Syntax Launches Platform for Value-Based Care Negotiations

June 8, 2023
Industry veteran Rachael Jones describes pain points in value-based care negotiations her startup aims to solve

Healthcare Innovation recently spoke to Rachael Jones, CEO and founder of startup Syntax Health Inc., which is launching this week with the announcement of a software-as-a-service solution  for health plans and provider groups to work on value-based care contracting together.

Syntax was built at Redesign Health by Jones and the founding team, and has raised $7.5 million in seed funding. Among the company’s advisors is Francois de Brantes, senior partner at High Value Care Incentives Advisory Group, and previously senior vice president of Signify Health. He joined in this conversation as well.

HCI: Before we talk about Syntax, could you talk about your background and how it helped you identify this opportunity?

Jones: Yes. I've spent the last 25 years in healthcare and health plans and solution vendors —  on both sides of the aisle, if you will, leading cost-of-care analytics teams, product teams and operations teams. But for the last 12 years, I've focused primarily on enabling health plans and provider systems to achieve greater success in value-based care. That's what excites me so much about launching Syntax. We're a company that's introducing what we think is a radical change to the practical work of value-based care contract design, with over 85 percent of health plans citing inefficient contract modeling as their biggest barrier to adoption. Our mission at Syntax is to usher in a new era of value-based care by enabling trustworthy, transparent collaboration and frictionless incentive design.

HCI: What are some of the pain points in value-based care contracting the Syntax solution addresses?

Jones: We are building a SaaS solution that provides analytics infrastructure and a collaborative virtual workspace that's two sided for both the health plan and the provider to accelerate value-based care. First, we focus on insights for what we call best fit payment model design. One of the biggest pain points in value-based care today is this lack of confidence around what is the right model for the provider, for the patient population, for the health plan. A lot of folks are guessing and trying to figure out what fits and then six or nine months later, realizing that the model hasn't worked out. You have a lot of folks who are upset and disillusioned that value-based care doesn't work. So we're really focused on delivering those insights upstream and designing a way to get the best fit designed from the start.

HCI: So if you're a large primary care practice working with a Blue Cross insurer, are there a handful of value-based care model designs to choose from — and the practice has to go through the process of looking at the contracts and figuring out which one is the best fit for them?

Jones: In today's world, you have teams of actuaries and analysts and network managers trying to do this internal modeling, and then they toss it over the wall to the provider who has to then figure out what it means.  At Syntax, we're building that tooling within the application from start to finish. So you're really looking at a templatized approach to standardize and automate the process of your contract build from the start. How do you look at attribution to understand who are the right members that should be in this model? What are the carve-outs and the exclusions that makes sense for this population and this provider? How do you take that contract from start to finish in a collaborative way where everyone knows what's at stake? You're seeing the financial projections right next to the contract terms. No gotchas and no guesswork. And you're really able to take that all the way through to a place where there's trust and collaboration built into the process.

HCI: Many provider organizations have been reluctant to take on downside risk. Would something like this solution give them more confidence to go into those type of models?

De Brantes: This ties back to my days at Signify, when its role was both to negotiate these risk contracts with payers and then support providers that participated in those risk contracts. And if you think of that negotiation between an organization like Signify and a payer, there is no information asymmetry because you have deep subject matter expertise on both sides that can tear through data and understand the complexities and the nuances of some of the terms and conditions that are embedded in these contracts. Where's the stop loss? How is the trend calculated? Simple things like how many years are you using in your baseline? Are you weighting them the same? All of those things are nuances that if you're a doc or any other provider organization, your job is to manage patients, not to be an expert in contracting. Reducing that information asymmetry is one of the keys to actually getting providers to understand the level of risk that they're truly taking on. Without that, there is deep anxiety that the person across the table from you is likely stacking the deck on their behalf. That's the whole thrust of what Syntax is trying to do is reduce the information asymmetry and level the playing field so that everyone is dealing with the same rules and understands the implications when you change a variable. You democratize this knowledge into a platform that allows for a fair and even-keeled negotiation between both parties.

HCI: Could providers use this tool to determine whether participating in a certain alternative payment model from CMMI makes sense to their organization?

Jones: Yes, I believe so. But our initial go-to market idea is focused on primary-care provider-based attribution. We see ourselves stepping into specialty and multi-provider attribution. I think that's an area of extreme interest, especially thinking about those companies focused on chronic or population-based illness. There's lots of value in offering a tool like ours to understand what accountability looks like for a kidney program. But we have a philosophy of crawl before you walk and walk before you run, so we're starting with PCP attribution first.

HCI: Has Syntax piloted this solution with anyone yet?

Jones: We completed a design pilot earlier this year with a large integrated provider. That afforded us the opportunity to test the concept and we received some really great feedback from the senior actuaries who actually said they can see themselves doing their whole work in our platform, which was a huge validation for us since my team and I came from this space, and we are really building this tool for the things we wish we always had. We were also able to provide some insights to that provider about how they can improve their value-based care strategy and increase provider engagement.

HCI: Syntax was launched out of Redesign Health. Can you talk about that relationship?

Jones: Redesign is an innovation platform that focuses on supporting healthcare innovation with specific problem areas and they've been a huge supporter of us in terms of our seed funding, as well as providing strategic and bac- end support. I call it scaffolding — as you build a company like this and take it to market all the things that might typically distract and burden the startup, Redesign has been a huge resource to step in and support that, so that my team and I can focus on really nailing the right solution and getting to value really quickly.

HCI: Anything you want to add, Francois?

De Brantes: Redesign is a cool model in the sense that you've got individuals like Rachel with deep subject matter expertise and then people like me, Blackford, Middleton and others who are part of the advisory group and can help in that incubation process. A lot of companies are appropriately very tightly focused on a product or solution for the over-65 population. Despite the weight that they carry in healthcare, that is still the minority population. There are 300 million people who are impacted by healthcare and, and so it's kind of exciting to work with organizations that are focused on 350 million people as opposed to 35 million individuals. It's not to say that the 35 million are unimportant, but the 350 million are important, too, so the ability to bring solutions that can be adopted widely by all payers, all different types of providers for all different populations — that's what's going to change the delivery system.

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