Healthcare Rethink Miami Tech Tour

Brian Urban:
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Yes, The Healthcare Rethink Podcast is going on tour. We'll be going coast to coast, hitting some of the biggest healthcare technology hubs across the country. Please follow us on this amazing tour when we kick off live in Miami, Florida. Yes, this is the Healthcare Rethink podcast on tour. We are at our first stop of a countrywide event here, live in Miami, Florida. And what cooler of a location could we be to talk about social health technology than the Papa offices? So today, we're going to be kicking things off with an awesome panel, helping us understand what are the big adoptions, challenges and trends happening across the ecosystem.

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So joining us here today, we'll go right down the row, senior vice president from Highmark Health, Nebeyou Abebe, CEO of Papa, the house that we're in here, Andrew Parker, CEO of CareCo, and world-famous, dare I say, podcaster, Mendel Erlenwein and I will say a growing legend in the healthcare IT strategy, advisement space, Eduardo Garcia. Thank you gentlemen for joining our first stop on this tour. So let's set some context here because we're now coming through 2024 and we look at healthcare today in terms of delivery, we're drastically gapped, frontline staff, midlevel practitioners, all the way to gerontologist and specialists and oncologists as well.

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So we're also seeing this amazing trend happening, healthcare deepening the patient/provider relationship at home. We're seeing social healthcare technologies, data, IT advancements across the entire ecosystem, but we're starting to see one of the biggest improvements in terms of investment and I'd say trust from a leadership perspective of going deeper into social health. And I want to talk, Neb, to you first because you've been at Highmark now for three years. You've built a foundationally strong team with SDoH. You have an amazing high-performance social care network that you've put together and you're seeing the evolution unfold before your eyes. So my big question to you is, are we here? Are we actually here at a place where leadership is deeply investing into social health and they see the connection into clinical medical outcomes?
 
Nebeyou Abebe:
[00:03:00]
Yeah, at Highmark, our leadership is fully aligned with whole-person health, right? And when you think about whole-person health, you have to think about physical, behavioral and social health. We're now in the process of building those enterprise capabilities and integrating with other teams across the enterprise to bring that to life. And you mentioned the high-performing social care network, that's one of our enterprise capabilities that also includes other foundational elements to help that come to life. So for example, back in 2019 is when Highmark launched our Enterprise SDoH Department.

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And back then, the focus was on finding ways that we can identify health-related social needs of our members and our patients. We are an integrated delivery system, so my scope includes Allegheny Health Network, which is our 14-hospital health system along with Highmark and we sell health insurance products across four states, Pennsylvania, New York, Delaware and West Virginia. And so when we think about at a very basic level, we have to be able to identify which members, which patients actually need our help from a social care perspective and so we started with a universal SDoH assessment, which covers all validated questions, covers nine different SDoH domains.

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And so that gives us a really good comprehensive understanding of the health-related social needs of our members and patients as well as our employees and the broader community as well. We have the universal SDoH assessment. We also have a resource and referral platform. So once we identify the social risk, we can then refer that individual to local care and resources. And so we took it one step further with the high-performing social care network where we launched early last year, early of 2023. And so the concept behind the high-performing social care network is really strengthening and bridging the gap between healthcare and the CBO world, right?

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So for years, health plans have been giving grants and those sorts of things to CBOs to help advance community health and help to advance the health of their membership, but we understand that, now with growing technology, there's better opportunities, more opportunities for CBOs to really create value for the healthcare system. And so at a high level, the high-performing social care network is a simple value-based arrangement with close to 40 CBOs in Allegheny County and Westmoreland counties where we are financially incentivizing them for addressing that health-related social need, but also sending the data back to us. And why that's important is, when you think about integrated care and whole-person health models, we're not looking at social care and isolation, we're looking at how we can address all the needs of our members.
 
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And so once we know that that social need has been addressed from our members and patients, we can then trigger next-best action for us to engage those members into our clinical interventions that have that proven ROI. So we believe by stacking programs, clinical, nonclinical programs with each other, we believe one plus one can equal three and that's the value that we're looking to create with this new model.
 
Brian Urban:

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I love that, the terms you used, stacking the interventions, the model you've developed, and if you're not getting it already, it's here. It's not a question of whether or not we should be investing from a health plan leadership. It's how far can we take it, how fast can we move. I love that, Neb. You opened this up in a great way and 40 community-based organizations, you started with not many.
 
Nebeyou Abebe:

Right.
 
Brian Urban:

You grew that out.
 
Nebeyou Abebe:

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We wanted to start with 20 CBOs. We grew it to 40 CBOs and early results are very promising with respect to improved health outcomes and lowering total cost of care, significant reductions in total cost of care, particularly for those members and patients that have gone through that are high utilizers of the system, but this is just one capability. There's many other tools in the toolkit, if you will, and more approaches and strategies we need to deploy to ensure that we are delivering equitable care that all of our members can access.
 
Brian Urban:

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I love that because I think about the diverse strategies across the ecosystem. I think about a really, I called it before, a public health athlete, the team that you have, your Papa Pals. Andrew Parker, what you've been able to develop over the past now almost eight years is phenomenal. You have such a reach, you're in homes, you have a more intimate companion relationship than I think anybody else does across the ecosystem. So when Neb was referencing that, is this where it is, we then go to the next level of incorporating a very detailed strategist like yourself in the mix here? And tell us, is this what you're seeing in ecosystem? Are you seeing health plans starting to say, "Yeah, I believe in this. Let's work with another vendor that's a partner really"? Are you starting to see this?
 
Andrew Parker:

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What I'd say is I don't think that the general healthcare landscape fully understands it. I think Highmark, and Neb specifically, has been really forward thinking around, "How can we help people in their community with their health equity needs?" But to his point around stacking, that's required. There's not a panacea to say, "This little thing will help everyone." It really is personalized and really needs to be thought of in that way. And we feel we are part of the solution, but we also recognize we're not exclusively the solution. But if you have a caregiving gap and you're lonely and you're isolated and you have several health-related social needs, you're ending up in the hospital, you probably need a CBO, but how do you get to that CBO? How do you know about that CBO? Do you feel comfortable asking your help plan for help from that CBO?

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And so what we find is by enabling a new kind of care, which we call Papa Pals, which are not home care professionals, which are not nurses, which are not doctors, which all of which have shortages and frankly are a little bit less engaging and fun to hang out with than your pal.
 
Brian Urban:

I agree.
 
Andrew Parker:

[00:09:00]
80% of your healthcare outcomes are driven by social health communities, components, access to transportation, housing, food, loneliness, things like that. And so can we support these individuals with what they need? I think it's great to ask, "What are your social needs? Now what? Can I help you?" And so maybe we can with some solutions, I love value-based care arrangements, to really make sure that everyone's incentives align, which really helps to steer the patients appropriately to make sure those that need certain access are getting it and really making sure that all the parties involved are aligned to that. And we're big believers in that too and want to become part of that.

