The company, which helps employees better manage their health plans, raised $ 130 million

Interview with Steven Loeb and Bambi Francisco Jordan Feldman, CEO of Rightway Healthcare, a platform that empowers employees to better manage their health plans. The company recently raised $ 100 million in Series C. Total funding was $ 130 million while the company was valued at $ 1.1 billion.

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Our goal for these digital health podcasts is to understand these three general questions as well: How do we empower the consumer? Are we creating productivity that also enables us to reduce overall economic costs? How is this advancement changing the role of the doctor?

Highlights from the interview:

  • Employees have more information, choice, and financial accountability than ever before, but lack the tools and resources to fix this. On the flip side, employers are looking for ways to involve their populations and address rising costs. There was no platform for member experiences or ecosystems that patients, staff and members wanted to use. That’s why Rightway was started.
  • Rightway has two platforms: one is on the care navigation page, and it is about optimizing the benefits above the medical and pharmacy plan to create empowered healthcare consumers. The other side is a full-stack platform for the management of pharmacy services (PBM), which replaces the previously established companies. These two form the company’s most comprehensive platform in the company’s healthcare.
  • More than half of employees don’t understand their health benefits. That’s because health care is confusing and complex. There are many nuances and outliers to how the system works, making it confusing for the average consumer. It’s not that people don’t want to understand, but nothing has been done to make it easy for them.
  • The company sees that over 40 percent of the population use Rightway every quarter. it has net promoter scores in the 80s and 90s; Companies that use Rightway spend 14.5% less on healthcare than companies that don’t.
  • Rightly mines over 10,000 data points to identify high risk and increasing risk members. One of the company’s greatest efforts is to understand the population. Hence, it needs to understand what is going on with this population and what is adding to the cost. Because of this, the company has a predictive risk assessment in place to understand who may need more help or assistance.
  • To create these member profiles, the company uses historical damage data obtained from the carrier. To determine the quality values ​​for doctors, the company looks for commercial and CMS historical data, databases such as ProPublica and Leapfrog. When the company creates networks, it has data partners to help create these categories. Some data is unique and internal, but most of it is connected through its ecosystem partners, which the company synthesizes and makes actionable for its members.
  • In 2020, Rightway launched a PBM called RightwayRx after employees asked how to get cheaper prescription drugs. Right now, 85% of prescription drugs are handled through PBMs: Optum, CVS, and Express Scripts. They make over $ 50 billion in operating profit when they withdraw money from retail pharmacies, wholesalers, and drug manufacturers, but they are not focused on the underlying employees and employers.
  • Rightway’s PBM doesn’t compete with companies like GoodRx and Amazon as they are on the cash-pay side. Instead, the company wants to reach out to them to make sure they have the best prices for the member. Rightway tries to give its members access to cheaper / cheapest drugs and integrates prices from Amazon or GoodRX. Rightway’s competition consists of traditional PBMs focused on the employer and health plan market.
  • Rightway started nursing navigation because they believed this was the digital doorway to healthcare and that every member has a doctor in their family and that kind of support could improve the health experience. People need a central ecosystem to become better healthcare consumers.
  • Rightway’s North Star revolves around member engagement, high customer satisfaction, and reducing the overall cost of care. The company expanded into the pharmaceutical industry to accommodate these variables. Now it has a navigation platform and a PBM to control pharmaceutical costs, so that member relationship can be supported lengthways in a way that no one else can. Rightway can now be a comprehensive platform in the corporate healthcare ecosystem.

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