Author: SHP Staff

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 10 – Keys to a Successful CIN | With Jason Crosby

In this episode, Jason shares with us the results of a study that shows PCPs may be unfairly punished with poor MIPS scores. Aaron shares a warning about two different crypto viruses targeting healthcare organizations. And we briefly discuss our upcoming season 2.

 

Then, Aaron sits down with our very own Jason Crosby to talk about CINs, how they work, how to start or join one, the keys to a successful CIN, the potential for legal pitfalls, and how CINs may fit the greater goal of providing value-based care. 

 

Aaron’s News
https://www.hhs.gov/sites/default/files/lockbit-3-analyst-note.pdf

https://www.hhs.gov/sites/default/files/blackcat-analyst-note.pdf

Jason’s News

Value-based payment system shortchanges PCPs, says study (fiercehealthcare.com)

 

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Aaron C Higgins

Executive Producers: Mike Scribner & John Crew

TRANSCRIPT

 

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 9 – Coding Changes for 2023 (Including E&M, New G-Codes, and Screening Reimbursements) | With Steve Adams

On today’s episode, Jason shares an article about how Mark Cuban is expanding his low-cost pharmacy project. And Aron shares about how charging for digital messages may be on shaky ground.

Jason sits down with our guest Steve Adams. A Certified Professional Coder Instructor with InGauge Healthcare Solutions with more than 20 years-experience with training others how to code in all arenas of care. Steve dissects the coding changes for 2023 in the Final Rule, including E&M, new G-codes, and screening reimbursements.

Aaron’s news: https://www.beckerspayer.com/policy-updates/mychart-message-fees-live-on-unstable-ground.html

Jason’s news: https://www.beckershospitalreview.com/pharmacy/mark-cuban-cost-plus-partners-with-2nd-pbm-hints-at-insulin-market-entry.html

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby

Executive Producers: Mike Scribner & John Crew

 

Transcript

Jason Crosby
All right, today our guest is Steve Adams, senior consultant with inHealth professional services.
OK, he is a certified professional coder with over 20 years experience of various settings including many, many guest speaking engagement. Steve, thanks for joining us today and welcome to the podcast.
Steve Adams
This it’s my pleasure. This is my first one, so I’m excited.
Jason Crosby
Alright, well, good deal. We’ll tell you what, what the timing of the the podcast we got about a month left just for the listeners month left in the 2022. So obviously the last couple of months.
Lots of changes, final ruling AMA and their coding changes. Let’s let’s dive right in. Can you give us a quick overview of the E&M changes you’re expecting or what you’re seeing for 2023 for the audience?
Steve Adams
Yeah, it’s really it’s really pretty easy. The biggest change that you’re gonna notice in your CPT books this year is there were about 393 changes in the CPT book, but nearly half of those were just revisions and deletions in the evaluation and management section. And you know, when I look at this, I’ve seen a new one, looks like they have about one new code, 49 have been revised and 25 were deleted. And we’re also busy that a lot of times people are missing out.
On all these revisions, and then Medicare just published their Federal Register about three weeks ago, when they came out with a lot of new G codes, they changing the time requirements for depression screens and for alcohol use screening. So there’s a lot of things going on regardless of what specialty you’re in. It would be, it’s worth taking a look at some of these changes that we’re going to go over today.
Jason Crosby
Fantastic. Let’s jump right on then. There which which are some of the key ones that you’re seeing as far as on the deletion side in any revisions that you had mentioned?
Steve Adams
Yeah. I think the biggest thing to kind of realize is that in 2021 CMS and AMA changed the way that we documented our evaluation and management services in the outpatient setting and they did that just to kind of see how it was going to work and it worked so well that now they’ve incorporated those changes into facility based coding. So now what you’re going to see is the opportunity to build total daytime on almost every visit still except the emergency room visits. But we are seeing all that time change we’re seeing now that you just have to have a medically appropriate history and a medically approx.
For an exam for all code. So if you’re used to doing auditing, you no longer will have to download a doctor for an initial hospital visit. If they don’t have 10 review of systems or an 8 organ system exam, I think probably the biggest thing that’s gonna be a change for a lot of people is CMS has done away with the observation codes. So we’ve seen the observation codes, deleted the initial ones, the subsequent the annual nursing facility code has been deleted.
They’ve changed all the domiciliary and rest home as well as home visit code, so they’ve deleted all those and again revised just about everything else. So even if you’re in the emergency room, you know they’ve revised those codes. They’ve revised the consultation codes, nursing home, home health. They’ve made some nice changes to the transitional care management codes that if you’re doing that, I’ll make it a little bit easier to explain to your physicians what’s happening. But those are some of the things that I want to kind of look at today is how they’ve incorporated those.
Observation codes. Now that you might be familiar with 992189921999220 and they’ve just incorporated those into the old initial hospital codes like 99221 used to read initial.
You know, initial hospital visit and now it just says initial hospital or observation service, so you no longer have the discharge code for observation and there’s a couple other little things that are important in there, especially if you do hospital coding.
Jason Crosby
Yeah, it it definitely looks like different settings have some variables that have been tossed in the some of the codes might have gone away, descriptions altered, that sort of thing. So what should folks be looking for that are there on the front lines every day in the coding world?
Steve Adams
I think the biggest thing that you can do is if you do in hospital coding, remember that.
The history and exam is all going to be medically necessary when it’s stressed to your providers about that. You also kind of want to be cognizant of the fact that CMS has dropped the conversion factor this year and some of the codes that we used to do really well on like your initial hospital code used to pay about $200.00. Now it’s down to about 170. The only code that’s really increased are some of your subsequent hospital visit codes and that’s because they’ve really stuck it to us on.
The time components. So if you do hospital coding a lot of times, doctors would do 99233 based on what we call unit 4 floor time. So if you spent greater than 50% of your time on the floor and that time was 35 minutes, you were able to build like a 99233. Now in the hospital nursing home everywhere else they’ve transitioned to total daytime. So it’s gonna be really important for you to update your physicians that the New Times are substantially more.
Then they used to be. So for example a 99233 that used to be 35 minutes greater than 50% was unit. Floor time is now up to 50 minutes unit floor time, so that changes the dynamics a lot on your Level 3 visits and one of the reasons that they went up on those codes, 232 used to be 25. Now it’s 35 minutes. So what you used to be able to Bill is A33 is now A32 and they’ve also taken out of the CPT book and this is important. The disclaimers that used to be under those codes. So it used to be AT233, which everybody wanted to bill, used to have to be 35 minutes greater than 50% unit floor time, or the patient had to have a such a significant problem. They weren’t responding at all to treatment, major complications. So I think that we’re going to see some reductions in the number of 9923 threes. And I mean, I think that when I’m teaching physicians this week and next week on all these changes, that’s the thing. I’m really driving home because at the end of the day, you actually have to document less.
Then you did in the past. The only thing that’s really shifted is the amount of time, and it’s no more greater than 50%. It’s total daytime and in your CPT book they have a section on that and they kind of go over with you. The nine things that count as total daytime. So I would definitely take a look at that, just open up the front of that CPT book and you’ll see all of these changes in the front where you’re and requirements are.
Jason Crosby
So some of the feedback I’ve been reading up on these changes, would you agree that the the process itself is more simple and flexible? What do you think there’s gonna be some natural give and take us folks learn what these changes are?
Steve Adams
I think the changes are the documentation. Requirements are so much easier. I I think that the thing about it is and honestly I’m.
I I work with several hospitalist groups and I think the one thing that’s gonna kill a lot of doctors is this time this additional time required for the 99233. I mean, if you think about a typical hospitalist working a 12 hour shift and they used to be able to build 9923 threes, you know three or four every couple hours and now they’re not able to do that. So I think once you start delving into it is really funny. Before we started talking, you know, I even brought up the fact that I’ve went back to school to get a third degree.
So that just because this stuff is getting a little bit more easy, I have a Plan B myself to back out of this system because this when I started in 92, this stuff was so difficult and it was so just redundant and there was no medicine being practiced. Now that they’re shifting to billing based on the complexity of the patient, that makes everything so much easier for your providers. And the thing that is really impressive is that the AMA has worked with CMS on this. And I mean, I’m really impressed with that. And I think it’s just.
And I think the future is gonna be a lot easier for doctors to support various levels of service.
Jason Crosby
Good feedback for sure. So with all that said, because every year there’s a lot to absorb with such changes.
For audience that’s listening that that is in there every day. What can they do to prepare for those changes here in the next few weeks?
Steve Adams
I think one of the things again that you do is you know you reach out to whoever you’re coding person is whether or not it’s a. If you work with the State Medical society. I know I do consulting for the Georgia Academy of Family Practice, Georgia, OBGYN Society, the American College of Physicians, and those are areas where if you’re part of those groups, you can they have webinars every year. I’m doing the OBGYN when this Friday and the Georgia Academy of Family Practice next week.
If you’re in plastic surgery, you can contact the Georgia Academy of Plastic Surgery, ophthalmology into whatever they should have some resources for you. Normally they have a consultant who works closely with them. Who does these kinds of E&M seminars that will get you ready and that way it’ll save you some money because the biggest thing that I see and I hate.
These companies who send you these emails that say, you know, did you know there were 373 coding changes and for $750, you know, we can explain it to you. And I always tell my private clients, you know, don’t do that unless it’s somewhere like in Las Vegas where you can fly out there or Miami this time of the year. But don’t get confused by the emails that you’re going to get. Contact your specialty societies, your national society. And again, they’re going to have some resources that will give you this information because.
I mean, if you look at Medicare, especially with prolong services, when we know that we had the 99417, when we went 15 minutes over for an outpatient facility code and then Medicare came up with their own code G2O12 and now we have these new prolong service codes for hospital. You know AMA came out with 99418, but now we also have Geo 3160317, go 318. There’s just so many little nuances.
In the coding world that you really, if you don’t want to pay a lot of money, reach out to your societies first. And I think that’s gonna be your best bet.
Jason Crosby
Yeah. So if if you’re a kind of keep going down that path.
If if you’re sort of new into the field or looking to to sort of take on this new skill set and maybe this is kind of OK Steve, go back to when you first got into the field.
How describe how best for that person to maybe expand on that if they’re just starting out aside from reaching out to the consultants, any other types of resources, education tracks or maybe highlight for us how you got into it as well?
Steve Adams
The hard thing about any kind of coding change is that they’re honestly just, there’s not a lot of people out there who specialize it anymore. I’d be just honest with you. It’s really hard. A lot of the hospital systems that I used to consult with have just decided, well, hey, listen, we’re going to go out and hire a guy full time to work in our facility. So what I would tell people to do because my neighbor, I helped her become certified and she’s worked for a great family practice here in Augusta.
For, you know, at least a decade and what I would tell her is just go to Google.
Umm, I mean, I have a wife and kids and dogs and cats and I love to make money, but I I’ve been in this business since 1992 because I wanna save people money and I would literally just go to Google and or YouTube and I would just type in 2023.
E&M coding changes or 2023 CPT. Coding changes and there are people who put out free information to kind of draw traffic to their website. So I would if your society doesn’t have anything and you want to learn more about coding, that’s a good place to start. Another fantastic place to start is your local aapc coding chapter. Now, if you’ve got an ink pen, I’ll tell you how to do this. I get calls at least once a week. Somebody who wants to enter this field.
Steve Adams
And when I tell him to do is coders on the on the whole are pretty introverted. We only like our own people and we get together usually every month that these local coding chapters and these local coding chapters, you get an opportunity to network with fellow nerds. And even if you’re not certified, you can do that. And the way that you do that is simple. You just, I’m going to give you a phone number. You’re going to call them or you can go on their website, you find a local coding chapter. You can join that local coding chapter and then they have guest speakers who come once a month, either virtually or in person.
And they talk about this and it’s so stupid to say this, but I mean, I’m a pretty big deal in this business and I have a a local chapter right here in Augusta, and they never ask me to speak anymore. I don’t know if it’s because they’re afraid I’m going to take their clients. I don’t know what it is, but I try to tune in every once in a while to a local chapter meeting and you’ll find good resources there. So here’s what you do. You call one 800-626-2633 and it’s easy to remember. That’s one 800-626-CODE.
Since a lot of us are on social media and etcetera, you can go also to the Internet and just go to Aapc American Academy of Professional coders.com. Apc.com has a lot of great resources and you can just call them and you can go to their website and just look for local coding chapters, call them up and just say, hey, listen, I live in the perimeter area of Atlanta. Do you have a coding chapter? They’ll tell you who the contact person is. You look them up, they’re going to have people come in and talk about.
Uh, talk about this. These coding changes and again, that’s a membership opportunity for you. And so that’s what I would say, yes. And I would say if you want to get into this field, I every time I talk to somebody, I’m like, yeah, you can come to one of my coding classes, but I can’t get you a job. You’re only going to get a job, usually through these local coding chapters. So I hope that wasn’t too long of an explanation, but use YouTube, Google, go to apc.com, join their organization. They send out newsletters, they have webinars that you can attend as well. And that’s how I would recommend it.
Jason Crosby
Fantastic. Fantastic. Very, very helpful. And it I I would add to that, it probably doesn’t matter what type of setting you’re in where you’re located there. There’s always an evolution to this part of the field that’s always going to have some sort of demand to it.
Steve Adams
And Jason, I don’t wanna interrupt you here, but I I’m going to because a lot of times people think well, I don’t want to be a certified professional coder. You know, I’ve been coding for 20 years. I don’t wanna be a CPC, the aapc of which I receive no money from. Trust me. God, I pay them probably $2500 a year just to teach their stuff and give their test. But they have credentialing for specialists. So, I mean, if you’re a GI coder, you don’t want to be a CPC, become a GI coder. You can take their certification test. Interventional radiology.
Again, you can do so many different things right now a big field is HCC and risk value based coding. You can take their online home study courses for that. There’s just so many opportunities. They’re on Facebook, they’re on Twitter. They have a campaign right now that just talks about how people have a three times better chance of passing their national exams. If you take their their online courses. So just don’t be constrained. And just think I want to be a CPC and know a little bit about everything, focus in on your specialty. That’s another opportunity for you to learn.
Jason Crosby
Great insight as we wrap up here to tell our listeners how can they get in touch with you if they need to request your services.
Steve Adams
It is so simple to reach out to me, the first thing I tell people is just my e-mail. So I have a I work for a firm called in health and that’s in Atlanta. I live in Augusta. A lot of people just send me emails because I’ve known in this industry as the King of coders. So really easy way that people reach out to me is just going to the king of coders@gmail.com and sending me an e-mail. I tried to make things simple. So the king of coders@gmail.com you can also go to my website. I’ve just updated it. A lot of that information that we’re talking about today I have.
The ICD 10 manual up there, I just have a lot of resources for 2023 and it’s easy to remember that too because I made coding consultant so my website isthecodingconsultant.com and you can go out there and take a look at some of my stuff and you can e-mail me from there. You can call me. There’s no secretary since 1992. It’s just been me, a rental car and a laptop and my number is simple, it’s 706-483-4728 and just in case my firm hears me, my company e-mail is steve.adams@inhealthps.com and that’s why I never give out that web because it’s a I don’t understand. When I worked at Mag Mutual, my e-mail was so cool. They used the first initial of your name and your last name at Mag Mutual. So I was saddams@magmutual.com. Now, if you’re, you know, I was involved in the first Gulf War, so it was really cool for me because older people remembered Saddam Hussein. So don’t send emails to saddams@magnitude.com I no longer work there. They sold us. So the kingofcoders@gmail.com is probably the best way to reach out to me or go to my website.
Jason Crosby
That’s awesome, Steve. That’s good. Alright, well, well, great information, Steve. We can certainly go on for hours, probably just diving into the details each time they’re it changes and we’ll have to certainly have you on again soon and really appreciate your time and joining us today.
Steve Adams
To my pleasure, half an hour out of my life is no problem. This is my first podcast. I can’t wait to tell everybody that I was officially on a podcast now, and I’ll be making millions of dollars and endorsement deals, and I’ll be pimping AMA stuff and ICD 10 products. I’ll have my own shirt line. It’ll be great. So thanks for giving me the opportunity to retire early. Guys. I really appreciate it.

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 8 – The Quality Payment Program 2023 & Beyond | With Aaron Higgins

In this episode, Jason shares with us a few of the “Top 10 Digital Health Stories of 2022” and Aaron discusses a recent survey that shows 6 out of 10 patients have had a poor experience with healthcare in the last year. Then we tease a bit about our upcoming changes in season 2.

Then Jason interviews Aaron about the Quality Payment Program (QPP). The program has continued to evolve in the last several years, and this year is no exception. Aaron goes into some of the history of how QPP came about, where the program is heading, and what practices need to be doing now to prepare for it.

Jason’s news: The Top 10 Digital Health Stories Of 2022 – The Medical Futurist
Aaron’s news: PX Pulse – The Beryl Institute – Improving the Patient Experience

Aaron can be found on:
LinkedIn

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby

Executive Producers: Mike Scribner & John Crew

Visit our website
Like us on Facebook
Tweet @ us on Twitter
Follow on Linkedin
Send an email contact@shpllc.com

 

Transcript

Jason Crosby

Hi. I’m joined today by familiar voice, my podcast partner in crime Aaron Higgins of SHP.

Today’s topic. We’re gonna cover the basics, the ends and outs and all things related to the quality payment program final ruling that recently came out. Aaron, how are you? And thank you for joining.

Aaron Higgins

I’m doing pretty good, Jason. How about you?

