WMP Project - Competitive Landscape

Part
01
of eleven
Part
01

WMP Competitive Landscape, Part 1

Maven is a leading women’s and family healthcare company that provides end-to-end coverage to women during parenthood. The company partners with employers and health plans to improve maternal outcomes. We have completed the attached spreadsheet with the requested details for each of the companies in this request.

Maven Clinic


Part
02
of eleven
Part
02

WMP Competitive Landscape, Part 2

BabyScripts is the leading virtual care platform for managing obstetrics, Wildflower provides smart connections for customers and healthcare providers, and HeraMed provides pregnancy and fetal HR monitoring at home through its HeraBEAT product. Columns E-G of the attached spreadsheet has been filled with information on the companies.

Wildflower Health

Wildflower is a "100% mission-centered, purpose-driven company". The company helps grow healthy families by making smart connections, right on their mobile device, between customers and their health care services and simplify healthcare for families every day by helping them navigate the health needs of moms, dads, children and elderly parents in one shared mobile app.

Services

Wildflower offers fertility, pregnancy, parenting and pediatrics, and family health navigation healthcare resources.

Partnerships

LifeMap Assurance Company

  • Wildflower partnered with LifeMap Assurance Company to launch the LifeMap Due Date Plus pregnancy app for expectant parents with short-term disability coverage.
  • The app helps in providing LifeMap members with helpful resources, health tips, pregnancy milestone tracking, symptoms monitoring, financial reminders.

Regence

  • Regence partnered with Wildflower Health to launch the BabyWise pregnancy and parenting app.
  • The app provides clinical health milestones, vital maternity resources, health trackers, and reminders for prenatal appointments for Regence members.

BabyScripts

  • Babyscripts is the leading virtual care platform for managing obstetrics. It is the only doctor-administered digital health resource that strengthens the relationship between doctor and patient outside of the clinic's four walls during routine, low-risk maternity treatment.
  • "Babyscripts leverages the full power of technology to elevate the standard of prenatal care".
  • Babyscripts is "the only company that offers a toolkit for tech-enabled prenatal and postpartum care".

Services

  • BabyScript specializes in women healthcare by providing health tools to give providers access to patient data in real-time.

Partnerships

Aetna Better Health of PA

  • BabyScripts partnered with Aetna Better Health of PA in its efforts to expand into the Medicaid market.
  • Through the partnership, participating WellSpan Health members can have access to pregnancy care solutions like remote monitoring and virtual care for high-risk conditions such as postpartum depression, and high blood pressure.

Cone Health

  • Cone Health partnered with BabyScripts to improve access to high-quality pregnancy care solutions by developing new modules.
  • The partnership will provide prenatal care, detection of pregnancy-induced hypertension, gestational diabetes monitoring.

Research Strategy

Findings reveal that HeraMed/HeraBEAT has not yet partnered with any insurance companies. We searched through press releases, media sites, the website of HeraMed and HeraBEAT, and statements by the leadership of the company on its partnerships with insurance companies. On the website of the company, it provided a list of health companies and organizations it has partnered with, and none of them includes insurance companies. Statements from the leadership of the company on its expansion to the U.S. market states that HeraMed plans to foster relationships with key medical organizations and insurance companies and through its partnership with German health consultant company Kinderheldin Gmbh, HeraMed intends to initiate discussions with the company's over 50 insurance partners on the use of HeraMed devices. HeraMed/HeraBEAT has not yet partnered with insurance providers by is making efforts in securing partnerships with insurance organizations.

Part
03
of eleven
Part
03

WMP Competitive Landscape, Part 3

All the requested information that we were able to find about What to Expect, BabyCenter, and Gennev is included in the attached spreadsheet. We were unable to find any partnerships between any of those companies and health insurance companies or payors, as is explained in the Research Strategy section below. In addition to providing the information in the spreadsheet, we also provided our research findings below.

What to Expect

  • What to Expect's value proposition is the following: "What To Expect is the world’s best-known, most trusted pregnancy and parenting brand, helping every parent know what to expect, every step of the way. The What To Expect brand mission drives everything we do, and it's as simple as it is powerful: 'Support happy, healthy pregnancies and happy, healthy babies.'"
  • As a content provider, What to Expect offers information and resources for parents in the areas of pregnancy, first year, toddler, family, baby products, and baby registries. What to Expect offers comprehensive services.
  • The one, recent news headline we found involving the company from within the past year was titled "Here are all the winners of the 2019 Webby Awards." That article from April 2019 announced that What to Expect won a Webby Award for its "Pregnancy Due Date Calculator, Shine."

