During this year’s HLTH conference, Demi Radeva, one of Digital Health Today’s global ambassadors, had a one-on-one with Aaron Friedkin, Chief Business Officer at Homeward Health.
Homeward Health is a technology-enabled healthcare provider delivering care to those who don’t have it with an initial focus on rural communities.
Aaron shares his perspectives and experiences for securing reimbursement and investment in what are often labeled “squishy“ innovations. These include innovations in spaces such as behavioral, wellness, health equity, and social determinants of health.
Read on for practical workarounds, tips and tricks.
Q1: Discuss the power of digital health technology reimbursement. How has it helped or hindered your progress?
Aaron: To-date, self-funded employers have empowered the first wave of digital health innovation because they have the power to decide what benefits they want to offer and discretion about how they think about various health problems and their solutions.
Unfortunately, payers must solve for the lowest common denominator which constraints their ability to drive innovation.
Over the course of the pandemic reimbursement for telehealth and other such innovations soared, as historical restrictions were pulled back. However, that is not enough to maximize reimbursement potential. That is why Homeward is a full-risk value-based care provider. We were intentional about this because we don’t want to be constrained by the payment models that exist in the industry today. We take full risk on the patients we manage which gives us the ability to deploy technology to support these patients that otherwise wouldn’t be reimbursed. We can do that, because at the end of the day, we are on the hook to keep that population healthy and help manage their costs.
Q2: What strategies, tools, and mental models have helped your company secure reimbursement?
Aaron: Approach these discussions from a partnership mindset, not a sales mindset. We partnered with the second largest Medicare Advantage plan in Michigan, Priority Health, which is also owned by the largest health system in Michigan. We began our conversations by asking – what are we both trying to solve here? A critical piece is to understand the problem that your partner actually has and being thoughtful about how to solve for it together. It’s not a sale.
Q3: What has hindered your ability to gain reimbursement?
Aaron: Nothing in particular, aside from it being a really hard problem. We are trying to be thoughtful about not disrupting the existing system that is already struggling to stay afloat in these rural communities. It is a balancing act of finding the right patient population that is not getting care today so we can support them while ensuring that business is not taken away from existing providers.
The unfortunate reality [that healthcare is a business in the U.S.] creates an opportunity. There is a significant portion of patients living in rural geographies that just are not accessing care. These are dollars that are not going to anybody and should actually be invested to take care of this population.
Homeward Health takes on risk for these types of populations and deploys underutilized resources for each specific individual while coordinating with what does already exist.
Q4: What can payers do differently?
Aaron: Payers need to focus. Often, they try to solve for all lines of business at once, but that’s unrealistic because of how different the populations and sub-populations within each line of business are. Payers need to step away from one-size fits all solutions and offer much more personalized solutions for the populations they serve, and really understand the needs they are solving for versus trying to solve for everything and everyone at once.
For example, in Michigan we partnered with Rite Aid. At first, it may seem strange, however, we understand our members, and this is one of the most effective ways for us to connect with them. It all goes back to truly understanding members needs and how, when, where they want to get care.
Lightning Round
- What is a saying, quote or phrase that motivates you?
The mission of Homeward Health: Rearchitecting the delivery of health and care in partnership with communities everywhere, starting in rural America. - What advice do you have for others working to innovate and healthcare?
Understand how to align incentives. - What book do you recommend to our listeners?
Drive: The Surprising Truth About What Motivates Us by Daniel H. Pink - What is a technology that makes your life better and easier and keeps you healthy?
Oura Smart Ring – it helps keep me grounded. - What is space in healthcare that isn’t getting much attention, but should??
Rural health – I am happy to see that it’s getting more attention, however, significant disparities continue to exist.
