Spotlight Interview: Heather Ridenoure, Senior Director Product, Contigo Health

About Heather Ridenoure, Senior Director Product, Contigo Health

Heather is responsible for product management including setting product strategy, identifying and implementing product enhancements, and prioritizing operational efficiencies. Heather has 23 years of experience in various aspects of healthcare including product design, quality/regulatory, project management, program operations, process improvement, benefit design, provision of clinical care, revenue cycle, and electronic medical record. She brings a balanced perspective to the complex health care environment with her clinical, operational and administrative experience. Heather lives in Rogers, AR with her husband and three children.

About Contigo Health, LLC

Contigo Health, LLC, creates new ways for clinicians, health systems and employers to work together supporting a common goal for all stakeholders to: increase access to high-quality care, enhance associate engagement, control costs and get associates back to work and life faster. Contigo Health delivers comprehensive services for optimizing employee health benefits.

Medical Travel & Digital Health News (MTDHN): How would you describe the organization and its position in the marketplace? Let’s start with Contigo Health as a whole and then the medical travel components.

Heather Ridenoure (HR): Contigo Health is focused on relationships between health systems, clinicians, and employers. Our products support common goals for all stakeholders including increasing access to appropriate and high-quality care, increasing user engagement, controlling costs and increasing user productivity. Two foundational product offerings are our Sync Health Plan Administration (TPA) and our Centers of Excellence Solution (ECEN Passport).

The ECEN Passport product is our center of excellence product. This benefit gives members access to appropriate, patient-centered, and equitable care. Designated providers throughout the country establish personalized treatment plans using both surgical and non-surgical treatment to ensure the best possible outcomes.

MTDHN: What are the qualifications for a designation to become a Center of Excellence?

HR: The selection process for ECEN Passport providers is a multi-step process. The first step is an extensive review of quality and performance data to identify potential partners.

Then, there is an invitation-only request-for-information (RFI), phone call with the organization and clinicians, and request-for-proposal (RFP). Throughout this process there is extensive review of quality, outcomes, and patient satisfaction data. Fewer than 5% of healthcare systems initially identified for participation in Contigo Health ECEN Passport meet the requirements.

Once the relationship is established, there is ongoing review of data and performance and extensive review annually.

MTDHN: Tell us about your self-funded employers.

HR: We sell products to all kinds of employers. Our corporate employers are from various industries and include health systems, manufacturers, retailers, and technology companies. We also serve healthcare-based employers including hospitals, and health systems.

MTDHN: Do they take advantage of your capabilities in processing claims or is it just access?

HR: Our employer clients take advantage of many of our capabilities. We have established capabilities to support the full continuum of clinical care as well as the capability to process claims and run their employer-sponsored and provider-sponsored health plans.

Our member advocates regularly interact with members and with the support of our clinical teams coordinate care across the continuum. We have dedicated teams for our ECEN Passport product that ensure that services are delivered to meet member needs.

Travel arrangements are managed through the dedicated team as well. The claim in this product is a bundled claim that is paid directly to the provider.

MTDHN: Is cost a consideration?

HR: Cost is a consideration in our ECEN Passport Program. The services are bundled for the surgical episode of care. Bundling these services affords cost predictability and cost savings for the employer.

Beyond the savings from a bundled claim in this program, we have demonstrated that appropriate, high quality care has also provided employer savings due to surgical avoidance and improved outcomes.

MTDHN: How would you characterize the employer/employee satisfaction with outcomes?

HR: We actually do quite a bit of work around satisfaction and have a very high net promoter score (NPS) for our ECEN Passport product. Our NPS score for the users is 87 and for our providers is 89.

While we have patient satisfaction and perception of care, data and outcomes, we are still looking at specific functional outcomes from members that we’re measuring as far as return to work, return to functional activities of normal lifestyle and so forth. Outcomes are very important and specific to each service line.

MTDHN: Could we go back a little bit to the joint replacement discussion? What about ancillary services related to that surgery?

HR: Immediately after the surgery, patients stay in the city where they receive the care for a bit for any necessary post-op services. If needed, patients will start therapy in the hotel. Then upon return home, members follow up with a physician and physical therapy in their home market.

The ECEN Passport clinical team supports that patient in the transition of care to home providers and ensure that needed services are available. We are looking at future opportunities for connecting virtual services to support surgical ancillary services as well.

MTDHN: What is the appetite for travel?

HR: We saw a decreased appetite with COVID and worked with our clients to ensure their members had options. This has changed drastically in the last six months with significant increase, however it hasn’t returned to the pre-COVID level.