Jason Crosby

Fantastic. Thank you. Thank you. So Aaron has been with us SHP for quite a few years now between our analytics department and as our IT strategist, but a lot of his background and current function is knowing anything and everything related to MIPS and now QPP.

But Aaron, as we get started, tell us a little bit how you got started in healthcare and specifically how you became involved with quality in the first place.

Aaron Higgins

Sure. So my background starts relatively benign. I was the IT guy brought on to a cardiology group in in the waning years of the Bush administration in the early days of meaningful use, PQRS at that same time, the practice, like many practices, was moving from paper church to digital church. And so I was brought in to help them move to their new EHR and it just kind of got coupled with the whole EHR.

Deployment of well, we have to do PQRS. We have to do this meaningful use thing. Using your EHR. You’re the expert on the EHR. So why don’t you run it? And so it had the snowball effect from there where a larger and larger chunk of time went from, hey, my mouse isn’t working to hey, how come my erx scores low and it just the the growth of it was sort of this natural onset and.

Coming to Savannah several years ago, I did primarily that sort of thing, PQRS and then at the time QPP or MIPS was new. So I helped the practice get on board with that and and do their scoring and then coming to SHP, it grew from just being a solo practice focus to helping a lot of our clients do their.

Their QPP work. So in that time I’ve worked with IPA’s and large practices, small practices, helping them solve their quality payment program questions.

Jason Crosby

Kind of a natural evolution from the IT background, EMR support and the QPP, which is pretty common. It seems like these days, if not clinical kind of coming from that EMR side gives you some unique insight I can imagine.

Aaron Higgins

Yeah, absolutely. Yeah. The the biggest part of that being successful with QPP really comes down to workflows, making sure you’re documenting the care and the right way according to your EMR’s needs. So that was really the biggest barrier that we had with adoption within easy sort of quality payment fill in the blank, whether it was meaningful use or PQRS, it came down to workflows.

Jason Crosby

Fantastic. Well, well on that front, let’s, let’s back up a little bit, explain a bit around the origins of the quality payment program.

Aaron Higgins

Sure. Uh, I’ve already mentioned PQRS and meaningful use, so those were the forbearers. But we actually have to go back even further to the late 90s. A lot of the private payers we’re trying to figure out ways that they could reduce costs and improve patient outcomes. And at the same time too the federal government was doing the same thing. And so the two kind of came together the private payers, a lot of the private organizations such as the American Medical Association and the federal government sat down in the mid aughts.

And said we need something, we don’t know what we need, but we need something that improves patient care. That’s measurable, that everyone can do. And in again the late Bush years, so circa 2008.

We started seeing a lot of rumblings from CMS about this new meaningful use program to get people to use EHRs and use them in a meaningful, useful way. EHRs were thing they just they weren’t widespread. And so that program took on a life of its own. And then under the Obama administration, it grew even further than by the time the Obama terms were nearly done. We ended up with MACRA, which was the Medicare and Chip Reauthorization Act of 2015.

From that MACRA program we got the quality payment programs which is the umbrella term that we use to cover MIPS. So the merit based incentive payment system MIPS, we got a lot of the ACOs and the advanced payment models that we have today APMs all of that came out of macro. So it’s been 20 years or so of just gestation and constant evolution of the programs.

Jason Crosby

Yes, sounds like it, whether it’s the alphabet soup that’s evolved over the umbrella of reimbursement underneath it, measures, et cetera, definitely a big evolution. So let’s let’s touch on that a little bit. Over the last seven years in particular, since it was passed in 2015, lots of changes even within that small window. Why would you say that it is and how has that program changed so much?

Aaron Higgins

One of the big complaints about meaningful use was how rigid it was. It it changed a little bit every year, but it was extremely rigid. There wasn’t a good feedback in mechanism for it. So at its heart macro was written by Congress to require a lot of feedback and CMS has taken that feedback every year, so they they release a proposed rule. And that being said, laws have always required a feedback period. It’s just with MACRA that was baked right in they were very strict on CMS soliciting feedback and very clear on the release schedule for and so every summer we get a proposed rule for QPP and then come Porter three or quarter four sometime we’ll see the final. Now this year it was great. Final rule dropped in late October is on Halloween. So it was a little bit of a treat and I say that because in prior years they’ve waited as long as the first week of December. So there’s not a whole lot of time to read through the final rule.

But, but going back to that feedback that that’s been an important element and a big driver of how the programs evolved when the program was first introduced, it was very all a cart kind of.

Take your own adventure sort of thing, and now it’s kind of going back to that rigidity that we had with meaningful use, but with a lot more care and a lot more feedback put into it with the introduction of MVP, which is the way that MIPS is going to evolve for non-APM practices in the future.

Jason Crosby

Let’s keep going on that path. So lots of changes obviously as you just mentioned.

And my folks are listening now to 2023 final rule, which just came out as you just mentioned.

Hit on specifically some of the measures and points that you feel are most influential for folks coming in with 23 bowl.

Aaron Higgins

Yeah, some of the changes that we’re seeing with 23 aren’t as huge as we’ve had in prior years. Some of the years the programs drastically changed. And again, going back to that feedback element, the final rules always have this question or an answer, I guess, feedback and answer response sort of mechanism in there. And it’s, it’s fascinating to read through that if you’re a normal like me because you get an idea of what CMS is thinking when they’re writing these rules.

And in many cases we’ve seen it where someone’s left comments and it’s made a change in the final outcome and we saw that this year too there were several measures that were proposed for removal and the quality and ended up staying and getting changed instead. So the feedback matters. But this year some of our bigger changes were actually a little bit of a surprise for some of us because they weren’t in the proposed rule. And CMS has allowed to do that. Things come up between the time that the proposed rule is released and the time that the final rule is released.

So they make changes, so one of the big changes is in regards to the certified EHR technology or see hurt. It’s right now 2015 C hurt is required to participate in any form of QPP.

But they have updated the CEHRT certification to the Cures update, so you need to make sure your EHR vendor is updating your EHR to the 2015.

Certified EHR Technology cures update it it’s a bit of a mouthful. Reach out to your EHR vendor, talk to them. It’s really important that you do that. Depending on how you’re reporting your quality measures, it could be as soon as January 1st. So this is really timely. That would be January 1st, 2023 or at the very latest October 1st, 2023. You need to talk to your EHR vendor. It has to do with the way that you’re reporting your quality measures really important.

Some of the other changes that we’re seeing is the automatic exemptions for small practices, so small practices. According to CMS QPP rules or practices with 15 or fewer eligible clinicians. If you are an eligible practice, you may be able to take some automatic exemptions on promoting interoperability. CMS has seen small practices struggle with that, so they’re taking the burden off while they either retool it.

Or they allow small practices to figure out what they need to do to actually do well on it.

And another exemption, but you have to apply for it is the cost category. The cost category is really hard for small practices to know what their score is going to be until after they get their scores. So there’s no chance for them to change it and that’s going to be available for small practices.

But there’s been a significant number of individual quality measures that were changed over 75 of them. Were we actually just did a webinar on this a couple weeks ago. I invited our listeners to go check that out. We go into greater detail about what those measures are, the new and changed improvement activities. There’s a whole laundry list of individual small changes that were made in the program this year.

Jason Crosby

Great info there. And to reiterate Aaron’s point, I think you’ll find the webinar very informative. Lots of info. There were about good 45 minutes worth of stuff where you guys to go out and check out.

Alright, given that know. we’ve obviously got various folks listening practices, hospitals, etcetera. What would you tell a practice who has not participated in MIPS before, or maybe who just hasn’t scored as well? Where should they start and seeking out? Should I go down this path or how to improve? What would you suggest first?

Aaron Higgins

Yeah, it is very daunting like any federal program, it’s confusing. There’s a lot of rules. The rules change every year. Where to begin and…great question…I would say start by seeing if you’re providers are eligible or not. If you know for certain that they are eligible or you’re maybe you’re practice as a whole is eligible.

Uh, so that’s important, because if you’re not eligible and you haven’t started this year?

For 2023, use 2023 instead as a preparation year to participate in 2024. Now, if you are eligible and you’re panicking right now, well, don’t panic. There’s a lot of great resources out there for small practices. Again, that’s 15 or fewer clinicians. There’s a lot of free resources available to you where CMS has vendors that will come alongside and hold your hand through the process. Of course, there’s CHP. We’re more than happy to sit down with you, spend 20-30 minutes on a call with you to talk you through what all you need to do because you’re going to need an identifying measures, measures that are relevant to your organization and your type of practice. Gonna need a fine improvement activities. You’ll need to check with your EHR vendor to see what measures and activities they’re supporting and promoting interoperability. Getting patients enrolled in patient portal, that’s where thing. There are a lot of moving parts and if you are eligible for MIPS in 2023 and you haven’t begun preparation.

Well, I hate to say it’s it’s too late. It’s never really, truly, too late. But you need to start working on it now instead of waiting until after the first of the year. But we are more than happy to help you out as HHP our website ashpllc.com webinars is where you’ll find recordings of all of our webinars regarding QPP. So that may be another place you want to begin.

A few years ago, Jason, we did some webinars about the origins, the individual origins and really deep diving into each of the categories. That would also be a great resource for someone who wants to learn the whole history and and how we got to where we are.

Jason Crosby

Yeah. Now that they’re, they’re reimbursement penalty.

Is climbing the ranks there and as hurtful as it is, another incentive to kind of get on the train there.

Aaron Higgins

Yeah, and and that that raises a good point, Jason, if you don’t participate and you are eligible, that’s a 9% reduction on your Medicare Part B payments. And for a practice that has a large Medicare population that could be huge.

Jason Crosby

Yeah. Yeah, early on that when it was less that was kind of the rationale for folks not participating right OHG it’s only you know one percent, 2% and now it’s nine. It’s kind of moves the dial a little bit. So we we’ve talked about how you got in the QPP, we’ve talked about the origins of it, we’ve talked about the changes for next year. And then just now a lot of what to do action called action type items, anything else you wanna highlight for the group?

Aaron Higgins

Yeah, I hinted at it earlier. We have the MIPS evolution, the MVP program so MVP is the way that traditional MIPS is going to evolve. If you’ve ever participated in an ACO or know someone who has think as an MVP, as a micro ACO. So that’s the way that the program will evolve in the future. We’ll make the administrative burden a little bit lighter and this final rule went into some more information about the types of MVPS that you’ll be able to choose from starting next year. It’ll be a voluntary process.

And then three years from now, in 2026, it’s going to be mandatory that you participate in MVP. So if you’re just getting started or you been in the program for a really long time, understanding what the MVP’s are and how they’re going to work for you is really important. Again, going back to, if you have questions about that, you can call us or you can call the QPP help desk there available at qpp.cms.gov and more than happy to help their great resource.

Jason Crosby

And I I’ll reiterate again that the webinar that Aaron’s referencing, if you go to shpllc.com\webinars, you’ll see it there dated November 15th.

Jason Crosby

Very informative PowerPoint presentation there for your reference. Uh, please take a look at it.

Aaron’s information’s on the website. Otherwise how can they find you here?

Aaron Higgins

You can find me on LinkedIn Aaron C Higgins or you can click the link in the show notes. We’ll have everything linked below, or you can shoot me an e-mail. That’s ahiggins@shpllc.com.

Jason Crosby

Fantastic. Great information. I appreciate your time, Aaron. And then slight appreciate everybody listening. I’m sure we’ll talk QPP at some point next year as well. Obviously what that thanks again for joining us and have a great rest of your day.

Aaron Higgins

And you too, Jason.

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 7 – Applicable Leadership Tips & the Art of Feedback | Kristin Woodlock

In this episode, Jason shares a report that shows that hospital safety improved prior to the COVID-19 pandemic, but did the pandemic erase all our progress? And Aaron shares how workers in all sectors are taking more sick time, but not for the reasons you might think.

Then, we both sat down with Kristin Woodlock, CEO of Woodlock & Associates. For years, Kristin has worked with healthcare organizations as both an advocate and a champion for behavioral health. Kristin now helps organizations work through complex decision-making challenges and develop better methods of communication. We dive into the realm of leadership. In particular with regard to leading during a time of change and innovation.  We further discuss the art of feedback and how best to manage such and develop as a core skill set within your organization.

News:

Jason’s News

Aaron’s News

 

Kristin can be found on

Website: https://www.woodlockassociates.com/

LinkedIn: https://www.linkedin.com/in/kristin-woodlock-7272a179/

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby & Aaron C Higgins

Executive Producers: Mike Scribner & John Crew

Transcript

Jason Crosby

Hey, everyone. I’m Jason Crosby. If strategic HealthCare Partners and your host along with Aaron Higgins, welcome to Beyond the Stethoscope Vital Conversations with SHP.

Jason Crosby

Today we are joined by Kristin Woodlock, CEO, Woodlock and Associates. Kristen, thank you for joining us today and welcome to the podcast.

Kristin Woodlock

Ohh thank you Jason and Aaron. It’s terrific to be with you. I’m really excited to join this effort.

Aaron Higgins

Yeah, Kristin, we’re really excited to have you here. A few months ago for the listening audience, SHP invited Kristen to come and speak to our organization. We were kind of facing a crossroads as we were determining some of our path going forward as a company. And Kristen really spoke to us and where we were at.

No, that’s terrific, right.

Aaron Higgins

Yeah. How to make some really difficult, complicated decisions in the process going into that and we got so much out of her, we had to share her with the rest of the world. So yeah, Kristin, thank you for joining us. So, let’s jump right in. Yeah, so.

Obviously, you talk to our company about change, and you know we’re in changing times, right? We we’re just coming out of the COVID pandemic, and the world is suddenly new.

Umm, so how can companies really understand the difference between the leading innovation in their space and then change ‘cuz we hear that all the time, leaders of innovation, what does that mean and how can a company understand that?

Kristin Woodlock

That’s a great questionnaire and I I think this is so important, I have to tell you, you know, I’ve been, I’ve been doing work in the field for well over 30 years in a variety of places. And I would tell you a year ago I would have said, well, there really isn’t a material difference between change and innovation. You need the same set of skills, maybe use them differently. And then I bumped into the work of Doctor Linda Hill from Harvard and she really changed my thinking on this and what she brings forth. I think this is just so important for teams right now and in any kind of organization is that.

Change when you’re doing change. You really have a clear sense of what you’re trying to do, so I think sort of for people who are in our space, the simplest example is like we’re going to have a new electronic health record or we’re going to have a new payment system, right? We know what it is. We know when it’s gonna work. We, you know, we know all of these various things. And what I’m trying to do as a leader in my organization is be clear on, you know, what it is we’re doing and create followership to that. But it’s pretty, you know, there’s a pathway for it. And I think most people will tell you if you used an electronic health record, it’s not always linear. But like, we know what it is. We know how we do that.

Innovation is just really different and I do think after the pandemic, this is where we are and so we don’t necessarily have that really clear vision and what but what we do have is a purpose. We have that that why statement. If you follow Simon Sinek, we have a you know that noble purpose. This is why we exist and this is what we’re doing and leaders who are doing innovation are really clear in that and are able to bring their teams forward to really think about a codesign process, right where it’s.

It’s rooted and shared understanding of our purpose and then a shared understanding of each of the various roles within the organization. And you’re really trying to inspire that team to do that differently. And I I think you know and I I know you both have, you know, have huge leadership roles thinking I don’t have a vision as a pretty scary thing. But I I think if we’re, if we’re honest and we reflect on where we are post pandemic, I think there’s so much opportunity for innovation, but we can’t necessarily have a blueprint that’s really specific.

And at the same level of specificity with our electronic health record. So you know, thinking about those two things differently, thinking about the code design of innovation and thinking about also being really clear on your purpose are our key strategies for leaders who are thinking about innovation.

Aaron Higgins

I would say that the most daunting thing a leader has is where to begin, and I think that’s where we were at earlier this spring when you met with us, we were looking at this mountain. We weren’t sure First off, we want we knew we wanted to get to the peak, but we didn’t even know where the trail began. So I guess tell me about what you do. How does your organization help people find that trailhead?

Kristin Woodlock

So the first thing is to really come up with that purpose. And you know what’s interesting is sometimes I’ll talk to groups and say, well, we have a mission statement and I have yet there. There may be somebody in the audience who’s had the benefit of this, but I have yet to go work with an organization where people can tell me their mission statement verbatim. You know, it’s on the website. It’s somewhere maybe they get a couple of words. I can’t tell you how many times people like, I don’t really know.

So that that to me is an artifact of the past, we really need to give our teams and our whole organization that noble purpose. Why do we exist and we shouldn’t be afraid of that. We should be able to dig deep on that and say, you know, look, maybe we don’t need to exist, right. What is it that really is special about us and just to illustrate that, I mean there are there are many wise statements that you can find by using Google and typing in why statements but two that really stick with me. One is Google’s.

Which is to organize the world’s information and make it universally accessible and useful. Like anybody at Google has a chance of repeating that right? And like that can be an organizing principle, whether you are the CEO or whether you’re the last person hired to say, like, that’s what I want you doing in your role when you’re thinking about what’s the little cute art, artistic rendition of Google that we’re gonna put on today, I want you thinking about that purpose statement, right. It just, it just creates some glue for organizations. Somebody in my space and in working in the mental health space.

Used a why statement of people get better with us and it was just phenomenally helpful for the organization during the the COVID pandemic this group was in New York City, epicenter of the pandemic. People were out all over the city and the one thing that they had when they didn’t have any other information on COVID was that my purpose at this organization is that people are gonna get better with us. So what do I have to do for that? OK, I’ve gotta. I’ve gotta make sure that we are washing our hands. I’ve got to make sure that they have milk. I’ve got to make sure it just creates the glue and the stickiness. So.

