The Payer Mindset: Understanding and Selling to Health Plans
A conversation with Rob Coppedge and Troy Arnold from Echo Health Ventures.
In this episode of The Health Catalyst Podcast, I had the opportunity to sit down with Rob Coppedge, CEO of Echo Health Ventures, and Troy Arnold, a principal at the firm. Echo Health Ventures is a unique venture capital firm that partners with Blue Cross Blue Shield plans across multiple states to invest in and support growth-stage healthcare companies.
Our discussion centered on the complex landscape of health plans, the challenges and opportunities for startups trying to navigate the payer ecosystem, and what health plans prioritize when considering partnerships. Rob and Troy shared invaluable insights on how health plans think, how they evaluate new innovations, and the best strategies for startups to approach them effectively.
Watch the full episode below:
Top 5 Key Takeaways
Understanding the Payer Landscape is Critical
The U.S. healthcare system consists of public payers (Medicare, Medicaid), private payers (for-profit and not-for-profit insurers), and integrated delivery systems (e.g., Kaiser).
Private, not-for-profit health plans (like the Blues) operate differently from for-profit insurers like UnitedHealthcare, CVS/Aetna, and Cigna. Their priorities, decision-making processes, and risk tolerance differ.
Entrepreneurs must tailor their approach depending on the payer’s structure and market position.
Selling to Health Plans is Complex and Requires a Targeted Approach
Entrepreneurs often struggle with finding the right entry point into a health plan. Selling to the wrong stakeholder (e.g., CFO vs. CMO vs. Operations) can waste time and resources.
Startups should identify their primary value proposition—whether it's clinical outcomes, cost savings, or administrative efficiency—and align it with the payer’s priorities.
Many successful startups start by selling to large employers before approaching health plans.
Local vs. National Strategy: Focus First, Scale Later
Most startups aspire to national contracts, but health plans rarely commit upfront. Instead, they prefer small-scale, local pilots before expanding.
Companies should prioritize gaining traction in specific markets, proving value, and then leveraging those case studies to expand.
Example: Aledade, a value-based care company, successfully partnered with Blue Cross North Carolina by focusing on localized primary care provider networks before scaling.
Building Relationships with Health Plans Takes Time, but Strategic Capital Helps
Selling to payers is a long sales cycle, making relationships critical for success.
Startups should raise capital from investors who can open doors and provide strategic introductions (e.g., Echo Health Ventures).
Transparency is key—health plans value startups that are upfront about their current capabilities vs. their long-term vision.
The Future of Health Plans: Balancing Innovation with Simplicity
Health plans want to integrate innovative solutions, but they also struggle with fragmentation.
There is growing interest in value-based care models, but defining "value" remains complex.
Chronic disease management (diabetes, cardiology, oncology, mental health) is a major focus, but plans are challenged by how to thread these various solutions together without overwhelming members.
Final Thoughts
Selling to health plans is a long and complex process, requiring startups to deeply understand the ecosystem, tailor their approach, and be patient in building relationships. Payers are looking for innovative solutions, but startups must be strategic about where they start, how they position their value, and how they scale their partnerships.
Stay healthy!