The Right Way to Access Care

Speaker 1:
Welcome to Cowen Insights, a space that brings leading thinkers together to share insights and ideas, shaping the world around us. Join us as we converse with the top minds who are influencing our global sectors.
Charles Rhyee:
Hello, my name is Charles Rhyee, Cowen's healthcare technology analyst and welcome to Cowen's Future Health Podcast. Today's podcast is part of our monthly series that continues Cowen's efforts to bring together thought leaders, innovators, and investors, to discuss how the convergence of healthcare, technology and consumerism is changing the way we look at health, healthcare and the healthcare system.
And today we're talking about healthcare navigation and putting power back into the hands of consumers. And joining me today to discuss the topic is Jordan Feldman, co-founder and CEO of Rightway Healthcare. Jordan launched Rightway in 2017 to help streamline healthcare offerings with a high-tech, high-touch platform. And the Rightway platform serves as a single point of contact for an employee throughout their healthcare journey and allows employers to optimize costs while producing high-quality, cost-efficient healthcare to employees. So Jordan, thanks for joining us today.
Jordan Feldman:
Thanks, Charles. Excited to be here.
Charles Rhyee:
Let's start off with talking about Rightway here and maybe your journey to where we are now, and what led you to start Rightway, and what kind of problems were you trying to solve for when you started it?
Jordan Feldman:
Absolutely. So growing up, I had a dad who was a cardiologist, so I always thought I would follow that path myself. Got to college, quickly transitioned out of that and started my career in finance. I worked at Goldman Sachs for about four years and then helped start a growth equity fund, called RedBird Capital. At RedBird, I started spending a lot of time in healthcare and healthcare services. So we looked at companies, like One Medical, like Accolade, like Quantum, like Healthcare Bluebook, so really started getting familiar with what was out there, what impact it made, what worked, but also some of the gaps and deficiencies in what was being delivered.
So I took a step back, and with my dad, we started to think about what could this look like? How could we start to innovate and right-size the current universe of delivery. And that's really where we formulated the idea behind Rightway. And it was a simple premise. It was, how do we give every member, every patient and every employee, a doctor in their family? When you have a doctor in your family, that's someone who knows healthcare, that's someone who you trust, and that's someone who can hold your hand from point of diagnosis to the last bill paid. And the whole delivery is, how do we wrap technology, analytics, insights, around that personalized approach to deliver a more elegant, more empowering, more seamless healthcare experience? That's where it started.
Charles Rhyee:
Yeah. And to your point, having a doctor in the family is a different experience growing up, actually seen for me. How have consumers historically been supported in navigating through their healthcare?
Jordan Feldman:
Yeah. So what's interesting is, the care delivery in most cases will be adequate, but it's really the care decision support that most people are confused by, and that aha moment was around a lunch table where five different friends, family, extended friends, came up to my dad and said, "Hey doc, where can I go for my a fibrillation? And how do I get an appointment for a wellness visit in your office? And do I need to be on this brand drug? Or are there better alternatives? And how do I use this new telemedicine benefit?
So it was really around that care decision support that people don't have that advocate. They don't have that centralized resource that they can go to and through, to answer those questions. So in a lot of cases, employees can get in the hands of great care delivery, but it's really the longitudinal continuum that members are most frustrated and [inaudible 00:03:58] by, and that's where you hear the anecdotes and the means of just looking stuff up on WebMD and feeling hopeless and helpless. And I think that's a big part of what a typical member journey looks like. So if you can start to fill those voids of not necessarily while you're being seen in the doctor's office, but everything else that goes into it before, during, and after, you can start to really transform what it means to be a consumer in healthcare.
Charles Rhyee:
And what you say makes so much sense and it seems pretty straightforward and obvious when you state it that way. Why do you think it's been so difficult for that kind of offering to be in the market? I know some have tried, but what do you think has been the challenge that hasn't really made it really take off the way it probably should?