BabyCenter

  • BabyCenter's value proposition is as follows: "BabyCenter is the world's number one digital parenting resource, with content that reaches more than 100 million people monthly. In the United States, 7 in 10 new and expectant moms online use BabyCenter. Around the globe, BabyCenter content is available in nine different languages, and more than 50 million parents visit BabyCenter's 11 websites every month."
  • As a content provider, BabyCenter offers information and resources for parents in the areas of pregnancy, baby, toddler, preschooler, big kid, health, and gear/products. BabyCenter offers comprehensive services.
  • BabyCenter markets its services direct to consumer.
  • The first, recent news headline we found about the company was titled "Everyday Health Group Acquires BabyCenter, the Leading Global Digital Parenting Resource."
  • The second, recent news headline we found about the company was titled "BabyCenter® Reveals Top Baby Names Of 2019."
  • The third, recent news headline we found about the company was titled "The Most Popular Baby Names In Australia For 2019 Have Been Revealed."

Gennev

  • Gennev's value proposition is the following: "Gennev is the first-of-its-kind online clinic for menopause. Our mission is to help women take control of their health in the second half of life."

1. Article Headlines Within the Past Year

Research Strategy

We looked for, but were unable to find any partnerships between any of the companies (What to Expect, BabyCenter, and Gennev) and health insurance companies or payors. We used three research approaches in looking for that information. First, we conducted broad searches for any articles that might have announced any such partnerships. While we found some articles about partnerships involving the companies (What to Expect, BabyCenter, and Gennev), none pertained to a partnership with a health insurance company or payor. For example, we found a partnership announcement between BabyCenter and Facebook through Cision PRWeb. Since we were unable to identify any applicable partnerships through articles, we next checked company profiles through sources such as StartUp Health and Crunchbase. Those sources only yielded some information about Gennev's partnerships, which included Enzyme Health, Hyster-sisters, Microsoft, Global Women 4 Well-Being, and North American Menopause Society, but none of those are health insurance companies or payors. As a third research approach, we checked the companies' websites, including their online newsrooms, to see if they published partnership lists or articles about partnerships. However, we found no such information about applicable partnerships through the companies' websites. Accordingly, we entered "N/A" in the respective cells within the spreadsheet.
Part
04
of eleven
Part
04

WMP Competitive Landscape, Part 4

The required information for Progyny, WINFertility, and Carrot have been provided in columns B-D, rows 3-8 on the “Fertility” tab of the attached spreadsheet. Progyny, WINFertility, and Carrot specialize in providing fertility services only.

Selected Findings

  • Progyny uses “cutting-edge science and the largest high-quality network of fertility specialists” in the United States to empower people to achieve their dreams of being parents.
  • WINFertility has been delivering the “most effective fertility treatments and family-building solutions” for over 20 years.
  • WINFertility’s health insurance partners include Anthem and Blue Cross & Blue Shield of Rhode Island.
  • Carrot provides flexible coverage that meets the growing demands for fertility benefits of employees located in 40 countries.
  • Carrot has published content on its website, podcast, and social media pages such as Twitter and Facebook to markets its services to employers.

Research Strategy

Examples of Progyny’s and Carrot’s partnerships with health insurance companies or payors are not publicly available. To identify the required information, we first examined content published by Progyny and Carrot. An examination of Progyny’s website, IPO prospectus, and social media pages did not reveal any information related to partnerships with health insurance companies or payors. Similarly, Carrot has not made any announcements about partnerships with health insurance companies or payors on its website and social media pages. A press search also did not provide the required information. The articles examined only talked about Progyny’s IPO-related news, Carrot’s product launches, and other general information.
Part
05
of eleven
Part
05

Competitive Landscape, Part 5

Prelude Fertility, UnIVFy, and Modern Fertility are additional competitors in the women's health services space that offer fertility-related services. Details on these companies are provided in columns E, F, and G; rows 3-8 of the attached spreadsheet.

Prelude Fertility

UnIVFy

Modern Fertility


Research Strategy:

We began this research by looking through the above companies' websites for their value propositions. From the websites, we also extrapolated information on the services they provide. We leveraged information from these companies’ websites, social media sites, press releases, and news articles from media outlets, including Forbes and the New York Times, to determine the marketing strategies and recent news headlines of these three companies. However, we had to extend the scope of our search to include 2017 press release articles to get additional information on the marketing strategies for Prelude Fertility and UnIVFy.