First up is really go through that process to come up with your purpose and it’s, you know, it’s not a mission statement, right? It’s something repeatable. It’s your essence of why you exist and it it really helps you to think about that, that innovation front that we were talking about before.

Aaron Higgins

OK, so let’s dial it in a little bit more. Obviously, there’s the big, the big vision statements, the corporate vision statements. What about me as a leader within the company? Maybe I’m starting a big project or something along those lines. How can we take those bigger idea principles and shrink them down to a more individual basis?

Kristin Woodlock

So what? What is different? I think if you were on this path of you, you know your purpose, your, your, you know you’re in the innovation, Layne. A couple of things you need as a project leader, not even just the CEO, but a project leader we need to socialize within our organization if we are taking the innovation path, we have to understand that that you know failures face plants, things don’t go as planned as part of the price of admission to doing innovation because we are we are experimenting, we’re learning, we’re figuring that out now that’s not.

I’m not talking catastrophic error but really saying in the spirit of innovation, we’re gonna make some mistakes. We’re gonna have to, you know, back the car up and go a different direction and know that going into it, that’s something that’s really important. I think for project leads. And I think different, right, that that may be another cultural element that you need to to really give to your teams. The other is really skilling up and having and having what could be tough conversations around the innovation, right. The innovation may mean we stop doing something.

The innovation may mean that our fiscal department has to support the physicians differently going forward, right? So they’re in this innovation. We need to make sure that we have actually skilled up our folks in how do you not tap out of conversations when they get hard? How do you help people through when they’re sort of stuck and we’ve always done it that way, you know, and how do we really, really follow this moniker of clear as kind, right that we are so often taught and told and raised to say that you know you just.

You just don’t say anything if it’s not nice, don’t say anything, right? We. I’m just so nice and polite. But the reality and in this in this business environment and in innovation, we have to be able to give each other feedback and we have to be able to really talk to people about what’s going right and what’s going wrong and what we oftentimes do is we tap out because it gets uncomfortable physiologically and we end up going to somebody else and talking about that person. Right. So clear as kind means as we’re as we’re on this innovation project, we are clear about what our roles are.

We’re clear about how we’re going to move forward and if you know, if we are drifting a bit, we want somebody to be able to come back to the project lead and say I’m not sure we’re on track. And let me tell you why.

Jason Crosby

Well, you, you hit on what probably was my favorite portion of your presentation to our firm, Kristin. Honestly clear is kind and it’s something we have actually talked about quite a bit, quite honestly since that presentation, so…

Aaron Higgins

Yeah, it’s come up multiple times.

Jason Crosby

It’s come up multiple times and from staff all the way up to our principal.

Kristin Woodlock

For who?

Jason Crosby

Because as you mentioned, sometimes with there’s hesitation And delivering a message that may sound confrontational of sorts, right? So if you don’t mind go a little bit more into. Clear as kind, unclear is unkind. What you would tell a new leader when they feel like it’s an obstacle to communicate in such a way? Dive a little bit deeper into there, if you will.

Kristin Woodlock

Sure, sure. So you know, I think when we think about this, so clear as kind does not mean you know Jason, that you and I are debriefing a meeting that we had, you know earlier today and I come in and I say like you were a real jerk in that meeting, right? You just talked over everybody. You didn’t give, you know, like man, you’re intrusive and it just it just killed the whole project, right. That might be clear, but it is not. It is not serving the work so. So clear is kind to me means.

As a as a good team member where regardless of my hierarchical position in an organization, is a good team member, I’m committed to serving the work and I’m committed to sharing feedback in a way that is that’s focused on that work because I want it to work. I want us to do well with that. So Jason, I may come in to you afterwards and say, you know, in that in that staff meeting today, as soon as you started talking about our project and then you linked it to the quarterly financials, everybody shut down. And I don’t know if you did you notice that.

And you may say no, Chris, I didn’t notice that at all. Ohh my gosh, that’s not my intent at all. Yeah, well, I think we lost people on that and you know, I think it just was perceived as being not mission driven and just bottom line driven. And I think we need to go back and repair that and Jason, you may say like well, what do you think might work with that and what might we do, right? So you know I know that’s those these feel a little bit artificial when you know they’re not something they’re not like the big you know problem with that staring at you. But I think that’s how you look at that, right. So I didn’t in any way diminish your role as an executive within the organization.

I’m just. I’m just sharing that when you link that project to finances, there was a real negative like dimming and the room and that’s not what we wanted. So how we gonna fix that? Right, so we keep it about what we’re trying to do with the project, you know, like another one that I’ve heard, you know, and I do work with the with the Brené Brown Group One is one of the ones I think she has. She has just communicated beautifully is if you have somebody on your team, your project team who just is always jumping in and answering, you know like before anybody has a chance.

The think about consequences and how things are gonna come. You’ve always got your sort of person who’s gonna answer, answer, answer. Clear is kind might pull that person aside and say, you know, we go into the operations meeting today. I really want you to sit back and let other people answer. Well, well, why? If I know I have the, you know, the right answer because I really want us as a team to work up some different, you know, different muscles. And I want to hear from some different voices. And one of the things I really, really would appreciate you helping is asking those really detailed great questions that I know you can ask Aaron.

And really try to pull information out of others within the meeting, right? So, you know I didn’t come and say you’re overly talkative. You’re getting in the way, you know. Shut up. Right. Like, that is not kind. That’s not gonna be helpful. But what I did was sort of talked about, you know, I want you to step back a little bit more. I want to hear from others. But one thing you can really help me with is asking questions. If you feel like, you know, the answer, ask some questions, it might help us get to that answer. Right. So you really have to come into it from the perspective of serving the work and by the way, you also got to be ready.

If somebody you know gets you know you, you could have somebody get ticked off at you. You could have somebody cry, you could have somebody say I’m done on this stupid project. So remember we are emotional beings. So when you’re doing this, you just have to be prepared for that. I. And I think coming back to, I just thought this feedback was really important. I want this project to be successful. I certainly didn’t intend to make you angry, to hurt your feelings. How can I fix that? That’s not. That’s not what I wanted to do. So let’s talk about it a little bit more.

Jason Crosby

Great point there. How now flip the table of that conversation. Communication being a two-way street, right. And we all have different personalities, you know, personality types, etcetera. What maybe advice would you give to the person on the other side of the table who maybe has difficulty receiving that what is perceived as unkind but is actually trying to be truthful? From someone else, any advice to give it to the person receiving the feedback?

Kristin Woodlock

So I do. I mean it was and it’s sort of I am totally reading between the lines and probably painting things, you know, Jason and Aaron with your team that may have not may not have happened, but I loved what you said about after we started to have the conversation about clear as kind and what that can do to really create innovation and good communication within a team.

You talked about how much you have talked about it, right? So I think it is very hard within a team or even between, you know, a supervisor and A and a colleague or a supervisor or somebody or supervising to just start in with this and not have had a conversation about, you know what I’ve heard this really great thing that I want us to think about. And that is clear as kind. And let me tell you what’s behind that. Let me tell you what that means. You know, it’s intended to serve the work, to give real feedback and real time to people and for us to gather, to come about, like, what’s going to happen next. And I think if you create that culture and expectation ahead of time.

It helps people when they tend to get defensive reactive, they feel like you’re criticizing me. And if I so I would socialize that with my team. I really want us to show up this way with each other. And if I see somebody struggling, I’m probably gonna reach out to that person one-on-one and say whether again, whether I’m just a colleague, I you don’t have to do this in a hierarchical way and just say I just, I I see a struggling when we’re really trying to deal with clear as kind. Is there something I can do? Can we talk it through? You know, I did not hear Jason and any way criticize.

The work that you did on that dashboard, what I what I heard him say is that the data and the dashboard was making people on the team really judge each other. And so he wanted to take a different route at it, but that had nothing to do with how you created the dashboard, right? So sometimes you can give people specific feedback on where you think they’re getting stuck and it can help them through it. Again, regardless of where you are in the organization.

Jason Crosby

Do you think you mentioned how the from the right? Very first question about innovation and how different that’s been just in the last year versus the your first thirty, would you would you say uh communication and difficulty in communication has also been a little bit more difficult post you know with pandemic people working from home you know there’s a lot of talk of turnover quiet quitting all these types of things. Do you feel that’s made things even more difficult whether you’re giving or receiving the message?

Kristin Woodlock

Yeah, it’s, it’s interesting. And I you know, I do think it’s important for your for your listeners to like remember that, you know, I’ve had a very long career in like running large health systems and doing, you know, even taking one large nonprofit into bankruptcy. And, you know, under a massive spotlight. So I’ve, I’ve actually run stuff. What’s been interesting to me as a consultant is, is in the first five or six years, did a lot of work, you know, and the demand that people would come to me with was I’m, you know, I’m restructuring my health system. I’m bringing in different affiliates. Can you help me with that structure with that process? It was.

Very much about the business of behavioral healthcare or healthcare in the last year or so, I, I just my phone rings off the hook or whatever the cool technology is of the day. I’m sure I have the latest technology. It’s not, it’s not, it’s not a landline. I’m not that I’m not that technologically backwards, but so. So my phone rings off the hook, I get the emails and it’s all about like I need you to come in because like, I feel like my staff is burnt out. I I feel like people are tired, you know.

It’s like all of my clinical staff wanna work from home, but I can’t make that work. You know, we aren’t having the tough conversations we’re irritable with like it is so much about, about the ability to communicate with each other. How are we going to set up new norms and really doing that? And what’s been funny? Jason, I think is, as I’ve started to work with some organizations, in particular using DARE to lead, which is just one sort of tool in my toolbox. What I found is that it creates enough conversation. But then people start saying, well.

Yeah. Well, we’re there to lead train. Well, I didn’t see Aaron show up that way.

You know, Jason shows up that way, but I didn’t see Aaron show up that way. So the there’s just so much to unpack and I think what I have really resonated and liked about Brené Browns work is that she gives us very concrete tools and language so that like clear is kind right that that can be pretty simple. But that a team can sort of have a shared commitment to have a shared understanding, you know, skill up about how to give each other feedback and what does really engage feedback look like, which is important.

Kristin Woodlock

And also like if we’re if if we’re starting a new project or I’m asking you to do something, this is another Brené Brown tool that I think is helpful on this on this emotional teamwork and she’ll say make sure you paint Don. So. So I don’t just go to Aaron and say get me get me the spreadsheet of all of our expenses that we’ve had with outside vendors for 2021 and Aaron’s going to do the best he can to figure out what the heck is in my mind and what I’m gonna do with it. Right so he’ll try he’s gonna spend a lot of time really trying to.

You know, buff and polish, something that looks really cool, but what I didn’t tell Aaron was that I was really looking at outside vendors that we could potentially consolidate and look to group in a different way. And so I wanted to see some affinity elements of that and I wanted to see who ordered them and I wanted to see more detail on the invoice about what we actually purchased from them. So when Aaron delivers that product to me, I’m going to be like, this is not what I wanted and Aaron’s going to feel bad. I’m gonna be mad ‘cuz I wanted to share it with you, Jason. Then two hours.

And and So what we really are trying to focus on this as well is me sitting down with Aaron and saying like I I’d like those invoices. And Aaron says like paint done for me, Kristin, if I don’t think to say it, I’m like, OK, here’s what I wanna do. Here’s why I wanna do it. And Aaron might say, you know what, I know you’re thinking and voices, but we actually have a better tool. I think if we look at our purchase offers and the then the purchasing system that we do, that’s going to give us the information you want. And I think if I pull that together, it’s really going to impress Jason in terms of, OK, great, right, let’s do this.

So really having that detailed communication and frankly like some people hate doing that, they hate spending the extra 15 seconds saying why you want it. I’ve even seen some leaders hate it because they don’t really know what they want.

Like they know what it’s like. I know when I see it and whatever you give me, Aaron, is not gonna be what I want, right, like, but. But if you can, if you can have that conversation ahead of time, it’s amazing how much that streamlines the work. It, you know, it gave Aaron a chance to, to show off a little bit to me about how he knows what’s going on in the system. And he’s like, yeah, alright, good. I really influenced this. Right. And his work was actually productive instead of needing to go back and do it two or three times. Right. So. So there are some little things that we can do as organizations or we can.

You know, we can take a, you know, a bigger, more holistic approach. I do work with some organizations who dare to lead, like across the whole organization. But you can do some little things that really help sort of tamp down some of the anxiety, angst, conflict and can really start the team working together with a with a fresh set of energy. And I think that’s what I heard you to describe sort of happened after I spent some time with your team.

Jason Crosby

  1. Yes.

Kristin Woodlock

He said. I felt that lift, you know.

Jason Crosby

No question, no question. What? So lots of very good applicable tools for audience that that was able to listen to all that. What as we wrap this up, what are some of the quick hit type things? Would you advise to whether it’s a new manager, right, we’ve got practice administrators, we’ve got hospital administrators listening, it’s hectic quick environment.

Where can they go? Find some more information along the lines of what you just discussed and find you and maybe a couple things as to what they can take back and apply in the near term.

Kristin Woodlock

Sure, sure. So they can find me at uhwoodlockassociates.com. All the contact info is there. You know folks that I’m following right now. I I think the Dare Delete podcast that that Bernie does on Spotify is just fantastic whether you’re driving, walking, you know, hiding in your closet where whatever you’re trying to do, they’re about 45 Minute podcast. She brings in amazing people. That’s why I heard doctor Linda Hill talk about the difference between change and innovation.

I just think those are 45 amazing reenergizing informative minutes so that that’s a really good, good resource. Brené Brown does have a website and has a bunch of freeware activities, including a daring leader assessment that you can take if you’re just curious about sort of what some of your skills, you know, skill spots, soft spots are, I think Simon Sinek ‘Start with the Why’ is really amazing in terms of getting to the to the purpose part of things. So, you know, I think those are some, those are some quick lifts.

I think that are out there that that really would give you a lot give, give the listeners a lot of things to start working on.

Jason Crosby

Fantastic. I’ll tell you what I for those lessening, do yourself a favor.

Go to Kristin’s website, engage with her. The presentation you did for us. Of course, Kristen, whether it was the clearest unkind, the 5C’s there. July, we went through all those tools.

And as someone that you know, if you’re doubtful of if this is your fearful that there’s fluffiness to the discussion, I’m here to tell you no, this is one of those things where there’s not as applicable tools.

In in these applications that Kristen is talking about, so please, if I if you are looking for such an engagement, I would encourage you to do so, Kristin. I really, first of all appreciated the presentation and thankful for the information today as well.

Kristin Woodlock

Great to be with you both. Thank you so much.

Aaron Higgins

Yeah, thank you Kristin. My only regret is that we didn’t have more time, so we might wanna have you back sometime here in the near future. So.

Kristin Woodlock

Sure. Have to come back.

Aaron Higgins

Thank you for joining us and everyone. Thank you for listening to vital conversations with SHP. Again, our guest today was Kristin Woodlock. You can find herwoodlockassociates.com or Google her name. I did. I found plenty of ways to get a hold of her. If you want her to come talk to your organization, she’s available for that as well. Alrighty. Thank you. Kristen. Jason, you both have a wonderful day.

Jason Crosby

Thanks Aaron. Thank you.

 

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 6 – Direct Contracting Marketplace | Troy Reichert

In this episode, Jason shares about a recent study showing that Telehealth is here to stay. And Aaron talks about the growing attitude in Washington about mandating cyber security in healthcare.

Then Jason sits down with Troy Reichert, the Chief Revenue Officer of Coral, where he oversees all business development strategies working with advisors, medical providers, and industry leaders to expand the adoption and utilization of self-funded medical plans and direct provider relationships.  He is an “evangelist” for free market healthcare, fair & transparent pricing and choice for employers, employees, and individuals.  His TPA established one of the most successful direct contract programs putting doctors.

 

News Links

Jason’s News Telehealth is here to stay

Aaron’s News Washington’s Growing Need to Increase Healthcare Cybersecurity

 

Troy & Coral can be found on

Website: https://www.thecoralplatform.com/

LinkedIn: https://www.linkedin.com/company/coral/ 

 

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby

Executive Producers: Mike Scribner & John Crew

 

TRANSCRIPT

Jason Crosby
Hey, everyone. I’m Jason Crosby of Strategic Healthcare Partners and your host for Beyond the Stethoscope: Vital Conversations with SHP, today we are joined by Troy Reichert, Chief Revenue Officer, and Vice President with Coral, a tech-enabled marketplace and we’re thorough platform that connects providers to those seeking their services. Troy thanks for joining us today and welcome to the podcast.

Troy Reichert
Thanks for having me, Jason.

Jason Crosby
Right. And for our audience, some background on how we’re familiar with Coral and somewhat of a disclaimer perhaps we came across Coral while working with a clinical clinically integrated network client and the Indiana market who we were assisting with rolling out a bundling strategy. And during that time, we in the practice is found the platform very user friendly and just another mechanism that allowed the provider to interact and engage with the market. And so that’s how we came and crossed paths probably a few years ago, I’d say now, but what that let’s jump right into the conversation. Troy as we get started, tell us more, some background about Coral and the problem that you guys are trying to solve.

