Roger Batnigi, co-founder of Pearl Health, discusses how digital health startups should establish clear financial metrics and success criteria with payor partners prior to signing contracts.
“The question about defining success is not something that you sort of get into at the end of year one of your partnership. If it is, you're probably in trouble. There's nothing more important than actually getting that defined and not just kind of conceptually, but like literally in an Excel sheet, looking at it and saying, does this look like success to you?”
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Roger Batnigi: Startups should not adopt risk purely for valuation arbitrage
“I would not recommend moving toward risk simply for some kind of valuation arbitrage. I think you do it because It's needed to prove a new model of care or it's needed to cover something that that's just simply not paid for under existing CPT codes.”
Roger BatnigiApr 6, 2022▶ 7:50Risk-based Contracting for Value-based Care, a Founder's Playbook
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Roger Batnigi: Controlling care levers requires transitioning to full global capitation
“For example, if you needed to control and in your care model, you know, all of utilization management, you know, the claims payment network design. Well, there's probably no other way for a payer to let you have those keys other than moving to a true global ca…”
Roger BatnigiApr 6, 2022▶ 9:08Risk-based Contracting for Value-based Care, a Founder's Playbook
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Roger Batnigi: First-year risk-bearing startups must balance actuarial scale against exposure
“There's a balance between needing to be enough scale so that, you know, operationally from a unit economics perspective, You can make it work. And then from an actuarial perspective, you have enough credibility, but not being at so much scale or being so expos…”
Roger BatnigiApr 6, 2022▶ 24:26Risk-based Contracting for Value-based Care, a Founder's Playbook
Insight
Roger Batnigi: Risk-bearing health startups must hire late-stage talent earlier
“You kind of have to bring in a lot of the expertise and process that you might see in a larger later company earlier, if you're going to move down this path, because the stakes are so much higher.”
Roger BatnigiApr 6, 2022▶ 28:35Risk-based Contracting for Value-based Care, a Founder's Playbook
Insight
Roger Batnigi: Transforming care delivery requires a decade-long investment timeframe
“You don't do this because you think you're going to have an outcome that you can point to in 12 or 18... Over a many year period, potentially a decade or more, that you're going to make a real impact on care delivery. And you kind of, you have to have that pat…”
Roger BatnigiApr 6, 2022▶ 28:50Risk-based Contracting for Value-based Care, a Founder's Playbook
AssertionNot checkable as stated
Roger Batnigi: Risk-based healthcare financial outcomes take 18 months to verify
“With, you know, the run out in claims and the reconciliation period, and even in Medicaid retroactive government adjustments on rates It could be literally 18 months until you have a financial answer on, you know, whether the model works.”
Roger BatnigiApr 6, 2022▶ 22:46Risk-based Contracting for Value-based Care, a Founder's Playbook
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