EP 1 - Steering the Wheel on Care Navigation w/ Justin Holland and Doug Morse-Schindler of HealthJoy
Welcome to eighty twenty with Pareto Health. I'm Andrew Cavenagh.
Andrew Clayton:And I'm Andrew Clayton.
Andrew Cavenagh:Well, Andrew, it's good to see you on another episode of eighty twenty. This episode, we're gonna spend some time talking about care navigation, care coordination. You you and I have spent time talking about it sort of offline, but certainly on some of the prior episodes, how important that is. Thrilled to have Justin Holland and Doug Morchtendler from HealthJoy joining us today. They've got some interesting views.
Andrew Cavenagh:Obviously, big partner of ours at Pareto. So happy to have those guys with us. Let's talk care navigation just for a second. When you think about the healthcare system today, it's incredibly complicated and companies like Pareto can do all these things. But if we can't touch the employee, if you can't touch the members' family, a lot of things aren't as effective.
Andrew Cavenagh:So just curious, your your your quick view of the landscape on care coordination, care navigation today, Clayton?
Andrew Clayton:I I think you hit the nail on the head. But it starts with even at home, you know, when my wife, my parents, somebody says, hey, how do I do this? How do I navigate the health care system? Right? And we're a family that's supposed to be living in in the health care space, that it's everywhere.
Andrew Clayton:And I'm interested in in Doug and Justin's, opinion on, where medical literacy is today. But we have such wonderful resources available to people, and yet we don't know effectively on a broad enough basis how to get them to those resources, both in terms of best quality of care, but also appropriate levels of care, not over care, or or not make sure we don't have misdiagnosis. But we see it absolutely every day. And something that we've stressed before is the importance of breaking down medical barriers in the employer employee relationship, that historically and the industry, in reality, has set employer and employee up at opposite ends of the relationship, creating a whole bunch of friction. And the more you can do from a navigation, the more you can do from an expertise standpoint, the better odds that those two entities, employer employee, are working cohesively together, adding and building culture.
Justin Holland:Andrews, appreciate you all having us, here today. Just do a quick intro. Justin Holland, the CEO and cofounder of of HealthChoice. Started the business ten years ago. This is my third tech company.
Justin Holland:And, other companies were not in health care. They were, in loyalty, some ad tech software, and, you know, came in with a lot of hubris thinking, hey. We're gonna go come fix Obamacare. And, hey. It's gonna be really simple.
Justin Holland:There's no tech people in this, in this industry, and we're gonna come in here and just throw some code around. It's gonna fix everything. Realize how how wrong we were. Keep reminding how wrong we are. That is not as simple as just technology, that there's a there's a massive ecosystem that we've had to to to grapple and, and do our best with.
Justin Holland:Team's about, you know, 450 people, and we're, you know, we're still focused on every day how we get people to affordable high high quality care. Doug?
Doug Morse-Schindler:Hey, guys. Doug Morse-Schindler I'm the president and cofounder of the company. Don't come from a health care background. You know, start out in in finance and strategy.
Doug Morse-Schindler:Justin and I have now worked on two tech companies together. I think coming into it, it was clear that there was a consumer experience problem, lack of transparency, huge amount of fragmentation. Andrew, you mentioned something about medical or health care literacy. That was one of the biggest problems that we saw. People just don't know the specifics of their plan, whether it's their network or whether it's their financial responsibility.
Doug Morse-Schindler:And what we're seeing is that things are actually getting more challenging, more complex, over the course of time. And I would also argue that true literacy amongst the population, while there's more and more onus on the employee to really understand the health care system, we haven't seen a whole lot of improvement over ten years. And and, ultimately, that's where we believe there should be solutions in place to really hold the member's hand to get them probably a little bit more literate, but also just give them the easy answer. Here's what you need to do, in order to make the right decision.
Justin Holland:Yeah. I mean, I think it goes back to, like, how many people just still self diagnose on Google. Right?