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And I think healthcare is shifting away from acutely supporting this one incident that you're having in this moment. What about all the other things that are happening to you on a daily basis that got you to that moment? Going to the doctor as part of healthcare, but to the whole-person health perspective, we cannot only think of the acute response to a clinical need. We have to think more broadly and more holistically because at the end of the day-
 
Brian Urban:

I love how you put things, Andrew. Every time I speak to you, you become wiser and wiser beyond your years because-
 
Andrew Parker:

More gray.
 
Brian Urban:

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More gray. There's gray too. The camera can't pick it up now. It's significantly different since the last episode he was on. Fix mine, [inaudible 00:09:59], but you simplify healthcare in many ways because your solution is a human-to-human connection. And that is, I think, one of the most challenging things to pull off at scale and you've done it. You've shown the industry. And someone, I'd say, who doesn't pull punches, and we're going to get back to you in a moment on economics because you've proven this out by the numbers, but, Mendel, I got to tell you, so you're spinning up more and more companies than I can count today, it's only two, but it's probably going to be more, you don't pull any punches. You talk to a ton of people across the ecosystem. What's going wrong today and what's going right?
 
Mendel Erlenwei:

It's a broad, but a great question. I think what's going right is I think really reflective even in this room today, the panel that's here between Neb from Highmark, what Andrew's doing with Papa, the first time I heard about Papa was actually while listening to Zeev Neuwirth's book, Beyond the Walls.
 
Brian Urban:

Oh, there is good plug for Dr. Neuwirth.
 
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Mendel Erlenwei:

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Big plug for Zeev. But I think what's most amazing is that, and this maybe answers both, there's obviously tremendous challenges in healthcare innovation. Healthcare is huge. It is complicated. It's this giant knot that everyone's pulling on one part of it to try to untie it, but someone else is pulling on the other and trying to untie it. And I'd say the biggest challenges are around regulation and red tape and things like that, but what's most heartening to me, and the people that I get to speak to, is the fact that people are interested in creating these partnerships, that people are interested in innovating and people are taking these things really, really seriously. They're taking social determinants of health really seriously, both the, "Do you have it?" and then, "What then?"

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There's so many people in this country that are trying to figure this out every single day and are actually executing on figuring this out. And I think what you'll get to in a moment, speaking about again Papa for a second, it's not just what you've done conceptually, but I think the scale reflects where the market is. It's not just a testament to the execution of company, but it's a testament to where we are as far as taking this seriously. And the fact that there's somebody on that other side willing to make that partnership really shows how seriously we're really doing this well.

So everyone that I speak to is willing, interested and really trying to innovate every single day. There's obviously challenges with maybe getting ahold of the right people and the right people finding the right people to make those connections, but they're all looking for them. Sometimes they're doing this, but they're all at least looking and I think that's a really good thing.
 
Brian Urban:

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I love that, Mendel, because I'm seeing and hearing from everything that you do, the more people that we can build around in the community, the more speed we can have to making an actual impact. And, Neb, you were shaking your head the entire time Mendel was talking. So from a emerging leader of really what's coming into your executive career at Highmark Health, you are on the other side saying, "Yeah, we want to invest. We want to build out this strategy," and you're doing the how. You have the why and then the what's coming there too. So is there a lot of things that stuck out to you from what Mendel was describing in terms of what he's been seeing in the ecosystem?
 
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Nebeyou Abebe:

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Yeah, absolutely. I think this work requires strategic partnerships, like-minded organizations coming together, rolling up our sleeves and innovating. We have to come at this problem leveraging unorthodox approaches and so that's what I'm most excited about, right? Having worked in public health, having worked for corporate America, now working for a payer and a provider integrated system, I see lots of opportunities for us to improve and to get better and also look at value in a slightly different way, obviously as a plan where we're laser focused on improving health outcomes, reducing costs, but there's also other value that can be created by deploying these integrated models for our members in the form of member experience, enhanced member experience, member engagement into those clinical and nonclinical interventions and member retention, right? So those are the types of, I think, quick wins that we could capture by all working together.
 
Brian Urban:

I love that, quick wins, but meaningful in terms of revenue as well for a health plan and also how you're actually changing the total medical costs, the spend, the engagement, the experience overall. And you talked a little bit about creative risk taking, one of the biggest creative risktakers in the room, I'd say, you have so many different careers ...
 
Eduardo Garcia:

Oh, my.
 
Brian Urban:

... I can't keep track of it ...
 
Eduardo Garcia:

Oh, my.
 
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Brian Urban:

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... but we brought you here for a very good reason, not only because of your well-over-a-decade, it doesn't show it, but well-over-a-decade experience in global IT consulting, but the war stories that you've collected. You've seen, as what you call, the IT meat grinder. So it's amazing to have all of these point solutions. HIMSS this year was not only a regular zoo, it was a zoo beyond zoos. It had so many new startups, point solutions, follow through, strategic partnerships. How many will come back to HIMSS next year if they still exist? You see this all the time and trying to implement them into very big healthcare organizations. So I want to bring you here to have these war stories brought out. What's the biggest challenge you've seen across your IT career in putting together a solution that will fit and go to scale in a large integrated delivery network or health plan or whatever example you're willing to share?
 
Eduardo Garcia:
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Well, there's a lot, but before we get there, I just can't help but admire our backdrop here with the flamingo and we are here in Miami. And I do want to do a quick plug about Miami, and of course we're talking about social determinants of health and one thing that I don't often talk about, but I realized that I should, is the fact that I wasn't born here in the US. I was born in Venezuela. I've been here for over 20 years. And one thing that's always struck me living here in Miami all this time is the pipeline of Latin American entrepreneurs that have really built businesses, chasing the American dream, including in the healthcare industry, people like Mike Fernandez and his Alex who started Simply Healthcare and people like the Molinas who started Molina, and so on.


[00:16:30]
And it's people who ultimately understand the intersection between social determinants of health, what it takes to run a business viably and also how to deliver care affordably. And I'm sure that's something you've seen as well, Andrew, in what you've built here in Papa as well. So I just wanted to acknowledge that we're here, we're in your offices, you're seeing this firsthand and just the magic of being here in Miami and being able to understand social determinants of health really in real life. But back to the meat grinder, and I love it because now I can say whatever I want.
 
Brian Urban:

You're free. You're a free man.
 