After searching through the news articles, marketing reports, news articles, and the companies' websites, we could not find any information on their partnership with any insurance providers. According to Biospace and MarketWatch, the expansion of Prelude Fertility would lead to access to insurance facilities with the continued proliferation of insurance facilities, which led us to conclude that these companies have not partnered with insurance companies because of their small market shares. Although insurance providers are still not engaging with these fertility-service companies, it is worth noting that venture capitalists are getting more interested in the fertility-services market, with more than $178 million investment having been recorded in the past year, according to PitchBook.
Part
06
of eleven
Part
06

WMP Competitive Landscape, Part 6

Progeny is a neonatal care management service for premature newborns while Keriton is a lactation management app for nursing mothers. Detailed information on the value proposition, marketing, partnerships, product offering, and news coverage for each company has been presented in this spreadsheet.

Progeny

  • Progeny provides comprehensive, evidence-based neonatal care management services for premature and medically complex newborns. Its value proposition includes securing social determinants of health, optimizing savings levers, and ensuring payment integrity.
  • The company markets itself directly to customers (the families of infants), healthcare providers, insurance companies, employers, consultancies and third-party administrators (TPA).
  • It has partnered with Harvard Pilgrim Health Care and Virginia Premier. The services included in both these partnerships include NICU utilization management and case management.
  • Progeny was featured in Smart Business Dealmakers as it entered its 16th year of business in 2019. The article also mentioned Progeny forming a partnership with PE firm Sunstone Partners.

Keriton

  • Keriton Kare is a fully automated lactation management system which is available as a mobile app for both Android and iOS. The company specializes in feeding management, lactation analytics and patient engagement for neonatal ICUs.
  • The product is marketed directly to customers (nursing mothers), NICU nurses, lactation consultants, nurse managers, and IT/IS staff. Its value proposition is the improvement in process efficiency and safety for users and the improved experience for patients and nurses.
  • While Keriton has not published the names of companies that it works with, it has mentioned that two additional hospitals in Philadelphia have partnered with Keriton to train and go-live using its breast milk, donor milk, and formula feeding management platform. The company does not market itself to insurance providers.
  • Recent news coverage include Keriton being featured among the key players in the "IoT Healthcare Market" published by Brige Market Research (News Parent), and winning first place at the inaugural "Improving the patient experience" pitch competition hosted by Ipsos and 1776 DC (Technically).

Research Strategy

We were able to find all the information for Progeny as well as the required details of Keriton except for the names of the companies that it has partnered with. Keriton provides its services to nursing mothers, NICU nurses and lactation consultants, nurse managers, and IT/IS staff. Based on the information on its official website, the company does not directly do business with insurance providers. While it was found that Keriton had recently partnered with two hospitals in Philadelphia, their names have not been published. In addition to the company website, we searched through press articles, news sources and journals such as the Philadelphia Business Journal, Medcity News, Philadelphia magazine, Open PR, PR Newswire, etc. It was clear that the information on partnerships was not made publicly available.




Part
07
of eleven
Part
07

WMP Competitive Landscape, Part 7

The required information for LactApp and MilkStork has been provided in columns D and E, rows 3-8 on the Neonatal Nursing tab of the attached spreadsheet. LactApp specializes in providing breastfeeding and maternity services only while Milk Stock specializes in the shipping of breast milk.

Selected Findings

  • LactApp solves breastfeeding and maternity doubts in an individualized way.
  • LactApp offers "expert, confidential, and customized advice" on breastfeeding and maternity to mothers. The company exclusively focuses on breastfeeding and maternity.
  • LactApp markets itself directly to customers (mothers), healthcare providers, and companies.
  • Milk Stork promises to "make shipping breast milk easy" so that mothers can take care of other businesses. The company also promises to handle shipments with care.
  • Milk Stork offers shipping of breast milk for breastfeeding mothers on business trips. The company helps mothers get their breast milk home safely and quickly. It exclusively focuses on shipping of breast milk.
  • Milk Stork markets itself direct to customers (breastfeeding mothers) and employers.

