Category Archives: Podcast

Advances in care management: podcast interview with AxisPoint CEO Dr. Ron Geraty

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Dr. Ron Geraty, CEO of AxisPoint Health

AxisPoint Health is part of the new breed of care management companies, leveraging new data sources and digital techniques that go beyond the traditional paradigm of nurse call centers focused on a handful of common chronic conditions. Industry veteran, Dr. Ron Geraty (former CEO of Alere) took the reins of the company a couple years back.

In this podcast interview, Ron and I discuss the evolution of care management, the role of digital, and what the future will bring.

  1. (0:11) What’s the current state of care management in the US?
  2. (2:27) How is care management being done differently across populations: commercial, Medicare, Medicaid, dual eligibles?
  3. (5:36) Care management traditionally focuses on 5 common chronic conditions. Has it made a significant difference in those areas?
  4. (8:26) What attracted you to AxisPoint? How is it different from other population health management companies?
  5. (13:08) Who are the customers? Who is drawn to your approach and why?
  6. (15:26) You work with the most vulnerable populations. Do you attempt to influence the social and behavioral determinants of health?
  7. (19:18) What’s at stake for AxisPoint in the debate about healthcare in Washington, DC, especially since you are serving populations that have been a major focus of the ACA?
  8. (22:33) How will digital tools be leveraged for vulnerable populations? Will you still have feet on the street?

By healthcare business consultant David E. Williams, president of Health Business Group.

How to cure patient cancellations. Podcast with QueueDr CEO Patrick Randolph

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I can wait –if necessary.

It takes an average of 24 days for a new patient to get an appointment with a doctor, up 30 percent since 2014. In Boston, it’s 52 days! Physician schedules are full, and yet a significant percentage of appointments are canceled or patients just don’t show up –costing doctors billions in revenue and depriving needy patients of appointments.

These two things are related: with such a long wait the patient may either be cured on her own, go to the ED, die, or just forget about the visit.

Patrick Rudolph saw an opportunity to do something about this problem and started QueueDr to simply and automatically offer patients a chance to fill those open slots. You can listen to him explain in our podcast:

  1. (0:10) What problem are you addressing?
  2. (0:58) Why do you think the problem is getting worse?
  3. (2:25) Bad technology is a problem. What do you mean that your technology doesn’t require anything of the user?
  4. (3:44) What does it look like from the patient standpoint?
  5. (4:54) One of your customers says your product works “too well.” What is he talking about?
  6. (5:58) Do you think this cancellation issue is a standalone solution or should it be a feature in a broader system?
  7. (8:01) You’re not the first one to address scheduling and cancellation as a challenge. How do you compare with other approaches?
  8. (9:46) How would QueueDr work with a policy like charging patients who don’t show up or introducing an open access schedule?
  9. (11:58) Where will the company be five years from now?

By healthcare business consultant David E. Williams, president of Health Business Group.

Welcome to #CareTalk with CareCentrix CEO John Driscoll

In this episode of #CareTalk I banter with John Driscoll  –CEO of post-acute benefits manager CareCentrix—  about the health insurance company mergers, drug pricing, whistleblowers, marijuana and more.

Don’t miss the lightning round at the end!

By healthcare business consultant David E. Williams, president of Health Business Group.

HighRoads CEO Brian Kim talks next gen health plan product management

HighRoads helps health plans automate the creation of new products to help them get to market faster and more flexibly. It may sound like an arcane corner of the healthcare world, but in this podcast interview, CEO Brian Kim argues that his company’s platform is a game changer in the market.

Here’s what we discussed:

  • (0:15)What are the fundamental functions performed by health plans?
  • (3:40) Why has the process of defining and selling plans changed much more slowly than payment processing?
  • (10:29) What is needed to spur innovation on plan definition and selling within existing organizations?
  • (13:41) What’s the impact on these topics of action in Washington DC?
  • (15:46) What does HighRoads offer the market?
  • (18:02) Where are you getting the most traction?
  • (21:50) What can we expect on your road map over the next few years?

