The Transformative Power of Value-Based Care with Mike Kopko

In this episode of Friends of Project Healthcare…

Michael (“Mike”) Kopko, co-founder and CEO of Pearl Health, joined host Eric Thrailkill to shed light on the transformative power of value-based care in the healthcare industry. By focusing on proactive, efficient, and personalized healthcare delivery, and leveraging the power of data and technology, Mike believes we can create a system that provides better outcomes for patients and physicians alike. He also highlights the need for collaboration and partnerships as the keys in driving this shift towards value-based care.

Mike shared his journey as an early entrepreneur and shared insights on the mentors in his life that have been instrumental in his previous successful endeavors, including his time at Oscar Health.

“The promise it offers is connecting a lot of dots so that people get anticipatory, efficient, cheap healthcare delivered to them, not when they’re asking for it, not when they’re waiting online, but when they need it,” Mike shared. “That’s the hope, and I think the likely outcome over the next decade. It’s going to take a lot of different experiments, a lot of fits and starts, but the system I think, will become much more intelligent so that it achieves that value promise.”

Mike described the current healthcare system for most patients like a pinball machine. “You get banged around in all these different directions, to different providers,” he said. “But a move to population health value-based care is starting to try to close that system, connect it and say let’s stop the pinball experience. What does this person need next?”

Recently, there has been a shift towards a more consumer-centric and proactive approach to healthcare delivery. As Mike explained, Pearl Health aims to promote the benefits of that value-based care by empowering primary care physicians with the tools they need to improve patient outcomes. 

“We’re helping them participate in these programs as seamlessly as possible,” Mike said. “By bringing better intelligence to those physicians, they can get back to doing the kind of medicine they all thought they were going to do when they went to school.”

One way Pearl Health assists primary care physicians is with the ACO Reach model, providing them data necessary to manage population health at scale alongside building a unique specialty services marketplace.

“The thesis is we can lower costs and reward those who actually deliver better healthcare outcomes,” he explained. “Reach was created in the last few years because mostly it helps really accelerate that. It almost turbocharges that element of giving physicians the opportunity to capture that value.”

As Mike noted, every primary care physician in this country has an option to claim and convert their Medicare patients into a value-based arrangement. “This is a major moment,” he said. “The game changing moment is a real thing. We’re bringing information on patients that has never really been reviewed and looked at by your provider.”

By analyzing the vast amounts of data platforms like Pearl Health offer, healthcare providers can gain insights into a patient’s condition and develop personalized treatment plans. This not only improves the accuracy of diagnoses but also enables providers to automate solutions that patients would naturally seek.

Currently Pearl Health’s platform serves 800 physicians, which Mike expects will grow to nearly 2,000 next year. “As we keep moving up that continuum, what we’re really doing is helping them participate in these programs as seamlessly as possible,” he said.

“And we’re not alone.” In fact, Mike emphasized the need for more collaboration and partnerships in the healthcare industry.  

“There are other competitors out there and we’re grateful for that,” he shared. “This is a competitive market at this point, but what we’re all doing I think in aggregate, and Pearl especially, are focused on bringing better intelligence to those physicians.”

Mike shared that Pearl Health has executed a partnership agreement with Walgreens and has received backing from leading healthcare investment firms. In January 2023, the company completed a $75 million Series B funding round to build the infrastructure for their physician enablement services. 

Through these partnerships with primary care physicians, they are working towards improving healthcare outcomes and delivering better value to patients. “I think the likely outcome over the next decade,” Mike offered, “I think will become much more intelligent so that it achieves that value promise.”

Mike shared the importance of working together. “We’re all accountable, we’re all responsible,” he said. “Let’s make that a good experience that can be managed, controlled and cost effective.”

About Mike Kopko Michael is co-founder and CEO of Pearl Health. Michael served as an early employee and Vice President at Oscar Health, having built their pre-revenue Insurance Plan Sales and Network Contracting systems. He most recently managed the company’s largest P&L at +$2.5B. Prior to Oscar, Michael worked for Bridgewater Associates in the company’s Research, Client Service, and Recruiting departments. While at Bridgewater, he was the Head of Research Analytics where he reported to the CEO and Head of Research. In 2009 he successfully sold DormAid, a college service company, which he launched and ran while he was a student at Harvard. He is the recipient of Columbia’s Feldberg Fellowship, where he received his M.B.A. He received his A.B. from Harvard University.

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