Case Study: Fella Health
Up-and-coming, niche healthcare organizations are grabbing an increasingly larger foothold in the healthcare industry as their specialization and expertise prove to be quite beneficial for those who need their assistance.
In order to expand, these organizations need to either expand their hiring and staff, or they could look towards a company like Zivian Health to empower their scale. A great example is Fella Health, the venture-backed virtual care company with success in the men’s health field.
Fella’s primary focus is on improving the quality of life for men struggling with weight loss and chronic metabolic illness management. They are currently offering virtual care in a direct-to-consumer capacity. After proving the model and unit economics in one state, they rapidly expanded to other geographies' cost-efficiency using a nurse practitioner workforce. But in order to activate the workforce, they needed to understand the regulations of every state, particularly those requiring collaborating physicians for nurse practitioners to practice.
| Industry: Healthcare, Men’s Health | Products: virtual care model |
|---|---|
| Company Size: Small (~10) | Metabolic Assessments |
| Location: United States | Medication |
| Use case: Growth & Expansion, Scaling, Compliance | Personalized Coaching |
In the highly competitive weight loss space, Fella Health’s core competence and differentiator is their clinical excellence. Maintaining quality care and clinical outcomes without overspending is highly important. So Fella Health had to manage the quality of an advanced practice provider workforce as they attempted to scale their practice, while simultaneously avoiding the existential risks to the business of a compliance breach.
Fella explored three options: independently hire their own physician collaborators, hire a fractional medical director, or partner with Zivian to support their workforce.
Hiring physician collaborators. This approach required a significant lift, direct and indirect costs on the front end, and on an ongoing basis.
Upfront costs: costs of external job posting, devoting recruiting labor resources to interviewing, background checks, initial third party credentialing and primary source verification, legal research into state requirements, preparation of collaborative agreement, payment to the physician.
Ongoing costs: third party credential monitoring, compliance monitoring on a state-by-state basis, payment to physician collaborators
Time: Several weeks to months
Risks: Significant dependence on provider(s), limited control/visibility into quality, limited ability to scale quickly, falling out of compliance with state regulations. With increased scale, there is a need to either license the current doctor or begin the entire process over and hire new physician collaborators.
1. Hiring a fractional medical director: This approach has many of the same problems as hiring their own collaborator, with the differentiators being highest labor costs and significant uncertainty around time.
Up front costs: costs of external job posting, devoting recruiting labor resources to interviewing, background checks, initial third party credentialing and primary source verification, legal research into state requirements, preparation of collaborative agreement, payment to the physician.
Ongoing costs: third party credential monitoring, compliance monitoring on a state-by-state basis, salary for fractional medical director
Time: months
Risks: Significant dependence on provider/single point of failure, limited ability to scale quickly, falling out of compliance with state regulations. With increased scale, there is a need to either license the current doctor or begin the entire process over and hire new physician collaborators.
| Type | Description | Cost |
|---|---|---|
| Upfront costs | -External job posting, -Interviewing -Background checks -Initial third-party credentialing -Primary source verification -Legal research into state requirements -Preparation of collaborative agreement -Payment to the physician. |
1K 2K 200 300 200 5K 1.5K 600 —----- 10.6K |
| Ongoing costs | • Third-party credential monitoring • Compliance monitoring on a state-by-state basis |
250/mo 10K/yr 12K/year —--- |
| Time | Time spent on these tasks instead of scaling/development | Weeks |
| Risks | • Significant dependence on provider(s), -Limited control/visibility into quality -Limited ability to scale quickly -Falling out of compliance with state regulations. |
3. Partner with Zivian. After exploring the other two options, Fella decided to outsource this function to Zivian. They arrived at the decision after seeing cost savings, speed, flexibility, and a superior product, allowing them to focus more on core aspects of their business.
Up front costs: platform onboarding fee.
Ongoing costs: per user platform fees, collaboration fees equal or better than able to attain through their efforts.
Time: days.
Risks: mitigated as Zivian provides a roster of physicians
| Type | Description | Cost |
|---|---|---|
| Upfront costs | Platform onboarding fee | 2.5K |
| Ongoing costs | -Per user platform fees -Collaboration fees equal or better than able to attain through their efforts. |
310/mo |
| Time | Time spent on these tasks instead of scaling/development | Days |
| Risks | Significantly mitigated as Zivian provides a roster of physicians |
Zivian is a compliance and quality platform focusing on nurse practitioner and physician assistant collaborations. Our platform tracks governing rules and changes in real time, as well as creating an audit trail of all requirements on a state-by-state basis. With expertise in licensing, corporate practice of medicine consulting, fractional medical directorship, and independent quality reviews, Zivian does the heavy lifting behind the scenes so NPs, PAs, and enterprises can do what they do best: care for patients. In short, Zivian helps companies scale their advanced practitioner workforces while maintaining quality and compliance.
The integrative collaboration between Fella and Zivian has allowed for Fella to focus on the men they’re caring for while improving it’s bottom line. For hiring their own physician collaborator, in addition to the breakdown of cost above, which totals to around 35K a year, the addition of potential costs inlcude $90,000 for the physician’s licensure in all 50 states. If they were to hire their own collaborator, it would be slightly less at around 20K a year for physician recruitment, medical malpractice insurance, legal fees for contracts, and legal reviews of regulatory services. Nevertheless, both of these are exorbitant compared to Zivian’s average annual cost of around $6,220 which include higher quality diligence and compliance.
Zivian has reduced Fella’s expenses by around 80% if they were planning to hire their own physician, or by around 65% if they were planning to hire their own collaborator. This revenue has allowed for Fella to reinvest back into it’s company, which has improved it’s greatly improve the trajectory of the company itself. The role of smaller HCO’s like Fella are expanding rapidly in the forever globalizing world of healthcare. Therefore, for company looking for success similar to Fella, Zivian support them from the background.
