What the Health Just Happened?
Spatially Health
Ladies and gentlemen welcome to this week's episode of what the health just happened we talk about all things health care community Business and life the goods the bads the ups the downs the left the rights and everything in between We also bring on a variety of guests to talk about those topics again health care community business in life I think today we're gonna check all those boxes some health care definitely community Business side in life because I can't I love your advice I'm gonna say this is the most difficult name to pronounce in the history of the show at least reading it Reading it. Yes. I think it rhymes with elite because I would put you as elite is that fair? Okay, no take it. I'll take it sure elite and maydar Alfie. There you go. There you go I had to ask her like five times everyone calls you hill it You know how LinkedIn has that little button that you can hear the pronunciation They used to have it. I don't know if they have it anymore, but okay. I did none of that I was one of the first things I did she is the co-founder and CEO of a company called spatially health We're gonna talk a ton about it. I want to read a couple taglines from their website A cloud-based decision-guiding platform that operationalizes SDOH to promote health equity other tagline a health equity marketplace for SDOH interventions and solutions That's a lot. I know it's not working on this. Yeah, that's okay But I think diving in and understanding what SDOH is yes, what is SDOH? It stands for social determinants of health try what does SDOH stand for social determinants of health social determinants of health that's a mouthful SDOH, so we're gonna use that acronym a few times and then also ACO stands for Accountability These guys we're talking health care here. What does it stand for? Oh? Accountable yeah care here that was organization right so again. I love health care conversations I hopefully they learn some stuff along the way, but let's so spatially health it was founded in 2019 and you're based in Miami currently working in how many states? We're all over like almost all 50 states. Yeah, no coast to coast Where do you want to start you want to start serious or not serious? No, I'm not serious not serious okay Miami, South Florida. Yes, I grew up down there you did I didn't you grew up in Philly Yeah, in and out of Philadelphia moved around a lot we moved down to Miami and that first wave in like 2010 so so a while a guy we're the original trend setters original trend setters what's More healthy Miami or Philly Miami healthier. Yeah, what has more crime Philly or Miami? Both cool probably yeah, who has better weather? I'd say Miami we kind of slugged through the summer to enjoy the winter. Yeah summer's brutal Do you bounce around so again just give us a background here? I love this a PhD From University of Pennsylvania and city and regional planning yes Which cracks me up and then what you're doing in in SDOH and working with ACOs is pretty cool I think I'm kind of a nerd these guys like what is this guy talking about? Philadelphia Pennsylvania area like how come on here? Let's talk about city planning architecture. I heard this story Okay, so somehow was born in Philadelphia raised in Philadelphia state in Philadelphia until you know we started moving around So did my undergraduate my background's actually in design. So I'm a trained architect worked in the field for several years and then went to grad school and got a PhD in city and regional planning and The the commonality between the two was that you know The built environment influences your behavior and decision-making an architect You kind of design around it right you build spaces you define spaces you build buildings to kind of you know Guide people through different places and get you know what they need to get done done For me a house a building is like a machine right there systems in there. You need to there's a goal There's a purpose for it. So that was my approach in design the same kind of goes for cities But it's a much bigger field, right? So we have systems and cities often enough. They're called infrastructure What typically gets defined into structure is roads and railroads and utilities But if we kind of look beyond that there's a lot of infrastructure that Defines our day-to-day life basically everything that you do when you walk out the door at your house every morning So you have schools you have libraries you have parks you have shopping centers you have places of work you have places of worship You have today places where you exercise? And all those become systems And it became obvious that you know places have certain systems, you know a certain level of systems So my focus in grad school was developing evaluation systems for quality of life meaning providing models and Ways for municipalities to evaluate what areas are low in quality of life and in their toolbox and in the infrastructure that they have What can they better provide those communities to increase the quality of life large cities small cities like what cities are you size any size that you know Before the SDOH worlds. Oh, yeah, cities where you working with That was theoretical right that was that was the the the the systems that were designed and the modeling that I started off with That's that separated like a good city or a good quality of life first and not good quality of life So you kind of have different theories around that right you have cities that are Considered like the old European city now you love Europe like you go to Europe and she's like every city is like so quaint because there's a town square and you know your food is relatively fresh it comes from a local farm and people go to the Local store the small store to buy you know two tomatoes and you know go the next one to buy a few eggs And that's it and you basically do it on a regular basis So that gives you a sense of community. You're like you know these people The bigger the city gets the less you know that