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Innovator CEO profile: HealthSparq’s Mark Menton

In this Innovation Lab interview series, Menton discusses the recent acquisition by Kyruus, the company’s roots in cost transparency, what it has in store for the next 18-24 months and more.

Health Evolution | February 23, 2021

HealthSparq CEO Mark Menton has been working on cost transparency innovations since the early 2000s — and, as an entrepreneur, he has been through multiple merger and acquisition deals.

Most recently, Kyruus bought HealthSparq in what Menton describes as a mutual vision of connecting payers and providers and enabling them to share high-quality data. That arrangement follows HealthSparq’s 2014 acquisition of ClarusHealth, where Menton also served as chief executive.

Health Evolution spoke with Menton about what the latest acquisition will enable both companies to do that they otherwise could not, the promise of cost transparency, why he sees the forthcoming patient access and interoperability rules from CMS as a foundation to build upon rather than an endpoint, and more.

What is HealthSparq’s origin story?
Menton:
HealthSparq emerged from an idea in the late 2000s within Regence health plans that people have the right to information before making a health care choice – information on pricing, quality and provider reviews. Work began to integrate this information into the health plan member portal. Then when the ACA mandate happened and some other mandates occurred within the Blue Cross Blue Shield Association that pushed for cost transparency, HealthSparq was in a very unique space well ahead of the curve of developing these tools for health plan members. In 2012, we were spun out of Cambia as an independent company because there was momentum and demand in the market.

Not long after, I had the opportunity to become part of the HealthSparq team. I was at a company called ClarusHealth, which was in the provider search and directory space and had been bootstrapped while working to build out cost transparency on our own. We began having conversations with HealthSparq, and they ultimately ended up acquiring ClarusHealth. We brought 40 health plans to the table with a long history dating back to 2002, which was important because serving multiple health plans is a very different beast than serving just one. If you’ve sold something to one health plan, you’ve sold something to one health plan. There’s a lot to learn outside the four walls of any single health plan so ClarusHealth brought that expertise.

We’re just now at a point where CMS is on the verge of enforcing price transparency rules. So from your perspective as someone who has followed this all along, what are you expecting?
Menton:
It has been an interesting but somewhat frustrating road because tools that help health plan members understand what they will pay for care have been available for many years. But we still struggle with the fact that large numbers of people don’t know they exist or don’t use them. While there are many layers to why that is, one factor is that just making data available is not the answer. We have to create compelling user experiences and the information has to be understandable and personalized. For health plans, it is scary for them to free data and there hasn’t been a focus on enabling people to access this information and make it actionable for consumers. The mindset has shifted from thinking of health care as a shopping experience. When we first started, we talked a lot about trying to encourage people to shop for care, but what we have since learned through consumer research is people don’t like to think they’re shopping for health care. And no wonder – people are often stressed when they are looking to get a medical procedure so it’s not exactly like looking for a vacation. What they want is to understand the options, know how to be in control and save money. So it’s really changing the experience to become more of a guidance experience versus a shopping and search experience.

While price transparency tools that will meet the new mandates like ours are getting a lot of attention lately, we are also seeing somewhat related traction with our incentives program. It’s designed to nudge members to make smart choices about which providers to see or services to have by giving them some financial incentive. It’s about getting people to look at their options and make decisions, such as selecting high-value care, and then sharing in the savings. For the new price transparency mandate, the federal government reinforced the value of these programs for health plans and their members. These programs can also help improve health outcomes. We had one health plan in the northeast that offered an incentive on flu shots recently and had not only drove engagement from the rewards, but got a lot more people to get a flu shot during a critical time.

