Why clinicians can’t keep ignoring care coordination [PODCAST]

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“Provider organizations may look at their budgets and think the traditional model of fax machines and landlines is serving their entity in optimizing revenue streams. They may even look at their providers’ full schedules and believe there isn’t a patient population that still needs care. But this would be a miscalculation. Without appropriate methods to close the gap on referrals and communicate appointment information to patients, no-show and cancellation rates risk burdening providers and costing practices and health systems millions. With the right technology and procedures at the care coordinator level, patients in need of care can be seen quickly. Patients that otherwise would slip through the cracks in a health system’s infrastructure are connected with the care they desperately need. Finally, with this increased connectivity and patient care, provider organizations can continue to expand their networks and connect with more providers and services to make sure they stay competitive and relevant across the health care ecosystem.”

Curtis Gattis is a health care executive.

He shares his story and discusses his KevinMD article, “Why clinicians can’t keep ignoring care coordination.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. On today’s show, we have Curtis Gattis. He is co-founder and CEO of LeadingReach, health care’s communication network, and he wrote the KevinMD article “Why clinicians can’t keep ignoring care coordination.” Curtis, welcome to the show.

Curtis Gattis: Thank you so much, Kevin. It’s a pleasure to be here.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Curtis Gattis: I’m a native Texan. I grew up in Houston, went to school at the University of Texas here in Austin, and have been in Austin since the early ’90s. I started my career in sales and marketing. My early journey was with Dell Computers here. Everybody’s, of course, heard of the big PC manufacturer. I joined Dell in what I like to consider the tail end of the glory years. It was just amazing how that company blew up, and I learned a lot. In particular, I found my niche was sales management, sales leadership.

So I started my career there and quickly transitioned into the venture capital world in the early 2000s, and found that I really appreciated the process of what we call the product-market fit, just trying to figure out, how do we go and determine which products can we go and develop and sell into the market, and determine where’s the value there, and are people interested in it? And then, once we get that product-market fit, scaling sales organizations. So I really think in terms of kind of pipelines and funnels and processes. I’m a very process-oriented individual.

I was fortunate enough to take a break in my mid-30s, about 10 years ago, and really just try to figure out what I wanted to do next. I found some technology that I thought was really interesting and went down that same journey, and after a couple of pivots, found myself squarely in the middle of health care. So, classic tech guy that just kind of likes to solve problems, and found that there is a huge opportunity to improve communication and care coordination throughout the entire health care ecosystem.

Kevin Pho: So when you made that transition from the technology realm into health care, what were some of the biggest surprises that you had about the health care industry?

Curtis Gattis: Oh my goodness, they are pretty much innumerable. The first one in particular is how difficult it is to impact change in health care. It’s really hard to go in and change, in particular, what we’re focused on, which is the fax machine, right? If you think about it, when we go into any new market doing what we do, there are a hundred different EMR platforms in a big city like Miami or Dallas or Boston, and they don’t talk to each other, and therefore they fax. And there are about 15 billion faxes per year in health care.

A little fun fact for the audience, you guys can stump your friends with this one: The fax machine was patented in 1843 with a telegraph. So what is that, 178 years ago, or whatever the math works out to there? So that’s a long shelf life for technology. And as a technologist like myself, I thought, “Hey, this is going to be a slam dunk. We’re going to be able to go and kill the fax machine.” It doesn’t really exist anywhere. And unfortunately, just because of the nature of health care, EMRs, who are protective of data and obviously their market share, and again, just the challenges around connectivity and interoperability, the fax machine is still prevalent in health care, and that’s been the real shock to me.

We deliver what we believe is a far superior solution that really protects patients and helps folks focused on value-based care as well as fee-for-service initiatives. And yet there are some doctors that I talk to who are going to go to their grave with their fax machine. And so that’s really just been the biggest eye-opener for me: It’s taken a long, long time for us to get to some sort of critical mass, and that’s just because, again, it’s just difficult to impact change in health care.

Kevin Pho: So I talk to a lot of health care CEOs, and they come in with big ideas and want to move the needle, but then they run into the headwinds of health care that you talk about. So what separates a successful health tech startup that moves the needle from one that doesn’t?

Curtis Gattis: Yeah, that’s a great question. I’d say the first one is grit: just that ability to stick it out, that ability to really wake up every day being passionate about what it is that you’re doing and grind it out, right? It takes a long time, a lot longer than other industries that I’ve interacted with. So first and foremost is just determination and grit. We incorporated our company in 2014. I actually started working on this in 2011, so I’ve been doing this now for 10-plus years. And so part of it is just that grit, that “I’m not going to give up. We’re going to keep doing this. We’re going to keep making it better.”

