The needs of today’s seriously ill patients necessitates the development of new, longitudinal care models that integrate the patient-centered principles of hospice and palliative care, Dr. Darren Schulte, CEO of VyncaCare, told Hospice News.
Vynca launched as an advance care planning technology platform and expanded into the palliative care provider space through its 2021 acquisition of California-based Resolution Care. In 2022, the company rebranded as VyncaCare to reflect its broadened scope of clinical services. Schulte became CEO this past June, succeeding the company’s co-founder Dr. Ryan Van Werte.
Broadly, VyncaCare works with provider and payer partners to help manage complex, seriously ill populations. Its business model uses a mix of virtual palliative care, advance care planning, care coordination and symptom management services, among others.
The company has raised at least $40.3 million since its formation in 2013, according to the online startup database Crunchbase. Most recently, it secured $30 million in growth capital in a Jan. 2022 funding round led by Questa Capital with participation from Generator Ventures, First Trust Capital Partners, 4100 Group and OCA Ventures.
Since then, VyncaCare has continued on its growth trajectory. The provider has expanded to four new states and nearly doubled its patient census bring 2023 alone.
Hospice News sat down with Schulte to discuss the pathways that VyncaCare is building to new care models, new geographies and a more diverse referral and payer mix.
I wanted to start by asking you a little bit about your own background, how you came to this industry and how you came to Vynca.
I’m an internist by background and by training. After my residency, I went to work for my first health care technology company.
As my fourth company or health care startup, [Vynca] is more of a tech-enabled clinical services company. The others that I’ve worked with are more data analytics-oriented. My last company, Apixio, we sold in 2020. At that company, we used AI and natural language processing to read physician’s typewritten notes to understand clinical quality and risk.
So my background is industry, as opposed to having practiced and then decided to come over to the business of health care.
Vynca started out with its advanced care planning platform and later entered the provider space. Can you tell me more about how the company has changed, especially during the past few years?
We have developed and we still offer and sell our advanced care planning software that’s [electronic medical record (EMR)]-integrated for sharing, storing and creating advanced directives, [Physician Orders for Life Sustaining Treatment (POLST)] forms, and the like.
About two years ago or so we acquired a practice, Resolution Care in northwest California, run by Dr. Michael Fratkin. Resolution provided care, mostly virtual, for those with typically a year or less to live in northern California.
We started there, and then we’ve grown the practice to expand to what we call supportive care, serious illness management for those individuals who have heart failure or COPD, or kidney or liver disease, for example, who have complexity around their clinical needs, behavioral health needs as well as social needs. A majority of our patients actually are Medicaid recipients.
We’re also building out our technology platform and our data platform to enable us to provide better care more efficiently and effectively with both in-person as well as virtual visits, based on patients’ needs, acuity and preference.
How many patients are you currently serving and is it still concentrated in that California region?
We’re in five states today. About 80% of our patients are in California, but we also serve patients in Washington, Oregon, Idaho and Utah. At the end of this year we’ll be serving almost 1,700 patients, which would be an increase of about 2x, or 100%, in terms of our census at the beginning of 2023.
What would you say are Vynca’s top priorities for the coming year?
Top of mind for us is we are, as I mentioned, building out further our tech platform with algorithms to enable understanding of patient acuity, patient risk and needs, matching the care cadence to the needs of patients and stratifying them in terms of those needs, creating an automated means of enrolling patients for an easy referral partnership.
And then we are measuring interventions, the outcomes in terms of interventions, so we can really tailor what we do for our patients. We do good clinical care, earning 95% patient satisfaction and good ROI in terms of reduction of inpatient and emergency department visits, but the better we can get, the more efficient we can be. The more effective we can be at engagement, enrollment and outcomes, the better we’ll be.
And we’ll expand our scope to additional states, beyond the West, into the South and southeastern portion of the United States, as we get more of our health plan partners who will pay for the service. And then we’ll reach profitability, which is key. So we have positive unit economics of what we do. We can make money with palliative care, and so we hope to achieve that by the beginning of the first half of 2024.
As you move into those states, are you looking at acquisitions? Are you looking at de novos? How would that work?
In the back half of next year, we’ll be looking for acquisitions of practices to bring on to our platform. We think with a technology platform that allows for the right care cadence, the right interventions, the right mix of in-person and virtual, we will be able to bring on to the platform practices that are doing good work. But we think we can further scale their reach.
The first half of the year is really sort of getting that sort of in motion. So with expansion initially, it will be de novo work within those areas, with acquisitions to further scale the practice.
What would you say are the biggest opportunities that you see for 2024?
The biggest opportunity is really creating the notion of supportive care practice among specialty primary care, home health and hospice providers, not simply palliative care.
This notion that palliative care is for patients who have a year or less to live makes it something that patients and physicians are reticent to refer to. We believe this is a serious illness management company that really fits a need and a market.
There’s a lot of gaps in care for patients. Primary care doesn’t have the time to deal with complex patients, specialists think in organ systems, and hospice and home health have their own lanes that they operate within. There’s a need to help patients to provide the coordination, the clinical, social and behavioral support, and care goals and planning.
Now, we might see ourselves being able to occupy more of the different ends of the continuum and potentially in the future do home health or primary care. But today, we think that supportive care for serious illness management is a big need in the marketplace.
How would you characterize or distinguish the expanded supportive care model you’re implementing from a traditional palliative model?
Traditional palliative models often focus on a smaller subset of individual patients, but not exclusively focusing on the clinical needs. In our practice, when our patients come to us, sometimes the first visit they want to have is with our social worker, or to deal with their anxiety, depression and chronic pain issues that caused them to be not willing or able to deal with the clinical needs of their of the day or coordinating their care among all the different practitioners.
We see it as being able to expand to more cohorts of individuals. But the other thing is that traditional palliative care just doesn’t get the best reputation. Physicians are reluctant to refer. Patients are reluctant to enroll, because they see themselves as being on a glide path to hospice.
We see a need to go to the patient — to those who may have 12 months or less to live, to those who may have five years to live — who have an unmet need from an access perspective where they reside. There’s fewer primary care and specialty physicians to care for a lot of rural patients, for example, or in areas where, unfortunately, physicians don’t go to practice.
How do you secure reimbursement for these services?
We have different arrangements to be the easiest to work with for our partners. We do traditional Medicare. We do fee-for-service. We do a combination of fee-for-service and case rate contracts with plans we work with for Medicaid, Medicare and commercial lines of business, including Medicare Advantage.
Our point is to be able to be self-sustaining in various different payment models. We can take the fee-for-service patients if need be, or the case rate deals. We don’t go at-risk today. We’re not in that sort of model yet, but we want to meet the plans where they are, so we can provide the ability to reach the most number of patients.