Letter from Our Founder

Few people will disagree that it can be hard to find good medical care. From an Econ 101 perspective, healthcare supply historically doesn’t react as quickly as demand changes. More orthopedists don’t show up after an earthquake, there aren’t more ophthalmology appointments available after an eclipse, et cetera. Normally though, the changes that result in wholly inadequate access to care happen gradually over long periods of time.

One of these instances gave rise to Tribunus Health.

As I made the transition into adulthood, I lost three close childhood friends afflicted with behavioral and mental health disorders.

Each tragedy unfolded independently and privately – these topics were rarely discussed. As a young adult peer, I had little idea what (if any) kind of help my friends had gotten along their journeys.

I wasn’t alone of course. With the benefit of time and distance from those events, and as awareness of the behavioral health crisis began to crescendo, I began to realize my friends were part of a larger, more-tragic, story:

1. It’s highly prevalent. According to the National Institute of Mental Health (NIMH), in 2015, nearly one in five U.S. adults (46.6 million) lived with a mental illness, and around 4% (9.8 million) had a serious mental illness.
2. It’s undertreated. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that in 2014, only 43.1% of adults with a mental illness received treatment or counseling.
3. … partially because it’s expensive. A study published in the American Journal of Psychiatry in 2012 found that the overall cost of mental disorders in the U.S. was estimated to be $467 billion in 2012, with a projected increase to $672 billion by 2020.

The 30-to-90-day rehab facilities I’d heard about in popular culture were only a reality for families that could pay upwards of $1,000 per day – cash – sometimes indefinitely or repeatedly.

My friends hadn’t been in that 0.1%.

Because of the nature of the disease, the 99.9% of families without access to that kind of cash choose between significant debt and their child’s well-being – with nothing close to a guarantee in return.

As I dug into the Substance Use Disorder crisis, I learned that the number of available beds at treatment facilities well-equipped to handle serious illness paled in comparison to the need. A supply-and-demand imbalance could persist even when it came to critical, life-saving, preventive care.

But this didn’t make any sense. We all had insurance! Insurance was supposed to cover this! We paid in each month so that the sickest among us would have care when they needed it. Nominally, that may have been the case, but reality showed major gaps.

While I do have a list of gripes with payers, this situation wasn’t totally the insurance companies’ fault.

The nature of the disease made it hard for payers to distinguish quality facilities, some providers were gaming the insurance system, and brand name providers had great businesses going – why rock the boat by going in-network?

In the face of increased demand and as word of some providers’ healthy margins got out, new entrants came into the space. The limited number of individuals who could afford premium services were then spread across more facilities, increasing the number of empty beds. To fill them, providers turned to insurance companies.

But facilities were continuously met with reimbursement rate offers below the cost of providing their services, a problem often compounded by payer denials, payment delays, and processing errors. This created an environment of mistrust between the two parties whose cooperation was necessary to increase access to quality care.

This was the environment into which Tribunus Health was launched.

With limited history positioning themselves to insurers and very limited data about the market rate for their services, those providers (and the clients and patients they served) could benefit from the support of experienced and informed negotiators.

Our negotiators would bring the soul of a provider to the table, coupled with the knowledge of how payers tick. We would make analytically informed recommendations, rather than the well-intentioned guesswork rife in our industry that threatens to damage quality of care. We paired long-time industry veterans with impressive college grads and sent them to work against the grain of bureaucratic payer institutions, forcing payers to engage with the question “what makes a provider better?”

Five years in, the number of patients who have unknowingly benefited from our work in the form of increased access to quality providers, reduced financial burdens, and improved quality of care can conservatively be numbered in the tens of millions.

Though the patient-facing providers are undoubtably the heroes of this story, if the US is going to continue to pursue a market-based healthcare system, someone needs to fight this administrative fight on their behalf.

Making supply more reactive to demand in healthcare will improve outcomes relative to the amount we spend. To do that, quality providers need advocates to maximize their relationships with health insurance companies. That way, the best are recognized, rightly rewarded, and will proliferate.

Rather than talking about the what ifs of wholesale healthcare reform or not-quite-there-yet payment models, Tribunus Health stepped into the arena to improve the system as it exists today, becoming the leading advocate for growing provider organizations through our intensely data-driven, yet human approach to payer contracting.

It’s been more than a decade since I lost the friends that were the catalyst for the creation of Tribunus Health. But that memory – and the desire to fix what was broken – still drives me and guides our organization today.

– Kevin Isaacs