Troy Reichert
Yes, absolutely. So Coral actually started about six years ago and it was the result of a conversation between very well-known surgeon and a TPA. They were literally 2 miles apart. They were doing tons of business in terms of direct contracting together. But the challenge they had was literally the communication. So, they were phone, fax and e-mail like so many doctors, offices and surgery centers are doing, and they were having trouble. Larry, how do we handle the volume?
And out of that birth Coral where, you know, the founder of art company Greg Smith said, I can solve that problem with technology and so literally Coral is the communication platform between what we call payers and providers to help remove the transactional friction and make it easy for everybody to do business together.

Jason Crosby
Very good. Makes sense. Makes sense. So, who as you met on the provider side? Who would you say is the ideal target? Who? Who’s that? A user typically of the platform.

Troy Reichert
Certainly, we started with surgery centers, independent surgery centers are the core of you know the provider base today. Six years later, Coral has, if you think about sort of the boundary conditions of primary care on the left and emergency care on the right, everything in between those two points is what sits on Coral now. So, we have labs and radiology at the beginning of a point, an episode of care.
All the way through all the specialists and ending with physical therapy and everything in between, including behavioral health. So, all of that is on Coral. And the key for all of these providers is that number one, they understand their costs #2 they want to offer a guaranteed price for a specific service. So, they don’t, they have any mindset of a charge master. They are basically what we consider a cost plus they understand their cost.
They have to add some margin to be profitable and that then becomes the price that they charge to our clients.

Jason Crosby
What are you typically see given that breakdown there, what are you seeing mostly in that client base of yours in terms of that knowledge to get up and go on, whether it’s knowledge of the charge master versus cost plus, what’s some generic benchmark around that from what you’re seeing?

Troy Reichert
Well, certainly these uh doctors and the surgeons and surgery centers, they have to know their business. These are very smart people, not only from a medical standpoint but from a business standpoint. You can’t give someone a price without knowing what your cost is.
And so, these doctors, these surgery centers, they know what their cost of doing business is when they do a, you know, gallbladder surgery, they know it’s X dollars to do that to actually open their doors, pay for all the personnel, pay for the all the pieces they need and have a margin on there. When they do a total knee replacement, they know the same thing. So, number one, these doctors, these surgeons, these surgery centers, understand their costs. Becker’s Hospital Review says that.
Nine out of 10 hospital CEO and CFO’s don’t know their cost of doing business. That’s why literally they have to hide behind the charge master because there’s so much fluff in there that they that’s how they do it. My surgeon, my surgery centers, my hospitals, they understand their costs and they can give me a price above that which makes them profitable. But at the same time saving the plan, money, saving the employee money and paying the doctors more.
How that works, we called the triple play, but it does.

Jason Crosby
Fantastic. Well, there’s obviously a knowledge gain there with the platform on behalf of the provider and ultimately the patient you mentioned earlier about the relationships and how that was a big reason, how poorly even get started. And obviously building relationships and in today’s healthcare industries can be an issue.
So, what have you seen so far and how the platform and just the process behind Coral has allowed relationships and communication to improve between providers? You mentioned the spectrum there between primary care and specialist or whether it’s between provider and employer, provider, payer, etcetera. Speak to that for a moment.

Troy Reichert
Absolutely, Jason. And I think that’s literally one of the biggest issues that we face in healthcare today is that word that you just use relationships, we have a middleman in the health care business that is literally controlling both sides of the relationship. And my goal with direct contracts is to literally move out that third party, get out the middleman out of the way so that the payers.
And the providers can contract business together, can conduct business together. When you have a direct relationship with somebody, you have a different relationship. You have literally a different set of circumstances, agreements, understandings, assumptions that you are now doing business together.
When you put in a third party, when you put in a middleman in the middle of all that, it’s the middleman that filters everything. It’s the middleman that controls both sides, and that’s not good for health care. We need to put the doctors back in charge of medicine. We need to put the payers back in charge of, you know, that relationship, what they’re gonna pay and knowing what they’re going to pay. So it just elevates that relationship to a whole new status where it should be so that people can talk to each other.
The doctors, the payers and the providers and the patients all around the same wavelength, they’re on the same understanding. They have the same incentives. That’s another part, the perverse incentives that are in the healthcare today. We’re taking out those perverse incentives in a direct relationship.

Jason Crosby
Let’s keep going on that path. So, we talked about direct contracting and what we were familiar with you guys was long and some bundling models, you know that were being rolled out.
Let’s step back for a second and kind of talk to what those things are specifically, what’s up? What’s it look like in today’s world? You know, if you want to talk about what’s a, what does a bundled surgical procedure look like and maybe educate our audience a little bit for those that aren’t familiar with that.

Troy Reichert
Yes, absolutely. Every day we’re working with bundles. Everyone of us with, whether we go to a fast food restaurant in order, you know, the happy meal, the, the Big Mac deal or we get our bundled services from our cable provider that include cable, Internet and phone, it’s a bundle, a bundle creates efficiencies and in the same way with healthcare, when we put together a bundle in healthcare, it creates efficiency. So, a bundle in the surgical sense is the surgeon.
The facility and the anesthesiologist at the minimum. It requires that those three pieces are the same. Well, any of us that have ever gone to have a medical procedure done the surgery, we know what happened. We haven’t done. We don’t know the price. And you know, three weeks, 5 weeks, six weeks later, we start getting all these EOBs all these explanation of benefits and every one of them says it was very expensive and guess what? We owe money to every one of them.
In my world with a bundle, the patient gets one EOB. And unless it’s an HSA plan at the bottom, it says you owe 0. Because the Members are given the incentive of the zero out of pocket. And so, because the bundle, because of the cost savings, because of the efficiencies were able to actually give them the better care, the direct relationship at a lower price, the plans that our primary customers are self-funded medical plans. But the plans are saving money, they’re sharing a portion of that savings with the member in terms of 0 out of pocket. So that’s why we say you know the plan wins because it’s paying out less money why the patient wins because there’s zero out of pocket.
And again, because of the financial construct of the bundle, the doctors and surgeons are actually making more money than they would, you know, the fee for service models.

Jason Crosby
Fantastic. OK, now let’s drill in a little bit here. You guys have a pretty expansive client base. Let’s talk about that for a moment. And then as far as the types of clients you have specialties, ASCs, et cetera, you know maybe geographically what the typical ideal client, let’s get a little bit granular there because I want to also hear about some success stories, right, where is Coral really because as you mentioned it’s a platform that helps tie in relationships and expands on knowledge based off cost containment type initiative. Speak to let’s give it a little granular there and speak to your client basically success stories.

Troy Reichert
Yeah. So, we have providers in 49 states. We don’t have any providers in Hawaii, but we’ve got providers in every state. And again, there are all the specialists that you that I described before. And so, these specialists are looking for access and service respects to a different type of patient. My patients are three types of patients. They’re self-funded medical plans and they’re indemnity, medical plans. And the third one, they’re cost or the sharing ministries.
The shearing organizations, those are the three customers that are the payers on the system. So inside of Coral is the payers and the providers that come together and again in all over the country we have providers. We have over 10 million lives that are on the system to have access to Coral done by 85 TPA’s all the major Med management companies, nurse navigator companies use Coral. So, we’re trying to give the patients.
And access to a new tile type, a new breed, if you will, of provider who has said I’ve got your best interest in mind and I’m gonna give you a fair and transparent price. That’s the model.

Jason Crosby
Well, there, that’s a pretty expansive client base, obviously, to tap into. What are you seeing are as a practice comes to Coral for help. What is oftentimes the reason they’re specifying why you’re there and then subsequently, what’s that implementation look like once they acknowledge that, OK, this platform can help us with the reasons we’ve probably have already discussed. What’s that look like on their end and a typical, you know, practice or ASC setting?

Troy Reichert
Yes. And certainly, you know the ASC’s and the doctors and surgeons, they’re coming to Coral for a variety of reasons and motives. But we’re finding one of the most important ones is again that relationship. As you watch the hospital systems buying up and owning the doctors, you see PE money coming into the industry as you see what control the BLUACHs, Blue Cross, United, Aetna, Cigna, Humana, are having over the doctors they are looking for options. They’re looking for a change that they can be in control of, and literally direct contracts is that option for them. And so, as an alternative, they want to be in relationship with independent TPAs with corporations.
Uh, with that, you know, 50 million plumbing group so that they know that they’re going to see their patients. And so, the providers are looking for again that different type of relationship where they have a lot more control. Secondly, it’s very easy for these providers to come online to Coral, the Coral platform. If an individual can work inside of e-mail, they can learn you work inside of Coral. That’s how simple it is. Again, we have tried to make this system so easy, so.
User-friendly that anybody in their office can use it, typically in the office, in the doctor’s office and the practice and the surgery center, it’s the scheduling person that uses Coral and it’s the billing person that uses Coral and we understand there’s a lot of change over at the receptionist desk at the scheduling desk. So again, Coral has to be easy in terms of the ability desk, I’ll share a great story. One of our highest volume surgery center.
Uh, before Coral they were doing about 300 direct contract procedures a month. Today they’re doing over 800 a month before quarrel. They had three people working full time managing all their direct contracts or managing those episodes of care. Today, that same surgery center again over double over 800 procedures every month. They’ve got one person working 3 hours a week.
That’s the efficiency the Coral brings to a provider. And so if a provider wants to get into the direct relationship, direct contract business, they can literally manage that inside of Coral. It’s very easy and they’re in control of everything. They’re in control of their bundle. They’re in control of their components. They’re in control of their price.
That’s something that you know again when you get a network contract laid in front of you as a provider, there’s two things in there that’s in their contract is not in mind. It’s called time and it’s called money. My contract has no time limit. So if they are friend fed up, don’t see the value, don’t want to do it, they can get off tomorrow if they have a for orthopedic surgeon, if they have a striker increase for a knee implant, they can change that bundle in the in the system today and that’s the new price tomorrow.
So, they have ultimate control over their bundles and in in essence over who they wanted to do business with.

Jason Crosby
Fantastic. Well you, you certainly provide some really good, applicable informative insight into the practice there for the folks that are listening. If they want to find out more, how can they find out something formation about you or Coral?

Troy Reichert
Yeah. So, Sir, we have a website, Coral.IO. So, we love to talk to people. We love to show it. We can do it demo in about 15 minutes of the platform. And literally we show you the communication process between the payers and the providers, how that works, how that looks. We have about 400 navigators either inside of the TPA inside the indemnity plan or in the Med management companies that work to learn steer and feed patients into the surgery centers that’s into these specialists.
So, but again, we showed that in a demo and that relationship between the two and how it works.

Jason Crosby
Really appreciate your time and joining us today.

Troy Reichert
Absolutely. Thanks for having me, Jason.

Jason Crosby
Right. And thank you. We look forward to our next podcast and until then have a great rest of your day.

Transcript for Beyond the Stethoscope vital Conversations with SHP Episode 5 – Wound & Ostomy Care Gaps | Joe Ebberwein

Wound & Ostomy Care Gaps | Joe Ebberwein

In this episode, Jason Crosby and Aaron Higgins provide a quick overview of the PFS Final Rule that released at the end of October.

Then Jason talks with Joe Ebberwein. Joe is the Co-founder and Chief Financial Officer of Corstrata, a technology-enabled care management solution focused on improving outcomes for wound and ostomy patients. We gain data-oriented insight into this often-neglected area of care and how Corstrata is working on solving this care gap; then, they discuss how virtual care and telehealth are viable solutions for any provider to utilize.

News Item – PFS 2023 Final Rule 15 Takeaways

Register for the Nov 15th QPP Webinar

Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller & Nyla Wiebe

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby

Executive Producers: Mike Scribner & John Crew

Transcript

Jason Crosby

Hey, everyone. I’m Jason Crosby with Strategic Healthcare Partners and your host for Beyond the Stethoscope: Vital Conversations with SHP. Today we are joined by Joe Ebberwein, who is cofounder and CFO for Corstrata, a tech enabled solution provider for the wound and ostomy care markets. Joe, thanks for joining us today and welcome to the podcast.

Joe Ebberwein

Yeah, great to be with you today.

Jason Crosby

We look forward to it. Well, we’ve got some questions lined up for you. But first, let’s start with just some background information on yourself and kind of your journey to healthcare industry.

Joe Ebberwein

Absolutely. Yeah. So my background is actually accounting and finance, got an undergraduate in accounting and the CPA route and worked for both and this’ll age me, but both Arthur Anderson and Price Waterhouse. And started working in healthcare in early in that career at doing CPA work auditing and what’s in Atlanta for a little while, and then moved back to Savannah and actually began work with Memorial Medical Center, now part of HCA, but worked primarily on the post-acute side and the for-profit entities, which back then were the area ambulance and MedStar the ground ambulance, and then all of the other ancillary in home services such as home health, DME, et cetera.

So I’ve really spent most of my career in that space just about anything that could be done in the home from nursing traditional home health, Hospice, private duty care. And then as the years went on back in the early 2000s, the agency that I was involved with, we got into telehealth in a big way. And the use of vital signs monitoring in the home. So we were one of the early adopters, really nationally, and kind of became known as national thought leaders around implementing that, that use of technology in the home health space.

And we saw some pretty amazing results. We saw improvement in clinical outcomes and improvement in financial outcomes. So we were much more equipped to manage patients with chronic conditions like CHF, COPD etcetera in the home using this equipment again back in the early 2000s, clunky, expensive equipment that, fast forward, that was really kind of the initial groundwork for what my business partner Kathy, paid and I ended up doing at Corstrata about seven years ago. And really what we did is we took that concept of how can you apply technology to a healthcare problem. And we had experienced a big problem in managing chronic wounds for patients that were in from health. So similar to the teleradiology model.

We thought kind of came up with a thesis that we could move images similar to radio graphic images to a distributed workforce and that that workforce happened to be board certified wound and ostomy nurses. So we started doing a lot of R&D into research around how could we come up with a technology solution to that problem. So that’s really kind of how Corstrata was born seven years ago, but that’s my background.

You know, finance, accounting, but a whole lot of other hats along the way in early-stage companies.

Jason Crosby

Yeah, sounds like a natural evolution from the early 2000s. You know, you got see telehealth early on and home health. And now that’s kind of all you’re hearing about, right? So kind of makes sense now that you as you mentioned with Corstrata. So tell us, let’s dive into that. You you’ve touched on it; tell us a little bit more about the operations of Corstrata and the problems you’re trying to solve, who and who you’re trying to solve them for, right. Which who’s your typical client? What type of provider setting? Dive into that a little bit for us.

Joe Ebberwein

Sure. Yeah. You know, wounds are an interesting problem because no one really owns wound outcomes. You know, you’ve got cardiologists that are dealing with cardiovascular issues or endocrinologists dealing with kidney and diabetes function and that kind of thing. But nobody really owns wounds because they cross multiple comorbidities. You might have wounds related to vascular issues, lower extremity wounds.

Huge prevalence of diabetic foot ulcers in the diabetes population. One in four diabetics will get a diabetic foot ulcer in their lifetime and one in four of those will have an amputation. And then the five-year mortality rates are off the chart. Crazy for people that are that recover from an amputation. So those are the kind of wounds. Additionally, you have a multitude of other words related to different conditions.

Whether it be pressure injuries from immobility, or you know a lot of times you hear them referred to as bed sores and unfortunately that’s highly prevalent in skilled nursing facilities and a lot of them can be prevented with the right with the right education, with the right techniques, the right surfaces, et cetera. So it’s a $96 billion problem, 15% of all Medicare patients members have a wound and the real problem that we’re trying to solve.

And chipping away at it is that there are only 15,000 board certified when nurses in the country and that equates to about one nurse for every 600 patients. It’s not sustainable. The number of diabetics obviously we know that that’s growing. We’ve got about 37 million diabetics and another 96 million pre diabetics.

So it’s a really, you know it’s like a freight train going down the track and it’s it doesn’t have a good ending. There’s a big wall at the end of it and it’s all-around access to these specialists. So as I said, no one knows wounds across multiple specialties, multiple provider settings, whether it’s home health, skilled nursing facilities, we’re about 1/3 of the patients have a wound, L tags.

Rural hospitals, all of these different care settings have patients that present with wounds and yet we don’t have the expertise to really manage them and get evidence-based care.

One out of 10 nurses that are certified in wound and ostomy care practice in the post-acute space, so in that includes home health Hospice sniffs rural hospitals.

90% are practicing in the hospital settings and outpatient wound centers. So I mean you, you can see there’s such a disparity with where the experts are. We’re solving that problem with technology in a number of different ways. And I can go into that if you want or…yeah.

Jason Crosby

So with that the key obviously being technology adoption.

Joe Ebberwein

Right.

Jason Crosby

I on the on the provider side and some are a little bit more accustomed to that adoption. Some aren’t with that and with the gap in in qualify nurse on the, on the outpatient side as you just mentioned.

What are you seeing those as your key barriers or what other barriers are you seeing? To that to entry into those spaces.

Joe Ebberwein

There are a number of barriers, one of them that’s really interesting is some providers don’t want to take wound images of their patients wounds and you can kind of see that right because of litigation discoverable in the chart, et cetera. But what’s interesting is most of those patients say with a pressure injury or pressure ulcer, if it gets bad enough somebody is probably photographing that wound and what we tried to get across our client says do you want, you know, a qualified professional taking photographs of the wind over time to show the progression and have the medical records support that decline or hopefully improvement or do you want you know, the patient’s nephew to have the photograph in a in a court of law. So a lot of times we can get over that barrier pretty quickly the other.

