Hello, everyone. This is Jacob Emerson with the
Becker's Pay Your Issues podcast. Thanks so much
for tuning in today where we're going to
be talking about leveraging data analytics and clinical
expertise to improve kidney health management for health
plans. So to dive into what is a
big topic, I'm joined today by Joe Vadimatum,
who is the founder and president of HealthMap
Solutions. Joe, thanks so much for taking the
time to be with us on the podcast
today.
Thanks for having me, Jacob. Excited to be
here. Yeah. Likewise. And before we dive into
everything we wanna talk with you about, can
you tell us a little bit more about
yourself, your background in health care, and what
it is that you're doing today at HealthMap
Solutions?
Yeah. Absolutely. So,
I'm a Tampa Bay native, so the company's
headquartered in Tampa.
I grew up in Saint Petersburg, Florida.
My my background,
I,
coming out of school,
started off on an actuarial consultant path,
took a right turn after business school and
went into investment banking, and then eventually found,
found my place in health care.
I started off working
at WellCare Health Plans, and
company was focused and is focused on,
you know, now acquired by Centene, but focused
on the government program space. So really zeroing
in on Medicare and Medicaid populations,
which I found to be very rewarding,
and gave me a good sense of what
it's like to work
within those populations
trying to improve their care. I did a
little bit of
everything there,
worked in office of the CEO and network
and quality and finance and strategy, and,
strategy. And,
and then eventually made my way over to
a company called CareCentrix where,
we were focused on a very specific niche
of health care,
leveraging a home health platform nationally to
be able to,
improve the care that people received in the
home, but also
built out a post acute care program while
I was there with a with a group
of people
and, and eventually
risk on that and then also,
acquired a sleep management company that would
redirect,
the side service of sleep testing for obstructive
sleep apnea
over to the the home from an outpatient
setting.
And I'd say at CareCentrix,
it was great learning ground for how to
lead and manage,
and be part of a part of a
team really that led and manage
a, a growth company in the health care
space,
especially serving payers. Right? So we
figured out how to take an existing asset
and and leverage it to be able to
impact more of the health care dollar.
We
also
learned how to drive value through side of
service steerage
and build brand new programs leveraging clinical expertise.
And what I mean by that is that
post acute care program I mentioned, you know,
when I joined the company,
there is a PowerPoint deck, and that was
the full product at that
time. And,
and I was fortunate to be part of
the group that
built it into a real living, breathing,
program that served and and helped,
many, many people to avoid readmissions and optimize
their post acute care
services.
So so in doing that, we worked with
some of the leading clinicians in the in
the country when it came
to transitions of care
and post acute care health.
And I think I took all of those
lessons learned
from both WellCare and CareCentrix
as I went, and started cofounded really, HealthMap
Solutions with with some other folks to be
able to
apply those towards the kidney population.
I appreciate the background there, Joe. And and
did you wanna dive into a little bit
about HealthMap Solutions and and why you wanted
to take on the challenge of of kidney
health management?
Yeah.
So, you know, I I'd say for HealthMap,
we started the company in 02/2013.
And,
you know, at that time, we were really
focused on building out
a population health platform.
I I wouldn't say that we called it
that back in 02/2013,
but that's essentially what we're doing. When you
look back in hindsight,
we're really trying to build out a great
platform that,
could take the spare data,
ingest it, analyze it, and then push it
out to external stakeholders in a way where
they could take it. And and it wasn't
just data. It was insights for them.
And those stakeholders could be providers or members.
With kidney disease, you know, we really were
looking at it and thought, this was around
02/1516,
right, when we really started to go into
the space. And at that time, it was
one of health care's best kept secrets.
Not the case anymore. Right? But at the
time,
it was a population,
and this persists today, unfortunately,
but it it's a population where there's significant
costs.
So,
the predecessor towards end state from end stage
renal disease, which means
you're at kidney failure and you need dialysis
or a transplant.
Before that, you're in chronic kidney disease,
CKD. There's five stages of that. One is
the least severe and five is the most
severe.
And what we saw in the data was
that
every time an individual
progressed
from one stage to the next,
their costs would increase. Their per member per
month PMPM cost would increase, and it would
have a step function increase. Right? So on
average, there's a big jump each time.