Andrew Clayton:WebMD is
Justin Holland:Like, how many people just start their journey off of WebMD and, you know, find out you have some rare rare form of cancer, right, by the end of that. And, you know, what good does that really do, unfortunately? There's only so many different options. You're never gonna self diagnose effectively. You have to go see a provider.
Justin Holland:You're gonna have to engage with the system, and the problem is access has been really bad. And then on top of that, you just talk about those barriers between employer employee. Yeah. The employee doesn't trust the carriers. Right?
Justin Holland:We know their NPS we where their NPS score is. They're not trusting the decisions that are being made for them. So then they're kinda left to their own devices out in the system, which which makes it really, really challenging.
Doug Morse-Schindler:Let's start sort of the top
Andrew Cavenagh:of the funnel. I would love to start with the semantics. I said care navigation. We'd love to hear how you guys define the space. Then I wanna jump down to the words you just said, Justin, which is access and talk about that and particularly how that has changed relative to COVID and and virtual care becoming more accepted and prominent.
Andrew Cavenagh:And then sort of dive down into how you take the employee and change behavior or give them the ability to get to where they need to go in this complicated system.
Doug Morse-Schindler:I do think care navigation is is definitely the prevalent term today in the industry. Really thinking about for all the health care decisions that a member needs to to make or an employee needs to make throughout their journey, having a centralized organization or digital solution that they can go to, in order to provide the information necessary to make those decisions in a transparent way, ultimately resulting in the best possible pricing and the highest possible quality of care. There's a lot to unpack within that because in order to really understand what is the best possible pricing, what's gonna give you the highest quality of care. I didn't mention convenience, but that probably also fits into it and probably goes into the access discussion. It really requires you to understand and to map out as the care navigator, what are the options?
Doug Morse-Schindler:You know, what are the potential destinations that we could ultimately, you know, send an employee to? And that's where you have to start bringing in what does the network look like, what are all the other plans and programs that a given employer has provided to the employee population and really trying to understand given a specific care need, how do you ultimately push them or steer them elegantly in the right direction so that they make the best choice?
Justin Holland:We use the analogy internally of Google Maps. Right? Like, ten years ago, you'd have Red McNally in your back seat, and you'd be going cross country. You'd need, like, look at the roads. You'd, like, map out which way you wanna go, and then you'd end up like, oh, crap.
Justin Holland:This road doesn't even exist anymore because I'm I went off the highway. That's a bad experience. But you you think about it now. You use Google Maps, and you just click it. You don't even know where you're going half the time.
Justin Holland:Right? You just dial in the destination, and you just follow the directions that it goes. And there's a lot of enriching experiences during that time. You also have a couple choices. Hey.
Justin Holland:Do I want tolls? Do I not want tolls? Things I wanna avoid, I can add stops along the way. I can enrich my experience along the way. And I think, clearly, the job that Google Maps is doing is how do I get you from point a to point b with as little hassle and as fast as possible?
Justin Holland:And the difference is is that everyone has the same roads in that world, whereas in our world, it's personalized. Everyone has a different set of benefits. The benefits is somewhat of a map, right, that it's a little bit different for everybody. And then what you're trying to optimize might be different based upon what you're looking for. Our job is to navigate someone through this to a the most affordable high quality option.
Justin Holland:And I guess what, you know, carrier navigation ultimately should be trying to do is try and get the highest value, which is quality cost in both of those in those perspectives.
Doug Morse-Schindler:Regards to access, Andrew, which I think was the the second part of your question. Historically, it's interesting because when we when we started the company in in 2013, we kinda looked at the market, looked at really what was the current state of care navigation at that point, which was primarily, I'll say, a concierge call center type of model. There really wasn't a digital solution. It wasn't highly personalized. But we also looked at what was going on in the virtual care space.
Doug Morse-Schindler:And at that point, telemedicine was was relatively newish, was gaining some traction. I personally remember, you know, telling friends and family, like, the idea of actually going to see an in person provider for sneezes and sniffles. Like, you're not gonna do it anymore. You're gonna talk to somebody either over the phone or or via video. And, you know, of course, they're like, that's crazy.