relationship exists, but it still exists in different ways so Cities that were laid out like older cities like New York you have a bunch of squares You kind of have different areas that centralize and focus people that gives you Identity almost right. That's how you have all these different enclaves in Manhattan, or I'm just saying the Alicia Keys song New York But I'm a terrible singer. So I'm gonna not do that. I will not say What about Miami? Miami is interesting. It's different Miami has a bit of a Manhattan effect in the sense that You have the ocean on one side, right? And you have the Everglades on the other. So your real estate is limited Right, so it's not like yeah, no And that's what's driving a lot of the real estate because you have a limited and it's also driving everything vertical So did again you live in Miami you how often you are you in Jacksonville Northeast, Florida? That's where we met health chiefs. I like to give a shout out to people. That's the first time we met. Yes, I love health Bradbury My goddess. Yes. Yep. That's your goddess. Oh, yeah, I love that. Yes. I've been trying to get her on to pray to the goddess Nicole Yes, oh, I love that Senator Northeast Florida like what do you think our city's just so large as I look at it We have the beaches then you have this other pocket then you have downtown then you have that you know the town center like I love Jax. I I was the first time I went to Jacksonville. I came home to my husband You know how I get a 10 year itch every 10 years. I need to move I've never lived in the same house for more than five years. Well, you're welcome. Oh, thank you And came back like this. It's awesome. First of all, it's huge, right? It's like I think the biggest city in the country Graphically one in Alaska, but yeah, we nobody counts that but to me it seems like it was built for a huge population So I think there's a huge potential for Jacksonville to grow significantly What it attracts you so much about Jacksonville just on a personal level. I love places that that have opportunity kind of smell it So love it. It's it's no opportunity There's a lot right it's growing that I think health care I don't want to judge the health care system here in Jacksonville because there's some great stuff We could do some things to improve Like any city everywhere. I've got a random question. Who has better grocery stores, Florida or Pennsylvania. Oh That's tough because we got the Well, okay Corn up there is unmatched. So shout out to Publix. Yes, absolutely Popcorn chicken is like our sin, but yes, it's the best thing ever But Pennsylvania has the Amish so you can't get better chicken You're eating that chicken probably down here through Publix. So I have both of them Oh, man, we are I love Publix. Okay, so Founded the company co-founded the company. What's your co-founders name a D a D shout out to a D We love a D's we love a D's shouting out to people. We pray to the goddess a D. Yes That's incredible so so how did you two know each other where did this idea come from oh Really going back so a D. I know because she is a Childhood friend of one of my favorite cousins. So kind of. Yeah, yes And a D's like a brilliant data technologist. She's just a really really really smart girl really really smart Not much patience, which is good Gets to the bottom of things really fast, which keeps us on the straight and narrow so Twenty nine it's about 2018 2019 I was coming out of grad school. I was working with You know the different models that I was developing using location intelligence and spatial analytics. That's all based on geographic information systems, which is kind of like a CAD for a topography you basically build Topographic models. It's really unique because what is topography me and Justin. He's over. I'm just kidding. He's checked out. I I Topography like isn't it when you like typography like letters and oh my not Typography to be fair. He was over there staring at his film But again, I we never know who's listening who's not back in the day when you had to open a map and actually read a map And see where are the hills and where the valley on that before yeah and other scouts or You mean who knows when by? You're finishing your PhD and you again that the spatial analytics is something I think you might want to dive into and typography. Am I saying that right by the way? Yes, that's relevant Yes, so you studied that and then the two of you what met one day for coffee and started writing stuff on a napkin So I was working with the models right worked with small media and businesses worked with real estate companies work with you know marketing But it was just like not a passion. It was like felt like you're cutting butter with a steak knife This is a big powerful tool big, you know model that we built and They didn't need all that you know power was this overkill then started talking to some physician friends of mine and you know we're talking about what we're doing and They started telling me about you know this idea of social determinants of health where you know providers actually want to know a little bit more about their patients not just the disease state and We got to talk and like you know that's basically what quality of life is just with a different title with the different language and lo and behold a stioh really is not something that recently came about it's been around for a while at least the idea of it the knowledge that our health outcomes are The statistic is what like 80% of our health outcomes are determined by Thing the factors other than medical care. That's a stout 80% You go ahead try so basically just your environment. Yeah, can totally I've come stoh Social determinants of health like try to say that five times fast. It is impossible. It's been around Try to write that when you have a hundred fifty character limit And social determinants of health Or film just to fill it out. That's definitely not healthy questions. Although in school. Yeah 250 word essay I've been writing that four or five times