The other barrier is we’re really a value add to our customers, so whether it’s home health or Hospice or skilled nursing facilities because we are nursing model, we’re not billing any Part B, we’re not billing any commercial Medicaid. We bill our clients and our clients to get a return on investment from having access to experts. So we can reduce nursing time, home health visits, we can reduce. So we can reduce their spend on advanced wound dressings and also really to be honest help them with coding and reimbursement as well because a lot of times they’re misidentifying wounds and they’re leaving dollars precious dollars on the table from a reimbursement standpoint.

Jason Crosby

Sure, that sounds like if if 15% of the Medicare population have wounds and there’s obviously a growing number there. I would just imagine there’s greater demand for that type of service. Where are you starting to see some of those trends knowing that you’ve got the aging population, you’ve got hospital closures, not only rural hospitals, but you’ve got WellStar for goodness sake?

Joe Ebberwein

In Atlanta, yeah.

At the hospital, large hospital in Ohio. And that’s only gonna continue, right? So, go down that path a little bit. Are you are you gonna, do you envision continued demand for such a service or is that just going to become a barrier for you as well?

Joe Ebberwein

Umm, I think it’s gonna become quite an opportunity for further penetration in multiple markets. And I’ll tell you just a couple of examples. We are we’re working with some large hospital systems and on the West Coast and these are these are big hospital systems in urban settings and because of lack of staffing, they’re closing their ostomy clinics so.

Literally, we’re getting that business to our virtual consultations. We are able to do a 30 minute live video with the patient in their home, troubleshoot the appliance, save a ER visit and assist these hospital systems that are desperate for staffing of these nurses on indeed.com. I went on there today, there are 4001 Open wound nurse positions across the US.

Well, if they’re only 15,000 certified period, you can see there’s such a disparity with COVID kind of the great resignation of a large number of nurses who are considering leaving the profession. It’s a big and growing problem. So hospital systems, as you mentioned in rural facilities. Really just about anybody that in the post-acute space. Also that is dealing with the wound, a wound patient.

Jason Crosby

So what? What do you what do you say to those? Then there’s obviously the appetite that the man for the service that you guys are providing.

But many reasons, as we you just laid out there still slow adoption to that whether you’re still nursing facility, rural hospital provided a large health system. You know practice setting across the board, there’s not provider that can’t utilize the service. What do you tell those that are just hesitant to look in that direction and starting investigating you know a service like yours, what do you say to them to get them across the line?

Joe Ebberwein

Great question. And I do think that COVID and the adoption of telehealth broke down a lot of those barriers for us because a lot of facilities had to move to virtual care, they had to, you know, put the systems in place, not only from a technology standpoint, but also all the infrastructure. And so that has actually helped us in that in telling that story, but.

You know, for instance, when we talked to, say, rural hospitals that now are either not able to admit a wound patient or they’re having to transport them to a higher acuity system because of lack of expertise, it becomes really an amazing impetus to start considering using virtual care.

Jason Crosby

So, in the markets, almost telling them itself, “hey, this is why you need to look into it.” They don’t necessarily need the sales pitch. I mean, just listen to the market.

Joe Ebberwein

Right.

Jason Crosby

And let the market tell you need to look into. No, that that makes sense. What? Continue going down that path. Let’s pivot somewhat into that, you know, to me that virtual health, Telehealth is kind of the A disruptor that we need. So continue looking at that and let’s also look into your crystal ball, right. What are some innovations that you’re seeing in these service areas that you’re you know, what are you seeing coming down the horizon there?

Joe Ebberwein

Yes. So interestingly, we have and this is one example, but we have a diabetic foot ulcer prevention program. So obviously diabetic foot ulcers don’t just occur in the Medicare population. These are people that are working, they’re 40s, fifties, some even younger that have severe diabetes, they develop neuropathy and they end up with a diabetic foot ulcer and it’s just an incredible kind of cycle. It can spiral down well.

We have working with companies that have electronic sensors for measuring temperature and pressure in the soles of shoes. A lot of technology is moving toward prevention, and most diabetic foot ulcers are preventable. If you have the right early detection. So that’s one example. There are sensors built into orthotics for measuring compliance; and you know what ends up happening is that data, that sensor data that tells that someone’s getting into trouble, that comes to an entity like Corstrata, and then we’re able to intervene. We had a really interesting this is just an anecdotal story, but we had an interesting encounter with a gentleman who was using one of these monitoring systems.

And every weekend he would alert. And so we knew something was going on the weekend where he was getting elevated temperatures, which is a precursor to ulceration. And so, one of our nurses said, OK, let’s dig into this, let’s do a video call. I want you to show me every shoe you have. I want you to tell me what you’re doing on the weekend. We’ll turns out he had a part time job and a Funeral Home, and he had to wear a certain kind of black shoe. And it was not the proper shoe to relieve that pressure. So, we got him in the right shoe. The alert stopped coming in. But that’s the that’s the illustration of you got all this great sensor data, but what do you do with it? And then that human intervention, that biofeedback and coming up with a plan to to really prevent that ulceration.

Jason Crosby

Wow, that’s a great, applicable story that anybody listening can certainly resonate with right? I mean that’s great. Appreciate you saying that. So what’s now in the strategic road map for Corstrata? What are you guys working on today and over these next couple of years?

Joe Ebberwein

Yeah. So it’s been interesting over this last year where we had predominantly really been working mostly in the post-acute space like Home health, Hospice, skilled nursing facilities. What we’re starting to see are some of the emerging models for really acute care services in the home hospital at home, if you will.

And we’re working with a number of those who organizations that really help facilitate a hospital building a hospital at home program.

What where that becomes really interesting is, and this was really accentuated during the pandemic, you’ve got these acute patients; Who really, when there weren’t enough beds in the hospital, could be managed in the home with the right equipment. And when I say hospital at home, I’m talking there is hospital grade equipment, hospital bed, vital signs monitoring, all going back to kind of a Star Trek central station constantly monitored, daily nursing visits, nurse practitioner visits, etcetera. So you know, imagine that they’re really setting up a command center in the home that is, you know, transmitting data so hospital at home is an emerging market and a lot of those patients have wounds and ostomies. And so they’re engaging with us to do virtual consults for the people that maybe do not have experience with wounds, other innovative type things that we’re seeing are mobile physician groups that are doing primary care. Obviously the proliferation of ACOs and the whole value-based care bundles. You know we are in discussions with some payers that also have mobile clinical teams. So yeah, it’s really kind of been an interesting year and it’s a shift in who’s approaching us for those kinds of consults. Ostomy is a big deal as well, even though it’s not a big number like the wound population, it’s a really high 30-day readmission rate into the hospital. And so ostomies kind of go hand in hand with wounds because of the certification of their nurses.

Jason Crosby

Interesting that you know here you just talked about what, 20 years ago the focus was all in the skilled nursing facility if that and now you can span across any provider setting a CEO’s practice setting, it doesn’t matter come a long ways and there’s just the last 20 years. So another exciting few years ahead, I’m sure.

Joe Ebberwein

We’re seeing such incredible stories, both with individuals living with ostomies that literally were driving to an ostomy clinic 4 hours away. That can now do this in the privacy of their home to people with long term chronic wounds that just never had the right evidence based treatment plan. And we’re getting those wounds closed, obviously saving a lot of money for the providers. But the human impact Is amazing as well.

Jason Crosby

Well finally, Joe if our audience supposed to learn more, how do they go about doing so?

Joe Ebberwein

Sure. So lots of ways to contact us. Obviously our our website Corstrata.com, we’re on LinkedIn and Twitter and Facebook and just about any social media. So very easy to get us.

Jason Crosby

With some great information and even better conversation there lots of lots of data to support. You know what you guys are doing is a great thing. It’s a service that’s needed out there in the marketplace. So really appreciate that. And I’m sure the listeners will, will find it. This is useful as I did. You definitely opened my eyes to a lot of things there. I appreciate that and the we really appreciate your time and joining us today.

And I wanna thank our listeners for your time. We look forward to our next podcast and until then everybody have a great rest of your day.

Joe Ebberwein

Thanks for having me.

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 4 – Impact of Value Based Care Trends | With Sean Cavanaugh – Part 2

John Crew

It seems like to me and maybe you could touch on this There’s a very distinct difference between the traditional Medicare patient, they’re white blue and the MSA population and what I mean by that is in a sort of varies from state to state in terms of how it’s covered how maybe a Part D is wrapped in in part, B and others. Can you share just a little bit from your perspective the difference in the in the two models and in what and if anything is different for the physician to be successful in those things.

And the and the MA side, I apologize.

Sean Cavanaugh

Yeah, as you said MBA is growing rapidly. It’s competitive market with E 10 to have four or five big national companies and then often.

A long tail of smaller plans locally within a market. You tend to see a convergence on the types of benefits being offered but they can vary from market to market.

What we’ve told our practices is you know the good thing about MMA is even though it might be you might have working with Aledade you might have three or four MA value-based contracts. But the Stars rating quality measures are gonna be the same across all of them so you’re trying to do the same quality care.

As you said the populations can be somewhat different you know what is attractive about Ma Ma is good for people who need financial protection? Who are willing to work within a defined network of providers, but don’t have a lot of money out of pocket and specifically can’t afford a Medicare supplemental policy so you do see.

Often, lower income communities gravitating toward that product, but you know as we approach 50% of the Medicare population and if it keeps going north of that the differences will not be that stark. It’ll be more like the Medicare population as a whole. But we do see that particularly in certain regions of the country.

John Crew

You know you touched on something there that really is a a challenge for providers as we’ll talk to them. You mentioned those that are coming into the market build and then made platforms and they’re seems to be an awful lot of VC funded organizations that are coming in and they’re as to your point. There are those that are known and that there’s a lot. That’s unknown. The one thing that seems to be a prevailing model is in in terms of exposure for physicians are these that come in. They’re either looking to build a model.

And sell it to someone else or they’re looking to maybe build it and go public either way. There’s there’s this natural instinct from providers thinking. Everything’s a short term relationship? Can you can you sort of talk to that in a minute?

Sean Cavanaugh

Yeah, I think what you’re getting at is because MA is growing so much and because the big companies are you know long standing you know legacy. Companies like United and Aetna. There’s a perception that there’s an opportunity for smarter startups to come in and beat them at this business.

I’ve seen some good one, it’s like a lot of businesses. You see some really cool. Interesting ones, and you see some that you roll your eyes at and I think. I worry about the ones we roll our eyes at cause as you said. Medicare Advantage can be so lucrative you know you could start a business enroll a bunch of people and just sell the company and probably get rich. At Aledade, we’re pretty wary about doing business with them.

Which are also seeing though is some separation of the wheat from the chaff like?

Those same companies that looked at United and said look at that big dumb legacy company. Our learning that United is not so dumb and there’s a reason. They got big right. Maybe we don’t all support the reasons they got big but they know what they’re doing, and beating them at their own game is harder than it looks but you do see some promising ones. One we’ve known for a while for example, is a plan that’s small but growing called devoted health and I think they have the right values and.

Are in it for the long haul? They could have sold probably they could be rich? By now they needed to, but they seem to be in it for the long haul. They didn’t suffer you know last year. A bunch of them. The startups that went public suffered tremendously in the stock market. So I think over time you’ll see.

You know you’ll be able to separate the good from the bad and there will be some good ones. But we are very careful who we do work with for that reason like there’s no it’s not good for the patient if there’s churning through plans what they need just is a long stable relationship because the challenge with the seniors is managing multiple chronic diseases over the course of their life and so hopefully, the most stable thing in their life is their relationship with their PCP.

John Crew

That’s that thank you so much to piggyback off of that question one of the things that we’re been exposed to for providers that aren’t value-based medicine and excelling in value-based medicine. We are now seeing some of these companies who are beginning to come in regionally back and try to pick up the best of the best in each of the areas that they’re located in and build a new model that’s you know that is all with successful value-based providers using benchmarks from other areas as way to appeal to them.

So you’re you’re beginning to have instead of having a organization that was built and sustainable. You’re having those trying to pick it apart take the best out of it and build another one do you see that as being a problem long term?

Sean Cavanaugh

Potentially, as I said that’s certainly not the Aledade approach validate approach is everybody who wants to do better by their patients can probably get better. You know you don’t.

The other thing I would say is that limitation of that approach is the big plans aren’t looking for narrow networks in MA because that’s not consistent with growing their membership so narrow networks have been popular like in some of the ACA exchange marketplaces where people are paying out of their own pocket.

In some niche markets like that, and not that that’s so niche. It has a lot of people but but in MA even though people are choosing the product themselves. They people are not looking for narrow networks and so I don’t think that approach will have.

A long life in MA unless something changes that we haven’t seen yet. But there are places for narrow network high performers, but it’s not it often gets more talk than reality.

John Crew

Thank you.

Mike Scribner

Sean not to kind of cut a hard left in the discussion. But I guess it when it’s been the last few minutes kind of talking about. From a CMS perspective in general. What do you think is the future of value-based care from from their perspective and where’s the innovation institute going those kinds of things can you talk a little bit about that?

Sean Cavanaugh

Yeah, I think the this group. It’s CMS and the administration more broadly. They spent a good part of their first year trying to. Put out a road map and a statement of values and I think the important things they said were two things one.

We believe in value-based care and we have a goal by 2030 of getting everybody in Medicare and value-based care of some sort and they were a little vague on what that meant but I think what it means is get out of the traditional fee for service world where people are just paid to produce.

You know to produce services and get them into a relationship with someone who cares about the total experience of care both the cost and the quality. MSP’s being the largest example of that, but there are some other. CMS models that would need so that was the first thing they said. Not really that new right the Obama administration said that the Trump Administration said that maybe not in the same words, but said something similar.

The thing they said that was different, though, and that’s you know gotten a lot of attention across the country is a greater emphasis on HealthEquity so not leaving some populations behind whether it’s in value-based care or anything else or an access to care.

And so I think that’s what you’ll consistently see in every action they do is how do we get more people into these models and how? Do we design. These models so providers sign up lower income people providers improve care for lower income people or any community that hasn’t gotten the highest quality of care in the past.

I think both of those are incredibly laudable goals and we support them. They’re also very difficult goals. One you know value-based care, which we’ve dived into wholeheartedly, but you know it’s been a voluntary program. How far can you get involuntary programs.

We’ll find out and in HealthEquity first of all we will not make any progress unless they were shining a light on it unless they’re designing new programs around it. So more power to them, but we also know it’s hard Aledade . It’s been committed to this over the past year. We’ve been focusing on hypertension among African American patients because our founder far as I’d most Shari says that’s where we can save the most lives and so we’ve been we’ve made some improvements, but it’s been hard.

And the physicians love it like they love making a difference in their communities, but it is hard work.

So I think you’ll see, those two themes and in whatever form you know, whatever they’re doing out of the administration. Those will be the themes whether they’re working in traditional Medicare or MA, which are two from a policymaker’s perspective, two very different environments, but they’ll be pursuing the same goals.

John Crew

I don’t wanna throw a curve here, so bear that in mind as I ain’t asked. This question so you know, I appreciate that, your expertise is has been in the Medicare side what we’re experiencing in the various markets. You’re seeing the transition of Medicaid going into value-based models. So have you. Have you guys experienced any of the Medicaid transition models going into value-based and if so can you talk a little bit about what what the challenges of Medicaid value-based is versus Medicare.

Sean Cavanaugh

Yeah, ohh. I’m so glad you asked John because we have. We’ve got. I think hundred 150,000 Medicaid labs in risk contracts value-based contracts. And this came about because we started working with federally qualified health centers in a couple markets in a big way. And we started working with them for Medicare but they quickly said. Hey, you know, we’ve got all these Medicaid patients, so we have a relationship with a couple of plans where we’re taking risks for Medicaid and we’re.

We’re really happy and proud to be in the space but it’s a learning experience. One of the things you find is you know someone gets on Medicare they’re on Medicare for the rest of their life? So they may move through fee for service going to an MSA plan, but they’re in Medicare. The Medicaid population there’s much more churning. There’s less of a traditional attachment to a provider so you know Medicare patients tend to have if anything, too many physicians. Where in the Medicaid population. They many of them? Don’t have usual source of care so you’re trying to establish that.

And then just the clinical differences of you know Medicare population what they’re dealing with are as you know the management of multiple chronic diseases over a logical 2. No period of time. Where in Medicaid, you’re dealing with a lot of moms. A lot of kids some single adults and then the expansion population. But just clinically. It’s the interventions are different, but the good news is if you take a step back.

You know, some of the stuff they need is the same thing they need someone who’s got a 360 degree view of their health? What’s happening to them someone who’s looking at the data seeing when they’re in crisis and reaching out to them and wrapping them in the arms of primary care.

Someone, who’s accountable for the experience their experience of care they’re total cost of care and the quality that they receive so the needs are the same. The tools have to be adapted. I’ll give you an example. Like we in Medicare. We target what we call high priority patients for annual Wellness visits well bring.

The siding, which senior needs to come in for an annual Wellness visit is very different than deciding which six year old child needs to come in for a Wellness visit. O our clinicians. Our statisticians have been working on that and so that the intelligence works its way into our tools over time. But it is a new space. John you’re right like we don’t see a lot of other organizations rushing to take Medicaid risk.

But I think we felt like one we had to service our partners or the federally qualified health centers. If this is important to them. It’s important to us. But also you know, t hese folks need value-based care, too, so we’re going to be provider of it.

John Crew

I know we got it. I know we’re coming to an end. I have one quick question sort of related to that in both the care and The Cave models.

States varied by our health insurance. Let me go back to these varied by what models they have for example, in Georgia. We used to have a lot of gatekeeper models and we no longer have that because it more challenging coming into a state where we’re products are sold that don’t require gatekeepers.