Doug Morse-Schindler:How can you imagine that? Obviously, that has changed. If there's one, I would say, positive that came out of COVID despite the many negatives, it is just the the understanding that virtual care can be a very high quality, cost effective, easily accessible way to address so many different needs in terms of health care. And it's really just gained a a lot of acceptance and and frankly got a lot of awareness, which was one of the biggest challenges. And we've seen that even post COVID, that's also, I I would say, driving, additional investment and acceptance in virtual care beyond just what we'd call, you know, urgent care or general medical.
Doug Morse-Schindler:It extends into mental health, extends into chronic care, maternity care, you name it. Ultimately, what we envision is that virtual care will become a much, much larger piece of the pie over the next coming years in terms of medical spend.
Andrew Cavenagh:When you think about the the increasing prevalence of virtual care, just curious how much of that is providing people access that didn't have it before, and how much of that is a shift from physical to virtual?
Justin Holland:I think you have to define what access means. Right? Like, yes. Is getting a primary care provider in three months, is that is that access? You know, I think mental health is easier to say, like, yeah, they just literally could not get a provider within 50 miles.
Justin Holland:Right? I think the I can't remember what the stat was, but there was these huge, primary care shortages, you know, county by county. It's like half the country is is in what do they call, like, a drought or something, you know, something similar to that. We're saying that, you know, they did yeah. There was providers, but they were accepting patients where they weren't in their in the networks they had.
Justin Holland:You would assume that virtual health will ideally allow some of that excess capacity that was, I wouldn't say, improperly using it. Let's realize that there's a lower acuity option here that probably encompasses a majority of these cases that are going in into the space right now. Clearly, the rural areas, they're super challenged. I can't remember the data on the mental health piece, but it was way worse than primary care as far as, like, what access was. And, of course, then you load in a what, I don't know, has the amount of of demand on mental health for the last three years.
Justin Holland:We were at kinda capacity three years ago now, let alone the problem with, you know, this the second pandemic of of mental health issues now and now are plaguing across the country. So, yes, I would say because the lack of access, most of it now is just be the fact that, hey. They just weren't able to even go access what they had in many, locale in The United States.
Andrew Cavenagh:Let's talk about the supply and demand for primary care. Let's assume that's sort of static coming out of COVID. The demand for mental health up greatly. So the overall, let's just say demand is up. And then you have the capacity side.
Andrew Cavenagh:So one of the things that virtual is able to do is to reallocate existing capacity because it you're not worried about who is within 10 miles of me. It could be who's in the country. And so that's an efficiency, but that hasn't actually increased the the overall supply of care. A negative is that some people have opted to get out of being providers given the state of health care care. Care.
Andrew Cavenagh:But then there's also the flip side where I think that there are people that are willing to be, you know, one day a week, mental health provider where they weren't before because they had to do it physically. Now they can do it virtual. So there's also sort of an increase in capacity coming from that. And so just again, those are sort of my off of off observations. Just curious if you guys see those and see something else that I'm not, accounting for in that.
Justin Holland:I mean, you have to think of also efficient use of time of those providers. Right? Like, you know, you know, being able to do a virtual visit, we know they average out at eight minutes, seven to eight minutes in an urgent care general general medical sense. You know, they're able to see just a massive amount of more patients than than a typical provider in a, in a facility setting would be. And, also, the fact that we all know the primary care has been consumed by many of the systems.
Andrew Cavenagh:But I think it's also important to note, you can more efficiently see more patients in a virtual setting, But that seven to eight minutes that you're talking about, Justin, at the end of the day, that's not going away. Right? At some point, there is a a minimum where there's time spent with a provider and a patient, and that technology is not gonna change that.