Jordan Feldman:
Yes, so if you look at healthcare as a pie, and the 30 to 40% of healthcare spend that's wasteful or preventable, that's really what we're going after. We're going after the wrong intensity of care, the wrong site of service, and sub-optimal quality of care. And when you look at a standard member progression, you can see how they get into trouble around these three variables. If your back hurts, do you go to an orthopedic surgeon, do you go to a physiatrist, you go to a physical therapist, do you use the digital MSK clinic? Do you take to a leave and call it a day? And when you start to map out the care continuum, so a basket of 10 people, those who are navigating this journey on their own without the levels of sophistication, and insight and information, versus those that are navigating this journey with the dedicated and personalized port of someone who really understands the underlying ecosystem, you're going to look at those progressions and see much higher levels of efficiency in those that are supported, then those that are going about it on their own.
I think historically some of this was owned by folks' primary care physician. I think, as you've seen that landscape change, folks are left searching for alternatives. And I think the alignment of the underlying ecosystem doesn't necessarily allow for this. The health plans aren't in the business of customer service. They're not always financially aligned with the underlying member. They're sometimes seen as adversaria in the member experience because they're the ones denying claims and telling you where you can and can't go. So there hasn't really been a formal ecosystem or mousetrap created to capture that digital front door for the member. And I think that's where, as consumerism matures, we're really seeing a new age of what you can do to support the member around their journey.
Charles Rhyee:
Yeah, no that makes sense. So since you started the company, has the scope of what you're trying to do changed? Because obviously, you talk about the idea of having a doctor available to every family, to every person, to speak with and get trusted advice, how has Rightway's mission changed over time then, and how have you developed your platform to meet those changes?
Jordan Feldman:
Absolutely. So when we started Rightway, and this was a big part of my investing thesis around navigation and advocacy, is I really felt like it had the opportunity to be that platform in healthcare. Everyone talks about platforms and technology, but we don't have that first screen of your iPhone healthcare presence that we do in almost every other sector and category. And when I looked at navigation, I said, that may not be the delivery that has the best chance to impact healthcare all the way downstream, but it does have the best chance to really create the platform effect in healthcare.
So when we started Rightway, we wanted to be at that top of the funnel, at that front door for each member, supporting them across the widest variety of healthcare use cases and opportunities. And we started delivering this navigation in advocacy, and that's a very privileged position to sit in within the enterprise healthcare ecosystem.
You start to learn a lot about what members need, about what members are looking for. And in having that vantage point, you learn where there are frustrations, where there's friction, where there's pain points. And that's what we started to see, not only at the member level, but at the plan sponsor level. And we could clearly see that the opportunity to not only impact member experience, but to impact member and plan costs, was disproportionately around pharmacy. It's the highest frequency, most recurring part of healthcare, and the current consumer experience in that space is all sorts of backwards, and essentially non-existent. So as we took a step back and said, how can we continue to impact the member experience? How can we continue to reduce total cost of care? The entry to do more in the pharmacy space was obvious.
And we said, could we make the impact on pharmacy just being a navigation player? And the answer was no. And the underlying infrastructure and ecosystem doesn't allow for real optimization, for real transparency, for all of the vectors and variables that we pride ourselves on, on the navigation side.
So we had to go further. We had to build some of that infrastructure and delivery ourselves. We couldn't rely on the legacy PBMs to really help innovate around the member experience. What Rightway has now created, is that longitudinal platform across medical and pharmacy, that's going to be able to better control, not only the member experience, but also total cost of care. And that's where the navigation and advocacy platform has really expanded.
In an ideal world, we could have just been that optimization layer on top, and wouldn't have to rearchitect the underlying plumbing and infrastructure, but once you go under the hood of a PBM, you start to realize that a lot of the legacy delivery doesn't afford that. And that's really where our conviction to rearchitect the PBM space came to be, but with the same underlying principles, the same underlying principles of how do we most effectively engage and support a member, and how to reduce total cost of care? We don't need to own everything, but the care navigation plus the new to the world PBM is how we best believe that we can deliver this experience and this impact on cost.
Charles Rhyee:
Yeah. So Jordan, that makes a lot of sense. And it's funny you say that, because I feel like the old adage is, when you start looking at your benefits, what are the first things you look at it, is sort of your pharmacy coverage of copays, and see if your medication is covered. So it's clearly, I think typically, top of mind for people.
You talk about this increasing awareness of the need to help the consumers navigate their healthcare. And I think over the last several years we have seen that, right? Companies, like Accolade and others, and you mentioned earlier, and we've seen these companies come to market to assist in that regard, sometimes coming from different angles. You talked about pharmacy, maybe what are some of the other ways that you believe Rightway really differs from competitors?