I think, beyond that, it’s really just been exciting for us to determine: How do we bring value? Once we start to bring value, that’s when you can really start to open up doors. And there have been a number of lightning strikes throughout our company history where we realized, “Oh my goodness, hey, here’s what value-based care is really struggling with. How do we go empower those folks?” And then learning that, of course, not everybody’s interested in doing value-based care, so how do we serve the fee-for-service audience as well and ensure that they have the tools and resources that they need? So for me, it’s just been really exciting doing what I do best, I believe, which is really to talk to customers, understand where the pain points are, and then take that feedback back to our engineering team and come up with technology solutions that help alleviate those pain points.

Kevin Pho: All right, let’s talk about the KevinMD article that you wrote. It’s titled “Why clinicians can’t keep ignoring care coordination.” Now, for those of you who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Curtis Gattis: Yeah, you bet, absolutely. At the highest level, it’s really all about putting transparency and accountability into the transition of care. And so the premise of the article is really just around, regardless of what incentive model we’re talking about, fee-for-service or value-based care, we need to do a better job of transitioning patients. The reality is, the statistics say 50 percent of paper-based referrals ever convert to an appointment. So if I’m taking risk, that’s not acceptable. I can’t say, “Hey, Kevin, I’m going to send you over to the cardiologist and hope and pray that you get there.” I need to know you got there. I need to understand what happens. And then I need to understand, once that loop is closed, if there’s additional work that needs to be done, e.g. an imaging study or procedure, I’d like that to be performed in network, especially if I’m on the hook for the cost of that patient.

So we first kind of came to this from the perspective of a sender, right? That ability to transition patients and put some accountability into that process. So that led us to this concept of what we call the referral-to-appointment ratio: If I send you, as a provider, 100 referrals, what percentage did you get scheduled? And if 50 percent is the baseline for faxing, I expect it to be higher than that. So that was the first aha that we had.

But then the really interesting thing was, we sat down with a huge health system here in Austin, and we were talking to them about what we were doing. We were working with the value-based care ACO that was sending them patients with our technology, and they said, “Hey, Curtis, this is really cool, but the reality is we get way more faxes than we get these digital referrals. So we’ve got two processes. We’ve got this futuristic thing that is great. We can chat, we’re no longer playing the blame game, everybody knows what’s going on, it’s a better way of doing things. But the reality is we also have faxes.”

And we really dug into that process and started to talk to them about, “Well, how are you managing those faxes?” And they said to me, “Well, have you ever seen those accordion-style folders?” Like, “Oh, yeah.” “So we put ‘Left message one’ on the fax, we drop it in there, and we expect our team to call them back.” Well, I’m a big fan of the adage “You can’t manage what you can’t measure.” And what was the big aha to me is, health care does a horrible job of managing what we call the patient pipeline, right? Which is that notion of, if I get 100 referrals, what’s my close rate? What’s my conversion metric? What is that, what we call that referral-to-appointment ratio?

So we already talked about how that’s important to a sender, right? Regardless of whether I’m taking risk, I want to know. I’ve got a sick patient that I’m sending somewhere, and I need to make sure that patient is being seen. But as I sit down with the health systems who are still very much focused on fee-for-service, we realized, “Oh my goodness, this is a pipeline management tool. This is a CRM that does not exist in health care.” And it’s really understandable, right? You think about it. I talk to clinics all day long where, hey, the fax machine is buzzing, and the lobbies are full, and the doctors’ schedules are full, and so everybody thinks they’re doing a great job. Meanwhile, we look at the data and realize they have 500 patients who aren’t getting phone calls, and that represents 500 people who are not getting the care that they need. It also, in all candor, represents an opportunity for them to hire more cardiologists, because they have the capacity to have the demand, if you will, to go and service those patients.

So the big aha for us was, let’s go and start to teach health care a little bit more about this concept of pipeline management. And again, I come from technology. I’ve been responsible for delivering revenue for the board of directors and those kinds of things, so I naturally think about these types of things. And you look across every industry: Every industry can talk to you about their lead generation, their demand generation, their conversion metrics, and they manage it aggressively. But health care doesn’t really think like that. So this has been really great for us, to start to open up the eyes, if you will, of those operators of these specialty clinics and these imaging centers, and help them understand, hey, there’s a lot of opportunity right there underneath your nose, first and foremost to serve patients better, but also to make more money and improve the operations of their clinics.

Kevin Pho: So tell us a story of what the situation was before and the situation after you implemented a technology solution.

Curtis Gattis: Yeah, you betcha. So again, back to the adage, you can’t manage what you can’t measure. So typically, what we do when we sit down on the receiving side, on the specialist side, is we just determine a baseline: What is my conversion metric? And typically what ends up happening is we start to pay attention to that, and it goes from a 50 percent average to kind of the low 60s or so. OK, great.