[00:17:00]
Eduardo Garcia:

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So the meat grinder, we came up with this term, the IT meat grinder, because it is true, that the IT meat grinder is where all our beautiful utopian dreams about healthcare ultimately go to die, but why? Why does that happen? Let's understand that here for a minute and the horror stories and such. We have to remember that over all of these years, there's just been a mountain and years and years of constraints that the system has introduced that ultimately technology vendors had to adapt to over time to be able to do anything in healthcare today, right?

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So you have things that are running, that have been running forever and what that ultimately creates is this concept of technical debt. This is essentially a term that means things that you've accumulated over time that you know are ultimately going to cause a problem down the road, but you've figured out a way to put them in a box and set them aside for later. And inevitably, what happens is those things eventually come back and bite you, right? And there's a way to quantify that and so on and so forth. So all of that has come now to bear and now you have additional regulatory action. There's always additional regulatory action going over and over again. So it's a never ending chase, and ultimately, you end up with the proverbial house of cards, right?
 
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And I think the best way to make this real, especially for our audience, I'm sure a lot of people are watching and listening to us coming from the RevCycle world is prior auth, right? How many people ... And I've spent so much time working with payers and integrated health systems in this space, and inevitably, people will find themselves either OCRing a fax or generating some packet that's going to get faxed somewhere because they've ran into an interoperability dead end somewhere, right? And it's just simply because there's things that are broken somewhere in the technical debt pile that haven't gotten to and you have to get creative, right? So it's okay. At the end of the day, it's okay to get creative to be able to work around some of these constraints.

[00:19:30]
The question ultimately becomes, "What is the future? What is the permanent ..." Through some of these partnerships, for example, that we're talking about, "Are those going to incentivize people to actually address that technical debt because now we need to collaborate more, so we actually need better ways and better data for us to work in, so we will ultimately address those underlying challenges or is that debt just going to stay there forever?" I think that's the real question in the end.
 
Brian Urban:

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I love the way you opened up. By the way, and I take this back, we should have opened up with these comments, Miami, Florida, among other locations I think, I think of DC, I think of parts of California, Los Angeles, is really the birthplace of a lot of social determinants of health work, only from a policy perspective, but also from a community health perspective, a resilience perspective, which I think Papa contributes toward greatly. So thank you, and the backdrop, oh, my gosh, you can't-
 
Eduardo Garcia:
I couldn't help. I'm sorry.
 
Andrew Parker:
The real palm trees are even better.
 
Eduardo Garcia:
Thank you, Andrew, for the amazing backdrop that you've commissioned.
 
Brian Urban:
[00:20:30]

[00:21:00]
So I want to transition into something that we've all gone around, is value-based care methodology. So in my career, Cigna for a long time, coming out of Obamacare and second administration trying to stand up the 50-90 rule, there's been a lot of attempted movements going toward pay for performance, and ultimately, lump sum payments, full-risk capitated payments. And in my opinion, we're not going to get there. And a lot of our opinion across the RevCycle world, all the CFOs we talk to on and off the show, it's something that we're not even close to straddling yet, but what can get us there is investment into social health, not only from a technology perspective, but from a service model perspective as well.

[00:21:30]
So, Neb, I was thinking of you when I was trying to understand where this connects into value-based care. So CMMI, Center for Medicare, Medicaid Innovation, they've had an amazing push. They actually now are flushing out in the industry what they've seen through serving about 40 million lives and about 50-plus value-based care arrangements. So it's proving economically it makes sense that adoption is not there yet. So do you think now the investment into social health strategies and models like what you're doing here at Highmark Health is going to push that forward and really show economically the puzzle fit for advancing value-based care arrangements?
 
Nebeyou Abebe:
 
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I think so. To some extent, we talked about building the foundation, [inaudible 00:21:54] foundation from a technology and data interoperability perspective to make everything work and so that's what we've really focused on at Highmark and AHN over the past several years. And that's why AHN has gone full risk with Highmark. It's a shared full-risk arrangement, but we were able to do that because our clinical systems have all been integrated and we're able to share information back and forth. So a real-life example is when someone walks into our ER or has inpatient stay or goes to one of our transformed primary care facilities, just to give you a few examples, they're all screened with the universal SDOH assessment. With a simple click of a button, they can then refer that individual to a CBO, or if at some point, we'll be able to refer them to one of the clinical programs that they're eligible for or to a resource like a Papa Pals or some other strategic partner that we have a relationship with to address all of their needs, right?
 
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So we put in the work, we made significant investments and there's a huge change management component that we haven't even talked about too because it's taken several years for our providers on the AHN sites to really buy into whole-person health and there's a lot of clinical workflows that we had to develop and so on and so forth. So I think all that has really helped us move things forward. And then on top of that, really having a robust strategy for how you can truly integrate social health with physical and behavioral health. And so our population health teams and other key stakeholders across enterprise, we're all working together to figure out how we can do this really well. And so that's been our journey for the last five plus years and all this is sort of framed under our living health business strategy, which is really focused on achieving the quintuple aim.
 
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And going back to value-based care, I don't see how any organization can achieve be successful in a value-based arrangement without addressing the social determinants of health. As Andrew mentioned before, up to 80% of one's health and wellbeing is driven by these you non-clinical factors. And so where the creativity comes in is how do you integrate all the great community-based programs and community-based partnerships with the healthcare sector, right? All the assets that the healthcare sector can bring and how do you bridge that divide? And also when you think about population health, like stratifying your member populations and being able to meet the members where they're at, but also that includes ensuring that you have the right solution that makes sense, both in terms of what they need, in terms of to meet their specific needs, whether it's social behavior or physical, but also from a financial sustainability perspective, right?
 
[00:25:00]
We have to make sure that ... And that's where I think a lot of the research and all these pilots are coming in, people are bought into the concept of, "We need to do something around SDoH, but how do we financially sustain this work?" And so that's what we're really laser focused on at Highmark as well, is quick test and learns to scale. And we can't do that without going back to strategic partnerships, whether it's on the technology side or strategic partnership side in terms of solutions. All that work can't be done in a vacuum. We have to work very closely with each other.
 
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Brian Urban:
 
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I love that because you're not only a part of the evolution happening at Highmark Health, who by the way is not new to value-based care methodologies arrangements, practicing it since the first physician program quality design back in the early '90s. This is an advancement that's continued through generations of leaders at Highmark Health, but now you're putting a evidence-based framework behind your high-performing social care network. I think I got that right this time. I messed it up earlier. But that is fascinating because you're truly looking at shifting the economics here. And, Andrew, I wanted to get to you because you've done this from the angle that you've taken with your Papa Pals in your service model, is you've actually shown the value realization with having your model in place and other models too that I think are different across the ecosystem.
 
