Destination: Health Impact

Alan Roga, MD, FACEP: Great to see everybody. I'm Alan Roga. I'm the chief clinical officer here at Transcarent. I've been at the company for about five months now. Love what we do.

Alan Roga, MD, FACEP: Have met several of you already. For those who I haven't, a little bit of background. So I'm an ER doctor by training, although I don't practice anymore. I've been in healthcare for over thirty years, and I've been fortunate to have a lot of great different experiences. So I built three healthcare tech companies.

Alan Roga, MD, FACEP: I've been a multi time CEO—been in startups to large cap public companies. And I've also ran clinical operations for a variety of organizations: large health systems, large provider groups, and even the largest global telemedicine company for a period of time. It's been a ton of fun to be here.

Alan Roga, MD, FACEP: I've been asked to speak about how we create health impact, innovation, and quality. So I'm looking forward to giving you a little glimpse about what I see in the company and about a lot of exciting things ahead of us. So I'm gonna give you a little bit of preview about how we're gonna do things and how we do things now. We'll start with a little grounding. So we use the term health impact.

Alan Roga, MD, FACEP: What does that actually mean? Right—health impact is a framework. And what it does is it translates strategy to execution. Really what it is.

Alan Roga, MD, FACEP: Like Glenn talks about: less talking, do more. The framework is adopted from 2006 with the Institute for Healthcare Improvement anchoring really around three things: experience, cost, and outcomes—things that I'm sure many of you have seen before. And what do those actually mean?

Alan Roga, MD, FACEP: So experience is the patient experience—quality, satisfaction. Cost is self explanatory: how do we reduce overall medical spend, and really at the patient level? And then outcomes: closing gaps in care, improving hemoglobin A1C, hypertension—your typical quality measures. But why do these things matter?

Alan Roga, MD, FACEP: Right? So words on paper or on slide. But what they actually do is they're a forcing function. They're all interdependent. They're all related on each other.

Alan Roga, MD, FACEP: So think of them less as isolated entities and more as a forcing function to transform organizations. And organizations that adopt these principles do way better than ones that don't. So this is our version of health impact. This is our guiding principle. You've heard Glenn talk about it.

Alan Roga, MD, FACEP: The entire company is anchored around it. And I'll give you a lens now into what this actually means to us. So let's start with a little bit of grounding on what's current state of health impact. And I'll tell you that as I've looked through the organization, our results are very impressive. Again, I've been in healthcare for over thirty years.

Alan Roga, MD, FACEP: I think sometimes we get lost on the terms and words, but I've not seen these things in my career. And we'll talk about a few of them. So using our expert opinion service, seventy eight percent of patients have improved treatment plans. Now what does that mean?

Alan Roga, MD, FACEP: First of all, having been in health care, whenever someone calls me with a question—right, you're always somebody's friend with a phone number that has a medical issue—my first thought is always, do we have time? If you don't have time, that's where problems sometimes happen in healthcare. If you have time, typically you get to the right answer. And if you have time, you get a second opinion. So what do most people do?

Alan Roga, MD, FACEP: Right? Call a friend, look at Google—who do you recommend? But what we've done is create a process and methodology that removes any conflict of interest by getting your information to an expert in the field. We've already curated that for you. Getting all of your data—seventy eight percent of the time we're improving patients' care.

Alan Roga, MD, FACEP: Right? The national average here is about twenty to forty percent. These results are spectacular.

Alan Roga, MD, FACEP: Twenty nine days to cancer treatment—early treatment. Every single study in the area shows early cancer treatment detection reduces toxicity, improves mortality, improves patient outcomes. Plus, can you imagine just getting your diagnosis a little bit earlier? It's a great user experience.

Alan Roga, MD, FACEP: Forty eight percent reduction in readmissions when you enroll in our transitions of care and readmissions program. National average here: about twenty percent. If you do paramedicine—which is ambulances as they come to the house—or a case management program, both of which have their own challenges. We do this at scale. This is where you get your ER admissions, your hospital admissions reductions—getting very, very strong results.

Alan Roga, MD, FACEP: Complication rate in our surgery care is less than one percent. Again, I'm gonna give you some benchmarks. National average is one to five percent for low acuity surgery. Our surgeries are typically in that mid tier—five to ten percent. You know, we're at best practice levels here.

