This is Alan Condon with the Becker's spine
and orthopedic podcast. And I'm thrilled to be
joined today by Doctor. Nicholas Grosso and Doctor.
Louis Levis, who are the co founders of
the Centres for Advanced Orthopaedics,
and Medvanta,
which is the country's largest
physician owned and operated
musculoskeletal
business and management services organisation.
Doctor. Grasso and Doctor. Levitt, real pleasure to
have you both on the podcast with us
today.
Before we dive into this discussion, I'd love
to kinda hear a little bit from either
of you.
Do you mind sharing some insight into the
driving factors
behind that decision to set up Medvanta? Doctor
Grasso, I'd love to hear from you first.
Yeah. Alan, thank you for having us.
Yeah. A few years ago, what we realized
is what we had built with CAO was
a we had all the tools that an
MSO had, and we had so many other
things that we wanted to accomplish in the
musculoskeletal
realm. You know, we wanted to build an
end to end platform that would allow private
practice,
musculoskeletal providers to not only survive in this
crazy medical environment that we're in, but also
to to thrive. So that was the impetus
about three years ago. We are fully self
funded. Our docs and CAO,
fully funded us as a separate investment vehicle
to create MedVanta and give us the capital
that we needed to build the tools that
we have built thus far.
And, so I think that's one of the
things that I'm most proud about is is
we are fully, positioned, funded, and owned. We've
taken no outside money from anybody.
Doctor Levitt, doctor Grasso kinda set the stage
there, painted a picture for us. Anything to
add from you in terms of, that driving
factor decision behind with Vanta, what you're most
excited about today?
You know, I I do think and, again,
Alan, thanks for having us on. But but
I do think, you know, this, Centers for
Advanced Orthopedics
is the product of basically eleven years
of sort of integration consolidation.
And during that time, you know, our conversations
were routinely with the payers,
and they were baiting us with the idea
that value based care is around the corner,
and we'd better be prepared for that. And
quite honestly, we spent that much time preparing
our physicians.
It didn't appear to be happening in the
last few years no matter how hard we
tried, but we built we built a platform
and an infrastructure
for doing value based care, and we decided
that we'd spin off MedVanta. It it allowed
us as a business organization to be more
nimble,
and and we knew two things. We had
to solve the problem for access to physicians,
but we also knew that acquisition of patients
was now shifting,
if you will,
away from, you know, the doctor to doctor
referral. So we decided to pivot towards,
a a platform of services we can make
available
to direct to employers.
And that's and that that really was the
impetus to to spin off the business organization
and shift our model to a a a,
you know, a new clientele, if you will,
away from the insurance
company. Yeah. Absolutely. And I'm excited to kinda
dive into the the direct to employer aspect
in a little moment. But, yeah, I guess
to to kick things off, doctor Levitt, I
know
with large
health systems kind of increasingly dominating
regional markets, we've seen orthopedic
super groups and indeed MSOs
provide independent
practices with a real strategic advantage.
But when we think about America's aging population
driving greater demand for musculoskeletal
care, how do you see the orthopedic landscape
evolving in the coming years? What what strategies
do you see being essential for independent groups
to stay competitive?
Well, I I think the aging population is
living longer and is functionally,
performing at a much higher level.
And and they're the ones that are demanding,
prevention and wellness, and and we're really pivoting
towards that.
Once again, as doctors retire and, the cost
of of operation
to practice is is really continuing to grow
and increase,
they're sort of dropping out and closing their
practices. So with the boomer population
so readily available, we have to provide a
seamless
access to physician care
and be able to monitor that care as
we follow patients through. And so we've made
it easy, if you will, for patients to
access,
our our care providers
and be able to to, if you will,
shift the focus of our care providers,
not just from surgical mindset to basically being
care managers,
in in in processing patients from the entrance
of their injury all the way through to
the completion of their care. That may result
in surgery, but a lot more patients
exist that don't ever have surgical management. And
we're gonna take responsibility for those patients.
Mhmm.
Doctor Grasso,
with so much
consolidation
in health care today, particularly in the orthopedic
space. How does Medvanta
empower independent orthopedic practices to remain competitive
against some of these driving forces, large private
equity backed groups, for example, corporate pay buyers
to the tune of optimum and whatnot?
So much happening in this space, but I'd
be so curious to hear a perspective on
that.
Yeah. And and and Lou actually alluded to
it. What he said, we think one of
the biggest things going forward for private groups
is patient acquisition and retention.
The old ways of of getting patients from
your buddy down the street who's a primary
care provider or through the ER, those things
are gone. Primary care providers are being purchased
by hospitals or by PE back groups. So
we really have to what we wanted to
do and what we have done is we've
created an end to end platform where we
have digital tools proprietary to MedVanta, not using
third party vendors
that allow patients to have a digital front
door, everything from what we call our Vantastat
app, which is a app that can be
downloaded from the Apple, I Store or Android.