Justin Holland:No. But but they have made it so that, you know, nurse practitioners, right, they've they've expanded the scope of care for, physician's assistance and things like that to be able to kinda deal with some of that load. Doesn't help when, you know, we know that the number of of, clearly, the number of medical, sorry, the doctors is not increasing as the demand is. But, also, you think about the does does greater access long term, ideally decrease kind of the the higher acuity, bigger problems downstream, or it thins it out a little bit more. So you'd actually are getting capacity just later later on because you're able to address more, you know, earlier.
Justin Holland:You know, I think that probably the jury's out on that from a from a timing perspective. You know, you wouldn't make that assumption that if with greater access that you're able to make make an impact, with these lower acuity visits.
Andrew Clayton:I always find the process you go through of building a company like yours really interesting. So would you walk us through early days? Because part of what you needed to do was not quite Trojan horse, but find your way into relationships with behemoth in order to get the data, in order to get access, in order to share that with people from a navigation standpoint. So what what was that process like?
Justin Holland:Our first entry in was focused on ACA. So we were literally sold on top of Obamacare plans. We saw a a big need. 100,000,000 people are gonna be on ACA plans by 2025. We're like, oh my god.
Justin Holland:Have you been on one of those? It's really challenging. You know, $6,500 deductible. Most of those people who if they hit that deductible, they would be declaring bankruptcy. It was a hard premise and, ultimately, the important step of saying, hey.
Justin Holland:We need people to have insurance in the country if if that's how the system is built. The issue is it was massively unaffordable for a lot of individuals and challenging to use. So you're taking a population that's never been insured before, giving them insurance in a very, very narrow network and their set of benefits. It was kind of like a, you know, conflagration of of challenges there. And so we we entered and focused on that, and, you know, we partnered with, with an exchange, initially and and sold on top of it.
Justin Holland:But that DNA is important because we ultimately had added people who were willing to pay $20 a month for digital health products. And I think that that ultimately is just a lot different than the typical DNA in many, you know, health companies. And so, clearly, our thesis was incorrect. Was not a 100,000,000 people. Politics changed a lot in 2016, made that even more challenging from a perspective of, do we really wanna be, you know, attached in the ACA world when clearly the other side of insurance was probably more supportive?
Justin Holland:And so then we ended up focusing on the group space. You know, we started off going around all these Naho meetings, a lot of the the brokers across the country, local meetings, etcetera. And, you know, we started getting these eighty eighty LifeGroups, a 100 LifeGroups. We're like, oh my god. There's 80 people with the same plan.
Justin Holland:Because in our world, every single person had a different plan. Every single person had a different cost structure. So everything had to be personalized and architected down to an individual because we never saw the same plan. It was, like, 25,000 plans across 50,000 members by the end of it. And, you it's like, oh, wow.
Justin Holland:We can service it the same way for 80 people. That's a lot better than doing it every single individual. And then we were really fortunate to understand the the broker dynamic and how benefit consultants really end up being the customer for the most part, in in the, say, the small to to mid market. Their that vital function of benefits is really outsourced to them. And, typically, HR team, a 200, 300 life company had is understaffed and doesn't have the time and data to really dig into the details.
Justin Holland:So they're really depending upon the brokers to do that. So then we went to the brokers and understood the brokers' issues and challenges and tried to make sure that we understood that. And then, you know, now we're you know, we've been working with the TPAs recently and now, obviously, as we've, you know, grown closer with Pareto on the captive insurance piece, kind of understanding more of the ecosystem. Say, it's been a kind of a step function that moving up where a lot of companies because it's really challenging to sell in the mid market and and the small medium business, they have to go onto the jumbos. They have to focus way further upmarket, which, you know, going to work with a 50,000 employee company, you have a lot of leverage to work with it.
Justin Holland:Right? Because everyone has to work with you in the in their ecosystems versus in the mid market and the and the underdogs. They don't have the leverage. It's really nice is is what a big value out of what Pareto does, right, is gives the underdogs a bigger voice across the ecosystem, which I think is really, really important. But it's been a, I would say, a step function process of failure, to to to to get where we are.