Alan Roga, MD, FACEP: Primary care is tough, right? The number one factor for challenges in our health system is the lack of access to primary care. It's proven a million times.

Alan Roga, MD, FACEP: If you are an established patient in a primary care practice, typically it's somewhere between fourteen to twenty seven days to get in. If you're a new patient, it's twenty to thirty days. We are seeing patients the same day because virtual scales.

Alan Roga, MD, FACEP: And then the last one is our NPS score. Your typical health system is somewhere between twenty and forty on their NPS. Ninety is clearly best practice across the host country. And not only that, we did two million ambulatory care encounters last year. For a frame of reference, that's as large as some of the largest health systems. We do as many large volume ambulatory care visits as your major health systems at a ninety NPS score. So these results are really, really strong.

Alan Roga, MD, FACEP: I just want to start with a grounding here of where we are current state. And if you look in totality—breadth framework about pure experience, outcomes, and cost—showing you net promoter scores, showing you clinical outcomes, and also then showing you cost reductions.

Alan Roga, MD, FACEP: How did we achieve these results? Well, I'll give you a few examples. If you look at our pharmacy program, the results are spectacular: nearly eighteen percent reduction in the total pharma spend. I've looked at a lot of the clients in the room's savings on—and I should say claims—over the last year. I mean, we're talking hundreds of millions of dollars in pharma spend. This alone can move the needle materially. We're talking tens of millions of dollars for your companies.

Alan Roga, MD, FACEP: The average spine surgery saves thirty seven thousand dollars. The average expert opinion: somewhere between ten thousand dollars and eighteen thousand dollars. I mean, these are just a few select examples of how did we get here.

Alan Roga, MD, FACEP: Now I'm gonna show you where we're going. Here's what's very, very cool about Transcarent. I would say that we are uniquely positioned to actually execute on the meaningful cost reductions that Glenn is tracking towards twenty percent over the long haul. And I'm gonna show you why.

Alan Roga, MD, FACEP: When I got here, I said, “Glenn, we have every piece we need. We just have to put them together a little bit differently.” That's all we gotta do. We gotta execute a little bit better. We have our opportunities, but what I'm gonna show you is five key areas, and all five of them have the same thing in common.

Alan Roga, MD, FACEP: They all improve patient satisfaction. They all close care gaps. And they all improve costs. So all five of these are best practices of how we are on a journey to improve upon whatever our very impressive results.

Alan Roga, MD, FACEP: The first one—you heard Glenn give you a little preview about personalized health paths. I'm gonna give you version two.

Alan Roga, MD, FACEP: Right. So when you think personalized health path, I want you to think precision medicine, right? That we know about you, we know precisely what you need. Precision medicine and personalized health path—three things to remember.

Alan Roga, MD, FACEP: Right? I got a high schooler who my last one's getting ready to go to college. SAT: standardize, adherence, and trust. That's what precision medicine and personalized health path do.

Alan Roga, MD, FACEP: What does that actually mean? What do we do by that? We have tons of really special data. We have claims data. We have experience data. We have years of clinical history. We have documentation history. We synthesize all that using our AI to know about you.

Alan Roga, MD, FACEP: You think about why does it improve trust? By the way, twenty to forty points on net promoter scores typically—because we're not just blindly reaching out. We're reaching out going, “Here's what you need. We actually know what you need.” That's how you get trust.

Alan Roga, MD, FACEP: We standardize because everybody will be using the same song sheet. Whether you are frontline care worker to a nurse to a doctor to a pharmacist, everyone has the same information on every single patient. This is where we're headed, and I'm actually gonna show you how it will work in the future state.

Alan Roga, MD, FACEP: So personalized health path—by the way, when executed, precision medicine—five to ten percent cost reduction. Typically closes care gaps, improves net promoter scores, satisfaction, costs—all the good stuff.

Alan Roga, MD, FACEP: With personalized health path, as you think precision medicine, our AI capabilities—inagenic or agentive AI—think continuous execution. Now we know what we need. We don't have to wait for people to execute on the care.

Alan Roga, MD, FACEP: So what AI does is we're not disintermediating people. People are still in the process. There are humans that oversight, but it's moving things along because now we know at a baseline what you need. So as we're reaching out for your colonoscopy, your mammogram, your labs, we're using the health path to drive agentic AI.

