Kelsey Mellard, Sitka, on solving the specialty care access problem
Our guest on this episode is Kelsey Mellard, founder & CEO of Sitka, a virtual specialty consultation company facilitating primary care and specialty communication via video consults, also known as eConsults or “curbside consults”. Sitka and their virtual specialty provider network, Sitka Medical Associates, work with payers, provider groups and accountable care organizations to improve access to specialty care while avoiding unnecessary specialist costs. Last year, Sitka raised a $14M series A round of funding led by Venrock.
In this episode, Kelsey and I discussed:
- Her journey to starting Sitka and how her time in the public sector has impacted her career
- How Sitka closes the specialty access gap by removing scheduling inefficiencies and virtually connecting PCPs and specialists
- Her experience as an early-stage founder, including how she navigated taking parental leave as a Series A CEO
Beginning to 9:06: Starting Sitka to drive value-based care
That’s actually the motivating factor….a desire to improve health care, delivery and access and impact individual lives to actually move the collective into more value based care.
- The growing privatization of Medicare through Medicare Advantage, as well as the subsequent increase in risk-bearing primary care groups, prompted the need for a value-based specialty care solution. 42% of Medicare beneficiaries are enrolled in a Medicare Advantage plan, and a projected 51% will be enrolled in MA plans in 2030.
- Long specialty care wait times and a lack of PCP insight into patients’ specialty care can increase specialty care costs. “Curbside consults”, or calls between PCPs and specialists have historically averted unnecessary referrals and enabled PCPs to implement treatment plans unofficially advised by a specialist. However, these individual interactions aren’t scalable and come with unclear legal implications.
- By facilitating virtual interactions between PCPs and specialists, Sitka increases access to specialty consultations via Medicare-reimbursable eConsults and avoids unnecessary specialist costs while decreasing legal risk.
- Sitka has built a synchronous video engagement tool, but has found that the asynchronous product delivers the same clinical value while also addressing the scheduling inefficiency problem that delays access to specialty care.
9:06 to 18:23: Public sector experience driving private sector innovation
My motivation is squarely on positive impact. Are we moving the needle for every patient and provider’s life that we touch.…my experience in value-based care drives to a different level of desired outcome.
- After her experience at a Kansas City pediatric hospital and in Washington, DC with the Kaiser Family Foundation and the Advisory Board Company, Kelsey decided to join the federal government after the passage of the Affordable Care Act. She was an early team member of the Center for Medicare and Medicaid Innovation (CMMI) and worked to implement public policy to impact individuals and healthcare organizations.
- Kelsey followed this public sector experience with time at UnitedHealthGroup focused on policy strategy for UHC and Optum, the bundled-payments enabler naviHealth, and the senior care network Honor. Kelsey’s public sector experience creating policies to promote value-based care directly tied to her work implementing and enabling value-based care in the private sector and helped her keep the same clear mission focus throughout her career. This mission focus and belief in value-based care drives company prioritization at Sitka.
18:23 to 33:58: Addressing specialty access gaps and workflow efficiency
If we can alleviate those unnecessary referrals, create a better member experience with the primary care provider, we can actually reduce the cost, we can reduce the time it takes to get that insight and that care and create a better member experience.
- Primary care physicians are increasingly being asked to control the cost and quality of all care their patients receive, but referring out to specialists limits that influence. Patients may not make it to the appointment at all, or the appointment could take place 6–8 weeks after the PCP intended.
- One of Sitka’s institutional special needs plan (I-SNP) partners has found that for every initial “anchor visit” a patient has with a specialist, there are 5–7 follow-on visits, which may not be clinically indicated but are reimbursed via the fee-for-service system in which specialists primarily operate.
We’re untangling the economic incentives that currently exist between specialty providers and those primary care providers that are at risk for the total cost of care, but have no visibility as to what happens when they send a patient out.
- Focused on PCP workflow, Sitka has based their communication platform in video and integrating with EHRs to improve process efficiency. They find that a consult can take anywhere from 10 seconds to 2–3 minutes for the PCP to complete.
We’re really trying to bring these two worlds together in a collaborative spirit, through video and text communication that drives the ability for these specialty practitioners to be incredibly efficient with the talent, the skills and the knowledge that they have while upskilling these primary care providers just in time.
