How Quit Genius, Evry Health’s 100% At-Risk Deal Prioritizes Engagement and Clinical Outcomes

With thousands of digital point solutions on the market, payers and employers seek more out of their providers.

As a result, digital behavioral health companies have gotten creative about contracting. Gone are the days of per member per month deals. Now, many point solutions offer engagement guarantees, cost-savings deals and at-risk contracting.

Digital substance use disorder (SUD) provider Quit Genius is one of the pioneers in digital health value-based contracting. Last July, the startup announced that it made a full-risk payment model standard for its digital B2B addiction treatment services. While Quit Genius is unique in its fully capitated payment model, the company didn’t get there overnight.

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“Our approach in going to the market was we wanted to have performance guarantees right from the start. We wanted to guarantee meaningful clinical outcomes,” Yusuf Sherwani, co-founder and CEO of Quit Genius, said at the Behavioral Health Business’ VALUE event. “We wanted to go on a journey with our customers and gradually increase our skin in the game as we access more data. [That] started with really putting performance guarantees in the market, … then gradually increasing to a full risk model. And what that looks like today is we put 100% of our fees at-risk.”

Quit Genius is a venture-backed digital health company that offers services for alcohol use disorder, opioid use disorder and smoking cessation care. It has raised more than $78.6 million in capital. 

Yusuf Sherwani, co-founder and CEO of Quit Genius, speaks at the Behavioral Health Business’ VALUE event

Most of its risk is guaranteeing full clinical outcomes based on a set of independently validated scales that are biochemically verified. Quit Genius’ at-risk contracting also includes guarantee metrics around engagement, member satisfaction and operational metrics, such as access to a network provider.

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For example, for members with an alcohol use disorder, Quit Genius takes a harm reduction approach and uses the World Health Organization’s validated scales to measure healthy drinking. The provider is looking for anywhere between a 30% and 50% reduction in drinking days based on the WHO scale.

This at-risk approach fits into Quit Genius’ payer partner Evry Health’s approach to care.

“We’re fully at risk. Just keep in mind, we’ve designed everything to be value-based from the ground up,” Chris Gay, co-founder and CEO of Evry Health, said at VALUE. “We have a very different approach than any other payer. When we chose to work with Quick Genius, they already had strong analytical underpinnings and could demonstrate value.”

Founded in 2017, Evry Health is a large commercial group health insurance company that is focused on the mid-market.

Ensuring engagement 

Gay noted that Quit Genius’ engagement guarantees were among the most important elements of its value-based care contract.

“The other challenge working as a health plan is you can bring the best tools and programs and networks to market, and no one will use them,” Gay said. “People are creatures of habit and are also very distrustful of anything new. We found if you want to have a really good engagement, everything has to be reordered and changed. That’s why most digital health wellness programs fail. Because the incentives haven’t changed, the product design from the insurer hasn’t changed.”

One of the primary keys to engagement is clinical targeting using claims data to understand who is at risk. Even then, Sherwani noted that only about 15% to 20% of the population with SUD could be assessed this way.

It’s on Quit Genius to help educate members about their risks and the resources.

“It comes down to simple things like … an alcohol score quiz, perhaps as part of dry January, to really understand what healthy drinking looks like,” Sherwani said. “You’d be surprised at just how few people understand that what they’re drinking might be bordering on unhealthy, and they need added support.”

Chris Gay, co-founder and CEO of Evry Health, speaks at VALUE

But the partnership’s success relies on more than just the point solution. Rates of engagement and success are higher when the payer is actively engaged. Gay noted that Evry does not charge an additional fee to the member or employer using Quit Genius.

“We found you have to take the employer out of the equation wherever possible so that there is no impediment,” Gay said.

Another way that Evry supports engagement is by collecting data and algorithmically identifying anyone that could be at-risk of having a SUD.

“For instance, if there’s been an acute episode, and they’ve been admitted to a rehab facility,” Gay said. “It triggers a flag, and we know to have a care coordinator reach out, read the notes, suggest Quit Genius as an additional tool or offering just to make sure it gets mentioned in a compassionate and helpful way.”

Evry goes one step further in engaging members and offers them $1,000 for every adult member over 16 years of age that meets their health milestones. This means that depending on the member’s care plan if they use Quit Genius, they can get a financial reward.

“We financially work with Quit Genius, and there are payments between us as vendor partners. We also engage with a member and we give them incentives as they move through,” Gay said. “The math works, people, because you’re not just treating alcohol cessation or reduction, you’re typically treating something else alongside it. So what it’s worth – we like it a lot. And we think the model works mathematically.”

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