The Stretch – The Health Plan of Tomorrow

Kevin Fyock:

Today, we're going to talk about the way health care is delivered and received. Specifically, we’re going to dig into the evolution of virtual care and how these advancements are making way for a modern health plan that is built on a hybrid model.

It is common to associate the term virtual care with what was originally branded as telehealth, decades old alternative to in-person urgent care for simple issues. A minor sinus infection, or a case of pink eye. In this episode, we'll explore how, in reality, virtual care has evolved and expanded to a point where we'd say, over the next decade, it will be a foundational element to how care is delivered and how health plans and health plan designs will modernize.

It is increasingly clear that the future of care is hybrid. I am so excited to welcome Matt Cook, Chief Commercial Officer at Firefly Health to join us today. Welcome, Matt. Would love you to introduce yourself.

Matt Cook:
Thanks, Kevin. It's great to be here. So, my name is Matt Cook. I am the Chief Commercial Officer at Firefly Health. I just passed the year mark. So very exciting. And, you know, looking back at my career, everything that I've done has been at the intersection of virtual and health, whether that's in-home lab services, working at a virtual diabetes management company, so on so forth, and actually started my career in the benefits consulting space. I won't say which firm so, but that is where I started.

Kevin Fyock:
Well, you know, the timeliness of our topic today, you know, couldn't be more important. The U.S. is facing systemic issues that I think have created so many barriers to accessing and receiving and really staying engaged with care. No matter where you look, you open the newspaper, you read on the Internet about provider shortages and burnout.

You know, would love your perspective around how virtual care could help to address some of these barriers, maybe even from some of your own experience as well.

Matt Cook:
Yeah, not only is it timely, I think at a macro level, it is at a micro level. About a month ago, I had an emergency appendectomy, and it was a classic case of, you know, I'm busy and I've got a young family and I wasn't feeling great.

And, you know, old Matt without the technological advances probably would have sat on it for a while and would it all be fine. And then all of a sudden, you know, bad things would happen. And I would have been in the E. R. In this case, I was able to use what we'll get into virtual care and kind of solve the problem quickly.

But I think at a macro level, like it's here and I think it's here from every angle. The provider side, their shortages, more and more difficult to manage the vast array of conditions people are dealing with today on the employer or the plan sponsor side, continued rising costs. And then on the member side, we want things differently than we've ever wanted or, or the, you know, the patient side, the individual side.

So there's this nice coalescing, I think of parties here that are saying we need something to solve these problems.

Kevin Fyock
Yeah, that's fantastic. And I'm excited to get into it with you. I also think we're kindred spirits. I had an appendectomy when I was a kid. This was boy, it was certainly pre virtual care. It likely was even pre internet.

And I'm sure our experiences were a little bit different. So that's interesting that we share that. So, okay, let's make sure our audience and the two of us can get on the same page. You know, I'd love to dig into throughout this, you know, series of questions that I wanted to ask you around sort of what is virtual care, what is not. And maybe we can first start with, Matt, your perspective around who tends to use virtual care aside, of course, from, you know, folks who have an emergency upcoming appendectomy, but who uses virtual care in its current form.

Matt Cook:
We'll probably get in more and more as to like, what is the definition of this? And I think it's evolved over time, but I think our perspective, my perspective right now is that more and more people are using virtual care beyond, like you mentioned, just those emergent one off, I need to take care of something immediately issues.

What we're seeing at Firefly, members, individuals in their early to mid forties. They're dealing with multiple chronic conditions. You know, they really don't have the time and the luxury to go kind of take care of themselves. And I would say what's really interesting in the insight that we found is I just shared some demographics, but our perspective is that this isn't a demographic kind of issue or challenge. It's actually a psychographic one. And I think what we mean by that is, you know, you basically have different types of individuals who demographically don't look the same or feel the same, but have the same challenge, whether that's the frontline worker or the high-level executive, what we are seeing is that people want affordability and convenience, and that might mean they really can't afford it financially, and it really is inconvenient, or it means they don't have the time, and they really can't break away from work to go down to the office to get the care they need only to wait in the office and get 15 minutes and then hope that it gets better.

So it's really spanning all demographics, I think, at this point, and it really is coming down to convenience and affordability is what we're seeing.