- Commitment from Sitka’s partner organizations has been a clear driver of platform adoption. Creating economic incentives for PCPs to utilize eConsults in value-based care models and implementing organizational referral processes to establish Sitka as the first-line specialty consultation option have driven deeper collaboration for Sitka and their partners.
By making [patients] part of the request for expertise, it actually instills more trust in the relationship….These are fundamental behaviors that we have to drive in order to have a different trajectory for many of our members, and it’s all rooted in trust. If we can…be more transparent with the primary care provider and the patient about what the primary care provider is doing on behalf of the patient’s interest, it’s actually going to motivate that patient to have better adherence…
- Sitka’s platform also enables sharing these consults with the patient, which is less common. Kelsey believes this transparency helps PCPs build trust with patients and make clear that their medical concerns are being comprehensively addressed, even if they’re not seeing a specialist for a visit. The ability to share these consults with family members has also been impactful in enabling the patients’ caregivers to provide the best care possible as well.
…[W]e know that we can be a better, cost-effective solution to our partners and to our patients by practicing medicine across state lines with Sitka Medical Associates…
- Sitka has established a virtual specialty provider group, Sitka Medical Associates. This allows them to directly provide care across state lines, receive Medicare reimbursement for reviewing virtual consultations, capture additional diagnoses, and more directly guide PCPs in the care they deliver to patients.
33:58 to 40:59: Sitka and Venrock bullish on the VBC market
100% of the time, that primary care provider gets a video from our specialists, which allows this beautiful relationship to be developed between two practitioners who are likely never going to meet, but all have one common interest…the care for that patient.
- Last year, Sitka raised a $14 million Series A round of funding from Venrock, and have used the funding to add leadership team members and expand the business. This includes expanding their existing partnership with ChenMed and adding I-SNP partners, as well as SCAN Health Plan.
We have to, as a society, as taxpayers, figure out how to bring that massive $300 billion [specialty care] market into value-based care if we’re going to move the needle and have any sustainability of our Medicare trust fund.
- Sitka and Venrock are bullish on the value-based specialty care market based on the downstream impact of the growing risk-bearing primary care market. Specialty care costs are high and growing in the Medicare population, the vast majority of which is flowing through fee-for-service payment mechanisms. These trends combine to create urgency around moving specialty care dollars into value-based care arrangements, which is the product-market fit Sitka aims to achieve.
- Sitka has made a number of significant additions to the leadership team over the last year, focusing on value-based care experience as well as mission alignment to find the right additions for Sitka’s fully-remote team. Experience with early-stage companies and the challenging and rewarding nature of companies at that stage is also a key factor for Kelsey.
40:59 to 47:09: Navigating parental leave as a Series A founder
It was met with such excitement and joy, not only for George and I but also for the business, because it meant that the business had to grow to a point where I needed to be able to take some time off and it needed to continue on its path.
- Shortly after finding out that she was expecting, Kelsey closed Sitka’s Series A round of funding, shared this news with her new investors, and started the planning process for her upcoming maternity leave.
Having the support of your entire life from your investor community is a really heartfelt and magical spot…but it means that you as an entrepreneur have to be vulnerable enough to share that life with them in order to create those relationships…
- The excitement and support from her new investors enabled Kelsey to focus on growing the business and Sitka’s leadership team to a point where their success would continue during her leave. This accelerated decision-making timelines, forged deeper trust between Kelsey and the members of her team and helped her keep perspective on the role that the collective team has to play in driving Sitka’s success.
- Kelsey identified authenticity as the key attribute that enabled her to successfully make this transition and the attribute that she would recommend to other entrepreneurs in a similar position. This authenticity can help founders build deeper relationships with their teams and enable transparency in the organization.
47:09 to end: Kelsey’s advice to MBAs, and what Sitka looks for in talent
- Kelsey advised MBAs to take advantage of the “student hat” and talk to as many people in their industry of interest as possible. Students are in a position to ask questions and learn with no agenda and can reach out to organizations cold to build connections.
- Sitka is hiring across the organization and has roles particularly well-suited to MBAs on their growth team.
To see all of the roles Sitka is hiring for, check out their careers site.