Behind Herself Health’s Value Proposition
We are currently in the era of the consumerization of health care, according to Kristen Helton, CEO of St. Paul-based Herself Health. “Patients and consumers have different expectations around services,” she says. “There is a swell of demand and impatience that the [health care] system isn’t moving quickly enough to meet.”
For Herself’s target audience—women over 65—the phenomenon is all too poignant. A market that Helton describes as at the “intersection of ageism and gender bias,” older women commonly see their health concerns dismissed, which can lead to poor outcomes. Herself’s proposition is a primary care option that follows a value-based care model.
Her goal is to “set the standard for high-quality, primary care—what the patient experience and expectation should be. Hopefully, it brings better care to women all across the region. It is very hard to deliver comprehensive care that is well suited for everyone,” Helton notes. “When you narrow your focus like we have, it just makes it that much easier to improve the experience and the outcomes.”
That notion of outcomes is core to the value-based care model. Traditional health care’s fee-for-service model incentivizes providers to minimize time with each patient in favor of seeing more patients. The value-based model aligns provider incentives with a focus on prevention and keeping the patient healthier. It is being tested in many settings across the country.
Herself’s model is “tiered by patient need,” Helton explains. The federal Centers for Medicare & Medicaid (CMS) establishes a “risk score,” representing the predicted cost of treating a patient compared to the average Medicare patient. Providers are paid a set amount for a specific set of services.
This enables them to deliver services that may not be individually billable according to Medicare’s payment system, according to CMS—for instance, referring older patients with weak bones to an in-house program on fall risk and prevention.
Herself Health is still in startup mode, having just reached the first anniversary of its St. Paul clinic in January. Since then, it’s launched two clinics in Minneapolis: one in the city’s northern limits near Crystal, and another at 5450 Lyndale Ave. S. farther south. The company is working on clinics four (Roseville) and five (south metro). It’s also operating some fee-for-service care to provide some revenue and financial stability.
Herself has so far raised funding that totaled $33 million in July and investor dollars are going into delivery of services, additional team members, and technology. Helton will not know if the model is economically viable for several years, she says.