Research Strategy

We were not able to find LactApp and Milk Stork partnerships with health insurance companies or payors. To identify the required information, we first examined content published by LactApp and Milk Stork. We examined both companies' websites and social media pages. This strategy did not reveal any information related to partnerships with health insurance companies or payors. LactApp and Milk Stork have not made any announcements about partnerships with health insurance companies or payors on their websites and social media pages. A press search also did not provide the required information. The articles examined only talked about Milk Stork's partnership with employers. None of LactApp and Milk Stork partners on the companies' websites were health insurance companies or payors.
Part
08
of eleven
Part
08

Women's Health Plan Industry - Barriers to Entry

Startup capital, coverage and affordability, tech-enabled knowledge base, and customer cost of switching are four barriers to entry for companies entering the women's health plan industry. Mahmee, Carrot Fertility, Advantia Health, and Tia Clinic are some examples of companies that overcame these barriers.

Startup Capital

  • Startup capital is critical for any company entering the women's health plan industry. It entails the funding required to get the business going, which can come from personal savings, loans from family and friends or investments from venture capitalists (VCs). However, starting a company in the women's health plan industry usually requires the latter because of the size of the money involved.
  • The lack of adequate startup capital will incapacitate the competitiveness and growth of entrants into the industry that can't scale through this barrier. For instance, it was after Advantia Health secured a $45 million investment funding that it could grow its network system, fortify its technology services, and open a flagship medical center in Washington.
  • Mahmee is a startup in the women's health plan industry and it overcame this barrier by presenting to investors the bigger picture of a larger responsibility accompanying the objectives of the company. One of the focal objectives of the company is to tackle the life-threatening gaps in maternal care. It was because of this that the company could secure a $3 million funding from investors that included the likes of Serena Williams and Mark Cuban.

Coverage and Affordability

  • The lack of insurance coverage and affordability for women's health services plan by the target market is a barrier to entry for companies entering the women's health plan industry. Health insurance coverage is essential in the accessibility and affordability of healthcare to women. However, according to the Society for Reproductive Medicine in the US, the cost is a significant barrier for women to enjoy fertility treatment, as 80% of individuals marked for this treatment are not covered and they are indebted.
  • For entrants into the industry, this barrier will have significant negative impacts on their offerings as there would be a shortfall in sales because the affordability of their services remains a challenge for many women.
  • Carrot Fertility overcame this barrier through its Visa Carrot Card. This debit card is the first of its kind in the fertility sector and it makes it convenient for employees to afford women's health plans like IVF, egg freezing, and among other services.
  • Another startup that overcame this barrier is Future Family, which offers free fertility testing and personalized financing plan through a subscription payment model.

Tech-Enabled Knowledge Base

  • Tech-enabled health services is now a growing trend in the women’s health plan industry, and this is a significant barrier to entry for companies without the requisite tech-enabled knowledge base. Competitors in the women’s health plan industry are now harnessing tech-enabled, scalable personalization to improve health service delivery to their patients. Companies are deploying artificial intelligence (AI), machine learning, and cloud-based informatics to personalize women’s health service plans at scale.
  • The impact of this barrier on entrants into the industry is that they will quickly fizzle out in a highly competitive industry where tech-savvy companies, like Univfy and Jessie Health, will continuously outdo them.
  • A startup company, Advantia Health, received $45 million investment funding from BlueMountain. The latter was drawn to the former because it prioritized the integration of care and technology.
  • Extend Fertility also received Series A funding of $15 million after a total rebrand, which was a digital relaunch. Part of the total rebrand was to leverage its medical center in New York City on the latest technological advances.

Customer Cost of Switching

  • The customer cost of switching is a barrier to entry for companies entering the women’s health plan industry because they have to tackle the challenge of convincing women to switch to them, away from their contemporary service providers. This barrier may entail fierce marketing campaigns and incentives to persuade customers, particularly in the women’s health plan industry where feminine health concerns are not properly addressed.
  • This barrier would impact companies entering the women’s health plan industry in terms of financial cost surrounding the marketing campaigns they must engage in to get a sizable chunk of customers. Even if this was accomplished, there is no guarantee of this in the women’s health plan industry.
  • Tia Clinic overcame this barrier by entering the industry with a holistic offering, integrating both physical and digital platforms. This changed the way women interact with the healthcare system and saw memberships for the company's plan sold out within the first few weeks, while the waitlist accounts for many more.