The biggest jump being going from stage five
towards
ESRD because you have to then be on
dialysis.
So that was one problem statement that in
itself
just didn't seem to be,
addressed by anyone.
Then when you looked at just the fragmented
health care delivery system, right, the nature of
that creates a lot of clinical gaps for
these patients.
It's it's you got doctors doing their absolute
best, very good doctors doing their best who
are seeing these members. But because these members
are seeing so many different doctors
and,
getting care from other places as well and
getting scripts and, you know, guidance and advice,
it can conflict or be overwhelming
for the patient.
And that creates challenges for, you know, the
really the whole population.
And if you do find yourself
progressing towards that end stage, I mean, the
the stark reality of it is,
at that point, you're facing
a much higher mortality rate, so higher chance
of death. Or if you go into dialysis,
that is a life altering
and life sustaining therapy. Right? So life altering
not for the better, but, really, it's a
challenge. It's a physical and mental challenge. It's
an exhausting process for someone. To give you
a sense,
if you're
on in center hemodialysis,
you're going three to four times a week
for about four hours at a time,
and you're hooked up to a dialysis machine,
which is essentially doing
the job that your kidneys are meant to
do all day, doing it in in a
compressed time in four hours.
That's,
again, exhausting to the patient, but also what
a what a consumption of your time.
It that really does change,
change your life.
And I'd say, sadly, eighty percent or so
of the people who start
dialysis, quote, unquote, crash into dialysis,
meaning it wasn't a planned entry,
and oftentimes that's associated with the hospital admission.
So you had some tragic event happen in
your life, You got admitted to the hospital.
Usually, it's a fairly complicated admission.
And at that point, you know, your kidney
disease is getting its attention, but you're you're
at the end. And so it's almost like
a reactive level of dialysis, which can lead
to a lot of complications. So just
with all of those problem statements stacking up,
both the financial, the clinical, the patient experience,
the providers
feeling frustrated as well because they wanna be
treating these members as best as they possibly
can, but they don't always have all the
information at their fingertips to do so.
We just saw that there is this
nexus, right, this opportunity
for that, you know, quadruple aim, that that
people strive for, but particularly for this population,
where if you could
drive
information
to
the right
provider
and to the member
and help to guide and potentially close some
care gaps, but also empower that member on
their journey
and put them in a position to really
manage their care and be proactive about it,
there was that opportunity for lower costs,
better quality of care,
a better patient experience, and a better provider
experience.
So I think we did a decent amount
of research,
before we really decided to go down this
path to be able to really verify all
those things and to also see if we
thought we could make a difference in the
space. And once we got to yes, there
was no turning back.
Mhmm. And and, Joe, you mentioned that the
the per member per month cost keeps going
up as members
progress within their kidney disease.
You're speaking to a lot of health plans
right now. So what's your core message to
them in terms of why these plans should
be focusing
on their CKD and ESRD population?
Yeah. I I think it's a great point.
I I think the core message is, yes,
there are escalating costs
for this population.
And anything you can do
to slow that progression
and keep a member in a healthy state
is good for your members,
and it's financially going to be beneficial for
them, for the health plan.
And if you partner with someone like HealthMap
for for the for HealthMap as well, because
a good partner is going to take risk
in their ability to deliver on that value.
I think
addressing this population
who is,
multi chronic,
so multiple comorbidities
and high cost,
there's a great opportunity
to
improve their health. But also,
if I'm sitting in a health plan shoes,
if I bring myself back to those days
that I worked at a health plan, I'd
be looking at this group and saying, well,
there's a revenue opportunity here as well. Right?
There's a clinical opportunity, which
is paramount,
which translates into a cost savings opportunity.
There's also a revenue, a top line opportunity.
If you can drive better quality, that should
impact star scores,
if you're a Medicare plan or quality scores,
you know, if you're in any other type
of plan. And there's also the opportunity to
make sure that
chronic repeatable
diagnosis codes are appropriately recaptured. People will think
about
HCC
clinical,
intervention, right? Because it's the way through which
one provider can communicate to another provider asynchronously
about what's going on with that patient. If
you have the appropriate
level of codes recaptured
and shared and communicated across providers as you're
coordinating care,
then, the patient will get,
better and more appropriate care. And and really,
that's our goal. So I think
for the health plans, this should
scratch all of the itches that that that
they're focused on.
