Lessons from Corbin Petro, CEO and Co-Founder, Eleanor Health, delivering on a value-based care model for complex populations

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Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.

This week, we’re super excited to have Corbin Petro, CEO and Co-Founder of Eleanor Health. Founded in 2019, Eleanor Health provides evidence-based, whole-person care specializing in addressing the unique complexities of individuals and populations with substance use disorders and mental health needs.

Eleanor Health leverages proprietary technology and data-driven insights, compassionate teams, and value-based payment to deliver superior clinical and financial outcomes.

Prior to Eleanor Health, Corbin was the founding CEO of Benevera Health, a payer-provider JV and population health company. Corbin has an extensive background in healthcare including as Chief Operating Officer (COO) of the Massachusetts Department of Medicaid (MassHealth), a $13 billion agency providing health care to 1.4 million Massachusetts residents, advising a US Senator on health reform, and roles at Bain and Company, Goldman Sachs, Deloitte Consulting, and American Management Systems. Corbin is passionate about improving health for vulnerable populations, equity for women and other marginalized groups, and animal rights. She is co-chair of the board of visitors of Fenway Health, and on the boards of Reaching Out and the Eleanor Health Foundation.

Eleanor recently announced last month that they raised a $50M Series C Round led by General Catalyst with participation from Warburg Pincus, Townhall Ventures, Northpond Ventures and Rethink Impact.

‎Pear Healthcare Playbook: Lessons from Corbin Petro, Eleanor Health, delivering on a value-based…

Corbin’s entry into entrepreneurship:

• As the daughter of a public servant, Corbin grew up traveling around Ohio meeting a variety of people, which exposed her to the different types of challenges people faced, particularly with their health, and how social determinants impacted health outcomes. She was interested in public service, medicine, and healthcare, and the past 20 years of her career have reflected a combination of these passions.
• Prior to founding Eleanor, Corbin was the founding CEO of Benevera Health, a payer provider joint venture and population health company. Alongside a health plan partner and 4 hospital systems, they created a joint venture structure. Corbin shares that it was running this joint venture that solidified her passion for value based care. When going into patients’ homes to understand their clinical needs, patients would often be struggling with much more than the claim they were flagged for — beyond having diabetes, this person also struggled with accessing food and transportation, mental health issues, an opioid use disorder, etc.

“I understood that the root cause wasn’t what was often being surfaced in the data that we were seeing. That really led me to have an even stronger interest in the non-clinical components of healthcare and the social determinants, as well in mental health and substance use disorder as the root cause that’s driving a lot of excess utilization and poor health outcomes.”

• In her time at Benevera, Corbin saw the evolution of population health analytics. Corbin describes population health analytics as deploying and using analytics to improve patient satisfaction and outcomes, as well as show patients the various health paths one can take. One example would be preference-sensitive conditions, conditions where two potential paths, like surgery vs. therapy that lead to similar outcomes. Population health analytics empowers the patient to decide rather than solely the clinician. Today, Corbin believes population health analytics has evolved to incorporate more and more consumer data, which is a large part of Eleanor’s story.

Inspired through working with high cost and complex patients at Benevera, Corbin went to pursue Eleanor Health

• Corbin loved the innovation side of her role at Benevera as they built out a new asset. After so much time spent digging into high-cost high-utilizer patients, she started to recognize substance use disorder and mental health as the root cause for many poor health outcomes.
• Eleanor Health’s beginnings were a bit different from most, having been incubated at Oxeon Ventures. At Oxeon, Corbin built out a holistic care model that not only deploys non-clinical interventions in an evidence based way, but also survives from a reimbursement perspective when these interventions aren’t supported in a fee for service environment. While incubating with Oxeon, Corbin found a strong clinical co-founder and met her co-founder, Dr. Harrison.

Eleanor Health leverages an evidence-based treatment model with clinical and non-clinical factors to help people affected by addiction

• In over 30 clinics across 7 states, Eleanor Health focuses on individuals and populations with substance use disorder and other mental health conditions, particularly those who are moderate to severe in their acuity levels. Their business model is to take risk on populations like substance use disorder (SUD) or mental illness populations, populations who haven’t found their home within the healthcare system, with insurance partners and other risk bearing entities.
• These populations are incredibly complex:

80% of people with a substance use disorder have another mental health condition

70% have another physical health comorbidity

90% are not connected with primary care

• From a clinical perspective, Eleanor’s model is a medical home model built to address the root cause for SUD and mental health conditions. Eleanor’s specialized care model supports both clinical and nonclinical needs including full psychiatry, therapy, medication management, nurse care management, and peer support. They have a hybrid care model with brick and mortar clinics and a virtual experience. Particularly for this population of moderate to severe mental health patients, Corbin shares that it’s important to prioritize in-person care. What they’ve heard from their patient populations is a desire for hybrid care, from having access to virtual visits to being able to meet a peer advocate outside of the clinic.

Scaling Eleanor across Commercial, Medicaid and Medicare insurance:

• Similar to kidney care, Corbin believes clinical conditions like SUD and mental health conditions make most sense with a specialist lens care model that take on risk and the total cost of care. Corbin shares that Eleanor’s patient base is evenly split with around 40% of patients commercial, 40% Medicaid, 15% Medicare, and the rest self pay.
• Eleanor Health has expanded commercial partnerships focused on the bundled payment model. With a specific commercial payer, Eleanor will be assigned to a specific population in which Eleanor will then be responsible for engaging with the patients, supporting them with their care model and analytics platform.
• Demonstrating outstanding outcomes, Eleanor Health reported 84% improvement in substance abuse, 70% of members reporting improvement in depression & anxiety, and 84% reduction in ED and inpatient utilization.

Compassion and transparency lead to patient trust, which leads to a better ability to deliver care and better outcomes.

