Emerging Therapy Solutions provides end-to-end management of gene and cell therapy for payers, utilizing data analytics and clinical expertise to forecast costs and assess risks associated with high-cost treatments. The company enables insurers to effectively plan and price for catastrophic claims related to rare and complex medical conditions, ensuring access to life-changing therapies for patients.
Funding
$23.3M raised to dateRaised to date based on public sources. This may differ from the amount the company actually raised and is based only on what is publicly available on the internet.
Founders
Product
Problem
Payers face challenges in managing the high costs and risks associated with emerging cell and gene therapies (CGT) for rare and complex medical conditions. The increasing prevalence of these therapies requires accurate forecasting and proactive planning to avoid catastrophic claims and ensure patient access. Traditional methods often lack the specialized expertise and data-driven insights needed to navigate this rapidly evolving landscape.
Solution
Emerging Therapy Solutions (ETS) offers end-to-end management solutions for cell and gene therapies, providing payers with the insights, data analysis, and support needed to manage costs and risks. ETS leverages its expertise in specialty pharmacy and transplant to deliver a comprehensive suite of products and services, including data analytics, clinical content, network access, and plan design support. By proactively identifying patients and guiding them to therapy-specific Centers of Excellence, ETS ensures access to high-quality care at transparent prices, while also monitoring treatment outcomes and offering value-based contracts with pharmaceutical manufacturers.
Target Audience
The primary target audience includes self-insured employers, health plans, and secondary payers (stop-loss and reinsurance carriers) seeking to manage the costs and risks associated with cell and gene therapies.
Features
- Data-driven analysis to identify members likely to require cell or gene therapy, enabling precise forecasting of anticipated spend.
- Care navigation to direct members to therapy-specific Centers of Excellence with transparent, high-value financial terms.
- Holistic approach to care navigation, backed by expert physician consultation, assisting with appointments, travel, and financial aid.
- Continuous monitoring of the patient journey and care delivery, ensuring ongoing support and tracking treatment responses.
- Access to a network of top providers through Centers of Excellence, equipped with medical policies, prior authorizations, and strategic plans.
- Value-based contracts with pharmaceutical manufacturers to obtain claim refunds if expected outcomes are not met.
- Risk pooling and risk transfer solutions through financial management partners to further mitigate and plan for upcoming claims risk.
- ETS Knowledge Center and Clinical Content to stay on top of the latest innovations, monitoring the cell and gene therapy clinical trial landscape.