Research Strategy

While it was difficult to get sources that provided barriers specific to entry for companies entering the women’s health plan industry, we relied on common barriers to entry for every startup. Through the latter, we could juxtapose these barriers with trends and challenges in the women’s health plan industry. We could then establish four barriers peculiar to entry for companies entering the women’s health plan industry. For instance, the innovative use of new technology, like AI, is a trend in the industry and this aligns with the 'technical knowledge base' in the common barriers to entry for every startup. The same goes for challenges in the industry.

Through one or two examples, we also showed how women's health plan companies have overcome these barriers.
Part
09
of eleven
Part
09

WMP Competitive Landscape - Competitive Trends

Holistic healthcare model and tech-enabled, scalable personalization are two trends service providers must incorporate to maintain a competitive advantage in the women’s health service plan industry. Entrepreneurs, service providers and venture capitalists recognize that these trends will define women’s health service plans soon.

Holistic Healthcare Model

  • Companies in the women’s health service plan industry are migrating to a broader holistic healthcare plan. This trend aims to focus on patients as people instead of ordinary health records.
  • A shift towards a more holistic healthcare plan aims to highlight connections between emotional, mental, and physical health. This trend seeks to correct the dysfunction of isolated health specialists, which are frustrating for many patients, and offer them comprehensive solutions that address the basic cause of their health problems.
  • Fertility is one area that is witnessing this paradigm shift in the women’s health service plan industry. Recognizing that this area of medicine shouldn't be linear, medical treatment now comprises patient management as a supplement. For instance, companies like Norka Health introduce stress management, exercise, nutrition, and acupuncture to improve the patient experience.

Why It Is A Trend

  • According to the Director of Research at HTD, entrepreneurs, service providers, and venture capitalists in the women’s health service plan industry identify these types of women’s health service plans as one trend that will define femtech services soon.
  • Women's health service plan providers, like Norka Health, Tia Clinic, and Mayo Clinic, are adopting a paradigm shift from linear treatment to a more holistic healthcare plan for patients.
  • Norka Health is using the holistic healthcare model to gain a competitive advantage by improving patients' experiences.
  • The company also gains a competitive advantage through the application of this trend by making women's health service plans cost-effective for employers sponsoring healthcare. With this health plan, this category of employers can save money.
  • Tia Clinic is incorporating both digital and physical health apparatus with a new medical center in New York City. The competitive advantage of this model for this company is that it can now combine wellness, gynecology, and primary care for its patients under one roof.
  • The company used this trend to gain a competitive advantage by increasing its market share because its memberships sold out within the first few weeks of the opening of its New York City's center.

Tech-Enabled, Scalable Personalization

  • Companies in the women’s health service plan industry are now harnessing tech-enabled, scalable personalization to improve health service delivery to their patients. This trend follows the upsurge of the holistic healthcare model.
  • This trend seeks to understand behaviors and factors that guide each woman’s health outcomes by providing tailored, personalized solutions to each patient.
  • Making use of artificial intelligence (AI), machine learning, and cloud-based informatics, companies can personalize women’s health service plans at scale. This trend is also gaining momentum because of the advancement of digital tools, which healthcare providers are using to offer more personal and meaningful health experiences.
  • One area in the industry that captures the use of this trend is in the early detection of feminine cancers through AI. Other areas include diagnostic and fertility-tracking app services.

Why It Is A Trend

  • According to the Director of Research at HTD, entrepreneurs, service providers, and venture capitalists in the women’s health service plan industry identify these women’s health service plan as one trend that will define femtech services soon.
  • Women's health service plan providers, like Jessie Health, Modern Fertility, Univfy, EverlyWell, Allbodies, Ritual, and Nurx are leveraging this trend to accumulate larger market shares.
  • Jessie Health makes healthcare services, like at-home STD testing and sinus infection treatment, accessible to women based on personal data, such as digital preferences, risk factors, and locations.
  • The company is also "developing tools to help empower users to track, manage, and predict health events for themselves, their children and their aging parents."
  • Jessie Health is using this trend to gain a competitive advantage (increasing its market share) by meeting the needs of individuals with the most cost-effective and reputable solutions. This is because affordability and convenience are what modern consumers are demanding.
  • Modern Fertility uses anonymous data it continuously collects to "contribute to women’s health research and product development." The company provides economical at-home hormone testing services for women.
  • The company used this trend to gain a competitive advantage by attracting investments totaling $15 million to expand its women’s health service plan. It will also use this trend to gain a competitive advantage (increasing its market share), since affordability and convenience are what modern consumers are demanding.
  • Univfy also uses personalized medical counseling through a combination of fintech, machine learning, and AI to help women attain their health objectives easily. Univfy uses this trend to gain a competitive advantage by providing patients with lower financial risks, improved experiences, and increased market share for the company.