Again, it's how will this impact top line?
How will this impact a reduction in cost?
Will my members be happier as a result
of us managing this holistically?
Will my providers be happier? And and it
checks all of those boxes.
Boxes. Absolutely. And it sounds like it makes
a lot of financial sense, especially for for
health plans to really focus on this population
specifically, Joe. I have to ask, how do
data analytics and technology come into play here
within HealthMap's program?
Great question,
in many different ways. So,
you know, in the early days,
and it continues through today, we really focused
on being highly analytical in what we did.
So, you know, there's there's that Pareto that
everyone will reference where
across the board, not just for kidney members,
but across the board, about five percent
of the population
consumes 50% of healthcare expenditures.
So it's highly concentrated.
It's not as concentrated
in kidney disease,
but it there is a level of concentration.
So
for the populations we manage,
we found that somewhere between 25 to 30%
of the members are going to consume 80%
of the healthcare costs.
And being able to identify those members
is really important. I think the
the the mistake or or the misnomer is
that all kidney members, because they're so, they
have
have a lot of comorbidities, they're all going
to be very
high cost. Not necessarily the case. It fluctuates.
And so you have to be able to
identify
which members
are going to represent
significant costs in the future
so that you can find them during that
window of
opportunity where you could prevent progression of disease
states.
That might be kidney disease, but we also
are very focused on all of the comorbidities
because the driver
of advancing kidney disease tends to be
unchecked diabetes or unchecked hypertension.
So really, we've created a program that's holistic
in nature because we're managing
not only their kidney disease, but also the
the patient's comorbidities.
We're looking at other things that might impact
their ability to manage that care. Right? So
it it goes beyond the the clinical disease
itself.
Behavioral health is a clinical disease. We'll look
at behavioral health. We will also look at
social determinants of health. We're really motivated and
focused on just improving,
the access to care, the quality of care,
and the coordination of care for, all of
our patients.
So I would say I'd put that into
this sort of
predictive analytics, advanced analytics bucket as bucket number
one for tech and analytics.
The second
is really how do you engage with the
population.
So
digital engagement
is really critical.
You know, we at HealthMap, we,
we've always had a focus on this, but
we recently acquired
a company called Carium,
which is really a
phenomenal they built a phenomenal
digital ecosystem
for
providers,
members,
and
I use the word members and patients interchangeably,
but providers, patients,
and really health map to be coexisting and
sharing information.
And I think digital engagement is
just so critical. I think titrating
your level of engagement with
patients is really important.
What I mean by that is you could
have,
somebody who's CKD three
has,
you know, heart failure,
has
is diabetic,
and is a smoker, and also can't really
get around the house so well.
Right? That person
might need a home visit.
So we might arrange for a home visit
for that person.
That doesn't mean everybody should get a home
visit. Right? There's some people in our population.
You could be a stage four member
who is actually really well managed. You
can be a stage four member who is
really empowered. You have great control of your
health. You know what kind of foods you
should be eating. You know the medications you
should be on. You've got a really great
schedule of seeing your providers at the right
time, you're getting your labs done so you're
monitoring your
health,
that person
would scoff at a home visit, right? We
would say we wanna, we said we wanna
put someone in your home, they'd say they
might say, look. I'm really busy. No thanks.
I'm good.
But they could use
something simple like digital engagement
of medication reminders.
They might still be on quite a lot
of different drugs, and they could use a
reminder for, don't forget to take this med
today, or, hey, don't forget this script is
running out. Just make sure that, you know,
we get it refilled.
So
there's
a a a wide array of
intensity and types of modality of intervention
that you have. And I think having the
technology capabilities
to modulate that well is really important, and
that's another way it plays a role for
us at HealthMap.
And then, you know, I've kind of
tiptoed around AI with predictive analytics,
so far, but our third bucket would really
be AI. Right?
We're investing in this. We're leveraging it for
your traditional
machine learning predictive analytics, like I mentioned ear
earlier,
but we're also using it leveraging generative AI.