But you had a Ted Talk, you had your first Ted Talk, maybe a few coming up in the future here in Miami, it was a packed house. I streamed it. I didn't get the invite, but maybe next time, but the cool thing is that-
 
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Andrew Parker:
 
I didn't set up the invite.
 
Brian Urban:

The cool thing is you actually talked through, and I believe Medicare Advantage is a large portion of the population that your model faces, you talked through how you help not only cost savings, but engagement and the whole throughput of your model. So can you share a little bit of an update coming after that TED Talk and some of the economics behind your model?
 
Andrew Parker:

[00:27:00]
Yeah, I was talking to Neb. It's like, "If a tree falls in the forest and no one's there, does it make a sound?" It's the same as, "If you're saving all this money, but no one uses it, are you really saving any money?" And so first and foremost is getting people engaged with a product that fits their needs and we've been very fortunate because I think that's something we figured out right away, which is, if you have a friendly caregiver that doesn't feel like a traditional healthcare service, it breaks down a barrier from an emotional perspective, from an uncomfortable perspective where people are like, "You know what? I do need someone to take me to the doctor. I would like a nice pal. I read about that in the marketing materials. It's free. How many hours do I get?" You get 50 hours, you get 100 hours, whatever the number is.
 
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[00:28:00]
And so the thing that we've done best since day one is build this new kind of care, which is not doing bathing, not doing toileting, but they're really enabled through training and technology and screening, which we've taken to a level that no one that does in homecare has and we continue to improve it. And so first and foremost, people, older people and we deal with Medicaid in families and young mothers and parents, but most of our services today are older, they want the service, so that's step one. Step two is, "Well, what do they want?" Well, most of them want to do the things that you want them to do.
 
One, they all want to eat. A lot of them want to go to the doctor. Most of them want to get their medicine, but they don't know who to ask. They're scared. They don't know how to get there. They literally have no way to get there. They don't know how their new discount program from their pharmacy works. They weren't aware they could get medically tailored meals. And so can the pal help guide them on those things? And over time, does that save money? Does that improve outcomes?
 
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[00:29:00]
And what we find is that by pairing pals with people that have a need, and we've learned a lot about who needs Papa, not everyone needs papa, but if you have one or more health-related social needs, as we see you have two or more, we actually save more money. If you've recently left the hospital, we found that we were lower readmission by 18% on our study we just did with one of our customers who was on like 2,500 active and engaged members. Papa's been doing this for seven years. About 300,000 people have done a Papa visit. A good majority of them have done two and I think at least 60% of them have done three or more visits and it starts off typically for an acute need, "Oh, I need to go to the doctor." Then they admit to their pal, they're lonely, they're in a bad mood, they're not eating that much. They wish their health plan did this, this and that.
 
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And we, again, can't solve it all, but over time, we are able to reduce ER visits, reduce readmission, reduce total cost of care. We just announced a study that was done, third party-validated, looking at claims data, which we want to do more and more and more because we invented this new thing. And so the bar for saying that we save money and drive outcomes and engage people is higher than just taking a CPT code of this existing service and so we're working really diligently to prove that out. In our study, it showed we did a 9% total cost of care reduction. And if you used it two or more times, it got even more impactful and I believe, three or more times, we saw a 30% total cost of care reduction and I'm happy to share in the links, but we've really, really studied.
 
[00:30:30]
And it was obvious, "If you need help and you're lonely and you're isolated or you don't have a car and you're not sure what you're going to do in the morning literally by yourself," in my TED talk, I talked about the fact 25% of people that are 65 or older or in danger of becoming what is known as elder orphans, meaning they literally have no one and so what are we doing for these people? We're getting them community- based ... Papa does not, we do help them with that, but their healthcare in general I'm talking about, is doing these things that are for the first time ever, I believe thinking about the whole person. And again, to my earlier point, "Clinical is just a small portion. What's all the other things going on in your life?"
 
Nebeyou Abebe:
 
[00:31:00]
And I just want to underscore the importance of driving member engagement and activation. I think that's where a lot of plans, struggle around the country, I talked to my counterparts at other payer organizations and everyone struggles. We invest a lot of money in these great digital solutions, which are very, very important. It can't just be high-tech. It also needs to be high touch, particularly for those most vulnerable members that we have. And so that's critically important to any strategy, is to make sure that you can activate and engage your membership into these great resources that we're investing in.
 
Brian Urban:
[00:31:30]

[00:32:00]
It's the human and digital blend. And I like what you were saying too as well, Andrew, is your model's not for everyone in terms of every health plan, every population. In terms of a bell curve, it can be skewed left or right and it's just different. But when you find your sweet spot of how it's changing and engaging, that is where it can really be replicated across a lot of populations. And you're starting to see that. And when we talk about claim data, it's very important because you're seeing end-to-end care, Charge Master data as well. If you go deeper than the claim, you're seeing where points of care and costs come from. So there's so many layers to your studies that you take us through. I think it's really impactful that shows the industry, it's not just about Papa, but it's about who else can invent a model like Papa and have the impact as well.

[00:32:30]
And, Mendel, you talked to a lot of different tech leaders across the ecosystem and Neb was just focusing in on activation and you talked to digital lab therapies, you talked to AdventHealth leadership just the other week here recently. So what are you seeing in terms of trends of partnerships? Is there a heavier investment in one subsegment than the other or what's going on here?
 
Mendel Erlenwei:

[00:33:00]
Well, maybe a little bit more broadly, but it's interesting that you bring up Advent, because talking about just ... You were talking about the adoption of value-based care and so I had the pleasure of sitting with David Banks, the group CEO at Advent last week in Orlando and he said something that really clicked in my brain. They've also been around value-based care since the early '90s and they left some of those things and then they came back to a lot of those things. And what I think was really interesting about what he said, wisdom comes from time because then you get perspective and then you can see and then you don't freak out when the little things happen because you've seen that thing break and then get fixed once you see that.

[00:33:30]
And his point to me was that there's a lot of naysayers, there's a lot of negative takes on value-based care, "It's not going to happen. It's not going to prove. It's not going to show on the bottom line," and he said, "These things take time," and you're seeing rises in corrections and you see improvements in the corrections. And at the end of last year, when CMMI did this big recalculation that really affected a lot of reimbursement for a lot of the big value-based care organizations, that was a big hit for some people and then people thought this was going to be catastrophic for all of them. They're all going to drop off. And it was such an interesting perspective because to me it did feel that way. But to see his perspective from rising above and say, "No, we've been here, and the system, this is just a correction and it's actually part of the course."
 
