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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.

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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.

In 2 Days “Insight Into Wound and Ostomy Care, the Evolution Taking Place, and How Technology Such as Corstrata Is Playing a Role” Launches!

In 2 Days “Insight Into Wound and Ostomy Care, the Evolution Taking Place, and How Technology Such as Corstrata Is Playing a Role” Launches!

In 2 days our next episode “Insight Into Wound and Ostomy Care, the Evolution Taking Place, and How Technology Such as Corstrata Is Playing a Role” drops!

If you do not have much knowledge on Wound and Ostomy care, that will certainly change after listening to Joe. We gain data oriented insight into this often neglected service of care, and discuss how virtual care and telehealth are viable solutions for any provider setting to utilize. From there, we hear more about how Corstrata is working on solving this care gap.

Beyond the Stethoscope: Vital Conversations with SHP can be found on all podcast apps including Spotify, Apple Podcasts, & Amazon. 

Beyond the Stethoscope: Vital Conversations with SHP

Next Podcast Episode “Insight Into Wound and Ostomy Care, the Evolution Taking Place, and How Technology Such as Corstrata Is Playing a Role”

Next Podcast Episode “Insight Into Wound and Ostomy Care, the Evolution Taking Place, and How Technology Such as Corstrata Is Playing a Role”

Our next episode “Insight Into Wound and Ostomy Care, the Evolution Taking Place, and How Technology Such as Corstrata Is Playing a Role” drops next Wednesday, 11/9!

If you do not have much knowledge on Wound and Ostomy care, that will certainly change after listening to Joe. We gain data oriented insight into this often neglected service of care, and discuss how virtual care and telehealth are viable solutions for any provider setting to utilize. From there, we hear more about how Corstrata is working on solving this care gap.

Beyond the Stethoscope: Vital Conversations with SHP can be found on all podcast apps including Spotify, Apple Podcasts, & Amazon. 

Beyond the Stethoscope: Vital Conversations with SHP

Listen to Part 2 of “Value Based Care (VBC) Today and the Role of CMS, Providers, and Third-Party Vendors in Its Evolution”!

Listen to Part 2 of “Value Based Care (VBC) Today and the Role of CMS, Providers, and Third-Party Vendors in Its Evolution”!

Live today! Listen to Part 2 of “Value Based Care (VBC) Today and the Role of CMS, Providers, and Third-Party Vendors in Its Evolution”!

In part 2 with Sean Cavanaugh, CCO/CPO, Aledade, Inc., we address Medicare Advantage activity in the marketplace, further deep dive into Value Based Care (VBC) evolution and programs, how venture capital firms are impacting the market, and ACO success factors; among many other hot topics. Very insightful conversation from someone that has directly set the tone. 

Podcast Library

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.

American Diabetes Month

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Part 2 of “Value Based Care (VBC) Today and the Role of CMS, Providers, and Third-Party Vendors in Its Evolution” Launching Nov. 2nd

Part 2 of “Value Based Care (VBC) Today and the Role of CMS, Providers, and Third-Party Vendors in Its Evolution” Launching Nov. 2nd

We hope you enjoyed Part 1 of “Value Based Care (VBC) Today and the Role of CMS, Providers, and Third-Party Vendors in Its Evolution”.

In part 2 launching November 2nd, we address Medicare Advantage activity in the marketplace, further deep dive into Value Based Care (VBC) evolution and programs, how venture capital firms are impacting the market, and ACO success factors; among many other hot topics. Very insightful conversation from someone that has directly set the tone.

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Part 1 of Our Value Based Care (VBC) Podcast is Live!

Part 1 of Our Value Based Care (VBC) Podcast is Live!

Listen today to Part 1 of “Value Based Care (VBC) Today and the Role of CMS, Providers, and Third-Party Vendors in Its Evolution”!

With Sean’s background, we cover a lot in this first of two episodes. You’ll hear his viewpoint from both his CMS and Aledade, Inc. experiences related to today’s independent primary care physician, the impact of Value Based Care (VBC), and how Aledade practically support their practices for success in their ACO.

Beyond the Stethoscope: Vital Conversations with SHP can be found on all podcast apps including Spotify, Apple Podcasts, & Amazon.

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