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Q&A with Firefly Health: How we're partnering to power a better patient experience

By
Ribbon Team
December 6, 2022
Founded in 2017, Firefly Health offers employers a new kind of health plan. Built around their proven virtual-first care model and proprietary technology, they offer better outcomes, higher engagement, and unparalleled cost control. To understand how Ribbon Health’s data has powered some of these outcomes, we spoke with Jane Zhu, Director of Operations.
Tell me more about Firefly- how are you delivering on your mission statement?

Firefly is a payer-provider. We have a provider practice where we are running a virtual-first primary care practice, and we also recently launched a health plan and can provide a combined bundled offering of both care and coverage to employers. Our mission is “Half priced health care, that's twice as good.” So a big part of what we focus on at Firefly is how to both deliver that twice as good, as well as that half price health care. The part that I focus on with “half price health care” is really all about... can we navigate people to providers who are going to have long term quality outcomes and provide effective high value care at a low cost, and really deliver on that half priced health care? And the “twice as good” is really about... how do we build trust with members to actually influence their behavior and outcomes through trust? It's about driving engagement and trust, building that trust, and then translating that trust into outcomes.

How does your role at Firefly play into all of that?

I'm a Director of Operations. I lead Navigation at Firefly, and part of that is overseeing navigation on our care platform. What that means is helping patients get care- any type of care they might need outside of Firefly. That means leveraging our network and operationalizing everything that involves getting people seamless virtual and in-person care, beyond Firefly’s primary and virtual care offerings. As a health plan also, it's really important for us to have a provider network and to steer members and patients to high quality, high value providers- we actually have a financial incentive to steer people to those high quality providers.

On the topic of providers- what were some of the team's considerations when determining whether to build vs. buy Firefly’s provider directory?

When we first thought about buying this data, we were only a care practice. A big part of being a primary care practice is referring your patients to specialists and to care. That's a very hard thing to manage from a data asset side- our team was effectively using Google to look up which specialists were close to a patient, calling the office to confirm their address, trying to figure out, do they take their insurance? It was a very, very manual, time intensive process. It was neither efficient nor accurate and caused a lot of operational headaches. Our network and directory of providers pretty much only existed on spreadsheets prior to Ribbon. In terms of our provider directory on the health plan side, Firefly launched this feature called a “Care Pass.” Basically, it's a ticket for members to get free care when they follow our advice. If members engage with our team, get advice, and follow our recommendations about where to go for their care, their care is free. For us, that means now we need to find a doctor that's in-network, performs the care required by the member, and is high quality and high value. Ribbon is helping us power that decision. It's super important for us to send the patient to a doctor that's going to achieve high quality outcomes and be high value.

What ultimately led Firefly to work with Ribbon Health? Were you considering other partners?

We realized we desperately needed better provider data to help ease some of our internal operational pain points. And also, from a patient experience, the longer it took us to get the patient a referral, the longer they were waiting for care. One big reason that we chose Ribbon was the ability to look at detailed data underneath payers. For example, other vendors that we looked at could tell us Dr. Smith is in-network with Blue Cross, but Ribbon could tell us. Dr. Smith accepts Blue Cross, Blue Shield Choice Plus PPO. That level of plan detail was something that we just didn't see with any other vendor, and that saves us a lot of time and gives us a new level of data accuracy. In terms of other reasons why we chose Ribbon, the first is mission alignment. The second is that the team was very transparent, helpful, and I felt like there was a lot of partnership there. The level of service and support is pretty unparalleled. When we became a health plan, it became even more important for us to look at cost and quality data. I did look at a lot of other vendors, but the breadth of coverage that Ribbon has was just stronger than others.

What are the biggest benefits you’ve seen after making that decision to partner with Ribbon?

Accuracy, time saved, and patient experience. As a provider practice, we can leverage Ribbon's data and make a decision about a referral in minutes rather than spending time calling the office and using Google. There’s a lot less frustration and time spent on things that now can be solved digitally. As a health plan, we’re leveraging Ribbon to help us make decisions around how to drive down total medical expenses for our members. Ultimately a big driver of a health plan’s success depends on whether or not we're able to navigate our members to that high quality, high value care, and Ribbon is integral to driving those decisions.

Can you share an example of what that looks like in practice?

One of Firefly’s superpowers is our ability to continuously engage members (with an average of 45 clinically signifying interactions per year), and build a trusting relationship so that we earn the right to navigate them. Then they actually follow our guidance! More than 85% of the time, members follow our guidance and go to where we refer. This is powerful.

I’ll walk through a scenario- let’s say a patient comes to us and needs an orthopedic doctor. We’ll recommend Dr. Smith, Dr. Jones, and Dr. Apple, and if they see one of those three, we’ll waive their costs. How are we deciding that those three doctors are the best options? We’re using Ribbon’s data to inform that decision. That decision has a lot of implications- say the member has a $100 co-pay. We’re basically paying the member’s co-pay for them. But, the hope is that in the long run, because Dr. Smith, Dr. Jones, or Dr. Apple outperform their peers, the members will receive better care and realize cost savings. Because they came to us, we were able to navigate them to someone who is higher quality and higher value. If we're able to really steer that person to a better doctor, that's how we drive down overall costs in the healthcare system.

Finally, what’s next for Firefly Health?

From a network perspective, Firefly plans to continue to build out our ecosystem of high value partners to provide our members with a seamless virtual and in-person experience. We continue to build out a robust, national hybrid network that consists of digital health network partners, Last mile, in-home-care, and select health system partners. Our current employer customers access this hybrid network as part of our offering. In the future, we intend to enable others to tap into or ‘rent’ the hybrid network. As part of this network, partners will be part of a community that sees value in relationships beyond pure referrals. Increasingly, network partners are excited to utilize our platform for their own patient relationship management, clinical coordination, risk management, and proactive longitudinal care. We see this as an opportunity to further empower partners while doubling down on “co-treatment” vs simply “referrals.”

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