I recently joined the team at Pearl Health as its new Head of Data Science, and wanted to share some brief reflections on what motivated me to work with Pearl in its push to transform primary care.
Any discussion of healthcare in the United States tends to anchor on some difficult realities. I won’t review the issues with the system since so many thoughtful observers already have with greater clarity and nuance than I can offer. The short version is that costs are unsustainably high; outcomes are often poor; and patients and practitioners alike are unhappy. Instead of dwelling on familiar issues, I would like to explore why I think the Direct Contracting model — and the tools we’re building at Pearl to empower providers to succeed in it — offer so much promise in making things better.
Reason 1: Capitated Payments in GPDC Enable Primary Care Physicians to Focus on Improving Patients’ Health
Capitated payments for primary care, stripped of the onerous requirements that existed in prior value-based models like ACOs, allow doctors to focus on providing care, not generating billable services or ticking quality metric boxes. With Global and Professional Direct Contracting (GPDC), CMS has made remarkable progress toward creating a system that lets doctors focus on what they’re best at: improving patients’ health. As we have developed our own understanding of the GPDC scheme at Pearl, we have been impressed with the evident care that went into designing the new payment mechanism and how the strengths and weaknesses of prior Alternative Payment Models (APMs) have informed the new approach.
After the early experimentation with APMs, we see an inflection point where value-based care becomes central to how medicine is practiced in the US, and we plan to be part of the transformation. We understand that these periods of transition can be daunting for providers, who overwhelmingly feel like too much of their time and energy is spent thinking about the economics of medicine relative to focusing on patient care. The thought of navigating another new payment model does not excite the average doctor. We believe the DCE model will lighten the burden by providing a steady stream of revenue for practices and removing the focus on billing. These developments are critical to improving our healthcare system, but raise in turn the issue of managing a book of business and understanding progress toward value performance. This is why I view the opportunity at Pearl as being so great: the DCE scheme frees doctors from billing-centrism, and we provide the tooling to make thinking in this new value-based, patient-centric way painless.
Reason 2: Data Science at Pearl Health Poses Interesting Analytical Challenges that Make a Positive Impact
With the advent of this new push to value-based care comes a great number of interesting analytical challenges, which is of course a big draw for me. A world where we ask primary care doctors to orchestrate care and consider their patients as a population is one where good data science can unlock a lot of value. Identifying high-leverage moments for doctor intervention, flagging patients that might need outreach, generating a detailed understanding of the risk in their patient population — all of these combine sophisticated population health analysis and traditional product-oriented DS approaches, and all of them will be essential in helping doctors thrive in the new model.
Reason 3: Pearl Health is Building An Amazing Team that Will Make Value-Based Care Work for Every Doctor
The last thing I’ll note as I reflect on why I joined Pearl is the caliber of the team. The healthcare industry is a complex beast, and having experienced leadership provides any organization with a huge advantage. Michael Kopko, Ankit Patel, Jen Rabiner, and the rest of the leadership team bring an incredible depth of expertise to the challenges we face. This group has navigated the world of new payment models in leadership roles at places like Oscar, Clover, and Athenahealth. This gives us a big head start as we push toward making value-based care models work for every doctor.
If you or anyone knows anyone who shares our passion for making value-based care models work for every doctor, check out our open opportunities — we’re hiring!