Doug Morse-Schindler:I I think what's interesting is neither of us came from the health care insurance space. It was all all new. Our initial thesis that everyone was ignoring the consumer and ultimately that we needed to be able to empower them to make better health care decisions ultimately to impact cost. I mean, we've believed that from day one. Obviously, you know, we are focused on the individual market, moved into b two b for, reasons that Justin mentioned, but I would also say this industry has some unique attributes when it comes to distribution.
Doug Morse-Schindler:And distribution, of course, is so important in any industry, but really trying to figure out how distribution works in health care, in the insurance space, and aligning with the brokers and understanding, I'd say, just the various stakeholders at play, their interest, what's important to them, how we can provide as much value as possible to them. Was essential not to mention really understanding the pain points that our customer has. And when we say our customer, we really think about HR and the benefits leader. What are they going through every single day? They've got a really, really tough job trying to bring together these strategies, you know, together with their broker consultant.
Doug Morse-Schindler:How do we better understand their daily pain points, and how can we ultimately align with them as best as possible? That takes a while. And there's obviously different flavors and different personas, and there's so many different company structures, whether you're multi location or single location, just as one example. That's really where we've we've certainly one of the areas we've we've obsessed over and we'll continue to obsess over, looking forward.
Andrew Cavenagh:Healthjoy, what are the big bang ROI for you guys, you know, in terms of MSK, virtual,
Doug Morse-Schindler:and your top three? Within our core platform, ultimately driving members to the most cost effective procedures, which, you know, that's gonna depend on the facility primarily. That's where most of the cost comes in. Just as an easy example, getting them to go from inpatient to an ambulatory surgical center. That is going to, in pretty much every single case, have a significant impact on cost.
Andrew Cavenagh:In theory, we have people listening to this that might not know some of these numbers. You know, my mom, Clayton's mom, not everyone's from the industry. Just quantify that for the audience if you would. What's the delta and cost and facilities between, like, a knee surgery between inpatient and ambulatory surgery?
Doug Morse-Schindler:Yeah. So so typically, what we see and again, these are averages, depends on the market, depends on the facility. But I'd say you're looking at going inpatient, $4,050,000 dollars all day long. You go to an ambulatory surgical center, you're looking at the 18 to $25,000. So it's up to 50% savings just based on the facility itself.
Doug Morse-Schindler:The other interesting thing that most people don't realize is that the same providers who are working at at the hospital, they may have two days in the OR at the hospital, and then they have two days at the ambulatory surgical center. So you still are getting the same provider, same level of care based on all quality indicators that we see, and yet the pricing is tremendously different.
Justin Holland:And the provider in both cases makes the same exact amount of money for the most part, and all that variability is in the in the facility. And you and we do that same steerage for imaging where, you know, if you go to a local research hospital, it could cost 3 to $4,000 for for a routine MRI versus, you know, 500 to $700 at an imaging clinic that treats it like a hotel. And what's good about when they treat it like a hotel, they do it every day all day long. They're really, really good at it. And it's just that's where they've specialized.
Justin Holland:And so there's a lot of different layers of steerage. I mean, we we focus on trying to steer people to primary care outside of hospital systems because we know if they're in the hospital system, most likely, they're gonna get referred downstairs to the pharmacy that charges you $40 for a pill of Motrin, $500 for the X-ray to the MRI, down to the specialist. That's gonna be incredibly expensive, which that experience is really important for, you know, specific episodes of really, really challenging care issues. But on just the, you know, a brick and mortar annual physical and you're trying to just get through the system, there's gonna be a lot of downstream costs that you can't account for, which is why we look at virtual care also as part of that steerage of how do we get people to use, you know, lower acuity, lower cost options earlier than later. And that's, you know, a primary component of kind of steerage piece.
