Sales FAQ Flashcards
Garner vs. Care Navigation Tools
What makes Garner different:
Focus on provider performance (bottom-up approach)
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Engagement: Drive by our financial incentives
-45% average with Garner
-5% average with care navigation tools b/c no clear incentive to engage
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Member experience: Garner helps with directory, finding appointments, and talking through care issues
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Main Takeaway: Combo of all three is a truly unique product
Garner vs. Embold
Data
-Garner has 4x-5x more data (mulit-payer claims dataset)
-Embold gets most of their data from the Blues, locked into set of commercial payer
Episodes of care
-Embold still using episode groups
-Do have a few quality metrics
Implementation
-Embold causes disruption, creates physician network
-Garner works with existing plans and carriers
Garner vs. Healthcare Bluebook
Data
-HBB only looks at CMS data (Medicare and Medicaid), not as relevant to employers
-Garner looks at commercial data too
Incentive
HBB cuts member check if they engage in middle of episode of care, light incentive
-Ex: Use HBB to find cheapest MRI, they will cover portion
-Issue: people don’t engage in middle of episode of care
Care Navigation apps like: Castlight/Rightway/Alight
-Can augment vendors you have to work with Garner
-However, recommend you don’t deploy Garner alongside CNA b/c creates confusing employee experience
-When we deploy, employers realize: “Bought this thing 5 or 10 years ago, not getting the engagement or the savings I thought it would, so let’s replace with Garner”
Telephonic Concierge Services (e.g. Accolade or Quantum)
-Ton of groups that deploy some type of Accolade or Quantum alongside Garner
-They handle other functions of health plan that Garner doesn’t: member ID cards, dealing with things at prior authorization
-Garner can make our search results available to concierge teams at A or Q
-Some get tired of high PEPM cost, will use Garner to replace those programs, but not required to make Garner work
A Standard HRA - How does Garner work with this?
Most employers decide to replace existing HRA with Garner
-You can do both, but we don’t recommend it
-Creates confusing member experience
(I have this HRA over here, and then I also have Garner but I need to engage first)
-When replaced, employers can offer HRA usually 2x-4x richer
-while getting cost savings on the backend (claims reduction, plan buydown)
Centers of Excellence / Bundled Payments
Can embed those programs right into our search results
-Ex: Surgery Plus program: member searches “bariatric surgery”, in search tell member they have access to COE program
-However, Garner can help find high quality, low cost options in existing local market rather than paying additional fees with these solutions, and pull them out
Point Solutions
Currently have 60+ point solutions mapped out inside Garners platform
-Can make them show up in our search results
-Ex: Mental health solution - “stress” or “anxiety” bring it up in search bar, link right out to vendor
Other examples: Musculoskeletal, cardiometabolic, telemedicine
-Benefits of Garner: Some seen doubling of use in point solutions just by layering Garner on
What’s the difference between Garner and a tiered network?
Data:
-Garner has 4x-5x more data, and we use bottom-up approach
-Tiered networks: old analytics, have high constraints from state regulators, and hospitals really won’t let them evolve how they use data
-B/c: Most expensive, frankly lowest-quality hospitals have such good negotiating leverage for all the BUCA’s they can require that their facilities be ranked at Tier 1
-Garner doesn’t have those conflict
Plan Design & Engagement:
-Tiered networks are messy for employees
-Tier 1 doctor might refer someone to a Tier 2 hospital and member is left with huge bill, doesn’t get benefit of program
-Garner works with existing plans, really easy for employees to use
What do the carriers think of you?
-Good relationships with vast majority of health plans across the country
-Have claims feeds set up with most of the large BUCA’s/large regional plans too
Carriers are starting to push Garner to FI book because:
-health plans have constraints on physician ranking
-View Garner as way to improve underwriting margins without breaking eggs
What do Top Providers think of you? Do you have any relationship with them?
-Garner doesn’t have direct contact or preferred relationship with TP’s
-We do call the majority routinely to validate appointment availability
-Most TP’s know we exist, but we have no direct relationship beyond that
What do providers think of you?
Don’t have direct relationship with clients
* * * * * 1. 1. * * -Wehz
Does Garner factor in hospital performance into rankings?
We believe facility and facility cost matter
We include hospital performance in:
1. cost-per procedure
2. health outcomes (Ex: infection rate) into our rankings
Ex:
-Garner factors in where a doc performs surgery into overall view
-Ex: When doc changes practice from high-cost, low quality hospital to a low-cost high-quality hospital, our view on that physicians will change
-When doctors split between 2 hospitals, we take a weighted average
What is the composition of your data?
-Commercial: 50%
-Medicare: 40%
-Medicaid and other payer types: 10%
Why does having Medicare data help you assess patients in a commercial population?
We go rule by rule, apply it where it’s relevant and exclude it where it’s not
Look at CMS dataset of 70-75 year olds helps us understand how doctors treat patients between 50-60 in commercial population
However, won’t use CMS data to understand:
-pediatrics
-maternity care
-sports medicine (most patients 30-40)
-many other things