Kevin Fyock:
I love the analogy of the company made around psychographic versus demographic because I think a lot of the listeners I'm assuming would think, okay, virtual care, ingestion of technology, likely gravitate towards, you know, tech savvy and potentially even younger populations. But you're saying it doesn't necessarily trend that way from a demographic perspective.

Matt Cook:
No. And I think that is the most common question we get from employers and others we're talking to is, “Hey, well, this seems to skew towards the population you just described. And it's really interesting looking at it at that psychographic level. It's also a little bit visceral in that regard, right? Like, you know, we all value our time. We all want things to be affordable, convenient, accessible. So, it's kind of a little surprising when you look at it that way.

Kevin Fyock:
Oh, that's interesting.

So you alluded to, Matt, this idea that, you know, virtual care is an evolving trend and evolving machine, right? So, what predominant model from your perspective is, you know, really started to take shape?

Matt Cook:
Yeah. So when I started, you know, my career, oh so many years ago, it really was the emergence of what was called telemedicine. And I was reflecting as we were getting ready to talk, I was reflecting on like literally telephone is half of that conversation and our kids don't know kind of what the traditional telephone even looks like anymore. So inherently, like we started this whole move on a really kind of archaic model and a little bit of a flawed model itself.

It's not like the model of care change. It was just the modality of care change. And I think we kind of started from that perspective and hey, it was a great start. And I remember talking a lot to early groups and employers and others about, hey, this is happening. It's a good thing. I think what we've found is it can work in certain situations, this historical traditional telemedicine urgent care model.

But at a broad scale, it really doesn't. And it potentially adds costs if you look at the literature. And so from our perspective, the evolution kind of to V2 became, well, what if we put together more comprehensive models, primary care, behavioral health embedded, you know, nurse practitioners to support throughout that experience.

So you can deliver more longitudinal care, and it helps you actually create a hybrid model like that word you used earlier. I really liked that. How do you create a hybrid model so you can actually get people to the care that they need ongoing? And then I think we have a sense that the direction of that becomes a little more full stack over time where you can actually combine the virtual care with the administration of an actual medical plan as well. And that's something I'm really excited to talk about.

Kevin Fyock:
That's great. Matt, you're absolutely right. My children still don't know what a telephone is. They think all telephone calls are video in nature. So, don't even know how to hold it up to their ear. So, I'm glad they're around for the ride of these models taking shape.

You know, we talked about hybrid care. We talked about sort of what model is sort of evolving. Is it fair to say, Matt, that virtual care and primary care need each other?

Matt Cook:
I think so. You talked about the shortage. So, we could, we could start there and the numbers are staggering and they're not surprising.

We have to figure out how to scale the primary care interaction. And there's ways to do that, you know, outside of technology, we can, you know, level up nurses, practice at the top of our license. But at the end of the day, that doesn't close the gap. And so just like in every other industry, technology has the ability to scale. My perspective, I think in seeing how it's rolling out, okay, is that the average provider, unfortunately, is not fully financially aligned with a plan sponsor in today's system so we can solve the shortage, but we also need to be thinking about how can we solve the financial disconnect as well? And what I mean by that is, you know, you go to a primary care provider today, they're not going to know who your employer is or who your plan sponsor is. And they're not going to be thinking about how do I ensure that I'm, you know, thinking about that perspective. They're doing great work and they're trying to, you know, help that member, that patient the best they can, but it's a challenge.

I think technology can help scale, but it can also help drive better alignment of incentives going forward.

Kevin Fyock:
That's great. So they absolutely do need each other. They function. If I would paraphrase what you said, Matt, sort of they function maybe more efficiently when they're working together, sort of across this, I love what you said, sort of longitudinal care spectrum. That's awesome. So thanks for sharing that.

Now, what about those going back to psychographic rather than demographic? How about the population and I don't know if we can necessarily size it, but the population who's not using virtual care, why aren't they using it? Are there biases that folks have against virtual care?

Matt Cook:
There are for sure. And I think, you know, you think of a distribution curve. You know, it's pretty straightforward that it follows that type of math, right? There's 20 percent of people out there who they've been going to primary care and that local family provider for past 20 or 30 years, and they're getting what they need.