It allows patients to interact directly either by
phone or by text with a live person
and then get put into within twenty four
to forty eight hours, see one of our
providers. So, obviously, we're bypassing the urgent care
centers. We're bypassing the ERs, and we're getting
patients directly into groups that are working with
Medvant, who have access to our app. And
that's how we're gonna get these patients early,
and then we're gonna take them through their
entire episode of care through our other various
tools that we've built all the way out
the other end where where hopefully they're they're
better and back to being active, whether, like
Lou said, it's surgical or or or a
nonsurgical care. It doesn't really matter.
Well, we have all the tools to monitor
them all the way through. So I think
that's the biggest thing that we can help
any any orthopedic or musculoskeletal group with is
is how do you stay competitive? How do
you keep getting patients in your door,
and keep your keep the lights on, basically?
And, Alan, I'm gonna add to that. We
we're actually falling back on very old principles.
For the most part, patients don't trust insurance
companies,
and and with private equity having entered into
the market and institutions,
large hospital systems,
all seem to be motivated by the the
profit,
that that they can earn. We're falling back
on the principle that the primary,
essentials in medicine is for the physician to
care for the patient. Our our motivation
is patient outcome
and and and not profit.
And so, essentially,
we think we add that to to to
the marketplace now that's that's been missing for
a long time, and we think that's gonna
be attractive to patients going forward.
Mhmm. I'd love to hear maybe a little
bit more on some of those digital tools,
doctor Levitt or doctor Grasso. I'm kinda curious
on that aspect. Obviously, a big advantage there
for practices joining Midvanta.
We hear so much today about AI automation,
revenue cycle management, big data. Are there any
other tools that you anticipate on developing or
rolling out in the future to help some
of these practices in that space? Yeah. I'll
I'll jump in there, Alan. We already have
them. Right? So,
one of the things, like Lou said, the
profit motive taking care of patients has always
been kind of FIFA service. You get paid
for what you do. What we've gotta do
as we go forward as musculoskeletal providers is
figure out how do we stay whole, how
do we stay,
financially relevant,
but caring for the whole person. So we
actually have developed a wellness platform. It's we
call it Vanta Motion. It's a two d
to three d motion analysis
that's been, clinically proven to be effective where
we can evaluate people,
whether they be employees at a at a
company, whether they be pickleball players in the
elderly population.
And we could determine through our AI we
have an in there as well as actual
exercise physiologist that can review all that data
and then make recommendations to the patient,
of things they need to do to to
hopefully prevent injury in the future. And, you
know, you know, having an orthopedic surgeon talk
about injury prevention may seem counterintuitive because we
don't get you know, unless a patient comes
to us with a problem, we we don't
get paid. But we figured out a way
that we can actually do this as a
revenue generator for practices as well so we
can do well by doing good, by have
keeping patients healthy. And that's just one of
our tools, and we've talked about the Vantastat.
We also have a a a a online,
basically,
scheduling platform that can seamlessly integrate with any
EMR that's already done.
We also have an analytics platform that we've
developed that allows us to look way deeper
than just into our own EMRs, but to
look longitudinally back through a patient's history through
various data sources that we have to do
things like risk scoring and risk analysis. So,
we've already built all these things. They're already
out there and and running for CAO. So,
we're excited to show them to other folks
around the country.
Fantastic. So the app that you've mentioned, Vanta
Motion, there's an online scheduling platform, an analytics
platform.
Thanks so much for sharing a little bit
more of the specifics there. Doctor Levitt, I'd
love to go back to you. You kinda
mentioned this at the top of the podcast.
But when we talk about direct to employer,
Medvanta is obviously focusing on helping independent groups
transition towards value based care and indeed direct
employer contracting. Can you give us some insight
into why these models are the future of
orthopedic care and share some specifics into how
Advanta is making them accessible?
Well, number one, I think you put the
doctor in charge of of the of of,
basically, the the care pathway.
And I think decisions are made,
on behalf of the patient and and not
not on behalf of the corporation.
I also think that we know that if
you look at most self insured companies across
The United States right now, their largest spend
is in the musculoskeletal
domain.
Women's health and cancer also occupies one of
the top places, but but we have a
very large volume of of of our own
self insured employees. And we will verify that
our biggest spend happens to be musculoskeletal
spend, and it goes up every year no
matter how hard
we we we work to try to curb
those costs. Well, we think this end to
end integrated musculoskeletal
solution that we call the MedVanta platform,
of MSK,
we're gonna offer that to an employer, and
and we think that we can manage
the musculoskeletal
concerns that the patients have. And and Nick
points out, you know, when someone comes in
with a bad back, they go first to
an urgent care center. It may be two
weeks before they can see a doctor, and
there's already perhaps an MRI scan that's been
ordered unnecessarily.