Alan Roga, MD, FACEP: Organizations that drive and use agentic AI do much better than ones that don't. And our AI capabilities are very, very fulsome here. And you also see somewhere around eight to ten percent cost reduction when you're using agentic AI in this fashion.

Alan Roga, MD, FACEP: So precision medicine, continuous execution—then to risk stratification. When you think risk stratification, I want you to think intentional focus.

Alan Roga, MD, FACEP: Right? The top ten percent of every population typically drives seventy percent of your spend. Getting really good at this population and engaging them is one of the most powerful tools that we have on health impact. And there are three things that you do with this: right patient, right time, right provider.

Alan Roga, MD, FACEP: This is how you reduce hospitalizations, ER admissions, and it's one of the really most powerful tools that we can do—driving that top ten percent engagement.

Alan Roga, MD, FACEP: Now you get to the anchor, which is advanced primary care. Advanced primary care. So if you go: personalized health path is precision medicine; AI is continuous execution; risk stratification is intentional focus; advanced primary care is clinical ownership.

Alan Roga, MD, FACEP: What does this mean? As opposed to primary care, advanced primary care is a team model: care worker, nurse, physician, APP, pharmacist, behavioral health specialist, social worker. It's a team model.

Alan Roga, MD, FACEP: What it does is it takes a big population and translates it down to an individual team. So you're putting ownership to the frontline clinicians and the team that's taking care of a smaller part of the population. You take large populations and you bring them down into team models.

Alan Roga, MD, FACEP: What does advanced primary care do really, really well? Three of your areas of your highest cost spend: chronic disease management, number one.

Alan Roga, MD, FACEP: Fifty percent of your spend is probably in six categories: maternity, mental health, musculoskeletal, cancer, cardiovascular, pulmonary, and GI. And pharma traverses all of those. So getting patients into advanced primary care does really, really well with chronic disease management; does really well with imaging, which is probably one of your top five expenses as well; and ER and urgent care readmissions. This is the team model—fifteen to thirty percent typical cost reductions when executed well.

Alan Roga, MD, FACEP: We will be the first company that does this virtually at scale. Several of you have on-site clinic partners or even local primary care partners. They're doing advanced primary care, but your employees live everywhere. How do you scale it nationally? So working in concert with them is part of the model.

Alan Roga, MD, FACEP: And then last but not least is our care pathways. That is where we get to our partners, right? There are many, many partners in the room that do exceptional care. We're not going to do care delivery, but getting people to the right care is part of the methodology.

Alan Roga, MD, FACEP: So how do we put all these pieces together? Right—how does it end up working? And I'll take you through a journey.

Alan Roga, MD, FACEP: So personalized health path; risk stratification—right person, right care, right provider—to engage that top ten percent (especially around readmissions and ER diversions). Advanced primary care is the anchor—fifteen to thirty percent—chronic disease management, urgent care readmissions. And then care pathways to our partners. And I'll show you actually how this works a little bit.

Alan Roga, MD, FACEP: Last but not least to forget about is clinical quality. Alright. Now you saw in our slides: one place to make it easy for high quality care.

Alan Roga, MD, FACEP: I will tell you that one of the things I've been most impressed about at Transcarent is our quality program rivals most national health systems, and we do this at scale.

Alan Roga, MD, FACEP: How does it actually work? Because everyone talks about quality, right? No one's gonna tell you “bad quality.” But we really have a quality program that rivals pretty much every health system I've ever been a part of—major ones.

Alan Roga, MD, FACEP: How does it work? First, our AI capabilities: we can identify problematic areas, problematic functions. We can intervene earlier.

Alan Roga, MD, FACEP: The second is we have enterprise oversight. So we don't just do quality to track quality—we actually are monitoring it across the board from sub communities to enterprise quality committee. It's actually ingrained in our DNA.

Alan Roga, MD, FACEP: And the third is: I'm a big incentives person. Incentives drive behavior. Our entire organization is incentivized around quality from the frontline care worker all the way to our CEO—and me as well as most of the management team. So everyone is incentivized to perform on our quality metrics.

