Sentara Health Plans has tapped virtual care platform WellTheory to drive down autoimmune disease specialty drug spending.
It is the first partnership WellTheory has secured with a health plan, having already expanded its offerings to employers like the Maven Clinic.
After engaging with its members through a survey, Sentara discovered those in Virginia and Florida wanted more support for autoimmune diseases. Autoimmune diseases often go under the radar but account for more than 100 conditions and are driving billions in healthcare costs each year, said CEO and co-founder of WellTheory Ellen Rudolph.
“What they found was that a significant amount of their pharmacy and medical spend was related to autoimmune conditions,” she told Fierce Healthcare.
The partnership allows members at Sentara to enter a 12-month program starting with a root cause assessment. They are then matched with a care team including a dietitian, health coaches and care coordinators. Members will have access to customized nutritional resources, education programs, video calls with specialists and unlimited messaging.
Rudolph started WellTheory after experiencing autoimmune disease symptoms—like fatigue, brain fog and tremors—as a product manager at Oscar Health. She created WellTheory to help people with similar struggles overcome often overlooked conditions.
Recent patient questionnaires find WellTheory’s offerings have helped a majority of members report improvement in fatigue and digestive symptoms and report improvements in depression and anxiety—all while resulting in savings of nearly $10,000 per patient on biologics.
The company launched an enterprise solution in late 2023 focused primarily on self-funding employers. Some employers say autoimmune conditions account for 30% of overall pharmacy spend and half of high-cost specialty spending, said Rudolph.
“But part of the challenge is that it's a new category,” she explained. “These are invisible illnesses, where you don't need to look sick to be sick, and to be quite frank, there is often a stigma around these conditions, right? You don't want your employer to think you can't be fully productive or present in the workplace.”
The Sentara partnership will not just be limited to the insurer’s self-funded clients but also its fully insured book of business, she added.
WellTheory hopes to continue expanding its offerings to more payers nationwide, as more health plans recognize the importance of addressing these issues. She said autoimmune disorders also keep a low profile in the claims data due to the sheer number of conditions all categorized under different medical specialties.
“Our partnership is focused on helping to cut their autoimmune care spend by reducing the cost of expensive interventions,” said Rudolph. “This is everything from driving down hospitalizations to unnecessary ER visits.”
Since forming a partnership with Maven Clinic, the company now partners with Fortune 500 and 100 employers, but she declined to disclose the partners.
Last month, WellTheory closed a $5 million funding round and launched two artificial intelligence tools. One tool is a proprietary AI assistant to transcribe member and specialist conversations as well as draft care plans. The scribe has reduced administrative tool time by 65%.