Justin Holland:A big piece is gonna be prescription review, helping, you know, individuals understand that a prescription, say, at one pharmacy and another is gonna be a big dip price difference. There's also a lot of different programs that you can use in order to reduce that cost, whether that's assistance programs, coupons, etcetera, to, you know, hey. We're we can recommend therapeutic alternatives, that that you may not have known. That could be also, much cheaper. Or infusion therapy that's done at freestanding facilities, getting chemotherapy, for instance, in a hospital.
Justin Holland:First freestanding facility is tens of thousands of dollars of difference, you know, for the year, and it's a much better experience outside the hospital. There's a lot of these different types of optimizations that we do. We kinda bundle into that one primary concept of steerage.
Doug Morse-Schindler:So maybe to summarize the three areas. Number one, moving specifically on the procedures, inpatient to, call it, outpatient ASC. Number two, moving from brick and mortar to virtual care, which there's a few examples there. One easy one is emergency department, visits, which people still go to the emergency department because they have a sinus infection. May sound crazy, but it happens.
Doug Morse-Schindler:And then on the prescription side and and really finding, you know, therapeutic alternatives when possible.
Justin Holland:And MSK. Right? Physical therapy, but you don't have to go into a facility for physical therapy where we know adherence is even hard because people don't wanna get in their car and go drive to to physical therapy. So how do you make it really simple and bite sized to do it at home? We really typically think about everything we do as well, number one, how we connect people to care.
Justin Holland:That's our North Star metric as a business is connections. And then, ultimately, we're trying to drive making sure that it's hitting our mission, which is cost and quality. And in that vein, most of the things we're we're focused on, what is the framing that we have to make sure that we're driving doors that higher value care for for the individual?
Andrew Clayton:Thinking of utilization, if there's one thing that you look at and say, we could just get people to do x, one or two things where if we can move the needle a little bit more or why won't people just follow through on this option that's available to them? Stick with ROI. What what are the biggest ones, the lowest lowest hanging fruit?
Justin Holland:I think it's really hard to change. Once someone's had a specialist and has a diagnosis for a procedure, it's it's really late in the game. Right? Like, we're gonna do everything we can to make that change. Right?
Justin Holland:If I say the one thing they could do, if they have virtual primary care is make sure they're using virtual primary care, and then we at least get the follow-up, referral to the specialist. So we can, ideally refer them to the specialist that will make the diagnosis in a setting where we have high confidence that's gonna be in a, in a low cost facility. That's gonna be the best place. Right? Further upstream.
Justin Holland:Well, I wish HR would ask emails or numbers for all employees, like, it still blows my mind. Like, they don't have contact information, in many cases for for certain types of workers. We need to have ways of connecting with the individuals. As as much as I'd like to think that, you know, posters and QR codes are gonna get us there, they're not. Right?
Justin Holland:We really need to have access into the individual and getting that information.
Doug Morse-Schindler:There's low hanging fruit everywhere, which, you know, you look at the amount of waste in in the system, and it's it's massive. Our thought is how do we get as many members to come to us before they make a decision, or we need to be proactively reaching out to them and engaging them before they make a decision. And whether it's, you know, the examples that that Justin gave or, you know, the really easy ones are going into a research hospital to get an MRI. I mean, you're going to pay, I don't know, $2,000, let's say, on average. And if you go to a freestanding facility, you're probably gonna pay 30% of that.
Doug Morse-Schindler:That is one microcosm for, I would say, the entire health care system. Basically, there's $100 bills on the ground everywhere, and it's our job to make sure that people have an easy way to scoop those up with the net.
Justin Holland:But I think it kinda goes back to initial point you made about, like, there's a barriers between the employer and employee, right, where there's a trust issue inherent. And if you think about it, the typical way that still people go pick their provider is friends and family. That's it. How does, you know, the consumerism and things like that of the individual is really, really important because people don't shop in the same way because you can't. Right?
Justin Holland:The the the data the data is not really, in in a in a format for for a for a person to be consumer, which is, you know, part of the one, I'd say, the overarching theme of what we're trying to accomplish is try how do we help empower the consumer so they think they're gonna come to us first to start that process. Right? They start on Google, then they ask some friends, and then they end up going to some provider that was referred to them. And I don't think we do that for anything else, any other purchase. Right?
