Vitori Health has been recognized as a Market-Shaping Enterprise (MSE) by Catalyst for Payment Reform (CPR). Independent and influential, CPR’s thought leaders empower health care purchasers to proactively improve today’s dysfunctional healthcare market. Vitori is proud to advance this mission.
CPR has published a white paper that examines the evolution, mechanisms, and strategy behind MSE solutions. It also explores the most important questions health care purchasers should consider when evaluating an MSE vendor.
As part of its research, CPR interviewed Neil Quinn, Vitori’s Chief Strategy Officer, for his perspective on current market practices and how MSEs can make a difference.
CPR | What’s your “theory of the case” as to why health care costs and prices continue to rise unabated?
QUINN | Costs and prices continue to rise unabated because there are no real countervailing forces to reduce the systemic financial inflammation. This has created a chronic business interruption disease for employer-purchasers that constantly drains dollars, hours, and energy away from core business priorities. At 20% of GDP, U.S. health care is a monopolistic mega-business that’s increasingly driven by shareholder profits, mergers and acquisitions, and massive multi-faction lobbies.
Unfortunately for employers, it has been generally unfettered by government public-good and antitrust guardrails and is not beholden to free-market forces. All actors in the health care system continue to maximize their financial interests and advantage to the detriment of employer-purchasers and their people.
CPR | Why have traditional health plans been unable to stem the tide?
QUINN | Too often the firemen are the arsonists. Efforts by traditional health plans to control costs and prices are analogous to spitting into an out-of-control fire. With deeply embedded conflicts of interest, these plans have neither intrinsic motivation nor external pressure significant enough to motivate meaningful and durable solutions.
Entrenched stakeholders aren’t going to disintermediate themselves. Their existing business models are reinforced by an interwoven collusion with provider systems, broker-advisors, and other healthcare matrix entities to collectively maintain shareholder priorities.
CPR | What types of strategies have the greatest potential to rebalance market power toward health care purchasers and consumers?
QUINN | Market-shapers are always great simplifiers. Trying to rebalance market power using broken traditional components results in a whole that is less than the sum of its parts. At best, it is simply managing the racketeering. The strategies with the greatest potential are those that recuse themselves of legacy industry elements and economics.
The sweet spot includes transparency-focused solutions such as Fair Market Payment™, net lowest cost Rx pricing technology, direct primary care, and bundled value-based contracting. These and other strategies create a consequential rebalancing of market power towards purchasers, while often removing financial barriers for plan members and patients.
CPR | On the flip side, why can Vitori as a non-traditional entity succeed where traditional models have failed?
QUINN | We aren’t saddled with the “hammer and nail” rigidity that maintains the status quo. Our success begins with the high-minded goal to truly liberate employer-purchasers and plan participants. Independence from legacy system components and economics gives us the freedom to solve problems created by that system without conflicts of interest and furtive revenue streams that deter traditional stakeholders from pursuing meaningful strategies. This unencumbered business model has given us the ability, agility, and drive to rapidly fail, adjust, and succeed.
CPR | What would you say is the greatest challenge to growing your business?
QUINN | One of our greatest challenges is getting past the “room with no windows” that keeps employer-purchasers in the dark about proven, better health plan alternatives. They are unaware that their broker-advisors and legacy insurance carriers hide these options and gaslight them into a disquieting Stockholm syndrome loyalty to their captors.
We routinely challenge a deeply embedded Principal-Agent problem built on enormous information asymmetry. The Principal (employer), who should be well informed and at the heart of the transaction, is instead veiled from price, quality, and value purchasing comparatives. The cabal of Agents (brokers, insurers, provider systems, PBMs) does not act in a transparent and trustworthy capacity, perpetuating economic and structural conflicts of interest.
CPR | What do you need from employer-purchasers to make your product successful?
QUINN | Employer-purchasers need to let go of their “devil you know” mindset and stop buying into the narrative that employees can’t handle change. Although there may be risks in taking action, they are far less than the risks of comfortable inaction that have enabled a vast transfer of wealth from working Americans to the medical industrial complex.
As legal fiduciaries to their health plan participants, employers need to ask themselves: Do traditional insurers/payers really have my organization’s and employees’ best interests at heart? Can I afford to ignore the financial competitive advantage that proven alternatives offer? What has happened year-over-year to employee disposable income and health care financial risk through our moral inertia?
As a Market-Shaping Enterprise, Vitori Health joins CPR in its commitment to rebalancing power in the healthcare market. Every aspect of a Vitori Health plan makes it easy for employer-purchasers to gain control of costs and ensure a better, more compassionate member experience.
Catalyst for Payment Reform (CPR) is an independent nonprofit corporation whose mission is to catalyze employers, public purchasers and others to implement strategies that produce higher-value health care and improve the functioning of the health care marketplace. CPR does not partner or endorse offerings from Vitori Health or other vendors.