Healthcare Reimagined is the Society For Healthcare Innovation's podcast series. Our goal is to showcase innovation in the private sector as well as within provider organizations and government entities. In the wake of the COVID-19 Pandemic, Healthcare has been reimagined, and what used to be a location-centric delivery model has shifted to one whose focus has moved outside the walls of traditional healthcare. On Healthcare Reimagined, we share strategies from clinicians, entrepreneurs, health system executives, and business and political leaders who have shifted their models to meet the new reality brought on by COVID-19.
David Contorno - CEO and founder of E Powered Benefits
Imagine if your employer gave you the choice between paying 20% out of pocket for your surgery/specialist visit/X-ray at the local name brand hospital, and having the same service done at a different location where care quality was higher for $0 out of pocket. For employees of companies that work with David Contorno and E Powered Benefits, this is a reality.
50% of Americans get health insurance from their employer, and most employers rely on brokers to give them advice on how to cover healthcare. Unfortunately, their incentivizes are not aligned. The average health insurance broker makes commission, so as the cost of the health plan they sell to an employer goes up, they get paid more. As David Contorno is fond of saying, if you look at our health system today, almost everything that goes wrong is the result of someone or more often everyone involved being better off when care quality goes down, or when price goes up. That's why David decided to change his model.
David's firm. E Powered Benefits, exclusively provides value based health plan management for companies by sharing up front fees, never taking commissions, and creating provider relationships that incentivize high quality low cost medical providers. Their business model has produced average 1 year savings of 40%, as well as substantially reduced cost for employees. These two things are basically unheard of in this space. My conversation with David was eye-opening.
The stereotype of insurance companies is that they love to deny claims. As I learned in speaking to David, that’s not exactly the case. The MLR, or medical loss ratio, says that every health insurance company must spend 85% on healthcare costs. 15% is then left for overhead and profit. Therefore, the only way for insurance companies to increase profits is for costs to be higher. What ultimately ends up happening is that high value care (defined as care that is likely to cure you or treat you with the least intervention possible) ends up being harder to get approved.
We also discussed the underutilization of Primary Care, and how when health system employ doctors, often the way they pay them incentivizes low quality, high severity/cost care. RVU’s, or relative value units, means doctors are paid on how much value (i.e. revenue) they’re helping to generate within the Health System. If you go to a doctor at that health system with a back problem, writing you an opioid script and sending you to a back surgeon for a consult is far more lucrative than sending you for PT outside of the system.
We touched on the new hospital transparency law, which theoretically should make it easier to understand Hospital billing. Unfortunately, the law required that hospitals post a machine readable file online, and many have taken advantage of that verbiage to post files that are machine readable but human unreadable. Even worse, some hospitals have put code on their website that prevents it from showing up on Google, which means you have to go to the hospital website and search for a page made intentionally hard to find which is ultimately unreadable by a human.
Finally, we spoke about David's transition from a commissioned broker to an innovator and disruptor. David used to get paid hundreds of thousands of dollars a year from name brand insurance companies for changing employers to their brand away from their competitors, and for resigning existing employers. When he realized this was causing more harm than good, he closed his business, and started a new company with a model where he is paid a flat fee on an exclusive basis with his employer partners, with bonuses for cost savings and better outcomes.
Bettina Hein - 4 languages, 3 companies, 1 vision for the future of chronic disease management
Bettina Hein is the co-founder and CEO of Juli (www.juli.co), Pixability and SVOX. She is a serial tech entrepreneur and has built successful tech companies in Europe and the U.S. She is a global leader at the World Economic Forum and a judge on the Swiss version of Shark Tank.
Juli is a chronic condition management platform that was developed to help people use their healthcare data to nurse themselves back to health. Juli has a consumer-facing app that ties in data from wearables with user generated data to help patients identify triggers for their conditions, and suggests “levers” to pull that can help them ameliorate their symptoms. Currently the platform is used for asthma, depression, migraines, chronic pain, and bi-polar disorder.
While most other chronic disease startups have a human component, like a call center, Juli reduces costs by using an AI-generated bot. Though Juli went live only 6 months ago, the app already has 6,000 consumers, and Bettina is launching her first clinical trial with the University College of London for consumers with asthma or depression.
Bettina is an optimist, and saw the silver lining of starting a company during a pandemic in the ability to recruit the best and most diverse team to develop her technology. It also allowed her to stay at home and be with her children while running the company. During COVID, consumers got more and more comfortable using their devices for health, which has helped accelerate Juli’s adoption.
