Primary Concerns: Centivo Stresses Team Building For Consumer-First Healthcare

Healthcare is top of mind, of course, amid the pandemic. And it’s also a given that a robust healthcare plan would be a drawing card for employers in gaining and retaining employees. Both of these dynamics are in motion as the new year starts to play out. But so is another dynamic: the traditional healthcare model is broken.

In an interview with PYMNTS, Alan Cohen, chief product officer of Centivo, accepted that assessment. But as an executive and author that has had a front seat to healthcare’s evolution over the past five years, he has ideas and created new concepts for healthcare, including his current approach, which says that a team-based approach can provide a continuum of care as self-insured employers seek to make health care affordable — and accessible.  In general terms, the Centivo model makes it possible for employers to embrace a self-insured option in providing healthcare. The company has claimed that this model helps save the employers 15 percent over the cost of traditional healthcare, and where employees do not pay deductibles.

As Cohen told PYMNTS: “I don’t think it’s a surprise to anyone there’s general dissatisfaction in what both employers and employees get from (current insurance providers). It’s been historically dissatisfying.”

Part of the solution, at least as defined by Centivo: “We decided to start a company that would compete with the health plans out there.”

That competition comes against a backdrop where, as Cohen noted, the gamut of Americans — all the way up to even successful, gainfully employed professionals, cannot afford healthcare.

“Their deductible is so high and their cost share is so significant that they simply can’t afford to access the healthcare system,” Cohen said. “And there’s great research out there that shows people in these high deductible plans, especially people who are lower-income brackets, avoid care. In some cases, they don’t stick to their medication regimens. And they really feel like they don’t even have health insurance.”

Centivo, he said, is designed with the consumer in mind. It addresses the individual living paycheck to paycheck, slowly building savings. Yet a single significant medical event can rock even the best laid financial plans, often sending them into bankruptcy. Juggling a $5,000 deductible, annually — before any co-coverage kicks in — is a financial hardship in and of itself. That challenge is thrown in even greater stark relief when viewed against the 100-year storm that is the pandemic.

In terms of mechanics, Centivo administers the claims for self-insured employers (who save money on premium taxes) and the employer themselves fund the claims. Cohen noted that 84 percent of companies with more than 500 employees — and 100 percent of companies with more than 5,000 employees, self-insure. Incentives are in place — along with deductible-free healthcare — if patients follow treatment plans coordinated by their primary physicians.

“It’s simply a way to reduce the cost of health coverage because they’re not paying taxes and they don’t have to accord to the state mandates,” said Cohen. And, he added, for an employer, “free primary care is the best return on investment you will ever have. Because if people are connected to primary care providers it will make them happier, healthier and will reduce costs over time.”

But, with a nod to the current healthcare system itself — insofar as the delivery of care is concerned —  “We certainly are under great stress in certain parts of the country with hospital beds,” he said, “where hospital beds are kind of running out; where pop-up hospitals are being created in parking lots.”

Building The Network

But the takeaway is that there is more than a need for more hospital beds. There are also stressors on the provider side of the healthcare equation, according to Cohen. The model of primary care — where one doctor, one point of contact, is the one person who knows everything about a patient — is anachronistic.

There has been a number of approaches seeking to streamline and improve care. But even the best-funded initiatives from marquee firms can fail. Witness the recent unraveling of Haven, the joint effort between Walmart, Amazon and Berkshire Hathaway. One reason for the unraveling, said Cohen might be tied to the fact that, in general, firms are unwilling to cede control of the process.

Amid its own efforts, he said, Centivo strives to build what Cohen termed “networks around primary care providers” — through the company’s patient care center.

“It’s a team approach,” explained Cohen, “with a group of clinicians and a group of nonclinical people,” spanning physicians, nurse practitioners and health coaches — a gamut of coordinated care.

The patient is part of the team, said Cohen, where the model is scalable, and coordination of care can deal with even Black Swan events (like the coronavirus).

Stew Leonard’s, a family-owned and operated farm-fresh food store chain with seven locations in Connecticut, New York and New Jersey, moved to Centivo in 2020. “The focus on primary care and quality, as well as their nimbleness, is what drew us to Centivo,” said Karen Mazako, vice president of human resources at Stew Leonard’s. “Our team members love the predictable costs with copays instead of deductibles and coinsurance, and I love having a partner working right alongside us to improve outcomes.”

Centivo said last month that it had raised $34 million in a funding round.  Cohen noted that the money raised will be earmarked for product and tech development — particularly provider facing technology while expanding its client company roster and provider base.  The company has been focused on the New York metropolitan area, southern California and Florida.  The company will also expand its footprint to other metropolitan U.S. locations.