Research Strategy

For companies to maintain competitive advantages in the women’s health service plan industry, we highlighted two service plans, namely, holistic healthcare model and tech-enabled, scalable personalization, as trends shaping the future of the industry. We considered these two trends based on their recognition in femtech services by entrepreneurs, service providers, and venture capitalists. The second reason we considered these trends is because some service providers in the industry are already incorporating these trends in their service delivery. Aside from describing these trends and why we chose them as trends, we also provided examples of companies that have used these trends to gain competitive advantages.
Part
10
of eleven
Part
10

WMP Project - Biggest Cost Drivers

Some of the biggest drivers of cost for women healthcare include the advancing medical technology, the greater need for care, and the intensity of care.

Advancing Medical Technology

  • New technology development is most frequently viewed as the biggest contributor to the growth in the cost of women's healthcare services plans.
  • The rate at which technology is developing and the introduction of new technologies is forcing companies to use more expensive technologies for the same clinical problems.
  • New health technologies improve the outcomes and leads to patient satisfaction but tend to cost more than existing ones.
  • Evidation Health's, Evidation Health’s technology powers a novel discovery engine for behavior-focused studies and a modern delivery platform that connects everyone who wants to participate in better health outcomes.

Population Needs for Care

  • The rising rates of chronic disease in women is also a factor in healthcare spending but it only accounts for a disproportionate percentage of overall health spending.
  • Examples include iSonoHealth’s automated ultrasound and AI platform that detects early breast cancer.
  • KaNDy Therapeutics has developed drug therapies for female sex-hormone-related conditions that focus on menopause symptoms. The company raised a $32.2 million in a Series C funding round in August 2019.

Price and Intensity

  • Women are charged more for their healthcare products and services, as there has been an increase in the amount of technically complex, advanced services to address care needs.
  • Women pay higher prices for healthcare products and services in the US than any other country in the world.
  • Progyny partnered with employers to allow them to offer coverage for IVF, egg freezing, and other fertility services.
  • Vizient optimizes the supply operations to drive operational efficiency, lower supply costs and achieve clinically-integrated supply goals with strategic solutions that deliver industry-leading savings and value.
Part
11
of eleven
Part
11

WMP Project - Risk Profile

Trinity Health and the Pregnancy Medical Home program are two examples of women's health plan service providers with a fee for risk, also referred to as value-based, business models. The value-based model, which is fast replacing the traditional fee-for-service model, applies one or several of the four strategies of execution. The model has improved healthcare by reducing costs, improving quality of care services, and increasing patient satisfaction.

Examples of Service providers

  • North Carolina’s Medicaid primary care case management program, the Pregnancy Medical Home program, is an example of a women's health plan service provider who has adopted the fee for risk/value-based model.
  • The program provides reimbursement to the health care providers on the basis of quality and comprehensive postpartum. The postpartum visits take place between 14 to 42 days to make sure the mothers receive the recommended optimal care as they transition to primary care.
  • Second example is Trinity Health. It consists of 92 hospitals across 22 states with 109 actively operational health care facilities. The women health care services they provide include gynecology, obstetrics, breast cancer and birth throughout their outpatient centers and home care agencies.
  • According to Trinity Health's Clinical Integration senior vice president, Emily Brower, 24% of the service provider's system has adopted the value-based model serving approximately 1.6 million individuals. They anticipate this figure to increase to 75%.

Business Model Description

  • The fee for risk also referred to as valued-based model is replacing the traditional fee-for-service model. This model seeks to reward efforts of service providers and enhance the quality of health care while at the same time reducing costs.
  • This system consists of alternative payment models (APMs) that the payers use to provide incentives to the health service providers to administer high-value services, care, medications, and products. The model eliminates unwarranted variation in the delivery of services and advocates for quality over quantity. This is contrary to the fee-for-service model.
  • Payers adopt four key strategies, one or several at the same time, for successful execution of the value-based model.
  • The first strategy is the use of incentives to improve care processes. They do this by providing enhanced payments for specific processes and services with the aim of increasing level of quality or reducing costs. An example may include annual bonuses, extra payment for high-risk patients and reimbursements.
  • The second strategy is the application of penalties for unwanted outcomes. This involves decreasing payments or no payments in the incident of unnecessary services or unwanted outcomes. This strategy aims at encouraging the provision of high-value health care services.
  • The third strategy is shared accountability in payments. This strategy involves accountability sharing between the health care providers and payers to incentive high-value health care.
  • The fourth strategy is consumer-directed models. Examples of these include value-based medication pricing and value-based insurance design programs. This strategy directly addresses the consumer of health care services to drive the value of healthcare.