[00:34:00]

[00:34:30]
And so when I get to speak to leaders that are doing certain verticals of healthcare, fixing certain problems in healthcare, and that's why I'm loving this panel today, because again on the Neb side, you've got Highmark and you've got on the Andrew side a specific thing that you're trying to fix. And I think that what's happening really is that there's a lot of individuals that are trying to fix specific problems, and because they're trying to fix specific problems, they're able to move very quickly. And then it feels like the system is not catching up because the underlying foundation of the system takes a lot longer to fix.
 
[00:35:00]
But I truly do feel and I think that the fact that you're sitting here today is part of a testament to this, I truly do feel that, underneath the surface, the system is slowly getting more connected, that healing is happening, and at some point, that's going to flip where you're going to have all the little pieces of healthcare that have been fixed by all the individual Papas and all the individual people, and at some point, that underlying foundation is going to catch up and we're going to have this click. That's maybe a naive take, but-
 
Brian Urban:

I love it. I like it a lot.
 
Eduardo Garcia:

[00:35:30]
I want to make a point on that because I think everything we've been talking about so far is great examples of what I would say is the delicate balancing act of really keeping the healthcare system alive, right? It's not just, and we can think of all the things people talk about, "It's access and this and that and the other," but great, you can have all the access in the world," but to your point, if you have somebody singing at home and they don't have a way to access the access, then what, right? So it's always this and just the same thing. You could have all the great digital tools that in theory give you ways to access, but if you don't have a way to interact with those tools, then what have you solved, right?
 
[00:36:00]
So it all comes back down to the, "There's a delicate balance." All these pieces, to your point, they have to sort of come together as an orchestration that has to happen for these things to ultimately bear fruit, right? And yes, there has to be patience behind that to be able to actually see the end result and I think you're making a really great point about that.
 
Brian Urban:
 
[00:36:30]
 
[00:37:00]
I love that. And the thing that you brought up too, actually all of you, was the system incrementally changing. It is a testament that we have an executive from a health plan sitting on a panel, healthcare IT, entrepreneur, CEO, entrepreneur, CEO, that are trying to fix different components and subsegments of the system that's continually malfunctioning decade after decade. The next generation of leaderships at health plans is influencing some of the traditional leadership that is still in place in health plans. And it's amazing because you serve millions of lives. The economics that will have a trickle-down effect will be such that cost of care has changed, engagement change. We're no longer disconnected, but to the wisdom that you had from the Advent CEO, it does take time. So I need to get to Eddie's mind here because how we got Eddie Garcia on this podcast is a unique story.
 
[00:37:30]
So HFMA Annual, we were there together. You didn't see me speak, disappointed, I'm going to hold that against you, but I'll let it go for a moment. Everything that I heard, and you correct me if I'm wrong, is bots. Bots on bots on bots on bots. Robotic process automation is one of the biggest things right now in terms of innovation, hitting revenue cycle management organizations and then going into healthcare. I think it's great. It's the first soft step into what we're seeing with AI that's going to come out. It's taking little admin tasks and cleaning it up, making it more effective. Is it cleaning up remittance? Is it helping reduce the amount of touch points and claims? I don't know, maybe, but there's probably more to HFMA that you saw than what I saw because I was fixated on that and some alternative data investments too. But ...
 
Eduardo Garcia:
Oh, my.
 
Brian Urban:
[00:38:00]
... let's break down some RevCycle stuff for a moment. Let's go into this space here. So what do you see that RevCycle needs now to have a better impact later? Is it back analytics? Is it stuff sitting on EHRs? There's a bunch, but give me your perspective on where we need to go in this space.
 
Eduardo Garcia:
 
[00:38:30]
Well, first of all, I will concur, and of course, I can now say a lot of things that I couldn't say before, which is fantastic. I'm savoring the moment, I would definitely concur, and no offense to HFMA, yes, a lot of the conversation in HFMA did feel like, "What are people doing today with RPA and what they're going to do with AI tomorrow?" to sum it up quite simply. And when you then take that and you go a layer deeper, at the end of the day, for a lot of people who are in RevCycle, it is ultimately how you're reverse engineering the process with the tools that are available to you. And at the end of the day, it's this, "Who's chasing who to work around all the constraints?" right?
 
[00:39:00]
And inevitably in that process, like we said earlier, you'll run into an interoperability dead end or the mountain of tech debt or whatever we want to call it, the meat grinder. The meat grinder will go and chew you alive. Sorry, IT people.
 
Brian Urban:

#meatgrinder.
 
Eduardo Garcia:
 
[00:39:30]
 
[00:40:00]
I love you. I love you, but it's true. So you'll run into that or you'll run into one or more payers that will be uncooperative, right? Now, I think that tide is shifting, and I do want to get to that with the partnerships because I think we're having just great examples of that here, but ultimately, I think, from a technology perspective where everybody's banking on right now is, "Okay, now that gen AI is here, what can I do with gen AI to work around those constraints in a different way? What can I do with gen AI that I can't do with RPA? Is there something I can do better? Can I predict or can I create a model that is actually going to give me a better result that would be with an RPA type of process, right?"
 
[00:40:30]
 
[00:41:00]
Now, of course, in an ideal world, if you have that pair-to-provider collaboration and you don't run into these interoperability dead ends and so on, there is so much more you can do, right? I just want to make sure that the audience understands that gen AI just going to be a magic wand solution that's going to fix RevCycle. You're still going to end up with a chase. I think things are going to get better in terms of more precision, right? There's going to be more creative solutions to problems that maybe couldn't be solved before, but at the end of the day, is value-based care and are some of these arrangements going to end up incentivizing pairs and providers to work more closely together, so that then you could have proper data, proper interoperability, you could have a collaboration that ultimately results in a process that works better for everybody, not just something that people are chasing around to see who can outsmart who with which tool and what technology?
 
It, in many ways, reminds me, I spent three years in blockchain when I was at Accenture, which was fascinating and how many times people talked about how blockchain was going to change the world and how many people talked about how blockchain was going to change healthcare, especially in this space.
 
Andrew Parker:
In Miami especially.
 
Eduardo Garcia:
And especially here, right.
 
Andrew Parker:
You're the Bitcoin capital.
 
[00:41:30]
Eduardo Garcia:
 
[00:42:00]
 
Right, exactly. And it's actually in a way sad because many of the use cases that came out from that era of blockchain were extremely promising. Things like shared accums and so on. There were so many things that, if you really think about, it's like, "Wow, this could really change the game," but yet you still run into the old patterns. And I think, at the end, I do want to bring up change management because you did bring that up earlier, and it's true. You can't have all these things. You can't have all the point solutions without change management and other things coming in there because technology alone isn't going to fix the problem. That's, I think, what people ultimately have to realize, is people drive process and technology, not the other way around.
 
Brian Urban:
Oh, man, maybe a preview to the final word you're going to give us here soon, Eduardo.
 
Eduardo Garcia:
Oh, the advice?
 