Our platform, for example, like the Vantastat or
or the Vantor Connex products puts them right
in the hands of either an orthopedic PA
or a doctor. Seamlessly, they make an appointment,
and we can usually keep them on-site and
on work because we have such a large
distribution of physical therapy services. If they require
rehab, we can provide it near where they
work. So we're gonna say to the the
employer, we'll take the risk. We'll take responsibility
for managing your musculoskeletal
care and the third party point solutions
that always seem to have the perfect solution
to to managing them. Their goal is to
keep the patient away from the doctor. Our
goal is, in fact, to move the patient
towards the doctor and produce the most optimal
care, and I think that's gonna be attractive
to the employer.
Mhmm. Doctor Grasso, we're obviously seeing
a lot of,
independent groups banding together recently in the orthopedic
space. A ton of, orthopedic MSOs
like Advanta Midvanta appear over the last couple
years. I'm curious to hear from you. Could
you talk a little bit about the biggest
growth opportunities
Vanta is focusing on? Where are your big
growth areas over the next two or three
years or so?
Yeah. So the yeah. That is definitely happening
around the country, but you gotta look at
these MSOs and see exactly
most of the MSOs that I'm familiar with,
the large, independent practice ones, they're they're doing
some great stuff with, you know,
on purchasing and certain other things that they're
doing together, but they really have not developed
any additional tools like MedVanta has because it
takes such a large investment in,
money and time.
So we we know all these groups around
the country. We talk to them, and we
think,
one of MedVanta's greatest
potentials
out there is working with these groups, right,
and offering the services through them to providers
in their area. Gives us almost a national
reach,
through the orthoform,
with its 5,000
or more orthopedic surgeons distributed, and I think
it's 48 states now, 47, 40 eight states.
We can go to basically any any employer
in the country and say, if we can
work with these groups in the orthoform,
we we could provide a nationwide,
coverage for for employers who may have people
who are outside of, like, Centers for Advanced
Orthopedics,
catchment area, which is basically Maryland, DC, and
Northern Virginia. So I think that's the biggest
upside out there is, we think it's great
that private practice groups are banding together to
to stay healthy and to stay relevant, and
then we just think we're gonna take them
to that next level.
I also think, Alan, that we've we're approaching
musculoskeletal
care as a regional problem.
Yes, we have a national appeal, but CAO
is our anchor
orthopedic group as we go direct to employers
in in our region. And we'd like to
go across the country and create anchor orthopedic
groups through the orthopedic forum network
in other regions and then use our tools
to basically transfer the same services to the,
direct to the employer model and and their
location as well.
Got it. So, two fantastic leaders. I really,
really appreciate both your time. Not just fantastic
leaders at CAO, but also Medbanta
and indeed your own practices as well. Don't
know where you find the time to squeeze
it all in. But I'd love to end
on,
kinda hear from each of you. Doctor Leveld,
I'll go to you first. So I guess
orthopedic surgeons,
what is the next kinda big trend that
you they should be paying most attention to?
Are you coming at this from a surgical
technology standpoint, a different trend standpoint? Love to
kinda hear just wrap up the podcast with
a an insight from each of you on
this question.
No. Look. I've I've been an orthopedic surgeon
for forty years, and I've seen sort of
trends come and go. But but we've always
been surgeons,
and I I think that for me, the
biggest shift in orthopedics is we have to
start taking responsibility for the full care of
the patient from the outset of their injury
or their beginning of their
arthritis
and take responsibility for managing them through the
entire, you know, duration of their health care
trip, if you will,
and become the trusted care providers
to try to produce again the the best
outcome at the lowest price. And and I
think the shift away from just being surgeons
to being full care providers to me is
the biggest change in the future.
Doctor Grasso? I'm just gonna echo that because,
I I think the biggest shift is a
mindset shift, from being the technologist
to being the care manager,
of of the MSK world. Right? And, you
know, you gotta look at the patient in
a way that is very different than we've
ever looked at the patients before. You gotta
look at them. You know? We can't just
punt things like diabetes and obesity and smoking,
and mental health issues and, social determinants of
health to primary care because they don't do
a very good job with it either. So
we start we have to and we have
the tools and see and, MedVanta
to
deal with these things, to take a patient
who may have some comorbidities,
who may have some things that are could
be optimized before a procedure and and and
take them through that. And that's something that
we as orthopedic surgeons have to accept because
that's gonna be our new role, and that's
how we're gonna really
succeed in this value based care world. It's
it's not just on a per click fee
for service, do a case, get paid, see
a patient get paid, but taking care of
the whole patient from end to end and
figuring out a way with MedVanta
to make that financially viable to to be
able to do that.
Alright. Thanks. So next one, feel for Todd
and great insights to round out our discussion
today. And doctor Grasso, doctor Levitt,
again, thank you so much for taking the
time to speak with us on the Beckers
podcast. So greatly appreciate and respect the the
excellent work that that indeed you and your
respective teams do, and look forward to catching
up with you both down the line. Alright,
Al. Thank you for giving us the time.
We appreciate it. Thank you very much.