And there's really no reason for them in their minds to say, I'm going to, you know, consider something different. The other side of that curve, I think there's 20 percent of people who are like, I want this yesterday. I can't believe that this is the way that it's always been. I need something different.

The real interesting question is the middle 60. I think it's been really enlightening to see that we've talked to a lot of people who are like, yeah, I have a primary care provider, but they're not like so attached to their primary care provider that they wouldn't consider something different. But what that different thing needs to be is convenient and accessible and meeting that person's needs, just like many other products and how people shop for them.

So there will be a continued transition for people who say, you know, I don't necessarily want to be the first mover here or I'm set with what I have today. But like many other things, I think it will, you know, evolve over time pretty quickly actually is I think the expectation.

Kevin Fyock:
And again to sort of stress, but you mentioned before, it sounds like hybrid really is, is key to this, right? So as we're thinking about the populations that might have some level of reticence to move down them and, you know. It's interesting, too, Matt, that it seems like not just virtual care, but even as we think about any type of, you know, new models or emergence of technology. In the early stages, our minds as humans always try to define what it is, what it is not, and not necessarily relying on data.

Is it fair to say, from your perspective, that this has kind of happened with virtual care as well? You know, that there was a swath of folks that just assumed it was low quality and only useful to young people, but as we're sort of discussing, it sounds like neither of those things are true. Would you agree with that?

Matt Cook:
I would. I think it really ties to like, what is the baseline perspective of an individual and to how they get their care today? When you said outed it, it sparked this little anecdote that we've heard where a lot of people, when they've gone in for their visits, historically, there’s a peace of mind element to what they're doing that doesn't actually have any like significant clinical impact, but makes them feel good.

And so, you know, if you've gone in for your annual physical, like they'll take the little gavel thing and they'll, you'll bang your knee and you'll be like, okay, my knee still works. You know, like. Your knee is fine, and it will be fine even if you didn't go in and have it bang, but you're like, okay, I feel better.

And I think that's part of the challenge or the mountain that people will have to overcome to understand like those things feel like they might help you. And I don't want to, you know, say it's not something that we feel, but it doesn't actually move the needle. And so I think as the migration starts to happen, as people are moving, they're going to say, I'm actually getting everything that like I actually need. Without having this like historical, this is what it needs to look like in order to get it.

In many ways, that's where even the concept of primary care has connotations of what it should be. And then when we at Firefly talk about the fact that your primary care provider will text you asynchronously every time you interact with them and, oh, there's actually a behavioral health specialist that's also working with that provider, all of a sudden say, okay, this is a lot more than what I'm actually getting. And I was worried that I wasn't going to get enough of what I already had. If that makes sense.

Kevin Fyock:
Yeah, that's great. And I would love to get into in just a moment, Firefly and sort of what you're all doing. So, you've alluded to some of that. So, I'm excited to hear about it.

Let's take an employer that hasn't sort of dove, you know, into virtual care. Can you walk us through what does the migration look like from so maybe current state and organization that hasn't dived into, you know, hybrid care, virtual care. What is the experience like? What's sort of the process that they go through?

Matt Cook:
I think education is a huge part of the opportunity that these employers have.

How do you talk about the things that you and I are talking about right now to assuage some of those concerns, questions around that population? At this point, if an employer hasn't, you know, kind of dabbled in any level of virtual care, there's probably a good reason why. And that probably ties to their population and what their population expects.

So, I do think the education on the front end becomes really, really important. I also think that providing a level of choice with that is important too. Meaning when you enter into the space, you can say, hey, you know, feel free to try this. It may not be for everybody. We're not forcing the move and all of a sudden I think people naturally adopt because it is ultimately a better, more convenient, accessible model regardless of the type of virtual care being provided.

So, it really does start on the front end and then I think the opportunity is to kind of tweak the experience or figure out what are the right solutions to put in place to continue to build on that momentum over time, but it will take time for sure.

Kevin Fyock:
Matt, I love that and this idea of convenience. I think we've seen across consumers, especially as the emergence of different sort of technology tools and models over the past dozen or so years, you know, really puts the consumer in the driver's seat, right?

