Concert Health kicked off 2021 with a bang by raising $14 million in Series A funding. Having recently passed the 20,000-patient threshold, Concert is looking to achieve multiples of that number for 2022 while expanding its geographic reach and potentially hiring hundreds of new workers.
Concert’s services revolve around the model of collaborative care, which has been at the core of the San Diego-based company since it was founded in 2016.
Under the model, behavioral health care managers are embedded into a patient’s primary care team. One of the goals of collaborative care is for a patient’s care team to be apprised of behavioral health conditions that can be identified during primary care visits, and which might underlie certain medical issues patients are experiencing.
“This is about putting a system and team in place that really helps primary care providers with more holistic care,” Spencer Hutchins, the co-founder and CEO of Concert Health, told Behavioral Health Business.
Inside Concert’s model
Concert utilizes more than 140 behavioral care managers who are either licensed or are working toward licensure. Concert’s clinicians work in conjunction with over 25 psychiatric consultants who specialize in areas ranging from substance use disorder (SUD) to women’s health, and who meet with care managers weekly to both coordinate and make needed changes to patient treatment plans.
Hutchins said that Concert measures patient progress using a GAD-7 or PHQ-9 assessment that looks for a 50% reduction of symptoms over a 90-day period. If a patient shows no signs of improvement after around six months, they can be referred to another level of care.
“Our goal is to work ourselves out of a job,” Hutchins said. “Normally, in about six months, you’ve done that for most patients. On the other side, you’ve tried enough things and the patient may need to be in a different place — not just a primary care setting.”
Collaborative care is covered by various commercial payers, as well as Medicare and Medicaid in some states. For its collaborative care services, Hutchins said that Concert derives steady revenue from payments made to a patient’s primary care team for services rendered.
“It is certainly not a massive profit center for anybody, frankly,” Hutchins. “But we do want unabashedly to be about putting more dollars into primary care offices. They’ve been left doing this care by themselves.”
Research has promoted the benefits of having collaborative care in a patient’s health plan, with improved health outcomes and lowered care costs among those touted. One of those early studies on collaborative care — which was published by a University of Washington research team in the late 2000s — asserted that for every dollar spent on care, $6 was saved in long-term health costs.
“A lot of people go to primary care providers with behavioral health needs either intentionally — because they have a relationship with their provider — or unintentionally,” Virna Little, the co-founder and chief operating officer of Concert Health, told BHB.
Little believes the collaborative care model is valuable in getting at the root of health care needs a patient may not completely comprehend.
“It’s like someone saying, ‘I’m getting migraines,’ but it really has to do with stress,” she added. “We know that many people who died by suicide saw their primary care provider in the month of death, and not a specialty mental health provider. Collaborative care really puts a system in place.”
To establish a partnership, Concert requires providers it teams with to routinely monitor patients for conditions such as depression and anxiety. This is done by making use of a GAD-7 or PHQ-9 assessment, which some in the industry believe can operate as a useful tool in dispensing value-based care.
Providers are also required to allow Concert access to a patient’s electronic medical records (EMRs).
“If we can’t document in the EMR where providers can see it, then we can’t really be part of the clinical team, and the providers won’t know what’s happening with their patients,” Little said.
The practice of sharing health records among various care providers has raised questions about patient privacy, with over half of Americans reporting to have concerns about the unauthorized use of such data, according to the Kaiser Family Foundation.
However, Little said that Concert — as a HIPAA-compliant company — only shares notes in-care with other organizations bound by HIPAA. Additionally, codes for collaborative care services are billed under the same ones as services that a patient receives from their primary care provider.
“Their concerns about having to segregate any mental health information are resolved,” she said.
Concert Heath’s plans for 2022 and beyond
Concert’s partnerships include those with providers like Chicago-based CommonSpirit Health, Connecticut-based Women’s Health USA and Florida-based AdventHealth. Hutchins said those partnerships reflect a willingness of providers to assume more responsibility and financial risk for a person’s health outcomes.
“We think most of them are going to be moving more and more to risk, and being measured by their impact on total quality and cost as opposed to just their activities,” Hutchins said. “Our goal is always to be along on that ride with them, taking as much risk as they are in that process.”
Although collaborative care is closely linked with value-based payment, Concert’s business is not completely built around the insurance model of services being reimbursed based on the quality of outcomes.
Overall, more providers in the industry have been moving toward value-based payment and away from the traditional reimbursement structure of fee-for-service. Concert itself is looking to the day where value-based payment will be the industry norm, even as the industry — for the most part — still struggles to establish consensus on what exactly constitutes positive care outcomes under the reimbursement model.
“It’s hard for the whole industry to make that transition,” Hutchins said. “I think we’ll be living in this intermediate zone for a long time.”
Although Concert is providing integrated services with specialty health systems, Hutchins said that the bread-and-butter of its collaborative care work is with generalist primary care providers.
“That’s where the majority of people get their care,” he noted. “They are already the biggest prescribers of antidepressants and anti-anxiety meds. We will continue to work with more and more specialty providers. But our partnerships are most natural when that physician becomes the principal physician for the patient.”
Concert, like a number of health care companies, has also leaned into telehealth during the pandemic. While Hutchins expects Concert providers to continue conducting a significant amount of services virtually, he believes that it will be done as more of a hybrid in conjunction with in-person care.
“I think it’ll certainly be a hybrid, and it’ll be about people’s schedules and their time,” he said. “I think we will become less obsessed with the site of care and more about access and the quality of care.”
Since its Series A round, Concert has doubled its count of states where it provides services, which now includes California, Arizona, Connecticut, Florida, North Carolina, New Mexico, New York and South Carolina. According to Hutchins, Concert will expand services in the new year to Texas and Missouri.
Concert also has plans to hire hundreds more workers in 2022. In anticipation of expanding services down the line, Hutchins said that Concert is currently conducting research to see how collaborative care could effectively address health concerns like attention deficit disorder and suicidal ideation.
“A big point is not only to replicate research, but to really extend it,” he added.
When it comes to how Concert will finance its growth objectives, Hutchins did not discount the possibility of doing so with more funding rounds. However, he believes the company does not necessarily need to go that route to make those goals a reality.
“We’re focused really on delivering value internally and funding ourselves in a sustainable way,” he said. “We’re a little old-fashioned in that we mostly fund ourselves with revenue. That’s been our focus.”