———-

By healthcare business consultant David E. Williams, president of Health Business Group.

Direct Primary Care: Interview with Dr. Jeffrey Gold

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When we think of insurance, it’s usually for things that are rare and expensive. You never want to use your car insurance, fire insurance, or disability insurance and you don’t use file a claim for routine things like changing the oil, buying a fire extinguisher or missing a day of work with a sore back. Insurance works best when it spreads big risks over a large pool of people.

But healthcare is different, and health insurance covers even small, routine things like primary care physician visits. Direct primary care practices change the model because they are paid directly by the patient, not the insurance company. That keeps costs down and increases the alignment between doctor and patient.

I like the idea, and in fact I interviewed an early practitioner of primary care back in 2009, before the Affordable Care Act!

Recently, I spoke with Dr. Jeffrey Gold, of Gold Direct Care in Marblehead, MA. He filled me in on how his practice works and why he’s a proponent of the direct model.

  • (0:10) What do you mean by “direct” primary care?
  • (0:47) How does that feel different from a typical primary care office? Is it the same thing as a concierge practice?
  • (4:58) You don’t accept insurance. Does that affect your overhead and enable you to be more cost effective?
  • (7:08) What happens when a patient goes out of your orbit to see a specialist or be hospitalized? Do you still have to deal with insurance companies then?
  • (9:38) Are there particular kinds of patients that are a really good fit for a direct care model?
  • (11:22) What would be the impact on the overall healthcare system if every patient were a direct care patient?
  • (14:10) Does the Affordable Care Act help or hinder what you are doing? What changes would you like to see in the healthcare law?

By healthcare business consultant David E. Williams, president of Health Business Group.

Drug treatment for opioid addiction: Podcast interview with CleanSlate CEO Greg Marotta

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The opioid epidemic gives addiction treatment providers an opportunity to demonstrate what they can do to stem the tide. CleanSlate operates treatment centers in multiple states, employing a medication assisted approach. In this podcast interview, CEO Greg Marotta describes what he’s seeing and how the company is responding.

We discussed:

  • (0:10) How serious is the opioid epidemic?
  • (1:09) What kind of approaches are traditionally to treat addiction? What works well and where are there shortcomings?
  • (2:22) Are people coming to treatment through primary care? Or the behavioral health system?
  • (4:06) How does medical/behavioral integration work? What does it really mean?
  • (6:56) CleanSlate is well know for medication based treatments. What kind of medications are available? Who is the approach best suited for?
  • (8:09) What is the typical course of treatment?
  • (9:49) As addiction has become more visible, it’s now front and center for others in health care. Do you collaborate with other organizations and if so, how has it gone?
  • (12:52) You operate in a variety of states, with different cultures. Do you see key differences between Massachusetts, and other states like Texas, Indiana and Wisconsin?
  • (14:53) Will we still be talking about an opioid epidemic in five years? What will it take to get out of it?

By healthcare business consultant David E. Williams, president of Health Business Group.

Bringing on-demand rideshare to medical transport. Interview with Veyo’s CEO

 

Uber and Lyft have transformed (and largely destroyed) the taxi industry. Now startup companies like Veyo are applying similar approaches to the medical transportation field. I interviewed Veyo’s CEO, Josh Komenda to get his take.

1.How is non-emergency medical transportation (NEMT) defined? What’s included? How big is it?

Non-Emergency Medical Transportation (NEMT) is a transportation benefit for Medicaid or Medicare members who need to get to and from medical services, but have no means of transportation. NEMT provides eligible patients with trips that are non-emergency in nature, meaning there is no immediate threat to the health or life of the participant, and no elements of life support are required in the vehicle during the trip. This includes transportation to medical appointments, urgent care, or the hospital. NEMT exists to ensure that participants have access to routine and preventative care, increasing overall health outcomes and avoiding costly ambulance bills or emergency room visits and it’s especially important for those with chronic conditions such as diabetes, heart disease, cancer, COPD, or asthma. As of December 2016, just under 70 million Americans were eligible for Medicaid NEMT benefits.

