Value-Based Care Success: A Micro-Macro Approach

Micro-Macro Glide Path of Services

At Pearl, our mission is to help primary care providers (PCPs) succeed in value-based care. To accomplish this, we’re building best-in-class technology that we can deploy at scale, while also providing services that target high-impact opportunities to drive performance for individual practices.

Our technology-driven “macro-playbook” allows us to enable all providers to focus their attention on the patients who are most likely to need care. Our operations-driven “micro-playbook” allows us to offer bespoke support to practices, while also surfacing ideas for what we should build into our product. These complementary approaches position us to help PCPs with their various needs, while also strengthening our technology over time.

Through both our macro- and micro- approaches, our high-level framework is the same. We use actuarial and data science to:

While this conceptual framework is consistent across both technology and services development, the specific solution path depends on the scale of the opportunity (i.e., is it at the ACO, practice, or individual patient level?) and its place within our product roadmap. Generally speaking, we believe problems that impact our broader population of patients are candidates for a macro-solution and those that impact specific practice cohorts or individual patients are candidates for a micro-solution.

Our Micro-Playbook in Action

Our Performance Operations team focuses on deploying the micro-playbook. We systematically surface the highest-risk patients and evaluate their journeys through the health care system, diagnosing the root causes of the barriers they face and presenting PCPs with novel solutions. Whether it’s identifying cost-effective, therapeutically-equivalent specialty drugs or enabling the PCPs to co-manage patients with value-minded specialists, we partner with Pearl’s Customer Success team and clinical advisors to engage PCPs on the optimal approach for improving patient outcomes.

As Pearl’s Chief Product Officer Jennifer Rabiner noted in a recent blog post, one of our core product principles is to “empower, not replace, the PCP.” This concept also applies to our operational solutions, in that we aim to give providers the resources and leverage they need to do what they do best: deciding what is best for their patients.

The Evolution from Micro to Macro

One of our differentiators is our ability to design for scale, so when determining whether to pursue a tech- or service-based approach, we think about it more as a glide path than a fixed state. As we incubate and test new service solutions, we evaluate how best to scale their impacts. To the extent that a given tactic fits into Pearl’s overall tech strategy, we partner with our Product and Engineering teams to build it into the product roadmap and, through this iterative approach, migrate the most effective solutions into our Platform over time.

Lauren Prial

Lauren Prial

Head of Network Operations, Pearl Health