From Risk to Reward: Healthmap’s Strategic Expansion, An Interview with Tom Gaffney

Healthmap Solutions has grown from its first customer in 2016 to managing kidney populations in 43 states. In this episode of The Strategy of Health from The American Journal of Healthcare Strategy, Chief Growth Officer Tom Gaffney talks with host Cole Lyons about staying focused while the market changed around it, moving to full-risk contracts, expanding into Puerto Rico, and what’s next.

A consistent model since 2013

Tom joined Healthmap as a board advisor in 2017 and became Chief Growth Officer in 2019, leading sales, account management, and marketing. He said the company has stayed true to the model it set out with in 2013, when it became the first kidney population health management company in the market:

• Population health at the core.
• Moving upstream. Many vendors focused on end-stage renal disease (ESRD) because that was health plans’ most immediate pain. Healthmap focused on chronic kidney disease (CKD) stage 3, where there is still time to slow progression. By stage 5 and ESRD, the goal shifts to managing the disease well, because kidney damage can’t be reversed.

Healthmap still manages later stages, but Tom sees expertise in the earlier stages as its biggest differentiator. (Related: How Early CKD Identification Improves Outcomes.)

AI where it matters, people first

Healthmap uses predictive analytics and AI through its proprietary platform, Compass, which has processed millions of claims since 2013. But Tom said technology is only part of the picture. Hands-on interaction with patients and providers matters just as much. The acquisition of Carium, announced shortly before this conversation, adds digital engagement capabilities to that foundation. (See our technology and analytics capabilities.)

From fee-based to full risk

Healthmap started with an administrative services model: a fee plus shared savings. Once it could deliver predictable savings, clinical outcomes, and service year over year, it moved into full-risk and capitated models in 2022 and 2023. Today most clients ask for capitation and downside risk, and Healthmap is taking risk on roughly $4 to $5 billion in medical spend. Tom credited CEO Eric Reimer’s long experience with capitation. (Learn more about value-based kidney care.)

Growing on purpose

Kidney care was a crowded market, and plans were actively shopping for vendors. Healthmap grew quickly but deliberately, with a target of two to three new customers a year. It chose clients carefully based on line of business, geography, existing membership, and fit, because not every customer is the right customer. That discipline let the team implement well and deliver savings, outcomes, and strong satisfaction scores.

Built by managed care veterans

Every member of Healthmap’s executive leadership team has worked at a health plan or delivered services to health plans. Tom contrasted that with competitors that came out of the large dialysis providers. As an independent company, Healthmap could look at the problem fresh. It also treats the whole patient. Nearly every CKD patient also has hypertension, diabetes, or both, so managing those comorbidities is part of the program.

Health care is local

In 2024 Healthmap shifted to a regional operating model, with local teams meeting customers, providers, and members in their own markets. Puerto Rico is the clearest example. After winning a contract with Triple-S, Blue Cross Blue Shield of Puerto Rico, Healthmap quickly opened a service center and hired 70 to 80 local employees to serve about 20,000 members on the island. Tom said building trust there took the right local hires. (Read Healthmap’s Success in Implementing Kidney Population Health Management in Puerto Rico and about the Puerto Rico office grand opening.)

He shared a story about a provider relations representative who thanked him on behalf of her family, three of whom had end-stage renal disease, when the program came to the island. She now works on the account management team supporting that customer.

“If we can be known for being compassionate, providing empathy, working first and foremost on behalf of the patient, the rest of the business takes care of itself.” (Tom Gaffney)

What’s ahead

At the time of recording, Tom expected Healthmap to cover all 50 states by year-end and to pass 200,000 kidney members.

Listen to the full episode

Find the episode page on AJHCS, watch on YouTube, or listen on Apple Podcasts or Spotify. Health plans can learn more on our Health Plans page.