or if they counted letters. Yeah That's good So again, it's existed. It's been I would say semi-relevant I I think covid kind of put a flashlight on that and said whoa, this is relevant. It blew it out of the water Like hold on a second. There are all these things that are relevant to health care Go ahead, Troy. Oh, no, it's just so funny said covid, but you started your business before covid. Correct. Yes So you were like you didn't see it coming and then all of a sudden you were positioned to be like ready to roll And yeah, it was it was wild during during covid because we thought oh my god the gods have shined on us here It is here it comes everybody's like, what am I supposed to do with this? Like for stioh with with social terms. Yes Physicians doctors they want their patients to be healthier, but it's a lot more complicated in that it's it's not easy Okay, so so st. Oh, we're gonna I want to get to a point where I stop having to say social determinants of health That's a very the popular term st. Oh, this is from the u.s. Department of Health and Human Services their website They said five domains of the big ones somehow I have six economic stability Education access and quality health care access and quality Housing that's what it is. I didn't delete that neighborhood and built environment and social and community context So these things are so relevant to health care. Can you? Dive into that like which one do you think are there one or two that are more important than the others? It's not which one is more important. It's how do you provide for those and you're gonna have? Different methods and different strategies for providing those some of those are long long cycles some of them are easier to attain and You kind of have to be able to separate then I say okay if we want to get You know results quicker. What are we gonna focus on that doesn't mean you let the others go? But these are deep social societal problems. This is not something that should be Looked at only from a health care perspective. These are deep deep problems What do you think the biggest one to tackle is maybe there's not one. I'm just curious like I look at all these that it's it's tough I think neighborhood and built environment is huge, right? I well that's what's the neighborhood and built environment. Yeah, that's what I'm a city planner you can probably you have the grade I would not say the greatest but the greater impact sooner because You can you can see what you have you can see what's missing and then you can fill it in with different, you know services with different ways So from those five or six that you said, you know, Jacksonville has a city specifically Which one do you think is the biggest challenge here? I wouldn't know what to answer to position. I don't know when you were listening all those off I was like man. I feel like it makes it feels well positioned on all those Let me tell you like personally, this is strictly an opinion, right? Maybe delete this out as I scratch my eyes I Think education access and quality This is my right so our education system in Jacksonville right now Is teetering the public health school system in Jacksonville I love you guys, but but it's a disaster. There are charter schools exploding what you're doing well It's it's just interesting to see what's happening with the education system here in northeast florida So if I had to take off my health care hat. Yeah, give you one silver bullet I would put everything into education starting with early childhood education three months six months like Below the age of one early childhood education all the way through high school I love that everything in but can education almost be one of the easier ones to tackle because so many people could actually homeschool And I know that scares people away, but that could be almost a guarantee way to Increase those numbers on education. There's probably lots of ways of doing it, but you're looking at a 20 30 year timeline Yeah, it takes a long life. Yeah, again, it doesn't mean don't do it if we can do it right now I'd you know, but be real you're gonna see the results and you know 20 30 years This is this is actually great because I want to go a little bit personal here for a second if you don't mind like What drew me to you? We met at this health cheese event one is she made me laugh like if you make me laugh for immediately friends That was the beer It was a whiskey nothing But you're I would say you're a good mom. I don't know you that well, but you you seem to be very Very close with your children, right you have a son and two daughters three daughters See a four we're just how much we have a fourth or not not together, but Modern science Education like in your household you I love I have to read this because I I don't know where you wrote it Whatever adventures life will bring your way always remember be kind be smart Don't be on the news and don't forget to call your mother Best advice I've ever heard That's it. So so in your household like how important was education? and learning I mean Every kid can learn right that's you know every child has the ability to learn not every kid is the same we have And hopefully she doesn't hate me for this, but our youngest is dyslexic um and You know We know when we realized that she's dyslexic It was a non-issue because she got the help that she needed and all of a sudden she realized she realized Mom, this is my superpower. I'm like, yes, it is. It is 100 percent your superpower But the point is that every kid learns differently like some kids learn a little bit more like Equally to each other, but so I think differentiated learning needs to be Adopted everywhere and people need to understand that not everybody can sit for four hours at a desk and you know Read and do you know the same drills or the same exercises some people are more experiential learners But when we had our kids we were actually living in princeton, New Jersey And uh when our son was like 18 months or something like I can't have you in the house