The In-Home Healthcare Revolution | with Jory Zunich

This episode provides an in-depth exploration of Nice Healthcare's model, focusing on how affordable and accessible in-home and virtual direct primary care (DPC) can revolutionize the employer-sponsored health plan market. Jory Zunich, SVP of Growth and Partnerships, details the company's strategy, which centers on removing the high cost of healthcare real estate to deliver convenient, integrated care directly to patients. The discussion establishes DPC as the essential "quarterback" of a modern health plan, capable of managing patient journeys and controlling downstream costs. Zunich shares his personal journey from the insurance world to DPC, highlighting the transformative power of experiencing accessible care firsthand.

The core of Nice Healthcare's value proposition is its integrated care model, which bundles virtual and in-home primary care, virtual physical therapy (PT), virtual mental health services, and a robust generic drug formulary (550 drugs) into a single, capitated offering. This approach aims to cover approximately 70% of a typical person's everyday healthcare needs. By employing all clinical staff (W2 nurse practitioners and physician assistants) and owning their technology, Nice ensures a consistent, high-quality patient experience, reflected in their 92% Net Promoter Score (NPS). The model differentiates itself from traditional telehealth by offering follow-up in-home visits for acute needs requiring physical examination or testing (e.g., strep swabs, X-rays, EKG, lab draws), thereby preventing unnecessary trips to urgent care or the emergency room.

A significant theme is the strategic use of DPC to enhance overall health plan design. Zunich explains that services rendered through Nice Healthcare do not generate claims on the underlying major medical insurance, effectively controlling premium increases for both fully insured and self-funded employers. Furthermore, the DPC provider acts as an intelligent care coordinator, steering patients to high-value sites, narrow networks, or direct contract partners for specialized care outside of Nice's scope. This proactive navigation is crucial for maximizing the cost-saving potential of modern, optimized health plans. The company serves a broad market, from groups as small as 10 employees up to large organizations with over 12,000 lives, demonstrating the scalability and broad applicability of the model across various industries and plan types (HMO, PPO, RBP).

The discussion also addresses the national crisis in mental health access. Nice positions its virtual mental health program in the critical middle ground between crisis-oriented Employee Assistance Programs (EAPs) and long-term, in-person therapy. This brief psychotherapy model addresses common issues like stress, anxiety, and boundary management, providing immediate access and reducing the system backlog caused by patients holding onto long-term therapy slots out of fear of losing access. Utilization is a key metric, with Nice achieving utilization rates over three times higher than typical virtual-only offerings, targeting a 9% monthly utilization benchmark across their client base, which underscores the model's effectiveness in engaging employees and their families in proactive care.

Detailed Key Takeaways

• Cost Control through Real Estate Removal: Nice Healthcare's core affordability strategy is eliminating expensive healthcare real estate (brick-and-mortar clinics). This allows them to deliver care via virtual and in-home visits, making the service highly convenient and cost-effective for employers.
• DPC as the Health Plan Quarterback: The primary care provider should serve as the central coordinator for all patient care. By establishing DPC as the front door, employers can ensure intelligent navigation to high-value specialists, narrow networks, or direct contracts, optimizing the overall cost structure of the health plan.
• Integrated Care Model for High Engagement: The model integrates primary care, virtual physical therapy, virtual mental health, and a comprehensive generic drug formulary. This consolidation of services increases patient engagement and utilization, as members find substantial value in a single, zero-cost access point.
• Differentiating Virtual Care with In-Home Follow-up: Unlike traditional telehealth, Nice Healthcare supplements virtual visits with in-home follow-ups conducted by NPs or PAs. This allows for necessary physical exams, strep swabs, in-home lab draws, and even mobile X-rays/EKGs, expanding the scope of treatable conditions and preventing costly urgent care visits.
• High Patient Satisfaction and Retention: Nice Healthcare maintains a 92% patient NPS score, significantly higher than industry averages (often in the 70s for other industries). This high satisfaction drives client retention, which stands at approximately 90% annually.
• Impact on Claims and Premiums: Services provided through the DPC model are not claims on the underlying health insurance plan. This actively helps control the claims experience, which is beneficial for both fully insured (influencing underwriting) and self-funded employers (reducing direct claims exposure).
• Addressing Mental Health Access Gaps: The virtual mental health program fills the gap between EAPs and long-term therapy, offering brief psychotherapy for common issues like stress and anxiety. This approach improves immediate access and reduces the system bottleneck caused by patients hoarding long-term therapy slots.
• High Utilization Rates: Nice Healthcare achieves utilization rates over three times higher than typical virtual-only offerings, targeting a 9% monthly utilization rate across its population. Consistent, high utilization proves the model's effectiveness in engaging employees across different group sizes and tenures.
• Scalability Across Group Sizes: The DPC model is highly scalable, serving employers ranging from a minimum of 10 employees up to large groups of 12,000+ employees, making it a viable solution for the small, mid, and large group markets.
• Strategic Off-Cycle Implementation: Many employers prefer implementing DPC off-cycle from their main benefits renewal date. This allows for a dedicated focus on educating employees about the new, high-value offering without being overwhelmed by other benefits conversations.
• Disentangling Primary Care Costs: The future of health plan design involves further disentangling primary care from the fee-for-service insurance model, turning it into a fixed, capitated cost with high value. This increases transparency and efficiency compared to costs hidden within opaque insurance premiums.

Key Concepts

• Direct Primary Care (DPC): A healthcare model where patients pay a fixed, periodic fee (capitation) directly to the primary care provider for a defined set of services, bypassing traditional insurance billing for those services.
• Integrated Care Model: A system that combines multiple health services (e.g., primary care, mental health, physical therapy) under one roof or platform, ensuring seamless communication and coordination between different types of providers.
• Capitation: A payment arrangement where a fixed amount is paid per patient per period, regardless of the number or nature of services provided. This aligns incentives toward prevention and efficiency rather than volume (fee-for-service).
• Health Plan Quarterback: The concept that primary care should manage and direct a patient's entire healthcare journey, ensuring they receive appropriate, high-value care and avoid unnecessary or costly services.

Examples/Case Studies

• Mobile Diagnostics: Nice Healthcare utilizes mobile X-ray and EKG units that can be brought directly into a patient’s home, providing immediate diagnostic capabilities for injuries (like a rolled ankle) without requiring a trip to an urgent care facility.
• Personal PT Experience: Zunich shared a personal case where he injured his wrist and accessed virtual physical therapy within three days. The PT determined the issue was related to weak back muscles, providing targeted exercises. This quick, accessible, and educational experience helped him avoid future re-injury and unnecessary insurance claims.
• Child Healthcare Expectation: Zunich noted that his young children (5 and 7) only know healthcare access through in-home visits, often receiving care in their living room while watching TV. This highlights the convenience and comfort of the model, resulting in "zero tears" during procedures like strep tests.