By Tom Ballard, Chief Alliance Officer, PYA
The new year has brought with it significant growth prospects for Utilize Health.
Founded in 2013, the Nashville-based company tripled its office space in late 2018, going from 1,200 square feet to 3,500 square feet, and plans are in the works to double the just leased space by mid-2019.
What’s fueling the growth? Jessica Harthcock, Founder and Chief Executive Officer, says it’s Utilize Health’s work with health plans coupled with an additional focus on third party administrators (TPAs).
“We went live with our second and third health plans in August,” Harthcock told us in a recent interview. The initial health plan client was in the Pacific Northwest, while the recently added ones are in the Midwest and South. Utilize Health expects two new contracts in Q1 andQ2 that will collectively increase the company’s volume of business with health plans by at least 3X, hence the need for growth space.
The newer opportunity – TPAs – was unexpected.
“We did not set-out to sell to TPAs,” Harthcock says in describing the new opportunity to serve organizations that process insurance claims or certain aspects of employee benefit plans for a separate entity. Yet, as TPAs compete to serve health plans and self-insured enterprises, an alliance with Utilize Health could produce important benefits.
Those familiar with the company know that its genesis was a spinal cord injury that Harthcock sustained in 2004 while practicing her springboard diving routines. It left her paralyzed below her sternum. The doctors told her the damage was permanent, and she would never walk again. Through hours of hard work, traveling, and research, she was able to regain the use of her legs and walks unassisted today.
The experience of finding the right treatment, however, convinced Harthcock that there was an urgent need for Patient Advocates, and Utilize Health was founded on that reality. The company has not abandoned its initial roots – serving individuals – it has individual members in all 50 states, but its growth strategy is based on working with health plans and possibly TPAs if all goes well in that emerging new arena.
For the Founder, the strategy is clearly about creating a “win-win” outcome for everyone – those who are trying to recover from a neurological condition and those who are paying the care costs associated which Harthcock says is a $240 billion annual expense.
Individuals with neurological issues – strokes, spinal cord injuries and disorders, cerebral palsy, traumatic brain injury, multiple sclerosis, and muscular dystrophy – are the sole focus of Utilize Health.
“Paralysis is just the tip of the iceberg for them” Harthcock says. “They are dealing with many other secondary complications and exacerbations such as loss of bowel and bladder control, chronic neuropathic pain, urinary tract infections, pressure sores and so on. Not to mention there are behavioral health components to an individual’s care as well. We see a lot of depression and anxiety amongst this member population. These complications and issues are what drive much of the care costs for those individuals with neurological conditions.”
As the company has grown from its start-up days to the current growth mode, it has evolved its offering to include three distinct services – data analytics/opportunity identification, care program management, and network optimization.
“Our proprietary analytics model quickly identifies health plan members with severe neurological conditions and assigns a corresponding risk level,” Harthcock explains. “The identification piece has been huge. It allows us to develop optimized care pathways for each person.”
The result is better treatment, greater patient satisfaction, and savings of 15 to 20 percent for the plan. Those same benefits could accrue to TPAs and the clients they serve.
Utilize Health also operates a proactive care management program for health plans and TPAs designed to help achieve the positive outcomes that the individual and the payer want.
“We actively go in and enroll individuals with neurological conditions in our program,” Harthcock says. “They have a Patient Advocate and a Community Health Worker, both employees of Utilize Health.” The former is a clinician with whom the individual covered by the plan interacts with telephonically. The latter are individuals located in local communities close to the covered individual.
“They are our boots, eyes and ears on the ground,” Harthcock explains.
Utilize Health has raised $4.5 million thus far from investors in Nashville and Chattanooga and is in the midst of a $5 million Series A round.
“We’re at an inflection point,” Harthcock says. “We’ve got scalability and the management team in place. We’re ready to pour gas on the fire.”
For those who know her, you have no doubt experienced the passion that Harthcock feels for the work that she and her team are doing. She captured it best when she said simply that “I have to do this.”