We spoke about the challenges of being a female entrepreneur. Bettina fundraised twice while pregnant, and fielded questions about her commitment to her company that most men never have to deal with, even if they have kids. The second time she fundraised while pregnant, Bettina decided to use it to her advantage, and told investors that, “you get the pregnancy discount if you invest before this baby pops!” It worked!
According to Bettina, there are three things that make a startup founder successful:
Naivety – You have to be naïve to embark on the adventure of starting a company, because if you knew what was really ahead, you would never start in the first place. Hutzpah – Having the guts to put yourself out there. Perseverance – Strap yourself in…it’s going to be a long road to success. Bettina has high hopes for the future of chronic disease management. What gets Bettina particularly excited is the ability to get all different types of data about what people are experiencing in real time, which can then be correlated to symptoms to understand what is happening with their health. Bettina believes this is ultimately going to revolutionize the way we treat patients, as we will be able to determine with greater certainty who needs what treatment and when.
Finally, what do tinder, advertising, and Juli have in common? Listen to find out!
Please make sure to check out Society for HealthCare Innovation - SHCI's website (http://www.SHCI.org).
Dr. Nate Link - Chief Medical Officer of Bellevue, and author of "The Ailing Nation: Lessons from the Bedside for America’s Leaders"
For 37 years, Dr. Nate Link has worked as a doctor, and now as the Chief Medical Officer of Bellevue, the oldest (and one of the largest) hospitals in America. Bellevue can trace its roots back to 1736.
In one of my favorite episodes to date, I interviewed Dr. Link about his new book, The Ailing Nation: Lessons from the Bedside for America's Leaders, which can be found here on Amazon. Dr. Link shares personal stories, such as the tragic passing of a head nurse at Bellevue from COVID-19, which devestated the hospital's staff.
We spoke about the importance of extreme ownership in leadership, and understanding the difference between a bad actor making a mistake for preventable reasons, and a systemic error that is the fault of the system (and thus the leadership that overseas that system).
Dr. Link spoke of the importance of agreeing on a goal. Bellevue dropped its mortality rate for severe sepsis to 14%, significantly below the state average of 25%. The same gap analysis that allowed them to do that could be useful in achieving agreed upon political aims. The problem in politics, as Dr. Link and I discussed, is that we don't set common goals as a country. For instance, almost everyone agrees that Americans should have affordable healthcare -politicians just disagree on how to get there. Many Republicans believe we need to accomplish that through free enterprise while many Democrats believe in a single payer system. The key, according to Dr. Nate, is to agree on a finish line and work towards getting to the ultimate goal - in this case, affordable healthcare for all.
Dr. Nate believes that just as the healthcare industry learned from fields like aviation, politics has a lot to learn from the reforms that have improved healthcare in the past several decades. As an example, the "sterile cockpit" rule that dictates that pilot not speak during critical parts of landing and takeoff has since been applied to nurses when distributing medications, and significantly reduced errors in dispensing meds.
If you are interested in medicine, politics, or both, I would highly recommend this episode.
You can find the interview on:
Apple Podcasts (https://bit.ly/NateLink)
Please make sure to check out Society for HealthCare Innovation - SHCI's website (http://www.SHCI.org), and our Linkedin Page (bit.ly/SHCILIP).
You can learn more about Bellevue and the NYCHHC network at www.nychealthandhospitals.org
You can find Dr. Link's book, The Ailing Nation here: https://bit.ly/TheAilingNation
Dr. Sanjay Subramanian - Founder and CEO, Omnicure MD
Dr. Sanjay Subramanian is the founder of OmnicureMD. Omnicure is a mobile first Tele-ICU platform that allows remote specialist to connect to connect with onsite healthcare providers without excessive costs.
Dr. Subramanian started the company to address the inefficiencies he observed over his 25 year career as a critical care doctor. Omnicure makes it easy for specialists to connect with patients by effectively “Zooming” the specialist in with PCP and nurse practitioners.
During our conversation, we discussed regulatory Barriers, which Dr. Subramanian described as the biggest issue he has had to confront in trying to grow the company. Every state has its own unique licensing requirements, which further contributes to the lack of accessibility of critical care physicians. Dr. Subramanian stated that the critical care physician shortage will never go away, and it will only hurt the patients who are in need of critical care. COVID helped
accelerate tele-health technology, but according to Dr. Subramani, permanent systems need to be put in place.