Matt Cook:
It does. And, you know, I was thinking of an analogy of the day for me personally. When Rideshare started, you know, 15 or so years ago, it reminds me a little bit of where we are now. I remember when Uber and Lyft launched, I was living in the Bay Area, but I would travel a lot for work. And, you know, I had my taxi routine down pat, like, I had this service that I would call and they would get me home and it worked well for me.

So, you know, as those solutions came into play, I wasn't the first adopter. I was really good with my routine. I didn't feel an urge to switch, but of course I would continue to hear and see about Uber and Lyft. And I saw those pink mustaches on the cars all that time ago. And I saw that it was becoming more popular.

And there was one time I had this really long flight and I got back to the Bay Area and I used my service. And, you know, because of the way the taxi service worked, it was late to pick me up, and then they took the wrong route home, and there was this harrowing kind of safety incident I went through, and basically it doubled my ride time home, and I said, all right, maybe now is the time for me to consider something different, and I gave Uber a try, and 13 or so years later, like I haven't gone back since.

And so as I think about the analogy here and you know, where are people and why do people move or not move? I think my experience was that, you know, people, when they think about the taxi experience, like a taxi can get you to point A to point B, just like a ride share service can, but the convenience of my time, knowing that I can get the ride share at the click of a button, I know when it's coming. I have the peace of mind that once I'm in the vehicle, I can get from point A to point B without worrying about, does the driver kind of know where they're going? It just became very clear in retrospect, like, why did I ever wait?

But I think that's exactly a lot of what people feel today. We do that for a taxi service. Our health is, of course, way more important. And so I can understand why people want to kind of take time to get there, but ultimately, I think people will realize this is going to be the more convenient model, and they won't look back once they do.

Kevin Fyock:
And like so many other trends within benefits, it's about meeting the member where they are right and finding them on that evolution, whether it's a technology evolution or a convenience or an efficiency evolution, but allowing them the right modalities to, you know, allow them to interface with the health care ecosystem in the way that they find most convenient for them.

Matt Cook:
And I think what makes health care challenging is the individual, the employee, you know, they have needs as call it a consumer of health, but they are reliant on their employer to basically be the intermediary to secure those services more often than not.

So, you know, I think HR buyers and benefits folks can can look at their as they do their employees as these consumers of health and say, what are the products? What are the solutions that they need? And, you know, it's been interesting. We have thousands of quotes and stories from our patients, our members.

One of the most often ones we hear is, “I had a little trepidation as I started to move into this model,” or “I wanted to try it and see how it worked. And now that I have, like, I can't believe I ever thought that there was a different way to do this.” And so it's been exciting to see that in real time.

Kevin Fyock:
So let's go back to your comments around Firefly and to give you an opportunity for you to tell the listeners, what's your team doing at Firefly? And based on the framework that we sort of set out, we've talked about these different models and the emergence of these different models and where employers and the market's gravitating. How does your model fit into this framework?

Matt Cook:
Yeah, so, you know, Firefly, we started a number of years ago, primary care docs actually founded Firefly on the premise of what we've been talking about, that there's going to be shortages, you deliver great care virtually.

And so, we really been building this virtual primary care model. The model itself is more of a care team approach. It is primary care provider. You know, NPRN, behavioral health embedded, and then we have member guides and navigators to help you really navigate the system. You know, I think there's some great things that we've been able to do that are different than, you know, I think how the historical primary care practice might work.

You know, the easy example, probably topical would be because we're working with employers and plan sponsors, we not only have alignment with the member to deliver great care, we have alignment with the sponsor to support the financial implications of the care we deliver. GLP1s would be a great example of that.

I think I saw a stat the other day that about 93 percent of fee-for-service primary care physicians are prescribing GLP-1s today. Now, Firefly will prescribe a GLP-1 if it's really the right thing to do for the member, but because we're thinking about multiple factors here, we have, you know, folks that can help make sure that there are steps you can take before you go all the way to that end state, whether we're going to help you with a nutrition program or help you with an exercise program with that broader care team.

And in that regard, you know, we're seeing lower utilization of GLPs than the average primary care provider would. So, there's a lot that we've done in our model. And then I want to pause and we can talk a little bit about where has it evolved and where are we going next, because there's been this really interesting breaking or insight point for us in the last two, three years or so that has been really exciting for us.