Jordan Feldman:
Yes. So putting back the investor hat, what I was looking at in this space was a bunch of analog or mostly analog systems, not a lot of personalization, not a lot of technology around the delivery, not a lot of scalability and cost efficiency for what was being delivered. But also, what I would argue are highly disruptive deliveries to the ecosystem. So carrying out the TPA and replacing UM and DM, and Prior Auth. And we said, is that really what consumers want? Do they really want more circuit breakers and more bumps in the road to access their healthcare? Or do they want true advocacy and support for the sake of better healthcare experiences? So when we looked to really build upon some of the legacy models in the navigation and advocacy space, the first thing we said was, it had to be a digital first front door. If we're really going to scale this and optimize, what's an increasingly mobile first hype of everything, really, we had to start with that first principle.
And that's where it started. A better experience around that digital part of healthcare. And that wasn't really being done in this traditional navigation and advocacy space. And then we had to layer in the personalization. We use dedicated and personalized clinical health guides to support every member. That goes back to that doctor in the family. So you're not calling a generic call center. You're not getting a different person every time. You're not thrashing with the traditional call center type infrastructure. So that digital front door, plus the personalized clinical navigator, and then wrapping everything into the ecosystem. So using better analytics to understand the population, where are the areas of opportunity, what are the care gaps? How can we start to optimize and improve around those three variables that we mentioned earlier, site of service, intensity of service and quality of care.
And that's where the analytics that we're pulling out and the population health approach to dealing with the membership really starts to allow us to be proactive and be precise and efficient in supporting that population.
So the analytics piece and the population health approach to engaging this population, I would say is one of the other big differentiators, because that allows us to really pull it all together and then measure the impact we're making. And that measurement, that justification for what we're doing, that ability to say that if you sign up Rightway, not only do we think we're going to make an impact, but we're going to be able to report it back to you. And we've just finished some independent actuarial analysis, where we're showing that companies that use the Rightway platform are generating 14 and a half percent less spend, than companies that don't.
And I think that's where it really wraps it all together on top of the high engagement rates, on top of the net promoter scores. So I think there's a lot of different ways and approaches that we are differentiated versus some of the legacy players, but those would be the four or five that I would point to as making the most acute impact.
Charles Rhyee:
And that's really interesting, the 14% sounds very substantial here. Do those studies look at the trend impact relative to, if an employer used some other type of service or sort of that they've just not used any?
Jordan Feldman:
Yes. So they will index match at the underlying member level, based on demographics, based on conditions, based on comorbidities, based on geography, plan design. So they're looking at the underlying member that's utilizing Rightway versus an underlying member that's not utilizing Rightway, but index match for all the same criteria that the Rightway members accounting for. So it would essentially be a company that doesn't have Rightway in place, but could have other digital services, digital therapeutics in place, just not the Rightway platform pulling it all together.
And that's where we really spike, right? It's not just care navigation and advocacy that's making a difference for the underlying member. What care navigation and advocacy is best able to accomplish, is illuminating the broader ecosystem, is being able to say, Hey, we have all of these other resources available. We have telemedicine, we have second opinions. We have a digital MSK Clinic, a fertility benefit. And by putting that all in a centralized ecosystem within the digital front door, which is that navigation platform, we can start to drive and increase utilization and adoption of these different services. So not only is it the primary care navigation that is making an impact, but it's all the downstream positive externalities from increased utilization and adoption of all of these other great tools and services that are out there.
Charles Rhyee:
That makes sense. And you talked about several of the key differentiators. Which one of them tends to really cut through the noise when you're in front of employer, potential clients? All of those are obviously very impactful, but do you find employers are gravitating to either the cost savings first or they gravitate to the member experience, what do you see that the employees tend to, sorry, employers tend to focus on most often?
Jordan Feldman:
Yeah, it's really a great question because there are a dual mandates of the Rightway platform. It's engagement and net promoter score on one hand, and then cost savings on the other. Look, I think particularly in this environment, post COVID where employee health and wellbeing, and support, and advocacy is so critical, most of the employers that are looking to Rightway initially, want to make sure that the member experience is there.