Right? And so far, we're keeping that mostly
inwardly focused,
but we have an AI digital assistant that,
supports our clinicians as they're speaking with
providers and members. We have the capabilities that
just makes our team way more efficient
just as they're
prepping for a call with a provider or
with a patient, for instance.
So that
they're spending less and less time on administrative
work and more and more time practicing at
the top of their clinical license.
It just puts the puts a clinician in
a different mindset.
We all hear about physician burnout, right, and
being having to
document and over document and review all the
documentation.
And it it ends up creating this unbalanced
approach where so much of their time can
be,
a physician's time could be focused on administration
as opposed to actually being in front of
the patient or being present with that patient.
We hear about that happening in the marketplace.
We wanna make sure that does not happen
here at HealthMap.
So we're leveraging AI to do that so
that when one of our care navigators,
which is typically
an RN,
is in front of a a patient,
they can spend the time really
empathizing with that patient, doing motivational interviewing,
and,
you know, practicing at the top of their
license. So
I think those those are the ways that
we're using it so far. And,
you know, AI is a brave new world.
We'll figure out the right ways to deploy
it. We're cautious with it as at the
same time,
and making sure that, there's always a human
being between the AI and the patient or
the provider. We think that's important right now,
especially when it's in its nascent phase.
Absolutely. And let me hook on there to
your last few points, Joe, about, your your
clinical team and the work they do because
you mentioned this is all about improving the
quality and coordination of care for for members.
As as you know, managing kidney disease requires
very very specific clinical expertise.
So how does HealthMap's clinical team support members
and providers effectively throughout this journey?
Yeah. I'm I'm glad you asked because I'm
I'm so proud of our clinical teams. I
really am.
We so first, they're they're led by our
chief medical officer, doctor Howard Chaps, who's,
you know, practiced as
a a phys ER physician, actually, and, and
also was at
Centene,
previously WellCare.
So
I would I would say, you know, between
him and we have, wonderful,
nephrology medical directors, we have a scientific advisory
board,
of multiple specialties, nephrologists, internal medicine, cardiologists,
you know, pharmacists, etcetera,
and endocrinologists.
That group,
collectively, I think of as kind of the
the clinical brain of the program, so to
speak.
And,
what they're really doing is
designing the right care pathways and protocols
to be able to be shared with our
our care navigators,
our our clinicians who are care navigators. Those
are
RNs,
sometimes nurse practitioners as well.
They're a combination of people who are in
the field, so they could be
face to face with the provider as we're
interacting with, you know, the the providers or
they could be, you know,
remote and they could be telephonically
interacting.
Our clinical model is structured so that
we take an entire population
and we identify,
the physicians that they're currently seeing, right? So
they see
a lot of different types of physicians, but
primarily they'll be seeing PCPs,
nephrologists,
endocrinologists,
and cardiologists, just given their comorbidities.
That's what we tend to find.
And what we'll do is we go into
the model our clinical model is one where
we're not
trying to compete with those providers.
We are very much working
alongside them. In fact, we're an extension of
their
practice. Right? So I think that really sets
us apart because
if you go in and you compete with
a provider in a given market, all of
a sudden,
you know, the the lines of communication are
a little bit harder and care coordination can
become a little bit more challenging. Right? So
we don't do that. We come in and
we're an extension of their practice.
There's as I said, there's some folks who
will be feet on the street. We'll work
with those providers to be able to share
information with them that they were otherwise missing
and highlight where there might be some care
gaps they just didn't know about because they
didn't have the data.
At the same time,
that group will be connecting to the member
to be able to say, hey. Look. We're
coordinating, working with your physician.
So you have this sort of coordinated, aligned
care team on your side supporting you.
And let us walk you through,
all of the challenges you're facing, and let's
get to know you and let's help empower
you in your journey to manage, those chronic
conditions. And really the goal for us, our
mission is to make it so that,
you know, kidney disease is not the primary
focus of their lives, that it's in the
background because it's being so well managed.
I'd say as those as those clinicians and
that clinical team works together,
they're supported as well by
social workers and dietitians and pharmacists. So it
really is that multidisciplinary
team approach that we bring to our
patients. And at the end of the day,
they're really focused on outcomes.
Right? So
to give you an example,
Jacob, that some of the outcomes that we
have are
slowing the progression.