Kevin Fyock:
Yeah, that's great. And maybe Matt, why don't you touch on the evolution? I have, I do have one question that I would love to sort of end on around sort of asking you to think into the future, but maybe you can touch on what you just mentioned around sort of that evolution. And I love the example too, of you know, the GLP, you know, market. It seems like every single conversation that we're involved in, in health and benefits that comes up. And so that was a really interesting take about sort of being able to follow the member and have a more holistic conversation rather than just jumping to the pharmaceutical.

Matt Cook:
Yeah. So, I've been using a phrase, don't hate the player, hate the game a lot lately. And you know, the idea behind it is like, I just want to take a step back, like if you assess what ”the game” is right, regardless of how we all feel about it financials incentives are not aligned. So, you know, traditional brick-and-mortar providers in a fee for service world, they're trying to deliver the best care that they can, but there's also some other pieces at play.

I think one of the questions I commonly ask employers when I'm talking to them is, you know, a primary care physician today, if they needed to make a referral, where would they refer? And the top two reasons for referral today are well, it's somebody that they know and like golf with or, you know, know socially or went to med school with, or it's somebody that they practice at the same system, health system with.

And you've probably seen that a lot of systems and even payers are gobbling up primary care practices just like milk in the grocery store. They are using them to become the entry point into higher cost care. Now, you know, I don't want to say that people are doing negative things and harming members, you know. I think our patients they're doing the right things that they see, but they're going to be more liberal in the use of that, “Hey, here's the medication. Good luck.” Or, “Let's just get you to back surgery.” And we've seen a lot of MSK solutions arise saying, “Hey, there's a lot of things you can do before you get to that point.”

I think what Firefly has seen is we deliver really great primary care, our members start to trust us. Well, what happens when we do need to in this hybrid model refer back to brick and mortar care? What does that look like? What does that feel like? And so what we've really done is we've built behind the scenes for us technology that allows us to refer to high quality, cost efficient providers when we do need to make a referral, whether that's a cardiologist or otherwise. And what happens as a result is we can drive unit cost savings, right? We can get a member, an individual to the right provider at the right time.

And once we realized that we said, well, why aren't we just taking on the full premium dollar? Why aren't we just taking on the risk of saying, let us own the member experience from top to bottom. They will like it because it feels like this really convenient, you know, kind of experience. Firefly is taking care of every element of my healthcare experience. And it aligns us financially to not only manage the preventative primary care, but to manage everything that happens downstream and in between. And so we did launch our own health plan product. So think of it as a virtual-first health plan where a member during open enrollment, they have their traditional plans. They can sign up for the firefly plan, and when they sign up for the plan, they're also signing up and selecting their dedicated primary care team along the way, and we can get into the impact of that. But I think, you know, our evolution where we see this going is more towards that full stack ownership of the member and of the financials associated with that.

Kevin Fyock:
Full stack for the member, and I would imagine for the member to a level of efficiency and simplicity too, right? Rather than having to go to a multitude of places.

Matt Cook:
You know, medical home is a common term that we've seen kind of the manifestation of. To your point, when a member comes to our care team, they might ask a question like, you know, “I don't feel good. I need help or I have something going on. I have diabetes and I've had some flare ups,” whatever it may be. But they also might be like, “Hey, you know, I want to talk to a provider. I need to go see this. I saw an advertisement for this medication. Are these providers and network?” Like, they can come to one place and on the Firefly and the way we built the technology is, our entire care team sees those interactions. And then we can triage if it's a primary care related need, let's have our PCP engage. If it's a referral need and helping, you know, scheduling the appointment, one of our member guides can do that on behalf of the member.

So a lot of different ways for us to control and manage the experience for the member. And it's value add for them. And I think that's super, super important. This isn't restrictive. It's not an HMO style product. It, the member retains all their choice. But when it's convenient and you trust your team, you're going to really follow the guidance that we provide. And that's exactly what we're seeing.

Kevin Fyock:
Sure. Yeah, that's great. So Matt, I love the overview of Firefly and what you all have done and will continue to do. I think employers, no matter what sort of benefits realm they're looking at, always struggle with how they're going to evaluate new and newer solutions.

So, I'd love your perspective, you know, specific to hybrid care, virtual care, uh, virtual-first health plans. What does that evolution look like and how do you help prospective clients sort of think through that?