And I say all the time, member engagement and member experience, high net promoter score, those earn us the right to save costs around healthcare. You can't just magically reduce total cost of care if you can't support and guide and steer, and synthetically narrow that network for highest quality, most cost efficient choices and options for that member.
So when we're going in to make that employer sale, they need to know that Rightway is going to deliver the same sort of personalization and dedication, and just empathy, to those underlying members that the head of HR, the head of benefits, the CFO, would really do. And then, that's year one, and that's year two, people are using it, you're starting to make an impact. And then over time you could start to show the cost savings. So I was actually a bit surprised that it was in that sequencing. I would've thought that the CFO was saying, "Any way to cut costs, we'll sign up for", but it's definitely a bit of a dual mandate, which I think allows us to lead with the appropriate value prop.
Charles Rhyee:
Yeah. You brought it up before, right, the real point of advocacy and navigation is to illuminate all the other benefits that employees have available. In other words, the employees are already purchasing and paying for a whole host of services. How have employers typically gone about communicating these benefits to their employees, and what are some of the challenges that they've had to be successful, to get the real ROI on some of these extra services that they provide? And how quickly can you, when Rightway comes in, really flip that over?
Jordan Feldman:
Yeah. I would use an anecdotal experience to address this. I mean, if you're an employee and it's October, and you're going through open enrollment, and you're trying to select what plan type you should be on and why you should be on that plan. And then you get a package of materials with all of the additional 15 point solutions that you have in place. And there are one page handouts, and you have a different password for each, and you don't know if the plan that you selected actually gives you the right to use it. And are they opt in, or are they just generally available for the whole population? So you're looking at a completely overwhelmed, confused, frustrated member at that open enrollment point, where they'll basically just remove themselves from that entire ecosystem and say there's too much going on here. There are too many passwords, too many signups, too many things to do. I don't know what I'm eligible for. I don't know how any of this works, and you just create an overwhelming environment for them.
So this goes back to that thesis, or maybe hypothesis, on why I think navigation can finally pull this all together in a platform like effect, it's because navigation can really centralize all of these, make these all available via single sign-on. And if you're a member and you don't know what to use, now we can start simplifying the messaging to the underlying employee and saying, "Hey, you don't need to worry about these 15 different tools and services that are being delivered. You have Rightway. It's going to put everything on the first screen of your iPhone. You're not going to have to worry about passwords for each. And then if you have any questions around the benefits of that digital therapeutic, versus an in-person visit, versus any of the alternatives, you can then have that asynchronous conversation with your dedicated care navigator, who understands everything that's in the ecosystem." So now we've taken a universe of almost infinite choice and optionality that the member can go to and through, and we can put everything in a coordinated and efficient way into that environment.
Charles Rhyee:
That makes a lot of sense. You brought it up before, COVID has maybe changed sort of the mandates. There's more of a dual mandate coming from companies, even CFOs, as you know they've... How much do you think COVID-19 has changed sort of the environment on how companies look at their employee benefits overall?
Jordan Feldman:
Look, I think it's changed how employers look at their employee benefits, and I think it's changed how employees look at their employee benefits. So I think this has created disruption at scale in the digital health ecosystem and has raised the stakes. The way that people used to interact with their telemedicine benefit or their second opinion service, or their mental health benefit, is very different than how they've interacted with it over the last 12 to 18 months.
And the expectations are now higher. They use those as the only option. It used to be if it didn't work, you had choices. You had the ability to pick up the phone and go to urgent care and go see your psychiatrist, or psychologist, and go to physical therapy. The world came to a standstill, but people still needed to get care, whether it be preventative or acute.
And they turned to these digital first resources and the stakes were immediately raised. There was no alternative. There was no ability to say, you know what, that virtual physical therapy visit, didn't do it for me. I'm going to go see my doc in person. So I think coming out of this, every virtual care delivery, virtual care decision support, is going to have to be that much better for the underlying member.
And I think they're now comfortable using it because they were forced to. And it's not just my view. I think anyone you talk to in the digital health space would say it's accelerated adoption by five, 10, maybe even more years than that because people were forced into opting in, and that created adoption at a slope of a curve that we haven't seen anything close to.
