David E. Williams: This is David Williams, co-founder of MedPharma Partners and author of the Health Business Blog. I’m speaking today with Jay Mason, CEO of MyHealthDIRECT. Jay thanks for your time today.
Jay Mason: Absolutely. Looking forward to talking to you David.
Williams: How do you fit into the health care system? What problem are you trying to solve?
Mason: We have a number of issues that we help our clients address, but it essentially comes down to getting patients and insurers connected for care at the right place and time. Often times there are roadblocks and miscommunication. People either don’t know what their options are and they make bad choices or they just don’t know where to turn for appropriate medical care in the right clinical and financial setting.
MyHealthDIRECT aggregates calendar availability of doctors throughout a community or a network, depending on how it’s deployed. Think of it as OpenTable for health care. An advocate, someone working on behalf of a patient or member, can instantaneously get to the website, put in the criteria and search for, compare and find the most appropriate appointments for people. They can then instantaneously book those appointments.
Williams: Where is it deployed? What is a prototypical situation with a patient?
Mason: There are number of very broad initiatives that are going on all around the country that we come alongside of. This includes supporting primary care medical home initiatives. and redirection of patients when people are showing up to the ER for non-emergency care. Health care stakeholders need to find a way to connect those people to the most appropriate medical home and then get them engaged.
We also work on the care management side where people with multiple chronic conditions not only need to engage, but really need to fall within the treatment parameters for their conditions.
We work with hospitals on the emergency department. When a patient is being triaged and it’s determined they’re non-emergent, if that hospital has an EMTALA compliant triage process we can become the next step beyond the triage itself. We can offer great alternatives for treatment. We can get a patient in later that day or the next morning to a clinic in a patient’s neighborhood, which is on the patient’s plan and speaks the patient’s language.
We can help after a patient’s been treated in the ER and needs follow up care. We certainly don’t want them to re-present for the follow up at the ER. Here is the opportunity for the hospital to schedule “the removal of the cast” or “the checking of sutures” weeks out. They would be able to book those appointments and put them into the record and make sure there’s a good cultural match so that these people do appropriately engage.
Williams: Jay, is there a particular socioeconomic or demographic category of patients that you’re dealing with or does it apply across the board?
Mason: Well on the hospital side, particularly when it’s ER focused the incidence for ER encounters is highest with the Medicaid population. It’s vastly higher than that of a private patient, commercially insured. So Medicaid is really where we’re focusing. We’re in nine markets around the country, engaging with the Medicaid population. We’re similarly engaging with the self-pay or uninsured population. It’s a lower incidence rate, but certainly is an issue and so that’s what we’re concentrating on today.
We also have initiatives that really get in front of the ER encounter or even before people are contemplating ER visits. It works with call centers in the community and it’s working with managed care plans in their care management and their disease management areas. They engage early on with people and try to get them to navigate appropriately.
Williams: What was the value proposition when you started the company a few years ago? How is it shifting with health reform and the emergence of accountable care organizations and patient centered medical homes?
Mason: We’re now a six year old company and our goals six years ago were the same as today: Try to get people to the right place at the right time.
We took a disruptive innovation approach as described by Clayton Christenson and asked where is the need great but the solution is not obvious? Applying that to health care we said it seems to make sense ito concentrate initially on Medicaid and uninsured patients who are inappropriately presenting themselves to the ER. That’s a great problem, an obvious problem to fix and so we began there. But really as a health utility, once we’re deployed in a community, we’re readily used for inpatient discharge planning, hospital call centers and more broadly for managed care plans. We plan on being used by many once we’re fully deployed.
And then lastly, we work with HIEs. As HIEs come into a community and are deployed, we can bring our solution set of searching and scheduling appointments into an HIE environment. Again we become –for lack of a better word– a health utility.
Williams: The HIE (Health Information Exchange) has gotten a lot of attention, but there have also been some challenges in terms of the business models and the technical infrastructure. Can you give me a practical example of what you can do with a Health Information Exchange in place that is more difficult or impossible without one?
Mason: Yes, HIEs certainly have their challenges. We’ve got some good experience, one in particular is here in Wisconsin with the Wisconsin Health Care Partnership and the Wisconsin Health Information Exchange. It’s a metro Milwaukee based HIE where all the hospitals participate and they utilize our tool. They’re sharing clinical information throughout the community but we’re also adding our scheduling abilities, so it’s a universal community-wide platform that we come alongside of and are helping.
It’s had some great results. It’s been operating now for a couple of years and in that it’s a sustainable model. It’s got really strong outcomes and it’s a highly collaborative approach.