In addition to physician shortages, high costs also prevent hospitals from having sufficient (or even any) critical care doctors on staff. With Omnicure, with the push of a button, hospitals can access critical care specialists, which has been shown to lower patient mortality rates and lengths of stay.
Omnicure can interface with the existing hospital EHR's, and can stream real time vital sign data and bedside-monitor-device data. While Omnicure is deployed and working today, it is also preparing for the future. As we discussed the move away from the hospital, Dr. Subramanian noted that you can provide tele-critical care anywhere. Not just in the hospital or ICU.
Dr. Drew Pate - Chairman, Division of Psychiatry & Behavioral Health, LifeBridge Health
A month before the start of the Pandemic, Dr. Pate stepped into a new role at Lifebridge. As the Chairman of the Division of Psychiatry and Behavioral Health at LifeBridge Health, he was charged with uniting the behavioral health leadership of the 5 hospitals for psychiatry. We touched on a number of interesting topics throughout our discussion.
Cost of care: Maryland has a total cost of care model that uses a hospital rate setting commission to set rates across the state on a yearly basis in order to create budgets. While it has resulted in reasonable cost containment, it excludes mental health, psychiatry, and outpatient care.
Telehealth: Prior to the pandemic, Maryland Medicaid had a narrow definition of who could receive or deliver tele-health, which made it very restrictive, and inaccessible to most. That definition was relaxed based on CMS guidelines during the Pandemic, and allowed patients who couldn't travel to continue getting treatment. One of the main points Dr. Pate sought to drive home was that in psychiatry, there is no statistical difference in the effectiveness of care based on the mode of delivery. Though change came slowly, and was brought about in large part due to the Pandemic, there is now legislation in MD to make tele-health a permanent change.
One of the more shocking stats that Dr. Pate shared was that although there is a 2-4x higher cost associated with a co-morbid psychological diagnosis, as a country, we're spending half of what we spent 30 years ago on behavioral health services.
One of the quotes from our conversation that stuck with me touched on the disparity between the way physical and mental health are addressed in this country. "There are 2 health care systems in this country, which are separate and unequal. We have a medical system which is more open and permissive in the way its allowed to bill and admit and treat patients, and then we have a mental health system which is incredibly restrictive in terms of access to quality and to services. "
When I asked who was to blame for this, though Dr. Pate believes for-profit-payors are a large part of the problem, he also holds himself and his peers responsible. He noted that for a long time, his profession refused to meaningfully participate in a more medicalized approach to treatment, and in measurement based care.
When I asked Dr. Pate how we could make things better, he had several solutions:
Reintegrate mental and physical health services. We should federally legislate medical necessity criteria, which currently have nothing to do with quality, and were created by MCO's.We have to legislate the types of organizations that are able to manage the healthcare of our systems - we should not allow for-profit insurance companies to be in the Managed Care business. Tens of billions of dollars in pure profit are being drawn out of the pockets of patients who have the greatest needs, since most of the big insurers manage most of the medicare and medicaid across the country. If we can provide folks with incentives to produce high quality care, that is one of the solutions to our health care criss. The more we can globally budget and include all services, and move towards national healthcare, the more we can improve healthcare.
Alon Joffe - CEO and co-founder, Eleos Health
On March 2nd, I spoke with Alon Joffe, CEO and founder of Eleos Health. Alon served for 6 years in an elite combat search and rescue unit of the air force, and left the military as a second lieutenant. During his military service, Alon was heavily involved in developing a mental health first aid program to deal with PTSD, which is what ultimately motivated him to start Eleos Health.
The prevalence of behavioral health issues in America today has been called an epidemic - 1 in 3 Americans now struggles with Anxiety, Depression, or both. Unfortunately, given provider shortages/burnout/turnover, the existing infrastructure is insufficient to meet this demand. That's why Alon co-founded Eleos Health.
Eleos Health is a Care Intelligence solution that is transforming the delivery of behavioral healthcare. Using Voice Ai technology that runs in the background of psychotherapy sessions, Eleos captures key insights from sessions. By understanding what’s important, Eleos is able to generate the baseline for the clinical note. In a recent case-study, they found they could reduce documentation time by 42%. Patients whose clinicians use Eleos also get better faster and more frequently - learn more here. Eleos empowers clinicians to focus on care personalization, and not on data-collection.