Performance Indicators

  • According to John Kelly, Edifect's Principal business adviser, the key performance indicators of the value-based payment models in health care are dynamically evolving. It is, therefore, the responsibility of the players in the healthcare industry to ensure there is consistent and adequate data to propel the model to success.
  • Healthcare value-based model performance indicators are determined through the applied quality measures by the payers. These include: structural measures such as the capacity of a hospital perform certain procedures and patient-to-staff ratios; Outcome measures such as readmission rates and mortality rates; patient experience measures collected through surveys; and process measures that determine desired outcomes.

Example of Model's Success

Sources
Sources

From Part 03
From Part 05
Quotes
  • "Prelude is a network of top-tier fertility centers across the US offering comprehensive fertility care. Whether you’re ready to build a family now or want to keep your options open for the future, Prelude meets you where you are."
Quotes
  • "Prelude’s national network of fertility clinics and egg donation centers across the country offers egg freezing, egg storage, genetic testing, IVF and egg donation services — all delivered with the highest level of personalized care by the nation’s leading reproductive endocrinologists and practitioners."
  • "Prelude’s network of fertility clinics provides a variety of options and care to meet your fertility goals: Egg Freezing IVF Donor Egg Services Genetics Services Male Factor Infertility Egg Donation Surrogacy Mail-Order Fertility Pharmacy"
Quotes
  • "Prelude offers personalized fertility services. Whether you're planning for the future or ready to start a family now, we meet you where you are."
  • "46 posts 658 followers 19 following"
Quotes
  • "We're on a mission to help educate women and men about their reproductive health and provide them with the best options."
Quotes
  • "Prelude Fertility provides personalized care and fertility services that help people have healthy babies when they’re ready."
  • "75 Following 364 Followers"
Quotes
  • "Where does a startup get $200 million and how have they acquired market-share so quickly? Meet the war chest and strategic acquisitions behind Prelude’s rapid market entry."
Quotes
  • "So Ward and his team built Prelude in part to help its newly acquired clinics revamp their marketing strategy. (Dr. Mehmet Oz, who’s perhaps medicine’s most influential marketer as host of “The Dr. Oz Show,” sits on Prelude’s board of directors.)"
  • "For the clinics joining the Prelude network, that’s meant ad campaigns at the local level, both on social media and online as well on traditional channels like radio and print. Prelude is also pushing a national ad campaign on social media and digital channels."
  • "Prelude’s goal: to pitch the chain as an one-stop-shop for fertility care, starting long before a woman is ready to conceive. We’re “making [the ads] more modern and speak to younger patients and younger Americans who live in social and digital media,” Ward said."
Quotes
  • "Prelude Fertility and Inception Establish the Largest Provider of Comprehensive Fertility Services in the U.S."
Quotes
  • "New Combined Company Will Dramatically Expand the Quality of Patient Experience and Best-in-Class Care"
Quotes
  • "Learn your accurate and personalized probability of conceiving with IVF when you receive your free Univfy PreIVF Report from a doctor in the Univfy Network. The Univfy AI Platform for IVF analyzes your complete health profile to make predictions with more than 95% accuracy."
  • "Knowing your success probabilities can help you and your doctor better plan for a course of treatment, rather than thinking in terms of a single cycle at a time, to maximize your chances of having a baby."
  • "Many Univfy Providers offer refund programs* and multi-cycle discount programs to help you afford more than one IVF treatment, if needed."
Quotes
  • "Univfy’s holistic AI software platform helps women and couples start effective treatment sooner. Fertility centers counsel their patients with our personalized reports showing treatment success probabilities based on your unique health data and your fertility center's live birth outcomes data. We help patients reach their goals with greater confidence and make it easy for fertility centers to improve transparency and efficiency."
  • "Univfy’s holistic AI software platform gives you a better experience and helps you succeed with treatment."
Quotes
  • "The funding will be used to scale business by expanding the US national network of fertility specialists using the Univfy predictive analytics platform and developing additional partnerships with leading IVF centers. Univfy will also invest in talent to expand its world class data science and product teams and its client services experts."
Quotes