We we slow the progression by about thirty
percent on average,
reducing
inpatient
and ED visits,
increasing plant starts to dialysis so that you
don't have that crash that I mentioned earlier,
and ultimately lowering cost. And I'd say
that
that's the crux of the whole program. I
mentioned that quadruple aim. I mean, for us,
we're focused, and our clinicians
are using the the data and analytics we
have to coordinate care, make sure that,
the patient's on a path towards better health.
And what we see when we do that,
when you look at the sort of financial,
ledger, so to speak, of that, you'll see
physician costs go up. Right? So our health
plan partners will see some increase in physician
costs, but that's drastically offset by a reduction
in hospital admission costs,
reduction in ED visits, and other facility costs.
And that's how you know,
really I
I was just talking to,
a leadership group here at HealthMap.
That's how you know that, we are mission
oriented because
the wallet matches the heart. Right? Like, it's
tied together. If we don't do better on
on outcomes for members, we're not gonna drive
savings. If we don't drive savings, then, you
know, in a value in our value based
care models, we're not getting compensated. So,
we are very much aligned on and focused
on that mission, and it's a it's a
pure mission, which is, a nice place to
be.
Fantastic. Well, I appreciate that overview and those
examples you shared, Joe. Some really great ones
for our audience.
Before we go, can you detail for us
how HealthMap's approach has evolved over the years
and what the future looks like for HealthMap?
Yeah. Absolutely. I mean so the the fun
thing about being in health care is that
it's never stagnant. Right? The the,
the landscape is constantly evolving, and we have
to keep evolving with it.
And and I I'd say
that's first and foremost for us. You know,
we've learned how to some of the things
that we've we've been we've done over time
and continue to do and improve on.
For instance, as we grew, we've been growing
quite a bit,
we've learned how to tailor our delivery to
different types of providers based on their characteristics.
Right? Some providers,
you might be talking to a massive group,
and you have to
deliver information to them and even access them
in their time in a certain way. That
would be very different from a small group
or a different type of specialty.
Sometimes,
you know, the the age of the physician
matters. Right? Like,
docs coming around in med school might interact
with you very differently than docs who've been
practicing for thirty years.
So we we've learned how to tailor our
approach to physicians, and we've also learned how
to tailor our approach to members
based on where they're at in in their
lives.
And we manage
Medicare members, Medicaid members, commercial members, exchange members,
all have very different needs.
So I think tailoring our approach is one.
The other way we've evolved
over time
you know, I think in the early days,
and and
this is true of many who kind of
go into a newer space. You see all
this opportunity
when you connect
with the external stakeholders, those providers and those
those patients.
You wanna be able to share all the
information with them all at once. And there's
a lot of evidence based guidelines and, you
know, care gap opportunities
that you could throw at these patients.
It it just tends to be,
overwhelming
for them.
And when you
when you can, first of all, curate
your interventions, we've we've leveraged a ton of
clinical expertise and data analytics to figure out
how to do that,
because it's hard to prioritize them.
But when you can curate those
interventions
and narrow them down and then deliver them,
you know, in the right sequence,
we find that you can get a lot
more throughput
of compliance and care gap closure as opposed
to trying to give them everything at once.
If you just thought about it, it'd be
overwhelming if I I told you, hey. I
want you to,
change your diet. I want you to take,
you know, these different drugs. I want you
to stop taking other drugs. I want you
to see your nephrologist
more often. I want you to go see
a cardiologist. And,
you know, I've got a bunch of labs
you have to take once a quarter. If
I just gave it to you all at
once, they would
you might feel like you failed before you
even started. But if all I said was,
hey. We really think you should go see
a nephrologist. Can we get you to a
nephrologist?
That's more manageable. Right? And so I think,
we've we're along with tailoring the approach,
being able to
curate and focus,
the the time and attention we have with
members and providers,
has been a really strong evolution in our
program.
Wonderful. Well, Joe, thank you so much for
taking the time to sit down with us
and for sharing your insights with our listeners.
We really appreciate it. Thanks for having me.
This is a lot of fun. I appreciate
it. Yeah. Absolutely. And I'd also like to
thank our podcast sponsor, HealthMap Solutions. You can
tune in to more podcasts from Becker's HealthCare
by visiting our podcast page at beckershospitalreview.com.