So we did this with a massive national health system in one of their cardio clinics here in Austin. Back in 2015, we established this baseline of 62 percent. Within nine months, we helped them drive that number to 94 percent. So their team just did a better job, with an easier way to manage these callbacks, of getting these patients scheduled. That clinic grew a million dollars in revenue at the clinic level, not including the downstream revenue of increased procedures, increased imaging studies, etc., for a very nominal $349 a month with us. We actually did a calculation of the ROI. It was a 19,000 percent ROI for that one clinic. So that was the real eye-opener for us, which was, again, hey, there is a great opportunity for us to put this technology in place, help them grow, help them meet their fee-for-service objectives, help them compete in the market, while serving the patients, and of course those senders of those patients to them, in a much more effective manner.

Kevin Pho: We’re talking to Curtis Gattis. He is co-founder and CEO of LeadingReach, which is health care’s communication network. He wrote the KevinMD article “Why clinicians can’t keep ignoring care coordination.” So Curtis, look into your crystal ball. In the next one to two years, what do we have to expect when it comes to that intersection between technology and care coordination?

Curtis Gattis: Yeah, that is a great question. I think we have to expect, and the good things we’re starting to see, the interoperability focus, right? The government, CMS, is continuing to beat that drum, which is critically important. And again, I think at the end of the day, we’ve just got to get away from faxing, right? There is no future model, regardless of whatever it shakes out to be, that can be dependent on such an archaic technology as faxing. So the good news is, I’m starting to see people embrace that.

I talk a lot about the ability to cast a digital net around an ecosystem. If I’m an ACO or a value-based care provider, I want to do that, make sure patients are getting the care that they need in the appropriate setting of care. Conversely, if I’m talking to a health system, they want to put a digital net around their ecosystem: their EDs, their urgent cares, their PCPs, and their inpatient discharges, right? Those are all their access points, and they want to make sure they’re going to their employed and affiliated providers, and then, of course, getting those procedures and imaging studies, in other cases ancillary services, back into their network. So we’re starting to see more and more people understand and realize that leakage and keepage is critical for, really, again, all business models.

And that’s where I believe kind of the foundation for next-level value-based care happens, right? When we engage with a value-based care organization, we start talking to their specialty network, and it’s no longer, “How do we feel about referrals?” Now we know what’s going on, and that helps the PCP articulate their value: “Hey, Dr. Kevin, did you know I sent you a thousand patients last year? That’s valuable, I believe.” And then we can also talk about, how well are you doing servicing my patients? Is your referral-to-appointment ratio in the 70s, 80s, and 90s? Are we doing a good job passing those patients back and forth, right?

And then beyond that, we can continue to build from there. Once we have that foundation in place, I can have a next-level conversation with you, Kevin: “Hey, Dr. Kevin, can you talk to me a little bit about why is your MRI utilization rate 3x the market? I’d like to have an understanding and a conversation with you about that.” Or, “Can we talk about site-of-service selection? When I send you an employee who works for this organization, their plan design means that that patient needs to end up in this surgery center versus that surgery center.” And all of this benefits the patient, and all of this benefits those who are paying for that patient’s insurance, be it the government, employers, or otherwise. So this is really where I’m excited to see people starting to understand and embrace that this leakage and keepage strategy helps everybody involved, and again, the patient is at the center of this equation.

Kevin Pho: So, leakage and keepage. Do I have your permission to use that as a quote later on?

Curtis Gattis: Yes, please do.

Kevin Pho: All right, my final question: What’s your take-home message that you want to leave with the KevinMD audience?

Curtis Gattis: You bet. I think it’s just, understand this concept of referral-to-appointment ratios. As a sender, it is a mechanism to hold my network accountable to a better standard of care, right? I no longer have to question what happened to my patients once they left, and especially the high-risk patients, right? Those are the ones that need to be navigated. So as a PCP or a sender, I would suggest that you start to think about, how well are these specialists actually servicing my patient population?

As a receiver, it’s obvious, right? It’s that undeniable ROI. And I would recommend, and the big groups that we work with have massive dashboards with their BI tools where we can start to say, “Hey, how are all my cardio, how are my ortho, how are my neuro clinics doing and managing this?” And the reality is, more times than not, it’s just staff behavior, right? Time is the enemy in the referral process. If you give a patient one phone call in the first 30 days and don’t get that second phone call to them until that second month, the chances of them coming in have almost gone to zero. And the chances of them going out and Googling and starting to look at Yelp reviews and other types of things, and getting them off course, just increase by the minute.

So as a receiver of this technology, or receiver of the referral, what I really encourage people to think about is throughput metrics: How quickly is my team actually getting that first phone call out there? And we all know that we’re all going to voicemail when we call patients, right? That’s just the reality of it, right? I ask that question all the time: How quickly, or how many times, do you leave a message for patients on your first phone call attempt? And everybody laughs. So how are you managing those follow-ups? The reality is, there’s a huge opportunity to understand: What is my staff doing? What is that scheduling team doing? And how quickly are they getting these patients through the process, so they have the best possible chance to get the care that they need?

Kevin Pho: Curtis, thank you so much for sharing your time and insight, and thanks again for being on the show.

Curtis Gattis: You bet, Kevin. Appreciate the opportunity.

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