Sean Cavanaugh

Yeah, we get that question a lot like how are you gonna control costs there’s no gatekeepers and we remind people? We learned this business in traditional Medicare where which is the ultimate PO right like there’s no gatekeeping at all. I think you know what I remind people is.

There was a backlash to the gatekeeper models throughout the whole country and people gave up on that for a while with good reason because it was used as a pretty blunt instrument.I think you can get a lot done with you know with your PCP being the gatekeeper your PCP who has your best interests in mind, and it’s not like a regulatory or contractual gatekeeper. It’s more of a quarterback. I’m here to get the best thing for you and spending more money isn’t always the best thing. We’re not worried when there’s no gatekeeper. You know that’s where we learned how to do this and. Yeah, you can save some money that way. But you can get better care. Another way through better PCP, you know, better primary care.

John Crew

Right answer.

Mike Scribner

Thank you. Sean we really appreciate it that was great.

Sean Cavanaugh

It was great talking with you guys.

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 3 – Impact of Value Based Care Trends | With Sean Cavanaugh – Part 1

Jason Crosby

Welcome to Beyond the Stethoscope Vital Conversations with SHP. I’m Jason Crosby. If Strategic HealthCare Partners alongside our principles. Mike Scribner and John crew your hosts for today’s episode today. Our guest is Sean Cavanaugh, chief policy officer and chief commercial officer for Aledade. For last several years have provided the technology and services to independent physicians as part of their successful ACO ventures. Previously he served as the deputy administrator and director of the Center for Medicare at CMS. Sean thanks for joining us today and welcome to the podcast.

Sean Cavanaugh

Thanks for having me, guys.

Jason Crosby
So, with that will jump right on the conversation. We’ll start off with John first.

John Crew

Thanks, this is John, Sean, we do appreciate you being with us today. I do the question. I have first is and I think as Georgia experience as well as nationally. We’re seeing primary care diminished independent primary care physicians diminish. We’re seeing more and more of the young residents coming out or preferring the employment model when you look long term and value-based care models do you see a Direct Line where you would be working eventually with employed physicians in these models?

Sean Cavanaugh

Yeah, I think anybody who’s committed to improving healthcare, which means doing what’s right for the patient’s working within a business model where you get rewarded for?
Preventing hospitalization rather than doing a hospitalization.

I think we’d be willing to work with them and I think anybody should be willing to work with them as you correctly point out you know in my current position, with Aledade. We’ve very much focused on the independent primary care. Doc and that’s because of alignment. We think they’re already there and their mindset.They’re fully aligned with value-based care and doing the right thing by the patient. I think and you’ve probably experienced this for hospitals. I have a lot of sympathy for hospitals. They’re in a difficult position as the world transitions to value-based care if we’re really gonna reduce hospitalizations. How do they change their business model. It’s not as simple as it is for independent physicians. But in the long run? I think they’re going to get there, and I think we’ll be happy to work with them and not just us we’re not the only value-based company out there.

Some already work with hospitals with some success. So, you know if this movement to value-based care is going to work. It’s gonna have to include everybody validates starting with the independent primary care physician because we think there’s where you get the best alignment initially.

Mike Scribner

So, when you think about the independent primary care that most interest Aledade? What are the characteristics of them that kind of lead you to believe that they’re gonna be most successful with BBC in the first place.

Sean Cavanaugh

Mike thanks for that question, we get that question often from insurers as well. Like Are you guys pull you know going in and finding the elite high performing primary care practices and forming like a specialized high value network and we’re no.

You know, we’re not taking just the high performers what we’re looking for is well first of all one thing we look for is some basics people need to be on an electronic health record, which most people are but not everybody. They need to have a pretty good track record as far as program integrity, not prescribing tons of opioids. But those are fairly low bars. Hopefully beyond that, what we’re looking for is practices that are tied to their community that know their patients.

That are looking for a better way to deliver care and are willing to consider the use you know our tools. You know as you know, we provide some data and Analytics. And some workflow tools to the practices what we find is if they give the tools a chance. They love them and then it doesn’t take any coaching to get them to use them. But that’s what we’re looking for someone who’s willing to try something a little bit different and do the right work for their patients and what we find is typically with independent practices, they feel like they’re doing that already.
And so, we’re enhancing their ability to do it.

Mike Scribner
Can you talk a little bit more about the kind of tools that you’ll do provide and the things that enhance the practice’s ability to be successful.

Sean Cavanaugh

Sure, what I usually say is it boils down to two buckets, one is. Who’s not in your practice that should be in your practice today?
Right rather than sitting and waiting for someone to come in. We’re going to give you data that your whole population, but not just dump a bunch of data on you. We’re gonna show you very specifically who just got discharged from the hospital. Yesterday that you should be reaching out to today. There’s all sorts of evidence that patients that could discharge from the hospital if they see their primary care physician within a couple of days much lower readmission rates better for the patient better for Medicare better for the practice.
In fact, I’ll tell you Mike a little story, a true story from you heard at the outset that I used to work at CMS.

When I was at CMS, there were studies coming out showing just that transitional care works patient gets discharged from hospital. Some see their PCP. They do better than those who don’t. We created a new billing code in Medicare called transitional care management. That’s specifically pays for practices to see those patients and pays pretty well. I think compared to some other visits. Then we waited two years and we looked at the data. And no one was using the code. So, you know the greatest plans coming to failure so I went around to the physician groups and I asked them. Why isn’t anybody using the code the first thing I heard from you know the family physicians. The Internist was we don’t know when our patients been discharged from the hospital? How are we supposed to do that?

So sometimes it’s as simple as that tapping into the local HIE tapping into directly to the hospitals and not just you know, creating a very simple way for the practice come in turn on their computer in the morning get a list of patients who left the hospital yesterday their phone numbers and it worked. List called these people bring them in.
So, like I said the first thing is giving you an understanding what’s happening in the patients who aren’t in the practice. A lot of data analytics to show you which ones really could use some help if you reached out to them.

The second bucket is: Who is we know who’s coming in your practice today and who’s in a value-based contract? What’s the most important thing for you to know about these patients? What are the quality gaps they haven’t had fill? What hospitalizations have they had recently? What specialists are they seeing? How many times have PCP knew you were seeing 3 cardiologists he or she couldn’t do something about that.

So, we get we give this 360 degree view to PCP’s and then we let them do what they do best which is provide great primary care, we don’t interfere with how they practice medicine. They know what’s best but we’re making sure they’re seeing the right patients at the right time.

John Crew

Sean to that effect, data to be actionable data needs to be as current as it can you share a little bit about how you received data and then how you disseminate that back to practices as real time as possible.

Sean Cavanaugh

Yeah, John, you’re exactly right you know the ability to take timely action is only as good as the data you’ve got. First of all, the tool. We give practices and we literally give it to them called the validate a it. Ingests data from numerous sources, so first of all we get claims data from the payers. We have partnerships with and sometimes that’s Medicare or sometimes it’s a commercial insurer. We get notifications as I said of admissions and discharges and transfers from the local hi. You’re directly from hospitals. We get lab results from the major lab companies.
Just massive and you know script Part D results on drug utilization. Massive amounts of data but as you said. We’re constantly fighting is the battle to get it faster and more accurate because finding something out claims data can be two months lagged.

Ironically, one of the things we found in a little bit proud of this having come out of CMS is the data. We get the fastest from a payer on a claims data tends to come from Medicare itself and we’ve been talking to the big insurers united.

Aetna and those guys and saying come on, guys you gotta be able to beat the government right? The thing is, they have these huge legacy systems that they’re all working to upgrade. But what we try to convince them is it’s in your interest too. The sooner these doctors know what’s going on with the patients, the better the care your members will get but we do have at times. We can only be as fast as the payer partners, but we try to get as timely data as possible.

John Crew

Thank you.

Mike Scribner

Sean as the ACO’s have matured that you guys operate. Has it been more difficult to when you get past the low hanging fruit? Is it a little bit tougher to plow the ground to continue to have success or does it catch a flow that just continues to improve?

Sean Cavanaugh

Yeah, that’s a very fair question. If we’re only getting low hanging fruit. There’s more low hanging fruit than I thought because we’re still improving even our earliest ACOs, which started in 2015. They’re still getting incremental improvements, they’re getting I think part of what you see is it takes time, like anybody who’s thinking that this will turn around in a dime is wrong.
When we look, we did a study and we’ve updated it several times. We looked at 5 different ACO. We started in five very different states across the country back in 2016 and we followed them every year. Since then, and what we’ve this is a study. This is not using CMS data. This Is Us doing all Medicare claims data matching those people against similar beneficiaries in their community and we see consistently every year, the same result and continuing to grow which is.

People in an Aledade ACO get more primary care so I think we’re up to in the 5th year, 4th year. It’s 35 more than similar beneficiaries in the community. 35% more primary care and what that leads to is about 14% fewer Ed visits about 15% fewer inpatient visits. Umm I forget the exact number around SNF visits. We haven’t plateaued yet it is plausible. But that’s why one of the things we’re thinking about is like? What’s the second engine like? How do we expand the ability of these practices to do more physicians and their staff only have so much time in the day are there services we could augment to help them so.

Until today, Aledade has always focused our services on the practice. What can we do for the practice. We’ve now created a subsidiary called Aledade Care Solutions, which will be patient focused? What can we do directly for the patient. But this is where there’s an important distinction between US and Optum and some others.

We’re going to do it in partnership with the practice. The practice will get to decide when the Aledade services are used who they’re used for and any data. We collect about patients by servicing them directly. We’ll go directly back to the PCP because we think that’s key keep the PCP in the driver’s seat.

So back to your question Mike. Yeah, there’s probably low hanging fruit out there, but there’s a lot of it. We’re still working on that and as we do like the problem with the phrase low hanging fruit. You forget these are patients. They’re getting better. Care like they’re going to the hospital last so that’s important, but we think with some adding some services and helping the practices directly with patients. We’ll be able to move beyond that, too.

John Crew

Sean when you have markets that aren’t as sophisticated as other in terms of the growth of value-based care, and you come into it. There’s this perception right wrong or indifferent by providers that this is gonna change my workflows within my within my practice. It’s going to be more time consuming. I’m gonna have to hire more people and so I may or may not see a return. I’m sure you’ve been exposed to that? How do you deal with that as you first come in and working with providers to introduce them to the value-based model.

Sean Cavanaugh
First of all, we tell them we, we do have no interest in blowing up your practice and changing making your life, miserable. We’re going to take you stepwise through this. We’re going to take you through different steps. You can do incrementally. We’re not going to throw the whole playbook at you. On Day One so things will change cuz. Let’s be honest, rather than churning patients through the practice like when you need to make more money right now, you’re incentive is to see more patients for shorter period of time.

To see the less difficult patients overtime, not on day one your business model is going to change where you’re going to want to focus on the harder patients. You’re going to want to refer out less when you’re capable of treating them. But that’ll happen gradually over time. The other thing we tell them is there’s some things that help you along the way our practices. When we have them doing more transitional care visits more annual Wellness visits. They see their Medicare fee for service revenue going up day one.

So what we call good fever service like if you’re doing these good preventive seat. Fever service services. You can see practice revenue going up 1015 before you get a set of shared savings check so there is a transition here that we can work with practices. I know you guys have done the same.

It’s not turning things on a dime and it’s not like seeing a drop in revenue, while you wait for a shared savings check there’s a pretty good pathway here.

Mike Scribner

So Sean what do you what do you all typically see as the role of the specialist in that I get that it’s very primary care based and very cornerstone in that world but. What is an effective relationship with various specialists look like?

Sean Cavanaugh

Yeah, that’s a great question one of the things I want to say is. I think the whole country is grappling with that question I know CNS is CMS has been struggling to come up with a specialist strategy and they’re continuing to talk to people what we’ve found that works best is especially in smaller communities where there’s not just a professional but often a personal relationship between the PCP and a specialist is to sit down and have communication about expectations. You know in some of our communities that literally we invite the specialists in and we explain.

We’re doing an ACO here’s why we’re doing it. Here’s what our goals are and the goals of the ACO are really good for the patient and so when the specialist see that they understand like they want what’s good for the patients too. But what we find is PCP’s often go into this conversation, thinking they’re going to lecture specialists. But when if you’re a neutral party in these conversations, you hear the specialists having very good.

Demands of the PCP’s too when you send me a patient be very specific about what you want you know how many specialists get a patient walking in, who said doctor so and so sent me why I don’t know. He just told me to come. See you so improving the communications and understanding what the expectations are I’m sending you to the specialist for this very specific purpose. I wanna hear back what the results are I want an understanding of who’s gonna manage that patient if this is.

If you’re referring to a cardiologist is my turning over management of this problem to the cardiologist or do I just need a second opinion on something? When we’ve seen these two-week communication. We’ve seen some bonds formed that are really fantastic where the specialists now becomes a preferred specialist because they’re seen as a partner and they’ve their business does better. But I’m gonna be frank with you. This is not true everywhere. I think sometimes there’s. A distrust is too strong a word but misunderstanding what the purpose of the ACO is.
The other thing is, and this is where we’re all trying to get better is. It’s really hard to know who’s a true high value specialist. So, the other thing is being transparent about the data. Here’s what you know Aledade. We provide our doctors data on specialists you know outcomes cost.

But we encourage them to have a discussion with the specialist about it and the typical. PCP doesn’t want to change their specialists like meaning switch, they want their specialists to be the most efficient and the highest quality. So, I guess if I had used one word instead of rambling on, I would have said communication like the communication between the specialists and the PC is so critical and it’s hard because everybody’s so busy taking a step back and talking about? What are we trying to accomplish here together it’s hard?

Mike Scribner

Where do you see the specialist being involved like where do two-part question? Where do you see CMS going in terms of coming up with value-based incentives for them and then what it? Where is Aledade place and is there any sort of financial model around that within the all’s ACO?

Sean Cavanaugh

Yeah, so I’ll answer Aledade first and CMS at Aledade. We’re experimenting we have such a broad network now you know in in 40, some states. Before we roll anything out to all of our practices. We test it in some markets. So, we’re testing a couple of different specialists approaches.

One is you know, there are some companies that have started up that will give you real time consults by phone or technology. That’s one pathway. Another pathway is literally trying to create profile specialists in your community and create. You know a preferred list of those who are signing compacts to work with the ACO who are shown as high value.

But it’s hard work and so we don’t have one single product. We’re rolling out across the country. We’re collaborating with doctors locally trying to see what works. And I think we’re a small part of what CMS is going through now. I’ll tell you when I was at CMS. We got requests from all different specialty societies, who all wanted to a value-based model for themselves, so the Orthopedists had some ideas and the cardiologists and the. And nephrologists and I think what? With CMS quickly learned is it doesn’t have the capacity to create new models for every specialty. It has had its bundled payment for care improvement, which are you know.

Certain hospitalization and post-acute care bundles that are typically special that’s oriented, but that’s been a mixed bag. I have seen them out in the community. This is CMS folks talking to the specialist talking to the ACOs trying to find a path forward. I do think they’re looking for some model where you could embed a bundled specialist model within an ACO.
What gets really hard there is pricing it accurately a number of specialist models that CMS is tried have had either overly generous prices or the rice has been too low and so you’ve seen results all over the map. I think that’s what you’re going to see is them trying to embed some sort of specialist bundles as an option. Or maybe mandatory within ACO. I don’t know, but that seems to be where they’re headed.

John Crew

Showing our in your in your response I caught something that I wanna ask you about in your pilot programs. You mentioned or at least. I thought that you mentioned a model that maybe you’re looking at telemedicine and as part of that downstream in terms of Specialist consults things of that nature did it did, I understand that correctly or is that something that do you see telemedicine playing a role in your models?

Sean Cavanaugh

Yes, I think certainly telemedicine has a role whether it’s extending primary care or improving communications between primary and specialty care.

The specific test that I was referring to is this group that is willing to so if you’re a PCP and you have a question about a patient’s cardiac condition. You can get a specialist console like within 10 minutes and what the results. We’ve seen from that are 2/3 of the time what the specialist is telling the PCP is what you were planning to do makes sense so it’s just.
Reaffirming the instincts of the PCP but giving them some comfort and then there’s just subset where they steer them a different way like. Either you know, escalating the care or saying this person does not have you know you don’t need to refer them to a specialist but it’s giving obviously that’s one level of support. You can give to PCP’s. It’s not a solution to? How do we integrate specialty care primary care better, but it could be an interesting piece of it and what we found in this test just because you asked is there are multiple versions of this. The one our PCP is like the most was the one where they got immediate feedback. Meaning, they didn’t send the patient home and wait 36 hours to get some feedback from a specialist and that’s hard to do, but that’s what they it seems to be essential like to get that feedback while the patient. Still, there, and they can change what they’re gonna do while the patient still in the office. But we have a lot more to learn here. I don’t want to suggest we solve this puzzle.

Mike Scribner

Sean, as y’all have you know sets the breath that that you do? Obviously, we deal with practices that are both urban and rural based? What differences have y’all seen in the operations of your ACO rule versus urban and what allowances have you had to make for that.

Sean Cavanaugh

Yeah, well as I said, so one of the differences is the options for specialists’ options for facility partners. You know in a rural community, you know the options can be less the upside is there may be a personal relationship. There so you might be easier to communicate with the specialist and have that sit down in the talk. We love the rural communities, and we tend to operate more in rural communities than a lot of ACOs and that’s because we work with imprint and practices and when you get into the major metropolitan areas? What you see is heavy consolidation or the practices have been bought up by the Big Health Systems, so that’s one of the differences. We see for us in the near term the opportunity to work in some of the major metro areas is limited.
Going back to your first question, though I don’t think that’s a permanent condition. I think everybody’s gonna be pivoting to value. At some point and we will be working with people employed physicians’ health systems in the larger urban areas. I hope that answers your question, Mike.