anymore. I need you Let's find somewhere. I can you know show you off for a few hours a day Pretty much and they had a prince in a montessori school Which is like the mecca of montessori teaching They actually brought teachers from all over the world to learn how to be a montessori teacher And if you know anything about montessori, everybody thinks or today I think oh, it's so bougie, right because you know Good good word by the way. That's a great word. That's right. The tuition is you know, so expensive for montessori schools But the reality is that maria montessori developed the method for Four villages, right where you can actually teach a child With you know mud and sticks and you know, I consider myself a montessori parent because they taught us as parents How do you deal with tantrums? How do you deal with a kid that you know, doesn't want to get dressed in the morning? How do you deal with a kid that's never on time? I've gone through all of those with my kids. I can tell you what works and what doesn't work But my kids are already old enough so you cannot call child protective services on me I love it. Oh, but my favorite was our oldest our son was, you know, mr Last minute. So he was always late. Come on. Come on get in the car. We're gonna be late We're gonna be like so I told them if you're gonna be late. I am leaving without you so I left. That's great. I love it. Like how old is he? I'm at the edge. Yeah. Oh, he was probably six or seven Oh, man He was at the end of the driveway through his backpack Mommy come back. I went kept going till I was at an eyesight Went around the block and came back and it's like you will never do that again I will clap for that. He will never late again My wife didn't won't love that. I all the time. I'm like He was safe. Listen, he was safe. Thank you. He wasn't being irresponsible In your driveway of your house. What's better, you know teaching him that lesson that yeah I will leave without you or I'm gonna be angry with you. I'm gonna yell at you. I'm gonna berate you So that's a lot of the skills that we were taught, you know in Montessori I'm gonna reel it in for one second because I and then go back to some fun. Did we go off track? That's what we do here I told you but then the second half will really dive into spatially what you do and we got a couple minutes left um We'll talk about uh ACOs again SDOH a bunch And then I really want to dive into what you're doing the statistics you have like who a good client or customer is Did you drive through the rain to come here? No, but I've driven through hurricane For what? I had a meeting here and I had to drive back and the hurricane I forget which one I don't remember the names One of the hurricanes was coming through. We didn't know where it was gonna land I remember driving looking at the bands of rain saying okay, if I time it this way I literally drove in between the bands You know, she's been in floor long enough, right? Because some people are like panic. My wife's still panics when when she sees hurricane, I'm like We might not even get rain done. Oh, we still call the locals like are we going or not going like eh? You can stay it's not gonna hold it out. Hold it out. Um So I asked you on the on the prep call. What do you do for fun? You remember your answer? I don't know who fun. I don't have fun. That was her answer like oh my god Fan is football. Well, she's not fun. I just have to listen to how much my son lost I love I love that you're listening to your son and talking to it But you you know you mentioned yoga reading you have a big household so household stuff Yeah, most of the kids are out of the house, but yeah, we have a big household big family. When do you downsize? We kind of started too. Oh my god. Yeah, so we moved from a big house to like a condo unit Oh, so you started the process. We're not going back Nice. Yeah too much work. I'm like we have so much stuff any advice on how to just get rid of stuff for kids You think now you have a lot of stuff. You're in the digital age Do you know what it was like before the digital age when you had all the toys and all the books? That's something I don't know if kids still look at his books. We have so we're huge books in our house We buy them now though. There's no more barns library. There's a well There's a couple used bookstores here locally too that are great. You can go buy kids use books and adult use books I like that's one thing in our house before you can even touch any digital device like you will play outside or read um How much time we got left? One minute any shout outs before I wrap us up Commercial break. Oh, you caught me up guard on that one. You know you could think about it That's all right. Well any of us on I will give a big shout out to jackson. I think you guys are awesome. Yes Yeah, you have to say do vol you know how to say do vol the right way do vol you guys say do vol can you do that or no? That sounds a little fanatic that do vol We got it people here are really nice. I got it really really nice. Oh my goodness That's already the time would fly. That's my least favorite part is when we run out of time first half though We got one more half okay elite helites. Can I start telling you calling you that helite? Yeah, elite helites Helites you know an ego. You don't do that. I like that Nadar alphive. I had to write like I had literally had to spell this fanatically co-founder and oh my gosh the alarm goes off that's on me co-founder And ceo a spatially health that's what the hell just happened Welcome back to the second half of what the health just happened if you Miss the first half here on the radio good news is you can catch the full episode on your favorite podcast platform under what the health just happened Oh my gosh that first half was all over the place. I enjoyed it. Hopefully you did too. We talked family We talked life. We talked social determinants of health. I'm gonna start calling it soda That's our internal soda. Yeah, I want to call it stuff That's just ridiculous Um some a co