We are looking at expanding our network to ensure that there’s less travel required.

MTDHN: How large is the network?

HR: We currently have 15 providers in our network with over 32 service lines. We anticipate growing both providers and service lines in the upcoming years.

MTDHN: And do you cover all 50 states?

HR: We do.

MTDHN: Let’s talk about medical travel in terms of internationals coming to the United States. Can they take advantage of this opportunity?

HR: If they’re covered under the employer-sponsored health plan, they are eligible. Many ex-pats are not covered under the same plan as their coworkers in the United States.

MTDHN: What is your vision for the next year or so as we begin to return to normal?

HR: I think we’ve learned a lot with COVID and our programs. We’re trying to create a continuum of care that supports the member with optimal care throughout the entire journey. This may include adding virtual service options on the front and backend of some of the services currently in our program.

We also want to expand our service lines as well and are focused on supporting members in other areas, such as substance use disorder and some other areas identified by employers that need to be addressed.

MTDHN: Is remote patient monitoring part of your umbrella of services?

HR: Some of our providers actually do engage members with remote monitoring and some do not, depending on the surgical procedure and the provider.

MTDHN: Can you touch upon accreditation a little bit?

HR: All of our centers are accredited by a CMS Approved Accrediting Organization. Centers that provide surgery in our ECEN Passport Weight Loss Surgery Program, have achieved MBSAQIP accreditation which is the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. In addition, our oncology centers are National Cancer Institute designated centers.

MTDHN: Do you ever compare what you’re offering to what the hospitals in, say, Central America or other places outside the United States are offering?

HR: We have not spent much time looking at that. But that is an area that we probably need to invest some time.

MTDHN: How would you compare the Contigo offering platform to other Center of Excellence programs in the market?

HR: I think the differentiation is our focus on appropriate care and truly looking at the delivery of care through the lens of the patient. We partner with providers that focus on delivering value and not value using the standard definition of only quality and cost. Patient experience including shared decision making and optimizing the care are critical elements in our solutions.

MTDHN: Could you describe a little bit about the process of signing on a new employer.

HR: The communication is different for each employer, but we work with the employers on the communication plan and provide resources to them. We have a communication platform with members, so we can do messaging there. For some, we work with their carriers in identifying patients who would be appropriate for outreach to ensure they know about the program.

Ideally, the people know about the benefit when they need it. And we make sure that they know how to access the information and understand the offering.

For those that have a mandatory benefit, there’s definitely considerable discussion with the member upfront about the offering and its benefits, as well as provider competency and ensuring that they understand and are engaged in the decision to receive care.

MTDHN: Let’s say I find out that I need new knee replacement surgery. Walk me through that process.

HR: The process starts when you engage with Contigo Health. We have member advocates designated for our ECEN Passport program. The member advocate will begin by ensuring you understand the benefit, provide information on what to expect, and then complete the necessary information and paperwork. The member advocate partners with a nurse from our clinical team to ensure clinical needs are met and refers you to the appropriate provider in our program.

Once the provider receives the referral, a coordinator at the facility and the surgeon will review your records and determine a plan of care based upon your specific needs. They communicate the plan to the member and share it with Contigo.

Our ECEN Passport team arranges travel and provides that information to you and the provider. You would travel for your surgery and work directly with dedicated team members at the facility while you are in the COE city receiving care.

When you are ready to travel home, the provider and ECEN Passport team coordinate a transition of care for you including follow up appointments, post-surgical therapy, and assistive equipment. The ECEN Passport nurse follows up with you to ensure that your needs are met, and recovery is as expected.

MTDHN: The report is sent to the employer as well?

HR: They don’t get the specific member level information, but they get a reporting package on the number of members and where they’re accessing care.

MTDHN: What is your advice to the smaller employer market? Should they just take their lessons learned from what you’re doing with the larger employers and make that best practices?

HR: I think we do need best practices. Some of the next steps in this space are to ensure that people make informed decisions about how and where to access care. That’s what we do: ensure that members get the right services. Many patients who don’t need surgery still need support in finding appropriate care.

Even for the smaller employers, it’s ensuring that people have information about providers, performance and appropriate level of care for different services. Sometimes that’s local. Other times you need to move out of your market to access care.

We need more transparency in healthcare. That would impact the outcomes of care across the country, as well as allow people who are used to making informed decisions in other industries to make similar decisions in choosing a hospital.

There’s a shift toward greater transparency, which haschanged drastically in the past 18 months to two years.

People are unaware that they may not have access to appropriate, high quality care in their market. But that’s really the role employers can play by supporting and providing some of that information about what services to access and where.