Justin Holland:Maybe for golf clubs. Right? You ask your friend which which ones he likes and you wanna play with them. But, you know, it's it's hard. And I think that these high consideration type of actions, how do we help empower the the individual with enough information as a care navigator or any care navigator?
Justin Holland:Right? I would say the one thing, go to the care navigator first. That's why the one thing I would tell everybody, regardless if it's HealthJoy or any of the other entities out there that are doing, you know, similar work, is the they're gonna have a better answer at the beginning than that probably go into your friend or family that had one individual experience.
Andrew Clayton:Yep. So you mentioned, MRI, and MRI is obviously an easy one because the the quality is not gonna change. There are quality data sources out there today. There are health system provided sources, I would say, and I would guess that we're not at the point where we can say with great accuracy that the quality data's there in order for us to be able to judge. How far away, in your opinion, are we and and what needs to happen before we can get to true quality analysis?
Doug Morse-Schindler:Yeah. A great question and something that is a constant topic with our partners, brokers, consultants, and and employers. You know, you look at where is the massive data that we have today. It's it's from CMS. From what what we know, it's it's kind of the the best national database of quality.
Doug Morse-Schindler:That said, you you really do a deep dive on it with anyone who truly understands the the quality measures, and there's not a whole lot of agreement on how impactful that data always is. And as as you mentioned, Andrew, there's, you know, also specific data sources out there from the health systems. They aren't as complete as CMS. I think one of our challenges has been we have a a national footprint of members today. And so we really look for solutions that that are gonna solve kind of the the problem for everybody.
Doug Morse-Schindler:We do see, however, and we've actually been doing a a lot of investigation that there are new entrants emerging, basically trying to take the CMS data, data from the hospital systems, and merge them together, ultimately to create almost a quilt, if you will, or an overlay of quality data, which we think is really intriguing. I don't know how long that's gonna take to get to a point where it is the accepted version of the truth, but it's at least exciting that someone's truly working on the problem. I think what's also really interesting is when it comes to quality, I would say you've got a few different measures in terms of, you know, readmission rates. Let's let's use that as an example or complication rates with a given provider or facility. But then there's also this other really important component, and that is if I'm the patient, what's the bedside manner of that provider?
Doug Morse-Schindler:And that's typically really important and really comes into play in terms of the overall satisfaction of patient provider relationship. And today, what's interesting is and we know this from when we make provider recommendations based on our best understanding of quality. The first thing you do when you look up a provider as a typical patient member of HealthJoy, I imagine, is you go on Google. And, you know, you look at health grades, you look at vitals, and if it's primary care, how how pleasant was the staff, how much time did the provider spend with me, how clean was the office, how quickly was I seen. And so it's one of the things that we've really tried to get a better understanding of, what's important to the patient beyond just what I would say CMS is tracking or the hospitals are tracking in terms of readmission rates because we find that it it does come into the overall patient experience, and that's also something that we should be capturing and sharing when it comes to, you know, transparency.
Andrew Cavenagh:Healthjoy in three years. What's it look like? What are your big, very audacious goals? What are the key things that you're working on?
Justin Holland:I I think an important part of carrier navigation is we have to make sure that there's confident that that trend, that it's verifiable, that all the data, that trend is reduced against not having care navigation in there. And I think that that should be a expectation that's all care navigation is held accountable to, once the data is there and you're able to work against that. Let's say that's a premise that that has to happen, and has to be easier in order to do that those those calculations as time goes by. The challenge that we have is a lot of things are about obviation, about not doing things versus reducing things. And so it's like when we look at, say, a example of working with our procedure partners, well, it's easy for everyone to understand, hey.
Justin Holland:If I'm gonna pay it a 120% of Medicare, we're definitely gonna save money against our commercial plan. Right? No doubt about that. We will think about, like, how to avoidance of care and how we characterize that and do a better job of of showing that end to end. It is something that's that's really, really important for us.