Mike Scribner

It does kind of bring me full circle back to question John asked way back at the beginning do you see value-based care and the financial incentives of that being so great as to shift that move toward employment in the 1st place toward independence is. So much more financially attractive in the future that it just shifts that tide in general.

Sean Cavanaugh

Yes, I do see that we’ve seen small aspects of it, so think of the world three ways. You’ve got truly independent. PCP’s you’ve got independent PCPS who’ve joined a hospital CIN and you’ve got people who sold their practice to the hospital. Those people are at phase three different landscapes. We work with the first two quite a few of the physicians. We’ve recruited in the last two recruiting cycles are physicians, who were in that Middle Group. They’ve been independent, but they’ve been working through the hospital CIN.

So certainly, we’re seeing that shift where the hospital hospitals are losing some of their CIN physicians because and again. I hope this is temporary. They don’t feel they had the clinical independence or the voice in that CIN that they would have working with Aledade or other independent groups that are truly physician led.

I think you’ve seen a smaller to a much smaller degree. The more extreme which is the in the third group, the hot employed physicians. The ones who went and either sold or practices or went straight out of training into the hospital citizens and I’m sorry into hospital employment.

But I don’t think that means they’re happy you know; we’ve talked to enough of them and we think there’s an opportunity and we’re exploring this of creating if those physicians saw like a turn key solution where they could come out of hospital employment. What they don’t want to do is look for real estate have to buy an EHR they wanna practice medicine right. Imagine a world where they could walk into an office tomorrow.

They could have in place an EHR staffing and more important value-based contracts for their patients and they could build up a practice from a value orientation from the beginning and they could pay for all that stuff that they were given through future shared savings. I think if someone and you know be frank. There’s something alludes kicked around. If someone developed a model like that. I do think you’d see that third group of employed physicians start to move out cuz. I think they went into employment for legitimate reasons. But I think they missed their clinical autonomy and the ability to do the right thing.

John Crew

Sean, I have a question, in relationships specifically to the MSP MSSP and the successor models. We are seeing at least with our client base. We’re seeing us significant shift of the traditional red, white and blue moving to MMA so we’re seeing a decline in the in the in the traditional model and a significant increase in the ma long term do you see there being continued long term success for models that are associated with strictly with the red, white, and blue.

Sean Cavanaugh

No, I think if you wanna be successful in value-based care if you want to be successful in senior care specifically you’re gonna have to be able to do both, you’re gonna have to be good at. MSP, which is the ACO program but you’re going to have to learn how to work in ma as well. And I think not a lot some practices don’t want to hear that, and I don’t blame them M. The Medicare fee for service patient is their last patient where the insurers not requiring prior auth and all that, but the world is just changing as you said Medicare itself is still growing dramatically with the aging of the baby boomers, so senior care as a field is growing, but as you said the part that’s growing is the MA enrollment.

Those seniors choosing to remain in tradition what I call traditional Medicare or some people call fee for service. They’re actually declining somewhat in an absolute sense, so even as the program as a whole grows.

An absolute number of people in traditional Medicare is going down. So, we’ve encouraged our we’ve been talking to our practice quite a bit at this, if you’re going to be really good at seeing your care. You’re going to have to learn how to do ma and at a clinical level. It’s very similar right. This is the same patients. It’s more, the stars measures getting good at that and getting good at complete and accurate. Diagnosis which is the risk adjustment part of MA.

And as you know that’s where a lot of people trip up there’s some who get tempted and to fraudulent things. We’re very careful to tell our doctors, we’re going to do this, the right way.
You know, and we’re coaching them on how to do that today.

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 2 – The Experience Economy | With Scott Regan – Part 2

Scott Regan

So have to look at all of this from the eyes of the patient and we have to look at it critically. That’s the that’s the first step, step back and look at the experience from the eyes of the patient. We know what that experience is. The doctors, the administrators, they know you know they know because you because you work with a lot of these folks and I’m and they probably gripe to you about some of these things and they gripe to me I work with a lot of physician practices and they’re always asking how do how do we fix this.

The check in process here our check in process is a mess. Well, it’s actually easy to fix if you want to fix it.

But fixing it requires the train people that do things differently, and that’s where we all always fail. People like to go back to the way the things were because they’re comfortable with it, and it’s easy for them may not be good for the patient.

Mike Scribner

And I guess to cut that positive.

It does feel like this is such an anomaly and that reordering my practice to be experienced based would be so unique that there’s there would seem to be some branding benefit, some you know leveraging of the concept owned two growth if we can crack that nut.

Scott Regan

Well, you know, I would look at the concierge medicine model not as going to that model, but looking at what concierge medicine is trying to do the, the, the whole basis of concierge medicine is trying to create a much better experience for the patient of one, a true one to one relationship. You got me 24/7. I’m gonna if you go to the ER, I’m going to show up for you. I’ll be there. All those different, all those things. And so in order to provide that, doctors are saying I can’t do that for 3000 patients. But I can do it for 600.

I challenge that thinking there was some things in concierge medicine then I think are applicable.

In a in a big practice, some of this you know and the payback. You know, if you just had one person dedicated to truly all they did in a big practice was answer the phone and get people to the right place and call people back the you know your it’s an expensive $30,000 a year maybe 35 of and but the reward is probably huge just by being able to have that kind of personal experience that somebody’s calling you back in 10 minutes. Sorry that you got voicemail.

Or they get a live person on the phone, you know, so you know, how do you know? Can we take the best of what concierge medicine has to offer and integrate it into a large practice that’s not doesn’t want to go to the concierge, right route. And I think there were ways to do it. The technology is there’s all sorts of technology coming out that that allows us to automate a lot of things and things better.

Unfortunately, you know the EMR’s or can be pretty complex and we’re focused on getting bills to the insurance company getting them through the payment processors and all those sorts of things that we lose sight of. All the other things that we could be doing to you know, beyond just making sure we drop the bill correctly and we and we collect the time we have to do those things. But we ought to be investing in other technology in other and sometimes just some as aesthetic.

Redesign of our rooms and our processes so that our patients, when we come in, they feel like this is a this is a warm and friendly place. I like coming here. I like coming here because it’s the experience is is very welcoming. I don’t feel like I’m just a patient with a number waiting to have a charge dropped and so many of us feel that way and healthcare today.

Mike Scribner

So Scott, as you interact with practices how do you assess for all that? Like, is there a process you go through to kind of get the pros and cons and kind of point it in a direction?

Scott Regan

I was asked to work with UH-4 primary care clinics up on the Jersey Shore last year and I’m still working with him.

And the first, and they’re very they’re their primary care practices and they, you know, the very multiracial, multiethnic communities.

And the first thing I did, I spent four hours just sitting in the lobby of each one of those practices. The first four hours of the morning on four consecutive days, just watching, just watching what happened. And the most amazing thing to me that didn’t happen was the administrator never came out to see what was going on herself. And the administrator is locked in the back office was literally chaos out in the front lobby. It’s and it’s designed chaos. That was the thing.

It was designed chaos. The process was designed that way and I’m sitting there and I’m looking. And when I brought the administrator out that afternoon and I said, I said Kim first, I want you to, I want you to look around on the wall. Say if there was a spot that they could tape something that told you what you weren’t allowed to do.

It they had a taped up there, you know, as of this date, we’re no longer. You can no longer give us checks as of this date. You have to sign in on this table over here. You, you cannot, you know, do not come over here if you don’t have your proper paperwork. I mean, there’s all this negative stuff. Is this vibe of Oh my God. It’s like we really don’t want you here. I mean it was. It was on the glass in front of the check in people. It was on the walls as it was everywhere there was. There was these.

Hand typed and a lot of them had grammatical errors. You know, somebody’s just pounding it out on their on word and printing it on their computer and they’re sticking it up on a wall. I said, what’s the impression you get here? No, you’re not wanted. You’re not wanted. I said the first thing you need to do is take everything off these walls. And she looked at me kind of stunned and she goes, but you know the CEO of the of the of the primary care system. He told me to put some of this stuff up there. I said well.

The it’s nonsense. Tear it all down, I said. You got it. And I said I and I and I challenged her, thinking that that the, the, the CEO wanted you to cover this wall up with me. Every wall and every window, every door with negative messages, that pretty much tell the patient you’re a pain in the bot.

You know, our life would be easier if you didn’t come in than if you did. And so part of this, and I mean if.

Sometimes we don’t see things in our own practice, cause it’s been that way for so long and we come in every day and we see it the same way that that we’re that that.

We don’t even notice it anymore. It’s just a part of the way it is.

And like you and I were at Memorial Health together back in the in days where it wasn’t a great place to be and it was, it was very much like that people you know.

It things were so bad for so long that people said that’s just the way it is here and we see and, you know, people are so busy in a practice, especially a small practice. So one or two docs, a lot of patients and they don’t have time to sit out on the lobby and look and look around and see what’s going and talk to people.

But if we don’t make the time. Then the design of the experience that you get is what you deserve.

Because only by really observing can we really understand what’s not working and what’s, you know, listening to the interaction between the check in person and the patient.

East dropping on the conversations of people in the waiting room and what they’re saying, looking around at the aesthetics, you know, looking at everything that’s posted up there, you know, we create more barriers than a lot of practices to communication and building relationships. Then we then we when we tear it down because you know it’s okay there’s been a change in the copay process. Somebody stick a note off saying effective this date you now have to give US 2 forms of ID and.

A birth certificate. Everything else. If you wanna be seen and you know, so why do we have to do that? Why do why do we have? Why do we have to stick all the stuff up on the walls? And that’s and that’s and.

Every practice I’ve been in, unless it is like a plastic surgeon, you know, high end, there’s stuff everywhere you look at. I mean, there’s magazines on the table that date back to 1950, you know, 2002, 1015.

And because nobody, nobody’s cleaned up the all the, you know, people just come in and they throw, throw stuff and throw stuff down. I went into one practice and there’s a little and there’s and there was a rack of cards for a church which I thought was kind of unusual and with little Bible statements on it and for this practice with and I asked him I said wow did you guys put this out that’s I’m surprised you would do this because I’m sure you’re kind of offensive to your Jewish patients and you’re Muslim patients and they said we didn’t know it was here.

No idea. So evidently you know the somebody came in from the church and just put stuff out.

And how long has it been there? Nobody knows, because there’s so much clutter that that nobody, nobody knows what’s sitting out there because nobody’s really taking a look at it. Nobody’s observing what’s going on. We walk in, we don’t see it anymore because it’s almost like we’re anesthetized to it. And we don’t want to deal with it because we we’ve never been able to fix it. So we stopped trying.

Mike Scribner

And I think that’s embedded in what you’re saying is that it’s the constant seeing it from the eyes of the patient or the patient’s family perspective rather than the administrative flow that has to occur to run a practice in the 1st place, right.

Scott Regan

Ohh, absolutely, absolutely we get. The administrators that I’ve worked with, and I’m sure you’ve seen the same thing, Mike, that they there’s, so I mean running a practice is tough work. It is hard today no matter what special to you’re in it is tough and you know you’re fighting insurance companies, you’re fighting.

You know the hospital on, you know, patients you sent or call coverage or whatever. There’s all this stuff going on that the last thing that gets taken care of is really.

The observational piece really spending time to be aware of the experience that you’ve created or not created in your practice, and we’ve gotta figure out how to carve time out of the day. I tell you what the number one thing that any administrator could do right now that would be a huge benefit. Spend one hour every day sitting in the lobby.

Just sit there and watch. You know, don’t be checking emails on your phone. Don’t sit there with your laptop. You know, you know, pounding out some correspondence or checking the billing status and tries. Just observe. And that one hour? You’ll learn so much, and most of you will just. And as Kim did when I had her sit with me, she was appalled, she said. I really can’t believe this has been going on under my watch. And I’ve been oblivious to it. I’ve been oblivious to it.

The next time I went up the month later, then before I even got to the practice, I said I am I I’m calling you just to let you know I’m. I just got off the airplane because got come to my practice first. I can’t wait for you to see it.

It was clean, it was neat. She actually came in on a weekend and bought her own paint and brush and painted the walls because she didn’t wanna wait. She didn’t wanna even get approval for it. She was the. And once I pulled everything off, you know, the tape ripped the paint off and you can see where things were tape. So I came in with my husband and we painted the walls and.

That’s a huge difference in appearance right off the bat. She still had a long way to go, but boy, I tell you what now. She was aware she was aware of this whole environment that her patients were being subjected to and the really bad experience. The next month I came up she in the corner. She had a little kids table with kids, books and little reading library because most of the patients come in with their kids, they’re working class people. And So what do you do and how do you keep the kids busy? So she had coloring books and crayons and.

And she had people donating this stuff. And so she had this little corner kids, kids section, I said. That’s brilliant. That’s and. And parents are like, ohh, I’d like to bring my kids in because they actually have something to do. So she, I mean it’s.

That’s you think that’s a small that’s a huge leap to moving from being a practice worried about just funneling patients through doing a practice as trying to adopt and adapt to the experience economy.

Jason Crosby

Scott, you mentioned a lot of ways to go about doing this, how some of the administrators can get started Fast forward a little bit post implementation.

Do you have mechanisms or they’re certain ways in which today’s administrator can measure the effectiveness of some of these? You know, tricks of the trade that you’re talking us through today, or is there just sort of a absorb these things into your culture sort of concept and frame of mind versus being so concerned about ROI measuring these items? Or are there ways in which you can measure them?

Scott Regan

Well, I think the best way to measure it is looking at patient volume and revenue because I I think this drives it. I really do and I don’t think this is just touchy feely stuff.

You know, without a doubt, if you have a great experience, people are gonna tell. Others are gonna refer people. They’ll, they’ll come back more often, especially if you’re in a more of a cash environment where you’re you have a spa or you’re doing laser treatments. But if you’re a strict, you know, orthopedic practice, neurology practice.

Pediatric practice and you have that kind of experience. People tell their friends. I mean they, they tell their relatives and somebody says, hey, I need a neuro, a neurologist. Who would you go see? It’s Oh my God, my neurologist. Unbelievable. What they do for you. Let me tell you. And versus one that says uh my neurologist.

I don’t anywhere but anywhere but there so there, you know, word of mouth marketing is still and always built will be the best form of marketing and healthcare and I don’t care how many billboards you put up or radio spots or you know, specials you run or events you do that that word of mouth referral is absolutely critical. And if we want more of those, we have to deliver not just great quality but we also have to deliver a great experience.

Jason Crosby

Fantastic. Well, Scott, if our audience wants to learn more, how can they go about doing so? How? How can they find you?

Scott Regan

Well, they can, you know, they can e-mail me at the.scott@leadworks.com. That’s LED. Dash WORKS. Scott at leadhyphenworks.com. They can pick up the phone and call me and I won’t put my phone number on here. But certainly if they contact you guys, you can send them my way. I’d be more than happy to have a dialogue with anybody who’s listening to your podcast. Who wants to learn more?

Learn from my experiences in trying to create positive experiences for physician practices and hospitals more than happy to share the knowledge.

Jason Crosby

Fantastic. Well, great information. I didn’t even better conversation, Scott. We share the listeners, will find it all very useful and hopefully applicable to their organization where you’re really appreciate your time. And joining us today. And we want to thank our listeners as well and. Certainly look forward to the next podcast. Thanks a lot, Scott.

Scott Regan

Thanks for having me.

Jason Crosby

Thank you.

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 1 – The Experience Economy | With Scott Regan

Transcript for Beyond the Stethoscope Vital Conversations with SHP Episode 1 – The Experience Economy | With Scott Regan

 

Jason Crosby

All right. All right. Hey, everyone. I’m Jason Crosby with Strategic Healthcare Partners and along with Mike Scribner, your hosts for Welcome to Beyond the Stethoscope, Vital Conversations with SHP.

Jason Crosby

Today we are joined by Scott Regan.

Jason Crosby

Scott, thanks for joining us today and welcome to the podcast.

Scott (Guest)

I’m happy to be here.

Jason Crosby

So today we’re going to discuss a concept folks may recognize going back what maybe the late 90s and kind of the other industries, and that’s around the experience economy. Healthcare is certainly a different place like meaning the industries today and engaging consumers even more challenging. So let’s just start there, Scott, tell us what exactly is the experience economy?

Scott (Guest)

Ohh, you know the the best way to describe the experience economy is by telling it how we’ve evolved from an agrarian society to now. This is like the fourth stage of the economy by using a birthday cake as an illustration. So bear with me on this. So you know, years ago, when we were in agrarian society.

Scott (Guest)

Our moms would make birthday cakes from scratch. You know, they get the wheat, the sugar or the flour, you know? And and it cost next to nothing to make the make the birthday cake we moved into the industrial economy and we paid Betty Crocker to have a a box mix cost us more. But there was convenience to it. And then we moved into the service economy in which we ordered cakes from the from the store. We go to the public or the Harris Teeter order, our birthday cake, bring it home for our kids.

Scott (Guest)

Now we’re we’ve moved into that experience economy where we don’t even have time to go pick up the cake from the store. We just outsource the entire birthday party to a company that specializes in them. They bring in the cake, they bring in the the air castles, set it up in the backyard. All the kids come over and now we have an experience. And so that’s really what we’re talking about with the experience. Economy is, how do we take the goods and services that we currently offer and turn them into experiences.

