Aligning with Employers & Health Consumers and Doing Something About It!

Glen Tullman, Chief Executive Officer, Transcarent

We are living in an era where employers, and their employees, are paying more than ever for healthcare and getting less. People don’t like the experience. The quality of care is inconsistent. And, costs are skyrocketing while outcomes are stagnant. And, the proliferation of new “point solutions,” while individually valuable, has resulted in a fragmented and misaligned system that is harder than ever to navigate.

In our divided country, a solid majority of health consumers (Republicans and Democrats, men and women, young and older, and all ethnicities) agree that healthcare is more confusing, more complex, and more costly than ever before . . . and getting worse, not better. In many respects, we’ve lost sight of the interests of the very people all of this innovation is meant to serve: health consumers. That’s you, that’s me, that’s all of us, our families, and our employers.

At Transcarent, our vision is to put all of your health and care in one place and finally make it easy --- yes easy --- to access high-quality, affordable, health and care. If it’s not easy to find the care you need, you either won’t get it, won’t use what’s available to you, or won’t continue to use it. Employers complain that while they are paying for point solutions, very few of their people use them.

Our answer? We’ve created the WayFinding™ experience, the first generative AI-powered, next generation navigation platform, that allows you to access all of the industry leading point solutions in one place, with single sign on (SSO), round trip data exchange, and the option to contract directly or through us. We’re making it easy.

But we also have to make it affordable . . . more affordable. In one of our offerings, Surgery Care, we provide access to the highest-quality and most cost-effective places to get your care . . . often known as Centers of Excellence or often Ambulatory Surgery Centers that specialize in a particular kind of surgery. And, like other providers, which include partners on our platform, we’ve followed the industry standard of charging a percentage fee for finding these sites and scheduling care. However, that means the more expensive the surgery, the more employers are paying . . . and that just doesn’t feel right or feel aligned with our mission or the best interests of employers or their employees.

In some cases, employers are being charged $10,000–$15,000 per case or up to 25% of the cost of surgery for coordination and little else, regardless of whether the surgery was necessary, could have been avoided, or is successful. That’s not adding value and it’s not a guarantee of better care.

So, effective today (and we’ve already implemented this with a number of our clients on their renewals), we’re capping all fees with a commitment to lower the cap in the future. We’re also adding second opinions on all major surgery requests . . . because we, as a consequence of our acquisition of Accolade earlier this year, own the largest and highest-quality second opinion provider in the country, 2ndMD. Using 2ndMD, a person considering surgery can have an independent expert surgeon, from one of the country’s leading Centers of Excellence, review their file and provide an independent assessment of whether the surgery is necessary. And then the Member talks directly with the independent surgeon to discuss it.

And, even more important, industry research shows that in the U.S., we perform about 30% more surgeries than we need to. Who’s paying for that? All of us and our employers. Expert second opinions keep people safer, preventing unnecessary surgeries, and save them and their employers money.

Enough Is Enough

Today, I’m calling on the industry to draw a line in the sand. Let’s all agree to cap our fees. If we want to rebuild trust in employer healthcare and truly deliver on the promise of value-based care, it starts with leadership and it starts with transparency.

Here’s what Transcarent is doing: We are capping all surgery case management fees at $6,500—period. No surprises. No upcharges. Whether the case is complex or routine. And when a surgery is avoided altogether because a second opinion deemed it unnecessary, there are no surgery fees.

We Each Have a Role to Play

Self-insured employers need to demand more. My suggestion: ask your surgery provider to share a list of all surgeries above the $6,500 cap. And then ask them to adhere to the new standard: a cap of $6,500.

Check if their incentives are aligned with yours and those of your employees. If the only way they make money is booking surgeries, expect them to do more than your people might need. Healthcare experts will tell you . . . every major surgery should have a second opinion first. The same people who won’t eat at a restaurant without checking Yelp will have a major surgery without the same rigor. Let’s change that together.

Benefits consultants play a critical role. Help your clients cut through the noise. Ensure evaluations are based on total cost of care impact and long-term alignment with the goal of accessing high-quality, affordable care.

And to our peers across the industry: join us. Cap your fees. Align your incentives. Put outcomes first. Together, we can build a model of care that rebuilds trust in our health and care and delivers measurable value.

It’s time to lead.