2.How is NEMT provided today? What’s good and bad about the traditional model?

Today, a large majority of NEMT benefits are managed under the brokerage model. State Medicaid agencies and health plans contract with an NEMT broker to manage their NEMT benefits for them. The broker is responsible for ensuring their members have access to transportation and managing the transportation providers who perform the actual services. Brokers must manage provider procurement, provider credentialing, trip scheduling, eligibility, reporting, FWA monitoring, provider payments, etc.. NEMT benefits may cover a variety of transportation modes, including sedan, wheelchair van, taxis, stretcher cars, and mileage reimbursement. It also may include reimbursement for public transportation or long-distance accommodations such as air travel if a member requires long-distance or out-of-state treatment. NEMT benefits cover all regions from urban to rural, and transportation is always the least costly and most appropriate mode, which is determined on a case-by-case basis for each member.

Quality of service in the NEMT field is plagued by inadequate technology, outdated business models, inconsistent and unprofessional medical transportation providers, and virtually non-existent transparency for the customer. The issues stem from an overly complex, fragmented, and difficult to manage process that has not changed in decades. For example, limited communication between the broker and transportation provider means little to no data is collected around the actual trips. Important metrics like on-time percentage or customer satisfaction are often self-reported by the provider. And the fixed fleet model that traditional brokers employ leaves little opportunity for flexibility – any issues stemming from scheduling, traffic, or weather can throw off the entire system. Even with current NEMT benefits, over 3.6 million Americans still miss or delay medical care due to transportation issues.

3.What are the characteristics of NEMT users?

Those receiving NEMT benefits are often frail, handicapped, disabled, in rural areas and without smartphones. Patients may require NEMT for a variety of reasons, including: lack of a valid driver’s license, lack of a working vehicle, geographic isolation, or the inability to take traditional transportation for physical, mental, or developmental reasons.

4.Who pays? What is the role of government and private insurers?

Medicaid NEMT is a $5 billion industry, funded by state and taxpayer dollars, and overseen by the Center for Medicare & Medicaid Services. Over the past several years, Medicaid spending for NEMT equates to approximately 1% of total Medicaid expenditures.

5.Have the rideshare companies like Uber and Lyft had an impact? What has limited their effect?

Some traditional NEMT brokers have begun exploring partnerships with consumer TNCs such as Uber and Lyft, although due to credentialing and training requirements set by CMS, most trips completed by those TNCs are consumer trips based in a healthcare setting (aka the member or facility is paying), instead of true NEMT trips. It’s important to note that this results in a solution that is not as efficient, coordinated, or suited to healthcare as Veyo’s. Veyo’s vertically integrated model is far superior for a number of reasons. Veyo is directly connected to its own TNC supply that it controls. When a traditional broker partners with a consumer TNC, it necessarily includes an extra administrative middleman in the value chain which is less economically efficient. What’s more, Veyo directly controls and oversees all aspects of its Independent Driver-Provider (IDP) network, meaning it can directly affect credentialing, training, background checks, messaging, etc., ensuring that its network is optimized and trained specifically for its customers. In addition, it can directly monitor, track, and manage its supply to ensure it always has the right vehicles in the right places, and it can directly control matching, routing, and scheduling tactics to make sure that it solves transportation needs for all member needs in all areas.

6.What does Veyo do? How are you different or better? What barriers do you face?

Veyo is a next-gen tech solution for patient transportation. The traditional NEMT model utilizes commercial fleets that are inflexible, expensive to maintain, and managed using traditional dispatch models. These fixed fleets have a difficult time scaling when demand is high, and leave providers with a surplus of vehicles on the road when demand is low. Unlike a fixed fleet, flexible fleet models allow capacity to be rapidly scaled up and down in minutes to meet demand changes. Our dynamic supply system constantly manages and optimizes the right supply levels for different modes across geographies (both urban and rural), ensuring that every member gets picked up on time.