stuff the second half will really dive into spatially health what you all are doing Which we touched on the first half, but first we have to play healthier. Not healthy Okay, even healthier not healthy public subs Healthy. Oh thank goodness. Health. They're not healthy Philly fans. Very healthy I'm gonna disagree on that one healthy unhealthy tailgating those games in december that's Health they're not healthy filling out paperwork and forms and you have to write out the entire term social determinants of health very unhealthy Health they're not healthy ceus continuing education units We'll keep it healthy you got to work through she mentioned her husband's in real estate and he has to do like Um You got any health you're not healthy skies? Healthy or not healthy driving from Miami to Orlando to Jacksonville back to Miami in one day to do this show It's healthy the day that you're driving. It's very unhealthy the following down It hurts. Thank you for doing that by the way. What's the diet like in the drive? Do you eat during the drive? Um Um no Oh my god, first of all no because honestly no because when I do these long drives, I have to take my husband's car And if I make a mess in there or spill anything. Oh, that will be a problem. So oh is it a nice car Sports car. It's it's a it's a nice enough car nice enough Health you're not healthy eating in the car I have no problem with it. But not his car. It's never healthy for me. I eat like absolute trash when i'm but i'm an almond mom So, you know if i'm going always have like almonds or yeah I'll like be jerking although that's cool. Sorry. I'm digress here. Okay Let's go back to the business. You are the co-founder and CEO Before we dive into what you're doing. What is it like being a founder of a are you still a startup? Would you consider yourself as in the startup phase? I think we'll always be in some startup phase It's just the nature of what we do. There's so much evolution in it. You got to stay hungry So I think we'll always consider ourselves startup adjust pivot Nice repeat how many employee like how many people work there? We're I think 13 13 right now Are they all in the state of florida spread throughout the US spread out throughout Many time zones technology backgrounds healthcare backgrounds like what's the workforce look like um? So actually nobody comes well a couple do come from a health care background, but not like the medical side of health care Um, mostly data data engineers spatial data scientists like heavy-duty stuff So not any of us by the way, I was just gonna say are you hiring you need some people to You don't need us. No, hopefully one day. Yeah Um For for an average listening like what what does the business do right? What do you how are you helping? Patients obviously I think ACOs like how many different sectors are you helping? I wrote I got it. I got a print out right here for an answer for this right? So would it make sense to kind of go back and even talk about what we're doing like So yeah back to social determinants of health. Um, so coming out of covid everybody's kind of like what the what the health what the health just happened. Good one. Um, and I think it probably didn't Didn't shock everybody, you know, but the the How bad it was I think really took everybody by surprise like how bad off some of you know, um uh certain populations fared really poorly and you know, we basically know the reasons why so um coming out of covid CMS in its brilliance and I give them credit Decided to promote and drive this concept of health equity meaning, you know, people that don't have the opportunity to Be at that level of health or their their ideal level of health or yeah their best health You know, they're going to need certain help to get there. Um If you take a step back it makes sense we kind of have a shared interest in that because the healthier We are the less it's going to cost to take care of us and medicine today is going to get more and more expensive as you know Procedures get more precise and more expensive and pharmaceuticals get more abundant and expensive So we want to try to stay as healthy as possible So The problem is you have this great idea, right? You have some pillars that are significant, you know in terms of deep social issues. How do you start bringing that into? health care so that You know, wherever there's the opportunity for a provider for a physician who? You know sees a patient sometimes more often than you know other professions How can that influence, uh, you know the health of the patient? What can organizations do? Um to improve people's health. So there's another issue that's happening in health care Which is I think really interesting is this whole concept of value-based care Which you know not coming from health care was a real draw in the sense that if we need to improve health care and get from A fee-for-service concept like how do you how do you basically gate health care in a way? That's not gating it It's through this concept of value-based care. We're actually Getting paid for value and not for volume I'm going to pause there real quick because it like it helps to just I don't know who's listening. We never know I don't know either and hopefully I don't get any angry They do they'll come to me and I'll I'll take care of that Think about it American health care fee-for-service, right? You go in you get your belly button looked at check a box You got to pay for that. You get a EKG put on your chest check the box go for it Value-based care is trying to drive value-based care, right? So incentivizes good care in order to I would say save money long-term Yeah to improve the health outcomes. You don't have to spend as much money. Yeah, so sorry now pick back up I just like to really bring it down because sometimes let's just like thank you for trying to briefly Explain that saying we're going to be hiring soon because I think you know need folks like you to help translate the you know the the disasters in my head. Um, so Why does CMS why does the government