Page 18 of The Probability of Us

“I’m glad you like it. I’ve always loved the charm of the downtown area.”

Peter’s smile is so genuine and kind, he’s not what I expected from the CEO of a health-tech startup. His eyes flash to the flowers in my hand and I see intrigue cloud his features, but he doesn’t ask anything as we all board the elevator.

Warren and I are in the back while Peter, Mac, and Jason stand in front of us. Jason keeps glaring over his shoulder at Warren, eyeing our coffees from the same shop, the flowers in my hand, and surely considering how we were laughing as we walked into the lobby earlier. His anger is so obvious and he’s acting the exact opposite of how we’re supposed to be acting towards the people who are buying our company that I can barely contain my laughter. I cover it up with a cough, but everyone glances my way.

Thankfully, it’s only a short ride to floor three—both for my fear of heights and the strangeness of this silence.

“Let’s meet in the conference room before the meeting,” Peter says to Warren when he starts following me in the opposite direction, to my office.

He nods then leans into whisper, “See you soon,” before walking off with Peter. My chest constricts as he walks out of sight. I’m already much too comfortable having him around and it’s barely been a full day.Fuck.It’s going to hurt when he leaves again. It’s going to hurt so bad.

“I don’t like that guy.” I jump when Jason speaks, not realizing he’s still standing right behind me.

I turn on him. “You don’t need to like him, but you do need to be respectful and professional.”

“I’m sure I don’t know what you mean.” He looks angry that I’m not siding with him.

“What you did today, can’t happen again.” I emphasize each word. “These people are here because they bought our company. We are supposed to be welcoming.”

“You’re not my boss, you know.”

My lips press into a hard line. And he wonders why I’ve never wanted to go out with him. “Want me to bring this up to Clara? Because I sure as hell can bet you she’d be on my side for this one.”

He scowls, and I fake a smile before walking away, saying a silent prayer that he doesn’t follow me.

As I replace the wilted flowers in my office with the new ones Warren got for me, I can’t help but think:Jason may not like him, but I sure as hell do.

Eight

AUGUST CURRENT DAY (TUESDAY)

The eight of us are packed in the main conference room while Peter stands at the front of the room, talking through slides of the company vision and mission. It’s basically what I expected. They want to create an insurance company that only has value-based care contracts with providers. Most established health plans are slowly shifting their current fee-for-service contracts over to value-based care ones anyway. So, in some ways, it’s nice to start solely with that intention, but there are still plenty of providers that are hesitant to switch over.

The current fee-for-service payments are simple—one payment for one service, and the more services performed, the more payments they receive. Value-based care is trying to flip payment focus from quantity to quality based. These contracts can get extremely complicated and there are many different components to them, but essentially, they all, in some way, have a variable payment that’s tied to patient outcomes. For a primary care provider, that could mean managing chronic conditions so there are fewer ER visits. For a surgeon, that could mean fewer post-op complications.

It can require more management from providers, and since the payment is variable, if they don’t manage their patients well, they could end up earning less.

When I’m looking at developing our strategy for these programs, these are all pieces I have to take into consideration. And our programs get deployed by all health plans in our system; we don’t work exclusively with anyone—which is my main concern after reviewing the materials they sent ahead of time.

It’s why I start getting giddy when the financial slides pop up in Peter’s presentation. I havea lotof questions, and I don’t think they have the answers to them.

“Moving on to the financial projections,” Peter says, standing in front of the screen. He glances at Warren to make sure he’s prepared. “Are there any questions regarding the calculations sent over?”

“Yes, I have a few,” I chime in, and Warren looks up, weariness in his expression. This is his area, and as much as I don’t want to admit it, he knows how I am. I only smile though, because heshouldbe weary. “I noticed that the only place you’re accounting for the impact we’ll have on the company is in the cost of healthcare savings. Are you planning on changing our company’s strategy away from consulting? Because I can’t help but notice that the savings projections are only a fraction of the revenue we currently generate.”

Warren clears his throat and sits up straight. “Yes, looking into the matter we found that it’s a conflict of interest for an in-house team to also consult out to other insurers.”

“Is there no way to keep it out-of-house then? So that you can still get the savings, but we can also keep our current business?” I push because this is important to me. I started working here because I truly cared and believed in what we were doing, and this feels like a fundamental shift in our core practice. “It seems like such a waste of all the expertise and the reputation we’ve built here over the years. Besides, if we do things the way you’ve modeled here, your savings projections are way too high.”

“What do you mean?” Peter asks, intently focused on every word I’m saying.

“I’m assuming you used the ten percent savings from our experience files?” I direct the question at Warren, and he nods. “Right, well we’re only able to achieve that level of savings because we have multi-payer alignment. With these programs, we’ve found that the providers are more engaged and attentive when, say, seventy percent of their members are part of a value-based care program, as opposed to if five percent are. And if they have five different sets of metrics to track from five different programs, they’ll end up only focusing on the one they believe will make them the most in return. As a result, they put more work into achieving the guidelines and striving to improve when they don’t have to change their practice for a few members. If you take away the consulting side of this business, you take away the buy-in of the physicians and the savings will not be what you’re expecting.”

Peter turns to look at Warren who’s shuffling through his papers. A smile pulls at my lips as he fidgets, searching for an answer—this part of the job never gets old for me.

“I haven’t been able to find a legal way for us to do that,” Warren says.

“Well, let’s keep looking,” Peter says to Warren, then looks at me. “Work with Miss Summers on this to make sure we’re capturing all of the nuances of the business.”

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