So I think employers are saying, we need to make this a part of our go-forward delivery, but we need to make sure that what we're putting in the hands of our underlying members are actually going to solve the problem and not just be some of the check-the-box solutions that we used to have. I think that was what plagued the digital health environment, is you just had these check-the-box solutions, that they were offered, they sat in the background, no one used them or appreciated them. And that was good enough because people weren't forced into using them, but that's all changed. The employer is taking notice. The employees are taking notice. And I really think it's going to usher in a new paradigm for all digital health. And I think that will allow the best products and the best deliveries, and the best services to really win the day.
Charles Rhyee:
And it highlights then the role of Rightway in all this, to make sure people understand what they have available to them. Maybe talk about sort of what the engagement... You already talked about very high engagement levels with your members, but maybe talk about what you saw during the last year in COVID, and how you were able to then help members through this time, maybe some anecdotes or how people used it.
Jordan Feldman:
Yeah, absolutely. I think, first and foremost, when it initially started, we saw a relative panic and understandably so, and members were just reaching out to their navigators for advice, for perspective, for what's going on here? What do I do? How do I get ready? How do I prepare? Can I travel? So I'd say initially, it was just education and perspective around what was going on. And our clinical team really took a lot of pride in just being able to support some of the understandable hysteria around this environment. That's where we started. And I think as folks started to settle in, you saw a complete evolution from, I'm going to see my doctor to what other alternatives are there to procure care. So that's where our navigation came and really went into action.
And for those that needed to be seen in person, we're able to coordinate very tight windows for in person visitation. Where there were alternatives, we were able to start highlighting where and how members could seek alternative care. And those would be all the digital and virtual options. But it was really around the conditions and comorbidities that have been plaguing employer healthcare spend historically. And it's just put those on steroids. So we were seeing mental and behavioral health become a top category. We were seeing musculoskeletal conditions through bad posture and just a new work environment, and a work reality, really starting to bother people. We were seeing some adherence around medications really falling off because people weren't just going to their pharmacy to pick up a few groceries and get their prescription drugs filled.
And now we're navigating the new world order of mail pharmacies and how to even get that set up. So it was mostly around the immediate byproducts of what COVID created. And then over time we saw a reversion to the meme. But I actually think the pendulum is so far on one side here, where people basically said, if it wasn't an emergency, I'm not going to have to go do it.
And if you look at some of the data, heart attacks are down, cancers are down, and I promise you, people didn't stop experiencing both of those tragic environments. They were just less likely to seek care around them. So I think it's going to be more critical than ever, that we all start to appreciate and recognize that last year's just general health and healthcare environment is going to come back with an unfortunate vengeance, and we need to prepare for that. And we need to make sure that we're doing our part, whether it's a navigation and advocacy company or an employer, or even the underlying member, to say, what did I forgo over the last 15 months? And what do I have to do to get back to equilibrium?
Charles Rhyee:
Yeah. And unfortunately, we're probably going to see that. As you think about it then, where do you envision Rightway's platform expanding going forward then to meet that challenge?
Jordan Feldman:
Yeah. So the first thing we did, and this probably accelerated that adoption, was to build in-house telemedicine. We saw telemedicine experiences over the last 15 months and they were inadequate. They were either triaged by a Rightway navigation platform, and it was almost like you were getting thrown over the fence. You'd show up for your telemedicine visit and they would have no context, no history on you, you'd do that transactional triage. And then you were thrown back over to the fence for a good luck with what's next. And we looked at that and we said, that's not the future of virtual care. That's not the future of telemedicine. Telemedicine needs to be connected longitudinally to the broader care continuum. So while we don't want to be a telemedicine company, we believe that telemedicine is a critical feature of navigation.
And that's because that linkage between member coming to our funnel, us saying that the appropriate triage is to telemedicine, but the universe of options after that telemedicine visit, is extensive. And that's where we can have the warm handoff back to your navigator, understanding the history bidirectionally, going in for the visit, our telemedicine doc knew was going on, and then going out of the visit, our navigator knew what was discussed. So now all of a sudden we can really deliver this linkage between navigation and telemedicine that hasn't historically been done. And you've seen some M&A activity with a similar thesis around this. But that's where we want it to start. Now, an additional massive effort for us has obviously been in the pharmacy benefit space, where we see a big opportunity around member experience and in total cost of care. So I'd say those have been the two biggest initiatives, but we have some pretty exciting stuff on the horizon as well.