Brian Urban:
Yeah. That is a beautiful point.
 
Eduardo Garcia:
People process technology. How much more consulting can you get?
 
Brian Urban:
[00:42:30]

[00:43:00]
This is not a plug for you consultants out there by the way. We're not paying any consultants that's watching this, but let's get back into I think one of the biggest balance sheet impacts that social health investments we'll see is the Health Equity Index. So for me, finally, CMS, their health equity framework is now putting application through measure. So we're in the two years right now of measurement. Now we're going to go into '27 and '28 when it actually hits balance sheets for health plans. So right now, just as a quick summary, the Health Equity Index is going to be a hard measure on how health plans are helping their population in terms of addressing social determinants of health, that's Part D, is one of the final rules that came out from January of 2024.
 
[00:43:30]
There's a lot of underlying elements to this rule, but essentially you have to maintain and capture needs of the population for Medicare Advantage and help close those. So right now, with what you've put together, your high-performing social care network, I finally nailed the name on that, by the way, you're in stride with helping Highmark and your care delivery partner, AHN, hit these measures. This is a huge deal and I think a model that's going to strike a big chord across a lot of Blue Cross Blue Shield licensees and other private health plans in the US as well. So I want to get your take on what you thought about the final rule coming out January and what Health Equity Index means for a lot of your strategy getting put in place.
 
[00:44:00]
Nebeyou Abebe:

[00:44:30]
 
So I think it was a good move by CMS in terms of advancing the national agenda to really have a focus on whole-person health. I would say that we are well positioned given the investments we've made over the last several years, not just with AHN, but our other strategic provider, provider partners, health system partners outside of Western PA in particular where we are making additional investments in strengthening those relationships, and again to the point earlier, really rolling up our sleeves and figuring out how we can better work together, both from a payer and provider perspective.

[00:45:00]
We each have different viewpoints on how to tackle things. We have different viewpoints on how much certain services should cost. So all the experience that we have captured from the AHN-Highmark relationship in Western PA, we are exporting it to other strategic health system partners outside of the Western PA area. I don't want to name all the health systems, but we are working very closely with them to capture SDoH data, to ingest it, and then to run the analytics to help us really determine what's the best approach to addressing the needs of our members.
 
[00:45:30]

[00:46:00]
I want to take it one step further. So in addition to ... We have over 20 different access points for our members to complete the SDoH assessment, but in addition to that, we're also capturing race, ethnicity, language, SOGI data so that we can tailor the programs and interventions to meet the specific needs of our members. So really focusing on member centricity. And so we are well positioned. We could work even more closely with our partners to help capture some of that data, which is challenging to capture for some of those members who have historically been disengaged in their personal health and wellbeing. But when you look at a higher level, what CMS is trying to do, which is, "Hey, we need to collect more data to get a clearer picture of the needs of our members and then being able to adequately intervene with the right solution," right?

[00:46:30]
So whether that's the high-performing social care network or sending a Papa Pal to the home of our members or sending, deploying some type of other clinical intervention, we are trying to figure out how best to prioritize the care plan, right? Because I always say that, if we have a member who is food insecure and who has diabetes and may be struggling with some type of mental health disorder, we know for a fact they're not going to be able to control the HbA1C, they're not going to be able to adhere to their medication while they're still food insecure, right?
 
[00:47:00]

[00:47:30]

[00:48:00]
So that's why it's critically important to have both these strong digital capabilities and tools because it's a way to reach more people, but also it's more from a financial sustainability perspective that checks the box, but also for those disengaged members, and I talked earlier about it's so critically important to focus on activation and engagement, right? And so these high touch solutions are sending someone to the home, particularly for those high utilizers that need extra love and attention, it's critically important to be able to meet them where they're at. And all that is informed by the data that we capture. And so I think the investments we made five years, six years back and the universal SDoH assessment from a DEI perspective, capturing more race, ethnicity, SOGI data and then working more closely with our popHealth teams and our product teams to really figure out what's the best set of interventions to meet the needs of our members.
 
Brian Urban:
I love what you said just a moment ago and you said it so naturally. I know it's downloaded in your memory.
 
Nebeyou Abebe:
I don't know what I said. What did I say?
 
Brian Urban:
 
[00:48:30]
The best thing is you talked about capturing data that trickles down to meeting the love and attention that people need. A health plan executive would have never said this sentence in my health plan career going back eight, 10, 15 years. That maybe would've been uttered in a quick marketing segment, but not in a strategy. This is built into the framework of how healthcare is becoming more right sized through love and attention and continual data collection and maintenance. It's not just a one-time thing. You don't just do a survey, it stays dusty and goes on a shelf. You continue to stay engaged and activate that relationship in a meaningful way.
 
[00:49:00]
Like that, you can't really see it because of the light, I'm having little chills. That is a very meaningful thing. And in terms of Health Equity Index, you have the momentum on your side. Many plans don't. So pay attention to what Highmark Health is doing. Andrew, I feel like you've done this for many years in your particular corner of the ecosystem. So is Health Equity Index one of the main drivers under your SDoH strategy going forward among other things, I would imagine?
 
Andrew Parker:
[00:49:30]
For us, it's critical. Papa has done almost 4 million in-home visits, over 7,200 cities in the United States in pretty much every single state, including Puerto Rico, not Hawaii though. We were close.
 
Brian Urban:
That's the next place.
 
Andrew Parker:
That'll be for a separate-
 
Brian Urban:
That's the next podcast, by the way.
 
Andrew Parker:
 
[00:50:00]
They have the needs as well, but for us, we've actually found that the people that engage in Papa the most are the people that need Papa the most and they also tend to be part of the soon to be Health Equity Index component. We have been very, very successful at, first and foremost, engaging higher needs population, specifically the SNP populations or other special need populations, Medicaid populations, people that are traditionally hard to reach. And again, it does have to do with the nonthreatening way we go about helping people. It is with the actual love and attention and care and we do find that those outcomes are risen.


[00:50:30]
So I feel like we are very well positioned for some new regulation. It's nice for us to see. We're very gracious that CMS is thinking about people from a whole-person perspective. It's been big changes CMS over the last couple of years and I think it's moving in the right direction. And most healthcare organizations are stumbling their way into figuring it out, but at the end of the day, we need to provide people with health equity. We need to make sure we understand those needs. There's not a one-size-fits-all and we should target these individuals with the right solutions.


[00:51:00]
We become much more ingrained in our partners ecosystem. So providers of our partners can now refer Papa. If I recognize as a doctor that you have a health-related social need and a pal fits, I should prescribe Papa. If I'm a care manager and I'm recognizing that you're talking about loneliness and you have no car and you wish you had this, yes, you may need a CBO, but you likely need a Papa Pal to help. And so we really are transitioning our business to becoming much more of a new provider. You have doctors, nurses, caregivers and now you have this new resource that is very nimble, available at a minimum of one hour, available in all cities and counties of the United States, and most importantly, entire focus is to care about the member.
 