care because the government's the largest payer, right? And they pay for Medicare and Medicaid and Medicare patients. They're tend to be holder Um, they tend to need services and they tend to um, you know have Other requirements to help them stay healthy. So I forget what I was doing this this happens to me. That's all right. The phone somebody's phone just where I'm almost animating. I'm kidding So CMS Medicaid patients that the government is the biggest payer. Why is value-based care so important to Medicare and Medicaid? Because Medicare is kind of governed in two ways you have Medicare advantage which has its own Like processes and models and ways of doing things which you know has proved its success some less and more But it's just basically is here to stay but then you have the other half which is largely fee-for-service And that needs to be kind of rained in so how do you do it without? You know negatively impacting people as healthy one people to get the services that they need you don't want any health care You know withheld from them, but you also want to reward the physicians the providers for quality so and for value Readmissions is that a big factor? It's one of the measures absolutely because that's a measure of oh, something wrong happens something bad happened Like why are they getting readmitted and it costs more money? Correct every time they're getting readmitted well significantly if you if you're readmitted like too fast again, that's over the conversation. Yeah. Yeah, okay So they have all sorts of like yeah, like you're getting tons of rolls and so again, like you mentioned something too That position was the stakeholders accountable care organizations providers care managers and patients right those are four big stakeholders Yes, so going after the value-based care. That's a great concept. How are you going to implement that in? You know in in day-to-day and that's where accountable care organizations come in. That's like a vehicle that value-based care one of the vehicles that value-based care gets implemented and It's really if you kind of think about it. It's probably You know not the best way to say it, but it's real It's a CMS's way of experimenting with different models to see what works and it's actually pretty brilliant Right, especially coming from technology. We're iterating all the time. We're testing if it doesn't work move on check something else Comes in design too rule number one in design. Do not fall in love with your work And if you think about it that way, you know, don't get stuck on something Trust stress test it see what you know, where does it break? Where can it be improved? So For CMS to try to move so many patients into value-based care They need a lot of different models to kind of see you know, what works not the same model is going to work for every single provider Not the same model is going to work with every geography and you know the different dynamics that are happening So accountable care organizations are really the vehicle um, and CMS is driving this concept of health equity now How do they do it? They came up with There's a history to it, but I'll just kind of fast-forward there is a relatively new model called reach ACO, which don't ask me what it's like I forget what it stands for because we just call it reach ACO And one of the drivers of reach is Writing out a health equity plan meaning okay ACO organization you have 20 30 40 50 100 000 patients on your panel And i'm really paraphrasing here Tell us. Yes, CMS doesn't talk like this Um, tell us, you know with your patient population, what are the gaps from an SDOH perspective? What are the patients needs and how are you going to help them? So CMS like I know you're paraphrasing. I'm going to try to paraphrase you even more CMS. You know what CMS is Okay, that's fine. Do you know what CMS is? The Center for Medicare and Medicaid services. Yes. Okay, which creates a lot of rules and regulations So they're they're creating these We'll almost call them policies and procedures for ACOs to follow these In order to they're payment models There we go. That's what they are They're payment models But they had a lot of you know metrics that have to do with quality and you know How do you you kind of get column like bonus points, but I just don't want to get too much in the weeds Not to get you know bored to many people, but you kind of get um You get bonus points for treating patients that have high needs Not medical needs, but high social needs And you want to know who they are because that's really one of the reasons why reach was developed was to be able to go after um More vulnerable populations and be able to treat them spatially is helping provide that data to ACOs or value-based care organizations Well ACOs are form of value-based care organization. Okay, so ACOs are our target model There's a couple of them reaches one of them mssp is another There's only about five hundred fifty or six hundred of those you know entire country I don't know by now how many there are because um there's a couple of new ones and some um left the programs Um, so call it about you know five six hundred of these um Warm hole. I don't remember what was wrong with this. I like you more more. This is this is what covid did to me I don't know if you have any long covid, but for me it is memory. Yeah, and Um, sense of smell we can we can rewind and edit over but I think like just keeping this in here as a stereo Um, you know, you know your audience better than I do It's it's tough what you're the main point is like what you're working on and doing is Very complicated. It is not easy. Everything in health care is incredibly complicated, but I remembered where I was going. That's here so Rewind remember when you know, there's statistic is that 80 percent of your health outcomes are determined by non-medical factors um Organizations physicians they know how to risk stratify their patients from a medical perspective They know the chronic conditions. They know, you know what the medical