“I’d say one of my biggest hurdles is US Weekly and celebrities going to rehab. Rehab often isn’t evidence based. People often don’t need a 30 day retreat to support their substance use disorder and mental health needs, so I think there’s a lot of confusion for patients.”

• Corbin shares that in the substance abuse and mental health space, there’s a lot of patient confusion surrounding treatments. Eleanor introduces an evidence based model that supports their patient populations in a compassionate way, building trust that allows them to further coordinate the rest of their care. This is a high-cost population for payers, and Eleanor takes on that risk by stabilizing and building the relationship.
• Corbin shares that some of the other barriers for payers and patients are abstinence based models, where the patient is fired for relapsing on their chronic condition.

“We would never kick somebody out of healthcare for going into diabetic shock or not being compliant to their diabetic care program. And yet, we do that with people who have a substance use disorder or other mental health conditions… It’s a product of stigma.”

• Eleanor Health’s model is focused on harm reduction, prioritizing meeting patients where they are and improving their health and care outcomes. Corbin shares that this is what patients appreciate most about Eleanor as a population not often treated compassionately

“I think that compassion builds trust and allows us to further coordinate the rest of their care, which is what our model is predicated on. For payers, this is a high cost population — these individuals are going in and out of the ED, they’re struggling to find their home within healthcare.

What we’re able to do when we stabilize and build that relationship is we put ourselves at risk.”

Each healthcare population will have a specific go-to-market designed around the best healthcare incentives and access; for Eleanor it is value-based care

• Eleanor primarily focuses on a value-based clinical approach and payment model, in order to reduce barriers for patients and provide preventative and continuous care and drives more aligned incentives for the patients, rewarded the value Eleanor creates.
• Value-based care is a reimbursement approach that ties payments for care delivery to the quality of care provided and rewards providers for both efficiency and effectiveness. In the 1980s, managed care organizations developed the concept of capitation, which tried to address the challenges facing PCPs and payers. CMS was also trying to curb increasings cost trends driven by quantity over quality incentives. The reimbursement approach emerged as an alternative model to fee-for-service which pays providers based on bill charges or annual fee schedules. Value-based care approach seeks to advance the triple aim of improving care of experience, improving health of populations and reducing per capita costs of healthcare.
• From the start, Corbin knew having coverage from insurance would be important since the SUD and SMI population spans across both Medicaid and Commercial Insurance coverage. In order to seek insurance coverage, Eleanor Health needed to measure data and the outcomes of their clinical model over a long period of time as SUD and SMI are longitudinal chronic conditions.
• Eleanor has a cash pay channel as well, but it’s never been a significant share of volume given even co-pays from insurance can already be a major barrier. For other companies and depending on the population, a direct to consumer cash pay route might be better because it’s often the quickest to stand up.

How to implement a Value-Based Model for your business

First, start at the lower end of the value-based roadmap as you figure out the efficacy of your model. To get to the risk model you want, prove your clinical and financial outcomes at scale.

• Continuum of risk across different value-based business structures:

1. Fee for service (volume-based, low-risk model)
2. Pay per performance (participating providers can receive bonus payments for meeting quality/efficiency targets)
3. Shared savings programs (upside shared savings when quality metrics are sufficient)
4. Bundle-based payments (only focused on a set of episodes of care with upside potential and downside risk)
5. Sub-capitation / Global capitation (similar to a traditional payor full-risk arrangement against total cost of care, bearing upside and downside risks)

• For more details: I highly recommend diving into A16z’s founder’s playbook for risk-based contracting for value-based care. Here’s a snapshot of the spectrum illustrated:

Source: A16z Risk-based contracting for Value-based care, by Julie Yoo and Justin Larkin

• The goal for Eleanor was always to move to population based risk. In order to get there, Corbin knew they had to prove their clinical model by

1. Proving clinical efficacy.

“The first two years that we operated, we really focused on proving that our clinical model and our outcomes were superior. With outcomes as our north star, we started to prove our clinical efficacy. That included improvements across a number of different evidence-based psychometrically validated skills and screeners that could be compared against the evidence base and the academic literature.”

2. Proving impact on total cost of care for the population.

“We started to prove our reductions in ED and inpatient stays for the patients who we served, and that really fueled all of those pieces really fueled our conversations with payers.”

• Eleanor Health still has a number of bundled payment models with certain payers, but they were able to start signing many population based contracts towards the end of last year around two and a half years into delivering care. Corbin attributes the fast progress to Eleanor’s proven clinical and financial outcomes over a statistically significant patient population as well as their ability to approach payers with value based expertise and a proposed structure.
• Corbin shares that when speaking with other founders on picking the right value-based structure for their business, it’s most likely the lower end of the value-based roadmap — pay-per-performance, shared savings, episodic/bundled payment structure — especially as they figure out the efficacy of their model. Taking more risk with a population-based model requires having a full population health infrastructure, which is often less possible when an early company is focused on delivering care

Looking forward towards Eleanor’s future:

• After their most recent Series C raise, Eleanor Health is now entering into Texas and investing more in their data and analytics tech stack. As Eleanor continues to scale their VBC approach, it will be ever more important to strengthen the foundational data infrastructure, balance upsides of scale with risk exposure and continue to deliver on impact for the populations that they cover.

Find people who you can learn from and don’t be afraid to ask questions.

• Corbin shares that an important part of entrepreneurship is changing course, learning from others, building good relationships and good ties because those relationships are going to help escalate the growth of the company that you’re building and your mission. The more people you talk to, the more you’ll learn and envision the mission that you have for your company.

“Be curious, ask a lot of questions, be appreciative, be humble. Those are the core tenets of my life.”

Interested in learning more about Eleanor or joining their team? Learn more on their website, Twitter, and LinkedIn.