Scott (Guest)

And leading edge companies I believe will find out very shortly that the next competitive battleground lies in staging experiences for consumers.

Jason Crosby

So what would you believe? Is the experience of coming more about things like theme parks and and movie theaters than it is about healthcare?

Scott (Guest)

It would seem that would be the case, but.

Scott (Guest)

And it really isn’t so.

Scott (Guest)

But you know this is gonna date me. But back in 1982, there’s a TV show called Taxi.

Scott (Guest)

Now, Mike, you probably remember the show it was on only on for a couple of years, but there’s a taxi driver featured, a taxi driver named Iggy, and Iggy is a New York City taxi driver who decided that he was going to go beyond just moving people from point A to point B. And he started serving sandwiches and drinks. He started conducting tours. He sang Frank Sinatra, you know, to people while he was driving. And he created this very unique experience that people decided that they really wanted to get a ride from Iggy.

Scott (Guest)

And and in the show a lot of people would actually tell you drive around the block one more time and they give him big tips. He understood way back in 1982 that if he wanted to separate himself out from being a taxi driver, and most people don’t think taxi drivers have much of an experience.

Scott (Guest)

That he had to do something different and create that unique experience. And we’re seeing that with you, with Uber drivers. I’ve been an Uber vehicles in which the first thing they do is they offer you a bottle of water. They’re trying to create an experience for you to separate themselves apart and to get higher, you know, get five stars because I had a bottle of water versus a guy who didn’t give me the bottle of water. So.

Scott (Guest)

Yeah, I mean the experience can be in anything. It’s it’s truly how do we how do we connect people in a way that’s meaningful to them to create a better experience for the things that they’re consuming everyday anyway.

Mike Scribner

So Scott, break that down a little bit for me. What are the characteristics of an experience that you’re talking about like make it a little more concrete for folks?

Scott (Guest)

Yeah. There’s two parts of this mic, there’s, you know, to an experience. There’s passive participation and then healthcare. We have a lot of that. If you’re coming into the orthopedic office or the plastic surgeon or the hospital, you’re coming in there for an appointment. You may have surgery scheduled that’s more of a passive experience. You’re waiting for other people to do the things to provide the services to you that you’re purchasing. Yeah. You’re engaged in it. Obviously, you’re going to have a knee replacement or you’re going to have a Botox injection, whatever it might be.

Scott (Guest)

So, but it’s still to some degree of passive experience. The other piece, the other characteristic is that we need to find the connection that unites them with that passive experience. So what can we do to create something that is that that really elevates the experience rather than just sitting in a waiting room and waiting for your name to be called. So you can go back and be prepped now and I’ll tell you, here’s a years ago I went down to Celebration Health down in Orlando. And they had it already figured out, so this this was the hospital, the model hospital of the future. When you went back into the MRI, you walked down this hallway that was designed to look like a boardwalk.

Scott (Guest)

And they had cabanas coming out from the side of the wall. You go back into and you there’s little sand on the side, but the floor is actually a boardwalk. You went back in the MRI room and it was beach noises going on. They lay you down on the MRI and the lights above you, you know, has the has that that plexiglass cover in front of the in front of the lights in the ceiling? And it was painted with skyscapes. And so.

Scott (Guest)

Then everything around it was designed to make you feel like you were at the beach. It was. It was an event. It would made it. It completely changed the game for people and patient satisfaction scores. There were through the roof, I mean, because they understood that it goes, yeah, people are coming here for an MRI. But how do we turn that MRI into an experience? And you can do. And we’re seeing this with airlines today. We’re seeing this Westin hotels recently decided, you know, people come here and they stay at our hotels.

Scott (Guest)

A lot of them want to work out, but they’ve they forgot their gym clothes, they they didn’t bring sneakers. Well, lesson started giving people loaning people complete workout outfits. They would they they they come in here, we have a closet full of stuff. Get what you needs or you can go work out. You know that that’s connecting. People say they had gyms that people weren’t using they had people in the hotel who didn’t have workout clothes and so they decided to create a better experience by connecting people who are passively using the hotel.

Scott (Guest)

And engaging them in their in, in, in their gems, Cadbury chocolate recently not too long ago decided to create spas based on new flavors of chocolate, and they offer these spaw experiences for free. And it was only for a couple of days. And when you missed it, people were like Oh my God, you should have been there. They had a spot that was based on this new chocolate flavor. It’s unbelievable. So you know, that’s kind of getting creative and understanding a little bit about how to create an experience.

Mike Scribner

Yes.

Scott (Guest)

Out of something that is just really more of a commodity. Do you remember in 1981-1982 somewhere around there the movie with Michael J. Fox ‘DocHollywood’ again I’m dating myself. Great Fleck. Great Fleck Michael J. Fox is a plastic surgeon who was in Hollywood and decides to come to this little southern town and set up shop now in Hollywood when you saw his when when you went into the lobby of his plastic surgery practice they had live dancers that were shadowed that were behind a screen in the lobby.

Scott (Guest)

And all you could see was their silhouettes and they were slowly just kind of moving their bodies and posing to provide these wonderful images of the human form. And that now or can plastic surgeons do that today, you know? Probably not. But there’s a lot of things that plastic surgeons can do to make the experience different than just somebody sitting in there waiting for their name to be called. And it’s not just plastic surgeons, Mike. We’ve all been to the doctor’s office in which you’re waiting in a really crummy lobby.

Scott (Guest)

For someone to open the door and call out your name and bring you back and and is that the experience that we’re gonna go back and tell all of our friends and family about and refer other patients to probably not.

Mike Scribner

You have a examples of that, Scott of specific you know our typical.

Mike Scribner

Practice that we interact with tends to be a fairly small practice, can be in a rural area. Do you have examples of of what people have done to improve that experience or the waiting or the flow itself?

Scott (Guest)

Ohh yeah that you know and some of them and and again.

Scott (Guest)

To create an experience isn’t isn’t always free. Sometimes the experience is just really great customer service training, but I’ve known physician practices who they stocked their fridge with water and soft drinks and little snacks. And you know they offer when people come in because they know they’re backed up. You know, they’re offered something. Hey, can I get you a, you know, a a Coca-Cola or can I get you some crackers? You know, it’s little things like that make a big difference. It says you’re more. You mean more to us than just a patient on a chart.

Scott (Guest)

We wanna make your experience as comfortable as possible and and sometimes it’s just the aesthetics around you. How ho can you change the aesthetic environment to make it a little bit more immersive now? I saw in a lot of this is enabling technology. You know,I was talking to a printer recently who they there’s new technology that you can have that can put artificial intelligence in the wallpaper so that if somebody actually.

Scott (Guest)

Holds up their [phone] they scan the the wall, they they see images that are on there and it’s not that. And surprisingly it’s not that.

Scott (Guest)

It’s affordable. I mean, there’s things like that that you can that if you think hard enough, you can say how can I make the especially the wait time. How can I make that wait time a little bit better? I’m sure you’ve walked into large practices and it looks like a Greyhound bus station. It feels like a Greyhound bus station. And I’ve been in those and that’s the last experience that people don’t want and the question is, who do we need to build this for?

Scott (Guest)

Eventbrite did a survey recently. They did a study and they found that 78% of millennials are willing to pay more money for a better experience, even if what they’re buying is the same. They experience is different, but the actual service or the product they’re buying is the same. They want the experience. And so those millennials, that’s the next generation coming up if we don’t start preparing them to, to embrace the millennials who really, who really want to feel like they’re being catered to, then we’re going to lose those to the folks who figure it out.

Mike Scribner

So how do they? How do those practices solicit that kind of feedback? How do you know whether or not your experience is memorable and driving that level of satisfaction in the first place?

Scott (Guest)

Well, you know, unfortunately most of our patients satisfaction surveys don’t get at the experience it it gets at the the basic things like wait times and we’re you know was the staff nice to me and did they were they attentive and did they listen and all those are important to the experience but doesn’t really talk about hey was your overall experience from the time you walked into the time you left and even in between.

Scott (Guest)

You know, how did it make you feel? So I think we gotta start by asking different questions on our patient satisfaction surveys to better understand what people want now. And the other thing is, is it really just asking and a lot of times, you know, if I’m a doctor and I have a solo practice or even if I’m a big practice, I need to figure out, you know, what do my patients want from me?

Scott (Guest)

That would make this experience so much better for them.

Scott (Guest)

I mean just.

Scott (Guest)

Here’s an easy one.

Scott (Guest)

If you’re running more than half an hour behind, is it possible to?

Scott (Guest)

Pick up the phone and call the patient and say we’re running about 30 minutes behind. If you want to come in later, you know don’t come in now. But you know you have an appointment at 2:00 o’clock, and we’re already. It’s 10:30. We’re half an hour behind, so I don’t want you here waiting around. So it’s it’s knowing that there’s an extra level of customer service that’s easy to deploy, yet how many? How many of us think about actually calling patients to let them know that we’re an hour or two hours behind, yet we go in and then we’re told, well, the doctor’s 2 hours behind today.

Scott (Guest)

And you have a 3:00 o’clock appointment and you see him at five 5:30 and.

Scott (Guest)

Had you known that you, you probably would have rescheduled, so you know, sometimes it’s, you know, we’re not asking the right questions all the time. And if we really want to understand the experience that our patients want, we have to ask them about the experiences to begin with.

Scott (Guest)

And patient satisfaction surveys aren’t set up for that. And quite honestly, I I absolutely believe that a lot of physicians and a lot of administrators don’t want the answers to those questions because they’re not gonna like what they hear.

Jason Crosby

So Scott, that you know.

Jason Crosby

Coming off, you know the pandemic, everybody’s shutting down and now patients are finally going back into their practice or hospital and you’ve had the uptick and telehealth repeat, you know remote patient monitoring. And I’m gonna guess that all of us are probably wearing a, you know, a wearable device now, right? So do you, do you think at this point in time?

Jason Crosby

Where Healthcare is going in terms of consumer engagement, that’s going to help. What what you’re talking to us about today in terms of the experience economy, is that a plus that you see?

Scott (Guest)

Well, I think it’s already uh impacting health care, Jason, especially some of the things that you just mentioned, you know the apps that you have, I I generally when I’m not feeling well.

Scott (Guest)

I pull out my phone and I talked to a doctor from my insurance company in 15 minutes and he’s diagnosing me and prescribing me and he’s giving me an experience right in my home. It’s like, that’s great. I don’t have to leave the house. I don’t want to go see my doctor because I got to go in the car and I got to drive 45 minutes. And then because I don’t have an appointment, they’re going to have to fit me in. It’s going to be 2/3 hour away.

Scott (Guest)

And I’m paying a copay, then I’m not paying with the telemedicine app. So the insurance companies are already they’ve already harnessed technology to figure out how to provide a better experience at a lower price point. That helps them because it costs them less for me to see the telemedicine docked than it doesn’t see my real doc. And it’s better for me because I never have to leave the house and I get to see him like in 15 minutes. I’m in the queue, and they’re there. So we’re going to be gobbled up by all the technology that’s coming down the road.

Scott (Guest)

That’s allowing others to circumvent the patient physician relationship if and which makes us more of a strategic imperative if we don’t improve the experience for our patients, they’re going to find an alternative solution and it may be another Doctor Who has a better experience. You know the Doctor Who you know and This is why a lot of people were paying money for concierge medicine.

Scott (Guest)

What are they really paying for? If you’re paying 1500 two $1000 a year to see your see your doctor whenever you want, you’re paying for the better experience people are willing to pay 1500 two $1000 for a concierge medicine experience rather than not paying it and sitting in that waiting room for for a couple of hours for the for an appointment time that you made six weeks ago and you’re still having a way to couple of hours. So this is all under foot and we can if I’m a physician.

Scott (Guest)

I can kind of turn my head the other way and pretend it’s not gonna happen, but it’s already happening. It’s already happening. Unfortunately, the typical doctor, especially primary care, it doesn’t know how many patient visits he or she is losing to the telemedicine apps. They have no idea. They may see volume going down. It’s like, OK, that’s we can blame it on COVID.

Scott (Guest)

But I’ll tell you what it’s I don’t. I think we’re naive if we’re gonna blame it on COVID. You know, if we looked at this a different way and if we said what if we charged admission.

Scott (Guest)

What if we were a theme park? You talked about theme parks earlier, Jason theme parks charge admission, so they know people are paying. You’re going to Disney. You’re dropping 150 bucks a person for that one day pass, and you’re bringing your family and you want the Disney knows we got to give these people an experience that’s worthy of that price tag. If I’m a physician. And I looked at it that way, what if I charge my patients at admission charge to come see me? I had to pay in advance. They had a it’s a $25 ticket.

Scott (Guest)

How would that reframe this? How would you rethink your whole business model and to some degree they are paying it an admission fee. It’s the copay they’re paying 35 bucks to to come see you. Yet we don’t look at it that way. It’s like, well, OK, you know, that’s for our service. No, I’m paying that regardless of what you what you prescribed for me. What I what I what happens in that visit if you know I’m paying that 35 bucks it better be well worth my 35 bucks to come see you. So we needed.

Scott (Guest)

We really need to rethink.

Scott (Guest)

How we’re practicing medicine by flipping this around and saying, yeah, we’re not just providing a service.

Scott (Guest)

But we have to provide a service in such a way that it makes for a much better experience for our patients.

Mike Scribner

OK, so step back if I was a.

Mike Scribner

Practice administrator or physician. Hearing this, I I would. I would probably saying yes, I agree with you, but it’s kind of intimidating to me to think about pivoting from what I’ve set up my practice to be over the last 20 years to to really change and move in this direction.

Mike Scribner

Help me give me what are my first steps. What are the first couple of things I need to be thinking about?

Scott (Guest)

You know my first up and I’ll tell you what, you gotta you gotta you gotta fix the entire process. I think my goal if I was a practice administrator my goal would be to get rid of the waiting room. Now I and I say that someone ingests because you’re always going to have to have.

Scott (Guest)

Place to park the family members would come along for the ride.

Scott (Guest)

But do we? You know, you go on a place that has a giant waiting room, and it’s designed the moment. And I’ve seen this. I’ve walked into practices. They have a waiting room that could put 50 people in it.

Scott (Guest)

The first impression you get is I’m gonna. I’m gonna be waiting. I’m gonna be waiting. How do we shrink that waiting room and figure out a process to get people through the front door faster and back into the exam room?

Scott (Guest)

Even if they’re waiting, just as long as they are in the exam room. But you make that a better experience. You know the worst thing is when you go to the exam room and you’re there for 45 minutes and nobody comes to check on you and you’re finally saying, I wonder if they forgot that I was here. Has that ever happened to you that you’ve actually had to walk out of the exam room and find somebody said you guys know, I’ve been in an exam room 6 for an hour and nobody’s come to see me?

Mike Scribner

Absolutely.

Scott (Guest)

Well, yeah, that’s happened to all of us. This happened to all of us. So we gotta fix our processes. We rethink how we schedule. We gotta you know there’s I mean you almost have to start at the end of this Mike and and look at at the people walking out and work backward how do we how do we improve this my daughter is a PA in a very busy internal medicine office in Atlanta and they and it’s all about as driving as much volume through as possible by by 10:00 o’clock in the morning they’re already an hour behind.

Scott (Guest)

And because they’re so focused on just, you know, you know it’s a cattle call and you know, and they get away with it because they’re, you know they’re part of the Emory campus. Everybody, you know, the internal medicine doctor has been there for a long time. But if you’re if you’re not in a tree primarily and they have a long roster of Medicare patients who would never go anywhere else because I’ve had a relationship with him for 20 years, you know, but we’re not always. We don’t always have that luxury.

Scott (Guest)

And especially if you’re a physician who has a cash business, dermatologist classics organs, lot of primary care doctors now opening medical spas, they’re doing skin care products. They’re doing laser body sculpting. They’re doing Botox injections because they can’t survive on a primary care model anymore that they have to find new revenue streams.

Scott (Guest)

If you’re in any of those cash kind of businesses, boy, I’ll tell you what. Now. The experience economy really takes hold because you’re not gonna go sit in a primary care doctor or family medicine office for an hour to get your Botox visit sitting around with a bunch of people who are sick and you know, and sniffling and and just not feeling well. And you’re sitting there because you want to get, you want to get your cool sculpting done. I mean, so we the, the, the whole thing has to be blown up.

Scott (Guest)

And we have to change the paradigm, especially if you’re an older physician. This is really, really hard because they weren’t brought up to practice medicine this way. They were brought up to be a good doctor, not not to stage an event for people coming in.

Scott (Guest)

The younger doctors that I’ve talked to that are coming out of medical school, who are who are on the are are millennials themselves. They get it and they’re investing in the in the types of things to create a much better experience, better waiting rooms that are process is better technology, apps that you know that, that track loyalty that people can, they they, you know, they get instant notifications, they all sorts of things to improve the communication.

Scott (Guest)

I still have trouble with my doctor getting somebody to return my call and I can never get my doctor on the phone. It always goes to voicemail and then it’s days before somebody actually calls me back. So.

Scott (Guest)

Heaven forbid it was really a life threatening emergency. I  know I can’t rely on my doctor to give me a call back on the same day. And this is the world we live in this world we all live in. And those are. It’s some basic things we have to fix. We’re going. Everybody’s going to call trees. Automated automated phone systems. Nobody ever answers the phone. It goes into a voice mailbox. Nobody’s checking the voicemail box so it could be days if anybody checks it at all. And by that time you’ve lost the patient. The patients are going somewhere else.