The Veyo Virtual FleetTM is composed of traditional transportation providers and our flexible independent driver-providers (IDPs). Our cost-effective fleet provides the safest, most reliable, on-time service possible. Veyo’s model is a complete, end-to-end NEMT solution that matches supply with demand, making it more efficient and effective, and ensuring the right vehicles are dispatched each and every time. This provides a better participant experience and more efficient use of vehicles. Launched in November 2015, Veyo is changing the face of what it means to be a non-emergency medical transportation broker by bringing this innovative ride-sharing technology to the antiquated NEMT industry.

Here is how we are different and better:

  • Veyo brings innovation for the very broad needs of health plan memberships. Consumer TNCs are built to primarily serve individuals without any special needs in urban geographies. Veyo’s virtual fleet model seamlessly includes its network of IDPs (Independent Private Drivers), and traditional, specialized NEMT fleets to meet the broad array of needs from ambulatory, wheelchair, bariatric, stretcher, and other modes as required. Our IDP drivers are trained and credentialed to federal and state CMS requirements, including First Aid, CPR, HIPAA, ADA, patient sensitivity, and hand-to-hand service. We serve members in big cities, small towns, and rural areas, and use a variety of scheduling, routing, and matching techniques that are designed to get every member to their appointments on time with efficiency and high quality service no matter where they live or what their needs are.
  • Veyo’s platform is designed for management of a transportation benefit. Government agencies and managed care organizations spend millions of dollars on a critical benefit that ensures their memberships can get to and from their appointment reliably. Veyo’s system is designed to bring next-generation tools to manage this benefit to ensure maximum effectiveness. Veyo supports call centers, booking portals, and member apps that verify eligibility, determine the most appropriate mode of transportation, and ensure the highest-quality access, reliable on time performance, and trackability and transparency, while employing sophisticated mechanisms to detect and prevent fraud, waste, and abuse. In addition, it can support customized eligibility criteria and steer members to alternative cost-saving modes such as mileage reimbursement and public transit where appropriate.
  • Veyo is built from the ground up to be a healthcare ally and use data and technology to cut costs and improve outcomes. From basic requirements, like managing eligibility files, PHI, and providing encounter data, to more advanced dashboards, reports, caseworker/intervention alerts, and app campaigns, Veyo’s platform, data, and tools are at plans’ disposal to drive initiatives aimed at understanding their membership better and piloting new programs to drive better outcomes. More than just a basic transportation service, Veyo understands that it is part of the continuum of care, and uses its ability to interact with members and collect data to help plans make the most of their investment in NEMT.

Some barriers we are currently facing include hesitation in the market about such a new solution. Because Veyo was built on technology for the healthcare market, our model is drastically different than the traditional players in the market and our results can often seem too good to be true. As we continue to record data and results from our current markets, it allows us to prove that the Veyo model does work for the NEMT market and can make huge changes for health plans and state agencies alike. For example, in our current markets, after completing 3.4 million trips, we are seeing on-time performance percentages of 98% and an overall grievance rate of just 0.09%.

7.Where do you go from here?

We are continuing to expand our model into new states, with plans to double in size in 2017. We are continually adding new benefits and features to the Veyo model, including a member-facing app that will allow members to book and manage trips on their own schedule. In addition to managing their own trips, members will be able to manage their own information, ensuring that health plans always have the most up-to-date contact information for their member population. In addition to focusing on improving the trip lifecycle, we’re also looking for ways to better increase the transparency between health plans and their members. Wellness initiatives such as flu shot reminders and annual wellness exam reminders can be built into member-facing apps, giving health plans one more connection to their members.  Our high-powered, data-oriented technology team and strategic focus allows us to reimagine many processes within the broker’s function, introduce new automation and efficiency, and provide new NEMT-specific tools and data insights for plans, agencies, and members.

By healthcare business consultant David E. Williams, president of Health Business Group.