needs are But what about all the rest? What about the social risks? How do they have any insights on what those social risks are? How do you find out what they are? How do you start bringing it into your workflows? How do you prioritize because you cannot trade all of your patients? Definitely not at once and not definitely not with the same services because health care is a bit of a hammer and nail situation where If you have a hammer everything looks like a nail So if they have a good transportation service, they're going to figure out how to help their patients with transportation services but sth is dynamic it's complex and there's lots of other services that could benefit patients in different ways to Improve engagement, which is probably one of the biggest priorities that Engagement you mean the patient and their families engaging in seeking care or engaging in seeking You know filling their prescription medications. What do you mean everything like engaging with your health like being curious? What what's what's going on with me? What do I need? You know, what do I need help with? Why am I taking medication? Why do I need a certain treatment? How can I help myself? You know get better if it's possible? So and then obviously, you know, the whole The support system around um So physicians want engagement they also want trust today, you know health care is the dirty little non-secret is that it's a business Yeah, yeah, and physicians have less than nine minutes with the patient They barely get through the medical stuff. They're not going to be able to get through, you know, any social care needs So cms has kind of put in different mechanisms to try to collect that data Um from what we see it's still really early on. There's a lot of room for improvement We're happy about that because that's what we bring to the table. So Unlike you know our approach to SDOH is probably different than what the market is used to because of our background and because what we're able to do You know leveraging location intelligence spatial analytics We actually get to the heart of health care, which is granular. I mean, excuse me hyper local. So health care is hyper local Health care is a local story location data is health care data. Yes, right. So You know when we first started in health care We started talking to you know some people and issues like oh, yeah, we already do we already collect zip codes. I'm like zip codes Okay from what I know zip codes is good for Santa Claus, you know to deliver packages through USPS But if anybody knows a zip code, you can have huge ranges and services and quality of life and access to care and conditions You know from one side to another. So all you're doing is kind of muddling muddling it up muddling it up. Yeah Into some kind of like a bulky average. Is it? I'm not kidding. You said boogie earlier. So I just had to that out there That's kind of A drunk boogie word, baby. I'm not sure what that word was so what we do in a very giant nutshell is we identify the health barriers for every single patient on the patient panel Unlike you know What the industry is probably familiar with is a concept of population health, which is also really important and it You know, it definitely helps with understanding diseases and you know, what's your population dealing from a medical perspective So and they basically look at you know 30,000 feet and try to understand what's happening at the individual level Our capabilities kind of inverse that and we model around the individual and then we're able to scale it up to any cohort So we can look at particular chronic conditions. We can look at particular services. We can look at a population of patients of a particular provider um, so there's a lot of different ways of of a segment of stratifying it And being able to build a strategy going back to the health equity plan How am I going to take care of 50, 60,000 patients? Who am I going to prioritize? So we identify the health barriers for every individual patient um, we then uh identify what are the right what's the right intervention type meaning we're Making that toolbox a lot bigger giving a lot more tools to that toolbox and then um, we also match it to the right service so Where does you I was gonna ask a question. I got a deep breath. No, no, I got I have a thought and a question Because she says them specifically about physicians like what's in it for me, right? So you let's say it's an ACO group that has a 60,000 uh, patient population or client population Like how do you answer that when they say because like you said it is a business Health care is a business. Mm-hmm. How do you answer that when physicians say what's in it for me? So first of all if you do it the right way basically our approach There's additional revenue that can be gained Through for example annual wellness visits a lot of ACOs get to maybe 50 percent of their patient population comes in for annual wellness visits This is probably more on mssp's and less on the reaches Um, so many acronyms mssp's and reaches yeah, um medical shared savings plan program something like that Good guess. I forgot that that's good. No, you you more than I did. Look at me five years I'm like, what are you talking about the first thing I did when we started working in health care is bought a dictionary a medical dictionary No, like an acronym dictionary didn't help me. I have one. I'm gonna bring it next time I have an acronym in health care. That's as big as any dictionary that didn't help me Okay, it just had more questions I think I locked myself in the room for like eight months. Yep. It makes no sense Okay, so so physicians For them that they're they're incentivized Better care for their patients of course But but the monitors want to do right. Yes physicians want to do right by their patients, right? They only want to that's what they're there for But there's a lot of barriers that is actually impacting getting that medical care if a patient cannot come for an appointment guess what they're not going to get