You mentioned earlier that HealthSparq acquired ClarusHealth. Now, of course, HealthSparq recently announced that it is being acquired by Kyruus. What was the driving force for that acquisition?
Menton:
For the last couple of years, we’ve been thinking about how we can connect payers and providers and Kyruus was having the same journey as the leader in provider search and scheduling solutions for health systems. We came together through mutual clients in Pennsylvania and realized it would make sense to connect our pipes, so to speak, because provider data is such an important and challenging area of focus for our industry. Graham Gardner, MD, who’s the CEO of Kyruus, and I had conversations about having a new transformative approach and we recognized the need to start creating a broader member/patient experience. Each of us has deep expertise in data and experiences with different health care stakeholders. We also spent time exploring options of what a partnership could look like up to and including an acquisition. Ultimately, that’s what it worked out to be. We think that providers, payers and consumers will all benefit from access to high-quality, accurate information as well as the ability to the connect other key components across touch points, such as booking appointments. Today if you’re on a plan’s HealthSparq-powered provider directory, you can research available in-network providers and understand how much your service will cost. Bringing richer provider data and appointment availability into the health plan workflow provides a significant benefit for members because if I’m researching a knee surgeon, I might find who I think is the best one, with a high quality rating, but if she’s not available for six months and I need surgery, that might not be the right doctor for me. And being able to pull in videos, philosophies of care and similar information to give people more confidence about their choices is going to be really powerful.

The next 18-24 months are going to be interesting in the health plan world because of the CMS mandates. But the mandates are not the end of the story. They’re new table stakes for plans. It’s about building on those to enable consumer experiences that actually help people.

Mark Menton, HealthSparq

Looking into the future, what should existing and prospective clients expect in the next 18 to 24 months?
Menton:
The next 18-24 months are going to be interesting in the health plan world. Because of the CMS mandates we discussed, there’s a lot of energy and discussion about meeting them. But the mandates are not the end of the story. They’re new table stakes for plans. It’s about building on those to enable consumer experiences that actually help people. So the message to our health plan clients is that “Yes, we’ll check the box with the mandate but that’s not the goal. The goal is to allow people access to the information they need and an experience that helps them make different decisions at different points in their health care journey.”

And with our move to Kyruus, we’ll also be working with clients to give them that richer, more robust data to augment the health plans’ data from a provider perspective to really help guide people and making access to care easier.

What should they expect a little further into the future? Perhaps 3-5 years?
Menton:
It’s hard to say what’s going to happen in five years but I do think the basic concept is a continuation of the blurring lines between payers and providers. That definitely is going to happen and from a Kyruus plus HealthSparq perspective we think we have enough to accelerate the breaking down of these siloed markets with the pipes and connections we already have in place. You can only make decisions based on the data that you have available and ensuring that information flows back and forth in a consistent, accurate data set is critical. I’m eager for the day when health care is easier for people – easy to find the right provider, easy to understand exactly what you’ll pay, easy to schedule. That’s what we’re building.

What accomplishment as CEO are you most proud of?
Menton:
In the last three years, we’ve transformed the entire company. We pioneered transparency, but as health care changed, we realized we needed to transform and scale. But we didn’t have the luxury of pausing and building a new platform. We had to rebuild the platform and the metaphor I used with our company was “Yes, we have to rebuild the airplane and, no, we can’t do it in the hangar, so we have to rebuild at 35,000 feet.”

Since I took over in 2017, we have rebuilt the executive team, changed the culture from more of an insular to a market and client focus – all while rebuilding the technology. It’s been interesting and fulfilling. Grueling at times. But if we hadn’t gone through that transformation to a flexible and extensible microservice-based architecture, we wouldn’t have had an opportunity to do what we’re doing today. So, I think the that one of my proudest accomplishments is recognizing what we needed to do and then being able to build a team that can help us transform the company.

What’s the most difficult challenge you’ve overcome, either since taking over HealthSparq or in previous roles?
Menton:
This is more from a personal standpoint. Being somewhat of an introvert, I had to become front and center at ClarusHealth, where I led the sales team in addition to being CEO. So it was interesting to be self-aware of some strengths and weaknesses and where I get energy and then to be able to challenge myself to push beyond what I was really comfortable doing.

What advice would you give to other CEOs, entrepreneurs, founders?
Menton:
One of the things that was told to me by a mentor a long time ago is “hire slow and fire fast.” When I think about the most important thing, and I see this whether you’re 5,000 employees or 150 employees, is that finding the right people is hard but absolutely essential. Often if there’s not a fit, it’s not a talent problem but, instead, it’s a culture problem. And when you have a person who is not the right fit, they’re usually unhappy, too, and so you’re doing both your company and that person a favor by recognizing that and acting on it. The culture you create is driven by the people who are on your team and if you don’t have the right people, you’re either crumbling from the top or rotting from the bottom. It’s not necessarily just on the executive team, it’s top to bottom, so making sure you have the right people is absolutely critical.

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About the Author

Health Evolution, Staff Writer