Alan Roga, MD, FACEP: I'm really proud to let you know that actually we perform and achieve over ninety percent of our individualized quality metrics as an organization, and we continue to improve. Those are really, really strong.

Alan Roga, MD, FACEP: So moving along the journey—not forgetting about quality—and this is how they all work in totality. I'm gonna take you through now a little bit of where we are headed with this in our future state.

Alan Roga, MD, FACEP: And by the way, I've talked to a few of our clients in the room about this plan, and I'm really pleased that it's been met with approval. We look forward to talking with you about more, but it seems like you're all looking for: how do we really do this better?

Alan Roga, MD, FACEP: Right? So this is a little bit of glimpse in the future. So a personalized health path—Glenn showed you what the membership sees. This is really what the teams will see.

Alan Roga, MD, FACEP: So we have already built a portal called Member 360. You could sort of see it in the upper left hand corner. But think about a scenario where we actually know about you. We're not just blindly reaching out. We're saying, “Hey, Alan, you need your colonoscopy.”

Alan Roga, MD, FACEP: “Hey, Alan, you're on the wrong med. Hey, Alan, there's a better choice for you. We'd like to talk to you about that.” That engagement rate goes through the roof. All of our data shows that when we reach out with a clinical intervention with a clinician, the conversion rates are astronomically high.

Alan Roga, MD, FACEP: Right? Marketing is, of course, important to engage—but clinical engagement as well is really high.

Alan Roga, MD, FACEP: So anyway, our personalized health path uses all of our data—personalized health paths on every single patient that we have. Not only what your clinical information is, but what's your plan? What has your employer provided for you that we can do? What is your benefits information? What is your risk score? So that our agentic AI can be reaching out.

Alan Roga, MD, FACEP: And just to give you a few examples—probably a little hard to see on the slide—but this is what our frontline care teams see. So: the prescription needs to be transferred; they've missed a couple of meds; we need to order labs; and we have to refer to a specialist.

Alan Roga, MD, FACEP: Everybody sees the same information. We have standardization, adherence, and trust. We know about you. We all have the same information, and we're looking to adhere you to the plan that we know clinically improves your care.

Alan Roga, MD, FACEP: So our agents—right, this is the typical consumer experience that we see on the app, which is very, very slick. But Sarah is getting a note that she needs a metformin refill, and we need to get some labs. And this is an appointment with Dr. Kunza that we would like to schedule.

Alan Roga, MD, FACEP: All of that—done. Again, continuous execution through our AI agencies because now we have a personalized health path that we know what you need.

Alan Roga, MD, FACEP: Then we have the encounter, right? On the left, you'll see our app—again, typical user experience, consumer experience, which is very strong. Doctor-patient connect: tell me about your treatment; tell you about your care; how did you feel?

Alan Roga, MD, FACEP: But what's important to note is on the right side. So on the right side, this is what our doctor sees—same exact information. Sarah needs a prescription for metformin. She needs labs and a follow-up referral to one of our partners for diabetic management and care. All of that—done. Done.

Alan Roga, MD, FACEP: Everybody is standardized. Again: treatment, trust—all of those things. And then, of course, the console concludes as typical where we've actioned and we're not waiting.

Alan Roga, MD, FACEP: So notice to the member: would you like us to send to your pharmacy? A lot of the consumer experience that you've seen Glenn show before—your hemoglobin A1C, your medication needs—we're giving you clinical information. Your appointment's been done.

Alan Roga, MD, FACEP: So without manual intervention, the health path about you—with your data—driving both clinical interventions, benefit information—again, standardized adherence and trust—engaging the patient, clinicians all have the same information, and then AI to drive everything.

Alan Roga, MD, FACEP: And not just for Sarah, which is sort of a traditional patient here, but really intentionally focused on that top ten percent—to focus intentionally on those high value, high cost claim areas—advanced primary care model.

Alan Roga, MD, FACEP: Here's how we've done as a company. Here's how we performed. Here's where we're headed. We have all of the unique capabilities. We're uniquely positioned. We'd be the first in market to do all these things. All of them are actioning right now, by the way. This is not aspirational. We have project streams in every single one going on right now.

Alan Roga, MD, FACEP: Our plan is actually to deploy with our Transcarent employees, which I'm excited about. Several of you have expressed interest to be early partners with us in our unique model. Thank you for your time.