medical care If your patient is a fall risk and you know, they are recently diagnosed as they would dementia And they are a fall risk If that patient falls and goes to the emergency room That's going to cost you a lot ding and remember we're talking about Value-based care meaning a lot of these organizations And i'm saying a lot and not being more specific because I don't um, you know aggravate anybody Do it Not yet. Not yet. Um, they take risk on their populations so You know, if you do good by mr. Smith, you get rewarded value, right? You get paid for value If you don't do good You're basically on the hook for that cost But nobody wants The doctors to go bankrupt or have any other, you know, financial issues, but those are basically like the guardrails Let's just call them. That's how We're trying to keep, you know, things in check and in line and it's still early So there's a lot of things that we don't know how patients are going to um, you know respond to a lot of these services or what's the long-term effect of these services and that's a lot of The you know the debates that are happening. So you have how long do you think it takes to feel like when can you? Show like this is working. This is a one-year thing a five-year thing a 30-year thing Well reach is on the clock for five years. So it's got to start showing and it's just i was showing some progress But I think it took a little bit For these organizations to get their sea legs on to to really understand like how to how to operate in this Um, and each one is finding their own strengths in order to Kind of figure out how to do this I think or what we're seeing now is now this the real concept of what we're here for is to drive health equity is starting to become real and There's less hesitation. There's more curiosity of like, okay, how can we really do this in a right way? That's efficient That is helping our bottom line, but most importantly helping our patients. That's the one thing for me Oh my gosh because we're all in business. I say it all the time. Money matters like my kids are in school Hopefully my daughter gets married one day and I can pay for a wedding, right? You gotta get cars all that stuff I tell my kids to elope like i'm all in for elope. I just have a nice dinner My parents are probably saying the same thing Um This is a weird question to have to answer this like so, how is your organization compensated? Are you paid by? ACO companies you're setting up direct contracts and then I have kind of a second part question to that so we We work in a way that is a win win win for everybody and that's it took us a while to figure this out Um, so for our ACOs, we basically charge a flat sass fee Um software as a service For another acronym. I know i'm like I became that person I became that person so you're charging a monthly sass fee It's yeah, okay. Yeah, it's a month but um You know bring on as many people as you want the more people are in a platform The better, you know the platform is the stronger the platform is I work with our channel partners to provide the right services to the patients So we welcome ACOs big and small Um, the smaller ones are actually really interesting because there's a lot to work with they're really exciting Yeah, the bigger ones have other challenges But there's a there's a lot of good work. There's they want to do good. So it's a really exciting time I think that's all the time too. Yeah, sometimes physicians get a bad rap because they only have nine minutes with a patient, but it like it's not Because of their choice, right? Direct primary care is a whole other conversation. Okay, second part. So like let's use reach for an example They're on a five-year clock. Mm-hmm. I think that's why there's not much innovation in health care It's like you're on the clock if you don't make this work in five years or less like you got to shut the doors down Well to drive innovation and health care you kind of need To follow the money you need to figure out what's in it for me. Why should I be doing this? So cms probably still has a lot of work to do on incentivizing Physicians taking risk on social care for their patients that there's that's still a lot of work that needs to happen We hear it all the time from physicians like what else do you want from me? I mean we had a physician saying what the you know exclamation What the exclamation am I supposed to be a housing expert like well? No, but There's a time and place to take care of that for your patient But there are other things that you definitely want to help your patient with like in-home modifications for you know Patients that have recently been diagnosed with dementia and art of all risk I knew this was one thing. Sorry. Oh, there's one thing the other is need investment money And what's happening in the you know environment this past year is hurting innovation in health care That's like a great transition to the second episode we do by the way because I told you this time. Am I invited to that? We should come to her. I still don't know. I already said we got I have two people lined up. I just got to pick a date You will you come back? I tell everybody else like would you do this again? Sure, and now we have like we knocked off the rust and I understand the show and that we could just dive in hit the other stuff We're almost out of time now. We're in Eagles jersey next time. So Let's go dolphins play jags Tomorrow because this show airs on saturday wink wink By the way seriously, thank you for coming. Hopefully enjoyed yourself. That's a lot very much There's so much to unpack. I think we barely scratched the surface Um, I wish you the best like how can we help? Who can we introduce you to talk about it more? How relevant social determinants of health are soda? I'm gonna say I'm just saying soda from now Well now you're on the cool kids. I'm one of the cool kids. Yeah, I made the club. Yeah, you're it. They got a long ways to go still Um Yeah, I had a blast. Thanks for joining us. That's what the help just happened [Music]