How Payers Benefit From A Better Patient & Provider Experience

A conversation with Tom Roark, VP of Payer Strategy and Contracting at Local Infusion. 

When Tom Roark thinks about the challenge — and opportunity — as VP of Payer Strategy and Contracting at Local Infusion, he draws upon the analogy of a hole-in-the-wall, family-owned Italian restaurant. 

“When you go there, you get really good food,” he explains. “Maybe the owner will walk over and greet your table. Overall, it’s going to be a great experience, and very different from what you’d get at Olive Garden. And yet, Olive Garden’s going to get business because they have higher density and a level of consistency where people know what to expect. But is it an optimal experience compared to the family-owned spot? No.” 

Expounding on this analogy, Tom explains that Local Infusion is currently that family-owned restaurant delivering an exceptional, high-quality experience. But to really be impactful, it has to scale. 

“That’s the biggest challenge,” he adds. “Because you want to grow while also preserving that same feeling.” 

We sat down with Roark to better understand how he’s drawing upon over three decades of healthcare experience to build relationships with payers and accomplish exactly this. 

This isn’t your first foray into the healthcare space. Tell me a bit about what drew you to Local Infusion. 

My last role was at a women’s health-focused company where there was a telehealth and mail-order pharmacy component. When I came across Local Infusion, I was intrigued by the proof of concept: I wasn’t joining an organization with 30-40 locations that needed someone to come and get better rates for us. Instead, we’re starting relatively small and trying to build the best patient-prescriber-payer experience possible. And when we get that right, then we can look to grow in a smart way. 

I also liked that we started in New Hampshire and Maine — smaller geographical areas, but higher density. So when we work with health plans, we’re really viewed as being local and not the big company from a big metropolitan area that suddenly wants to move into Maine. We started here in the backyard of small plans, and as we grow we’re quickly becoming more of a partner. 

Local Infusion is laser-focused on providing a better patient experience. How does that impact the work you do with health plans? 

Imagine going to a hospital outpatient center for an infusion. You sit in a rickety chair, you can probably see the person right across from you getting the same infusion, in a noisy room with a bunch of other people. The nurse is trying to cover 10-15 people. You have to pay to park, and then you spend 15 minutes trying to find where you are supposed to go. It’s a terrible patient experience. And then you think about Local Infusion: you’re not paying to park, you’re immediately brought to your own private room with TV, warmed blankets and WiFi, plus dedicated 1:1 attention from a nurse that specializes in IV. It’s no wonder we are seeing a patient satisfaction score of 98/100. 

In addition to the broader patient experience, we’re also delivering stronger clinical quality. Our nurses are experienced IV nurses — 94% of our IVs are inserted on the first try. We’re also seeing medication and care plan adherence of 98%, and a 97% emergency room avoidance rate — these are all best-in-class metrics and we continue to improve even as we grow.

From a health plan perspective, not only are we providing a better quality, and stronger clinical experience, but we’re significantly more cost-effective as well. Getting the “Cadillac experience” without the “Cadillac price” is automatically a win. 

We’ve also implemented better technology and processes to improve relationships with referring providers. How do health plans think about that? 

The last thing a physician wants is patients coming back saying…I hate where you sent me. On the flip side, if you’re greeted by patients who say…you know,this place was AMAZING. I was scared and really didn’t want to do this but the company made me feel at ease and something I was dreading was actually almost enjoyable, that matters. Beyond patient satisfaction, we have seen that it also improves medication adherence. 

If we have a strong patient experience, then we have a strong provider experience. And that makes it easier for a health plan to want to partner with us. Now the hurdle is how we replicate this experience. We’ve built a strong foundation of technology and process to scale from here. 

How do you think about analytics and data reporting to payers? 

Take a pharmacy, for example. They know that a patient came and picked up a 30-day prescription. But they don’t know if the patient took the medication correctly, if at all. All they know is that a transaction took place. 

We’re in a better position because we see the patient and the nurses administer the medication. We can ask questions before or after about how the condition is progressing, how they’re tolerating the medication, whether they have any side effects. 

There’s a lot of opportunity to collaborate with physicians and health plans to gather a bunch of data, especially since the bar is so low. At Local Infusion, we have our own idea of baseline clinical quality data to report out on. Did the patient show up? Did we keep them from having to go back to see their physician or have an unscheduled ER visit because something didn’t go right? By those metrics, we can then assume some cost savings and quality/level of care.

Part of my job is meeting with several of the largest health plans in the New Hampshire and Maine markets to really go through that baseline clinical data and utilization data. I want to figure out ways we can be more proactive and figure out what data is most available to them. There’s not a lot that’s standardized, not a lot that’s required, and a lot of providers in our arena don't share a lot of information.

From a technological and people perspective, we’re set up in a really nice way to collect that data.