Charles Rhyee:
Yeah, does that suggest an eventual evolution into more or less virtual primary care? You're helping people find the care they need and then help triage them, but maybe start then building a real longitudinal relationship, not just in their advocacy, but also in their care itself?
Jordan Feldman:
I think that's right. I mean, I think the relationship between members and primary care providers is at an inflection point, and is that going to be done in person? Is that going to be virtual? Is that going to be through care navigation? When I realized... And I've told this story a few times, when I realized that telemedicine was here to stay and that people were starting to get comfortable around telemedicine, it wasn't because I saw a bunch of consumer adoption or people saying, "I'd love to do a telemedicine visit." It was my dad, sometime in the middle of April, who's never done a telemedicine... Never delivered a telemedicine visit in his life. And here he was getting wired and plugged in and ready for a whole different type of experience. And after about a day or two, and then a month or two, and then a year, he said, "You know what? This is viable. I can deliver the value that I deliver."
And he's a preventative cardiologist. So I would argue for his population, he essentially serves as that primary care doc, but it wasn't so much the member saying that I'm going to interact with my PCP virtually. It was the provider saying, you know what, this makes all the sense in the world. I don't have to be 30 minutes late to each visit. I don't have to deal with all of the headaches and hassles of potentially being in an office. And I can just cycle through my patient load, spend more time with them. So I actually think this is coming from two different dimensions. It's employees saying, I don't want to wait an hour in the waiting room. And it's actually providers saying, I could get used to this.
So as it relates to Rightway, yes, do we want to hand the PCPs on site to be able to own that virtual primary care relationship? Absolutely. But we also know that there's a lot of great providers and PCPs that don't need to be a part of our formalized ecosystem to deliver great virtual primary care. So in the case where it's not happening with the Rightway provider, we want to make sure that we're enabling that underlying member, if my dad is their PCP, to get to him to be able to have that visit. So I think it's definitely something we're considering, but I don't think that we want to limit the universe of who members can go to for their PCP, by just saying it has to be a Rightway network provider. There's lots of other great docs out there.
Charles Rhyee:
Right. And this has all been great. And I think we're coming up on time. So maybe just to end with perhaps, five years from now, what do you think the world looks like? Obviously, you're very positive on the outlook for virtual care and where digital health is today. If you think about particularly advocacy and navigation, what do you think it looks like a few years from now?
Jordan Feldman:
Yeah. So, look, biased, but I very much think we're in the early innings of a navigation and advocacy, and even consumerism more broadly. I think it was already happening in the background as employees started to have more information, more choices, more financial accountability then they've ever had. But in a post COVID world, I think it's only going to accelerate that reality. So I think what employers and employees are looking for, are the centralized comprehensive platform around all of this, and we're seeing this with broker consultants, we're seeing this with TPAs, with coalitions, they're trying to pull all this stuff together. They're trying to say, Hey, you don't need this menu of choices, but we're going to curate the prefix if you will, and tell you what the best options are for a comprehensive delivery around member experience and managing cost of care.
So I think, whether it's consolidation with some of these players are just brokers saying, you know what, we're going to be the ones to pull this all together, I think we're going to see a lot more than that. And I fundamentally believe that navigation and advocacy is going to be that hub of the wheel to really make this all happen. So very bullish on where I see navigation and advocacy going, and I think navigation and advocacy will evolve by supporting, longitudinally, medical and pharmacy. And I think that's where historically it's been lacking. The pharmacy experience has been virtually impossible to impact in a consumer friendly way. And that's really where we're starting to focus on to make sure that the entire continuum is supported, not just a single medical piece of it.
Charles Rhyee:
That's great. Jordan, really thanks for joining us today. I really enjoyed this conversation and I think you made a lot of great points. And we'll look forward to seeing how Rightway progresses over the years to come and wish you all the best and hopefully you'll come back and give us an update sometime down the road.
Jordan Feldman:
Absolutely, Charles. Really enjoyed the conversation and look forward to being back with you soon.
Charles Rhyee:
Great. Thank you everyone.
Speaker 1:
Thanks for joining us. Stay tuned for the next episode of Cowen Insights.

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