[00:51:30]
Brian Urban:
 
Wow. I think the interesting part about what you noted is the care manager workflow, the clinical workflow. It's important that you're getting ingrained and integrated into that, or else otherwise-
 
Andrew Parker:
 
[00:52:00]
Historically, we're a cute business. We have a companion come over. It sounds really great and we knew it worked, but what we learned over time is this was happening organically. Doctors literally started telling all their patients about it, "So we built a referral system." It's an easy way for them to refer and say, "Andrew needs a Papa Pal," and then we run it and we assess 100% of our members whether or not they use Papa or not. And so we'll reach out to people, we assess them, we do this online, we do this on the phone a lot, which is where we actually found it's much more impactful because these are sometimes questions that people don't feel comfortable answering, so there's some thought around how we go about that.


[00:52:30]
And we find that people, when they start Papa are lonely. They are food insecure, they have housing issues, they have car issues, but they also have unhealthy days issues, "So how well do you feel physically over the last 30 days and mentally over the last 30 days?" and we do this assessment every 90 days and we've been doing it for several years over thousands and 30,000 plus people we have data on, even more now. And we find that we improve physical and mental and healthy days on average 25%. We've reduced loneliness in the population, going from lonely to not lonely on 69%. And almost 40% of people are no longer lonely at all. And a lot of it is not ... Pretty much, none of it is rocket science and none of it is science, though I think there's something to be studied, which we have, which is human connection is medicine.
 
[00:53:00]
Brian Urban:
 
[00:53:30]
 
The human condition part of it is amazing. The qualitative researcher in me is going crazy every time that you talk about the data that you're collecting that's non-scripted, you could say survey based, but it's not. Dialogue, it's true dialogue. Shout out quick to Dartmouth College Medical Humanity. That is a big thing that's coming out. You'll see some studies that'll be popping out there, but maybe Papa could be a part of that, but you do such an amazing job of the engagement. And the cool thing about care managers is care management software, where it's going today. There's a lot of natural language processes that are layered on top of the discussion a care manager, a nurse mainly or a PA, some sort of practitioner at that level has with a member. Let's talk about CareCo. So what's CareCo today and what do you think it's going to be in terms of matching what the Health Equity Index is holding health plans accountable for?
 
[00:54:00]
Mendel Erlenwei:
 
[00:54:30]
 So CareCo is simply put, it's a co-pilot for care coordinators. I strongly believe, so after building a human service-based care coordination company, having actual care coordinators talking to thousands of patients a month, we've built this augmentation co-pilot for our care coordinators that allow them to just do the thing that they're actually good at, which is care for the patient and then take all the extras, all the tedious work, all that wraparound and have it done for them. And I think that there's a lot of talk in the market about automation. I really don't believe in it strongly. We may get there at some point in the future, but just looking at the lay of the land right now, I think that there's technological advances that still have to happen, but even more importantly, there's societal changes that have to happen, being comfortable with some of those things.
 
[00:55:00]
And so just hearing what you guys are talking about, I think that we live in such an exciting time. The fact that CMS just did this and the fact that you guys are working on this and this is the exact piece I'm working at on with CareCo, is ingesting all that data and then making it actually actionable at the point of conversation. And what are we really trying to do here? What we're trying to do is bring healthcare back to the personal level that it had maybe, I love going back to hundreds of years ago, back in the shtetl, right? Back in the little town. I love to think, "What was healthcare then?" And healthcare was some guy who lived at the end of town that had a bag full of some stuff and he knew stuff. And if you were sick, you called him and he put leeches on you or something. That's how it was, right?
 
Brian Urban:
[inaudible 00:55:22] That's why you stayed so young.
 
[00:55:30]
Mendel Erlenwei:
 
[00:56:00]
 
That's the secret. I turned 67 tomorrow. But that person didn't have to worry about social determinants of health. They didn't have to worry about health equity. Why? Because that already existed. It was baked into the pie. They knew you, they knew your father, they knew your grandfather, they knew your exact economic situation. They knew what you ate for lunch, right? And so now that we have this massive scaled system, these are the problems that have come with scale and now we're trying to figure out, "Okay, how do we bring some of those things back?" right? And I think that we're at the cusp. We're at the cusp of a lot of these technological advances where we're ingesting a lot of this data and what is so inspiring to work at what we're doing with CareCo in the last couple of months, we've helped out with 15,000 conversations and it's taking that data and then saying, "How do we recreate that relationship using technology, but then giving that information to the human care coordinators that they can actually execute on that?"
 
[00:56:30]
And social determinants of health is really just a means to an end, right? Social determinants of health is about recognizing the fact that, a, it's important. These things that surround the patient's care but aren't actually care are important and they actually affect care. That's number one. But number two, it's really a means towards health equity and what health equity means to me, it's a very good buzzword, but what it means to me is presenting healthcare to individuals, to patients in the way that they want to be spoken to and presented to with both a cultural appreciation and a general contextual appreciation. And that's what we're able to accomplish at scale with this kind of tech and so it's really exciting.
 
[00:57:00]
Andrew Parker:

[00:57:30]
 
What I'll just add to that is that I came from early days in MDLive, early telehealth company, my dad is the founder, and he used to say that, "One day you won't say telehealth, you'll just say health." And in the same day, we probably stopped saying technology now. Now we're saying AI. And the same with health equity and SDoH, that's just how you care for people. And so it is a positive shift and it's really great to have leaders in huge organizations that are thinking about this and have, by the way, been closest to the patients for 50 years or however long your organization is.
 
And so it is a great shift, it's happening in real time and I think the ones that see that both, I think the people that see it personally, they had an experience somehow where their family was engaged in this way and needed health equity. You can't make assumptions about things. Then they're like, "Wow, this isn't just affecting these random dots on a screen. This is affecting my family and my community." So I'm actually happy about that progress.
 
Brian Urban:
I like-
 
Eduardo Garcia:
I want to say something provocative because you got me thinking here-
 
[00:58:00]
Brian Urban:
 
Oh, please, I've been waiting for it. We're 60 minutes in and you waited this long. Go ahead.
 
Eduardo Garcia:

[00:58:30]
Of course. In many ways, I think a lot of the things that we're talking about that now have terms, buzzwords, whatever you want to call them, they've always been there really. They've always been there, right? But what has happened really over the last N number of years is just the system has become so systemized or whatever the word is and everything has become so structured, right? Every now, it's more structured, more structured, more structured, more structured. So you have to come up with more terms and more terms and more things and ways to keep up with everything, but at the end of the day, if you boil it down, the essence is still there. It's always been there.