  • ""We're pleased to have such accomplished and talented individuals join us, as we expand our team in response to significant interest from fertility patients and providers in our Univfy platform," said Mylene Yao, co-founder and CEO of Univfy. "Univfy predictive analytics technology is the first of its kind, that combines machine learning, healthcare artificial intelligence and fintech to dramatically improve the experience of fertility patients and their access to IVF"
Quotes
  • "Breaking emotional, social and financial barriers to successful treatment"
  • "1,202 Following 1,530 Followers"
Quotes
  • "BBVA partners with fertility company for online health care loan"
Quotes
  • "Univfy uses machine learning to give women personalized predictions—and a sense of hope—for their chances of having a baby."
  • "Patients need hope. Univfy is another tool where you can give them very solid, data-based information to say, ‘Keep going. You’re getting closer and closer to the baby.’”"
Quotes
  • "What Univfy offers is a two-part solution. The first part is the IVF analytics. The Univfy PreIVF report is a predictive test, which provides fertility answers unique to each patient. "
  • "Companies that offer clarity in this space are in high demand, so it’s not surprising that Univfy, a California startup, is becoming a welcome addition to this space."
Quotes
  • "Univfy uses AI to help women understand what their fertility odds are, based on her complete health profile and her IVF center’s data."
  • "While leading NIH-funded reproductive medicine research projects as an assistant professor at Stanford University, Dr. Yao teamed up with Professor Wing Wong, a world-renowned biostatistician and expert in machine learning and Bayesian statistics."
Quotes
  • "Univfy®, an AI platform company whose mission is to improve fertility patients' experience and access to in vitro fertilization (IVF), announced today a collaboration with BBVA USA, the US subsidiary of global financial institution BBVA, to offer a finance program with rates starting at 0% APR (up to 18.99%)."
Quotes
  • "Univfy Inc., an AI company whose mission is to expand in vitro fertilization (IVF) access and affordability, and IRMS at Saint Barnabas will present a new prediction model at the ASRM 2019 Scientific Congress in October that will help women understand their individual chances of having a baby from egg freezing."
Quotes
  • "We are focused on fertility and we go deep—working with fertility doctors to incorporate the latest research into Modern Fertility. Two physicians review your test and if results look abnormal, they’ll recommend a plan for retesting."
  • "When you request a test it will be reviewed and ordered by a physician. Your test will be customized based on your birth control (yes! you can test on birth control!). Then, we’ll walk you through taking it at home or at a lab."
  • "Modern Fertility is more than a test—we’re on call to get you the support you need to make decisions about reproductive health. Get questions answered 1:1 with a fertility nurse, join our weekly Egginar, and learn from others in the Modern Community."
Quotes
  • "So we went to work building Modern Fertility. An easy way for every woman to get the info she needs to make decisions about her fertility."
Quotes
  • "Modern Fertility, which offers a $159 fertility hormone test and a consultation with a fertility nurse, aims to share “clinically sound, neutral information” on its social feeds and website, said Carly Leahy, a co-founder, pointing to a recent infographic on Instagram illustrating that one in 10 women has polycystic ovarian syndrome."
Quotes
  • "Know your body 💪, test fertility hormones and talk it out—whether you’re ready for 👶s or not."
  • "132 Following 1,715 Followers"
Quotes
  • "We're the only comprehensive fertility hormone test you can take at home in your jammies."
  • "38.4k followers "
Quotes
  • " Modern Fertility is trying to change that by providing women with a more accessible and affordable fertility test. The San Francisco-based startup announced today that it has raised $15 million in a round led by Forerunner Ventures. Founding partner Kirsten Green will be joining the board."
  • ""We built Modern Fertility by listening to women and understanding what they want," Vechery told me in a phone interview. ""
Quotes
  • "At-home fertility tests, such as those from Modern Fertility, EverlyWell and Let'sGetChecked, provide women with a convenient, proactive and relatively inexpensive alternative to traditional clinic tests. These hormone-based fertility tests are designed to give women a picture of their general reproductive health, and to encourage proactive decisions rather than reactive ones."
Quotes
  • "Modern Fertility hasn't invented anything new--obstetricians and fertility specialists use the same bloodwork as part of their initial patient evaluations. Nor does the startup aim to diagnose specific conditions. The company's goal is to make access to these tests--which can run as high as $1,500 in a clinic if not covered by insurance--easier to obtain and less costly. "
From Part 09