Matt Cook:
I think the first thing I would say is, you know, having been in this space for a while, like, I genuinely believe that a rising tide raises all boats.

So, really, I am supportive of any one or any company that's trying to do something different. That's trying to move things forward. Relative to, you know, some of the things that just haven't worked in the past. And we've been dealing with these double-digit style cost increases here, or, you know, at least high single digits for a while now. So, kudos to everyone kind of getting engaged in this.

I think my perspective on what the employer needs to look for is this balance between how do you make this something that your members, your employees, actually want to use? How do you make it convenient for them? Like, what are the pieces of the puzzle that do that while you try to balance the affordability question.

And so I'll just give you one quick example of something an employer could look for. How much onus are you putting on your employee to search and seek out the right levels of care? From our perspective, from the Firefly model, when we have that dedicated team that is in your pocket 24/7, you know, we are always one click away from saying whatever your need is, like I talked about earlier, you can come to Firefly. And we have the full context on who you are as a person, who you are clinically, and who you are as part of our health plan experience. We have that 360 view.

In other models, I think the challenge is maybe it's a navigation-led model or a plan design kind of variable co-pay model. You know, when you don't deliver the virtual care on top of that plan experience, you do put a little bit of the onus on the employee to have to figure out where to go and how to shop.

I think there's been these, you know, models that have existed for a while now around if we just gave members, individuals, the information around cost and quality, they'll make the right decision. I don't think that's the case. So, when you think about virtual care, when you think about virtual-first plans, you know, what you should think about is, is there a convenient way for my employees to engage with the care team, to engage with folks that can guide them through the process? And how do I deliver against that so that the onus is not on them to figure it out themselves?

Kevin Fyock:
I think that makes so much sense, Matt. And I, you know, it seems like convenience continues to come up in our conversation today, but I love sort of the measure that you mentioned there around the amount of effort it takes for an employee, for a member to sort of get to that next step. Sort of like, how much work do they have to spend? And sort of, can Firefly and others find ways to sort of shorten that time to a provider or shorten that time to just make it more convenient? So that's fantastic.

So Matt, maybe we can end on a question that I'd like to ask all of our guests. And if I could ask you to sort of look into your crystal ball. I mean, this has been sort of a fascinating download of one what Firefly is doing and where the market's going around, you know, virtual care, hybrid care, virtual first plans.

But in your mind, what will virtual-first health plans look like, say, 10 years from now?

Matt Cook:
Yeah, you know, I think you have a quick history of, you know, you had the HMOs in the 90s and then you had high deductible plans come into play. You know, I think we feel really strongly. I feel personally that, you know, in the next 10 years, most employers will have a virtual plan option alongside what’s more traditional plans.

And, I think you'll see a real migration, not just of the young tech savvy, but of people, you know, of all walks of life that we talked about. I think you'll see, you know, employers realizing more and more that it's not enough just to kind of try to use network discounts and plan design to move the needle.

This isn't, you know, the cost sharing kind of levers are running out to a degree. Like, employers don't more directly impact care delivery. the costs are just going to continue to explode. And so I do think these plans become the norm. I think employees start to expect these plans. I would mention these are benefits after all.

And so, you know, you want to deliver a benefit to your member. And I think people will be looking for these types of things as they, you know, look for employment or, or stay at current employment moving forward.

Kevin Fyock:
Yeah, Matt, that's great. And that really resonates with me, too, especially with the clients that I speak with. I use the analogy of we all have a pie to work with, and you can shift the pie or you can shrink the pie.

And it sounds like from what you're saying, this is an opportunity to shrink rather than shift the pie. And give an opportunity for greater convenience, greater efficiencies. This was a lot of fun, Matt. I learned a lot and I'm sure our listeners did too. So I just want to thank you for coming on and lending your expertise and giving us an opportunity to ask you a handful of questions.

And to our listeners, thanks so much for tuning in. We hope that you enjoyed “The Health Plan of Tomorrow.” This is Episode 3 of The Stretch, which is a podcast dedicated to the ideas that are revolutionizing the world of workplace health and benefits. If you've enjoyed this episode, we encourage you to subscribe to the podcast and follow us throughout the season.

We hope you'll join us again and enjoy the rest of your day. Thank you.