Justin Holland:But I think in order to enable all of these things is, really, how do we have really great answers across the entire not just, I would say, the continuum of care, but all the different possibilities of you think about the the giant pie chart of of cost of health care expenditure, making sure that there is, you know, sound strategies and with multiple different partners. We are agnostic to a level, and we wanna make sure that there is a lot of different options in there based upon what consultants, believe is is most important. And the reality is health care is really local, and certain vendors are better than others in certain places. So I say holistic ecosystem is kind of, like, I would say, the foundation, the keystone of that. And then, ultimately, there's a lot of insights about that ecosystem, I think, are really important for how plans should be designed, How do we help encourage the proper behavior with consumers?
Justin Holland:Ultimately, how do we get the consumers to understand that their decisions influence their premium? There is this somehow, this massive cloud in between those two concepts that ideally we can help, break down over time. So I'd say that the goal is, you know, how did we get there? And, you know, when we think about our big audacious goal, it's a it's 1,000,000,000 connections of connecting people to care by by 2027.
Doug Morse-Schindler:I think what we're also doing a lot of work is in order to engage with a member. And, you know, I'd say this is no different than, you know, what we see from companies like or or any marketing company. The more that you know about your member or your user, the better, more complete profile you have. You have so many more opportunities to personalize the engagement to ultimately impact behavior. And that's where we're doing a ton of work is to really build out the most comprehensive member profile that we possibly can so that we can get the engagement with the members.
Doug Morse-Schindler:It can be more and more proactive. Today, the reality is our system is it's too reactive. In a lot of cases, it happens after the fact. How do we get in front of more decisions? And in order to do that, we really have to understand what the member's going through.
Doug Morse-Schindler:And, ultimately, once we do that, engage with them, and as Justin said, then be able to seamlessly connect them to our ecosystem, to the partnerships that that ultimately we've developed. And that's ultimately what's going to really drive the the behavior change.
Justin Holland:It's a lot like, you know, Instagram. If you think about Instagram six, seven years ago, you probably never bought anything from Instagram. And now the Instagrams are they're so targeted. They're so well done because they're so applicable to, well, to a lot of things that happen outside of Instagram too, which is a little like a big brother ish, but, it works. They're really targeted.
Justin Holland:And as that ecosystem expands, then there's a lot better targeting that we can do. And it's similar to to an ad engine. How do we help drive people to those to those actions? We see it as a big unlock, and that's something we're working on. We'll have our first kind of v one of that in actually January.
Andrew Cavenagh:We appreciate you guys taking the time today. I like to tell anyone who will listen to me that I love what I do, and the reason that I love what I do is because of whom we're doing it for, which are small and biz small and mid sized businesses and their employees, and then who we do it with. And certainly, the who we do it with includes the Pareto team, but it also includes people like Healthjoy. Clayton has a phrase that I really like, which is the right side of the fight, and it's great being on the right side of the fight with you guys. We've enjoyed the partnership and look forward to not just continuing it, but expanding it.
Andrew Cavenagh:But so we've talked a lot about the ecosystem. A part of the ecosystem are insurance companies. You guys aren't an insurance company. We're not an insurance company. We're talking about navigation.
Andrew Cavenagh:So it just reminds me of the story I heard. The typical insurance company, the head of sales is in the driver's seat, foot on the gas. Head of underwriting is riding shotgun, hand on the steering wheel trying to control the car, and the actuaries is in the backseat staring in the rearview mirror given directions.
Doug Morse-Schindler:So I like that.
Andrew Cavenagh:That's the insurance industry, and it's why and it's why we're it's why we need to be on the right side of the fight.
ParetoHealth team:Thanks for listening to today's episode of eighty twenty with Pareto Health. We love hearing from you. If you have a question or an episode suggestion, please drop us an email at 8020@paretohealth.com. That's 8020@paretohealth.com. Dive deeper into eighty twenty by visiting us at paredohealth.com/podcast.
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