Williams: When you go into these situations, do you often find people on the cutting edge that want to adopt and people that adopt a little bit later? Is there that kind of pattern or does a whole market adopt at once?
Mason: We’re a first mover in this space. It is a very old problem we’re addressing, but we’re using new technology that’s been used in non-health care environments. We’re now applying them to health care. I think it leads itself to be used by early adopters and innovators, but I think it also equally applies to hospitals that suffer of pain financially. A good case for that is National General in Nashville, which is a great hospital. They’ve been putting some programs into place to be able to be a good resource to the community. We sit very well with that. So we’ve come alongside of them and have very successfully deployed and are complementing their efforts to serve the community.
Williams: Is your solution invisible to the patient; do they see it? Is there any continuity with patients over time or just continuity with providers and health plans?
Mason: That’s a great question. It’s an advocate model today. Case workers, discharge planners and PAs use it in the ER. Call center folks and disease management on the managed care side use it as well. So the patients have some interaction with it, but not directly. They’re not logging into our website directly. But, in the hospital environment at the conclusion of making an appointment, it’s printed out as far as a summary of the appointment, the location of it and any other instructions in their language. That way they are benefitting from having a written confirmation of their appointment based on their needs. They do that that successfully today. That’s how they’re engaged with it.
As far as the change, one thing we found is in the old manner when you went to a hospital and were directed to a community clinic, studies show that between three and five percent of the time that patient actually presented to that location for an appointment. Those are very low, dismal numbers.
We’re in the sixty-five to seventy-five percent show rate, a significant improvement. I think that has to do with the fact that we’re asking the right questions. We’re asking about language, importance of proximity, what payer they have. To do a culturally competent match is a real game changer for them. They find locations that are going to be most appropriate for them.
Williams: There’s a lot of talk about overcrowding of emergency rooms and people using them inappropriately. When you have that kind of intervention and that success rate in terms of the percentage of people that are showing up at a health center, does it shift the burden and the bottleneck onto the health centers? I know a lot of these places don’t necessarily operate with that much spare capacity. Do you see downstream impact on capacity utilization?
Mason: Well we do. Certainly community health centers, in particular federal qualified health centers and rural health centers for Medicaid get cost plus reimbursement. So their form of reimbursement looks a little different than for everyone else. And in fact their mission is to support and serve the Medicaid population. So they’re interested in this business and they desperately want to engage with these people and be a path of appropriate treatment for chronic conditions. So that’s their stated mission, clearly stated mission and so they are interested. There have been funds put in from the Administration, over the last two Administrations, to increase capacity with the community health centers. So I think the timing of that has been critically important and we’re able to connect into that.
Then on the charity side, conversely we have a front end revenue cycle management feature so the clinic prospectively can say this is the mix of payer that I’m interested in getting for these appointments.
They may want X percent Medicaid, Y percent Medicare, and Z percent self-pay or sliding fee and charity. On a prospective basis they can basically control the revenue cycle management functionality, which helps them get the patient mix that works best for their practice.
Williams: How will your field evolve over the next five years? What shifts are likely?
Mason: There are going to be a tremendous number of shifts occurring in health care, but I think if the trends are to continue we will see an uptick in accountable care organizations. Certainly care management and care coordination are critical components for a successful ACO. We’re kind of the glue that holds that together.
While a hospital may have a large number of affiliated physicians, there’s a large network of people who are unaffiliated and not on the same IT infrastructure that they’re going to need to connect to and coordinate care with. In our talks with C-suite executives of the health systems, we’re a welcome tool in that respect so I think that trend certainly is going to continue.
I think the bigger trend is just the budgetary challenges that the states are having with Medicaid and the feds with Medicare and their emphasis on getting people into the right clinical setting, but the most cost effective setting as well. That means searching for availability and that’s where I think our tool is going to be of particular importance.
Williams: Jay, those are the main questions that I have for the moment. Any topics that we haven’t covered today that you want to make sure to put on the table?
Mason: In the evolution of our company, the last area of growth for us is to begin to partner to provide a direct to consumer tool. It can include scheduling. Certainly there are a lot of practice management systems that provide that on a one to one basis; one patient to one clinic. But we are interested in working with our clients to begin to open that up and permit individuals the ability to be able to go on to their health system or their managed care plan or maybe their HIE and to be able to find and book the most appropriate appointments for them. That’s where we see the future going with our company and how we fit into some of these trends.
Williams: I’ve been speaking today with Jay Mason. He’s CEO of MyHealthDIRECT. Jay thanks so much for your time.
Mason: Thank you David.
August 8, 2011