Owned TPA
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9. Main Players in Typical Self-Funded Plan
Network
Plan & Plan
Sponsor
Risk
Mgmt.
TPA
PBM
People
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10. Value-Based Primary Care
Independent, Active Plan Admin. & Oversight
High-Perf. Plan Design, Docs. & Risk Mgmt.
Transparent Open Networks
Major Specialties & Outlier Patients
Transparent Pharmacy Benefits
Individual Stewardship
Health Rosetta Inside Platform
EnablingTech
Transparent,Aligned
Advisors
Structure of Ideal Health Rosetta Plan
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11. The Problem
Repeatedly building successful, client-tailored unbundled
plans is overwhelmingly complex for all key stakeholders.
Traditional plans Unbundled plans in
today’s current market
Health Rosetta-based
unbundled plans
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12. Problem Manifestations
1000’s of little things add up to one enormous problem
Vetting &
Selection
Data
Integrations
Contracting
Cross-stakeholder
Collaboration
Implementation
Execution
Workflow & Process
Management
Performance
Reporting
Plan detail
tracking
Member Education
& Experience
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13. Health Rosetta Inside
Lifecycle Infrastructure for Health Rosetta Plans
Plan & Sponsor
Data FluiditySolutions
Health Rosetta Taxonomy
Ever-Improving Foundation
13

14. What Health Rosetta Inside Does
14

15. Certified Advisor
+
Inside Platform
Empowered
Plans
15

16. Average Plan Lifecycle
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17. Plan Lifecycle Summary
Architect Implement
Iterate
Monitor
Underwrite
Optimize
Plan Sponsor &
Member Needs
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18. VBPC-centric Plans
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19. What Value-based Primary Care Addresses
Navigating Complex
Conditions & Episodes
Day-to-day Acute Care
Emerging & Latent
Population Risk
Different plan architectures impact each area differently.
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20. How Advisors Decide To-do or Not To-do
Possible in Geography? Possible for Client?
Select the Right Approach
Include Docs to Get
Employer Onboard
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21. Main VBPC-Centric Plan Architectures
Bolt-On Bolt-In Built-Around
High Deductible Plan +
MERP/member
paid/other.
Paid by self-funded plan,
w/ minimal plan changes.
All care, point solutions, &
incentives flow from VBPC
How Members
Enroll
Depends, but typically optional
for members
Typically Optional, but can be
Incentivized or Required
Incentivized or Required
Execution
Complexity
Low Moderate High
Typical Group Size <50 50+ 50+
Access/Experience ↑ High High High
Cost Savings Varies. May increase costs Varies greatly by utilization Greatest savings potential
Key Partners
Ideally level-funded or other
aligned fully-insured plan
SL/Captive/TPA + ideally
some key point solutions.
SL/CaptiveTPA + solutions in
all main Health Rosetta
Components + ideally a TON
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22. How to work w/ plans
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23. Speaking Employer
What they care about Showing ROI
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24. Remembering the Spend Distribution
Primary Care typically does not directly address the largest human
and financial costs in a plan.
<10% of
members
>80% of
spend
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25. MSK
General Steward
Ideally Value-based Primary Care
Individual Stewardship
CancerComplex Care Cardiometabolic
HospitalizationProceduresRare Diseases Specialty Drugs
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26. Potential Pitfalls
Broker Sophistication
TPA, PBM & Med.
Mgmt Swimlanes
Underwriting
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27. Questions?
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28. Value-based Primary Care Approaches
Smaller Patient Panels + Independence + Aligned Economic
Incentives
Nearsite ClinicsDirect Primary Care Onsite Clinics
Various HybridsACO/IPA-centric Virtual DPC
Emerging Trend: Combine approaches to better meet the
needs of multi-location and/or decentralized populations.
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29. Key Selection Issues
Any VBPC & Single Clinics
Adding a DPC Network and/or
Combining multiple VBPC Types
● Scope of Services of clinics
● How integrated into the rest
of the plan?
● Employer friendliness of
practices
● General VBPC provider vetting
● Doctors of both Genders
● Aligned TPA and SL
● Deciding the right
combination of approaches
● Normalizing scope of services
& pricing across clinics
● Dealing with Varying state
laws
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30. Key Execution Issues
Any VBPC & Single Clinics
Adding a DPC Network and/or
Combining multiple VBPC Types
● Eligibility & Enrollment
● Employer friendliness
● Coordinating w/ other
stakeholders
● Integrating w/ other care
interfaces
● Reporting and metrics
creation
● Who holds the contracts?
● Administering Contracts &
Payment
● Physician selection process
for members
● Coordinating reporting and
administration
● Simplifying member
education
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