[00:59:00]
And I think you're correct. The trend is, and we should really all strive towards that trend, is, "How do we get back to the simplicity of it all?" is, "Yes, SDoH, yes, it's important. Yes, it's a term, etcetera, etcetera, but what's underneath it?" And that's always been there. It's always been common sense to get to know the person that you're taking care of, right? It's always been common sense to make sure you have somebody who can actually be there when you need them, to help you with your visits and things like that. All those things have always been there. How do we get back to the essence of that? How do we not let the of the system get in the way of the essence of actually providing care?
 
[00:59:30]
Brian Urban:
 
Wow. It's almost unbundling the system. It's almost bringing into-
 
Eduardo Garcia:
Go back to the simple basics, back to basics.
 
Brian Urban:
Almost a medical-
 
Eduardo Garcia:
Just like you're doing with Care ... And again going back to what we said earlier, everybody's moving a piece of the puzzle, and if we're all moving pieces of the puzzle at the same time to simplify and go back to basics, then shouldn't the whole system follow suit, right?
 
Brian Urban:
[01:00:00]
Yeah, it should. Absolutely, should. I want to get to a final word from each of you, really speaking from your expertise, from your experiences life and in business of what the rest of our audience can take away and make their own change, make their own impact here. But before I do that, I want to lead in, Neb, with your background globally at Sodexo, you saw a ton in terms of consulting and also building a new infrastructure for health, wellness, wellbeing. You've taken that expertise and you put it into a very large integrated delivery network, a blended system, Highmark Health.
 
[01:00:30]
So kicking it off with this final word here, what would you advise other emerging leaders of health plans to start to invest in, whether it's social care technology, whether it's partnerships, whether it's strategy, service models? What would your advice be from what you've experienced so far coming now to a really strong high-performing social care network?
 
[01:01:00]
Nebeyou Abebe:

[01:01:30]
 
That's a really good question. I would say bring humanity back to healthcare or health, whatever term we want to use, but bring humanity back. And I think that's part of the conversation we're having now is ... And when you do that, then the things that we think are hard to overcome become more clear in terms of, "Okay, here's the best approach we can take to solving the problem," but when you center your focus on the employee or the patient or the member, that's when you can really solve really big problems. And that's what we've aimed to do at Highmark when you think about why we kept collecting all this information.

[01:02:00]

[01:02:30]
We're collecting all this information so that we can get a better understanding of the current health status of our members and the patients that we serve, so that we can then use that data to develop solutions to help them improve their life. And again, from a PopHealth perspective, there's different approaches, different solutions, interventions for different subpopulation groups, right? And you can slice and dice the membership in so many different ways, but when you just really think about, "Okay, how can we help this person?" whether it's someone who is a low utilizer, fairly healthy, preventing them from moving on to a rising risk category, what's the right best set of solutions that are affordable for both the member and the plan? And the same is true for other subpopulation groups, right? Rising risk and high cost, high utilizers.
 
It sounds fairly straightforward, but given the complexity of the healthcare system, it's very challenging. It's very challenging because it's a very convoluted system, but I am really excited too. I'm really excited about the time. I think there's just some new fresh bold ideas coming from so many different leaders and I really feel that we could move the needle and it's very promising.
 
[01:03:00]
Brian Urban:

[01:03:30]
 
I love it. What you said, I think automobile, internet, iPhone, social healthcare strategy, it's like the next big milestone, I think, that's going to economically impact the US for good and communities for great. It's going to be unbelievable. And speaking of community health, give me a final word, Papa, what would you tell to other tech entrepreneurs that now you're senior, you're grizzled in a good way, eight years into your organization, what do they need to focus on when they're building a solution and they want to take it into the ecosystem?
 
Andrew Parker:

[01:04:00]
Well, it's a two-part question. While we're at Y Combinator, they always talk about, "Build something people want," and so that's how you would normally build a company. The challenge is the people that want it may be disconnected from the people that are paying for it and they may want something else. And so how do you overcome those things? And it could be challenging in healthcare to bring something new to the table that doesn't fit in a traditional box that someone's not able to do anything with because it doesn't fit into this specific area. And so I guess you have to decide on what you want to be when you grow up. If you want to make a big dent in the world, it's not going to be easy, which I could attest to.

[01:04:30]
And it's something we want to do at Papa and we think that the most obvious answer is probably the right answer. And so to your point, it's going back to the basics. It's human connection, it's understanding people's needs and it's not trying to take the same thing that people did in the '90s and spin another arrangement around it or try to shift cost around in that way. It's caring about what we're supposed to care about, which is the people that use our healthcare system. And so if you think about what people need and want, and you could combine those in this case and work backwards from there, I think a lot of answers will become obvious.
 
Brian Urban:
Build something people want, but then figure out how it can be connected.
 
Andrew Parker:

[01:05:00]
And this one, I guess you'd add want to need if you're talking about healthcare, because want could be, "I want TikTok features, but I may not need that. I probably don't." I personally don't. Definitely not.
 
Brian Urban:

Exactly. We're an adult.
 
Eduardo Garcia:

Don't build technical debt. You're just starting.
 
Andrew Parker:

We have no technical debt, whatsoever. We're a tech debt-free company.
 
Eduardo Garcia:

No technical debt. You're not allowed.
 
Brian Urban:

[01:05:30]
Look at that. This is almost a taxi cab confession, "We have no technical debt." From one entrepreneur to another, so, Mendel, not only have you crossed the 8 million mark in terms of YouTube views with your own podcast, The Healthcare Trailblazers, which I think we'll probably see some follow-up episodes coming out of this group, but CareCo, Previva Group, you're going to keep building companies that are going to have a meaningful impact, not just for building new models of revenue, but for building new models of impact to the healthcare ecosystem. So what is your advice right now to all the leaders that you probably even talked to recently and soon we'll talk to about investing into social care technologies?
 
[01:06:00]
Mendel Erlenwei:

[01:06:30]
 
Recently, I've been really obsessing about this piece of advice for people, which is that focus on value and present value specifically. And I say this to both people that are building technologies and also people that are looking to invest in or buy technologies because I think that what we're seeing right now is a very unfortunate, but like I said earlier, part of I guess what's to be expected where you're seeing a lot of overhyping, especially when we're talking about AI and things like that. There's been a lot of oversold technologies. And then what that actually does is have this massive adverse effect on the general market because then everyone right now has AI fatigue. Everyone's just like, "Oh."

[01:07:00]
And so I think the best way to approach the question both as a builder and a buyer is just, "What is the present value?" If you're out there trying to show something, do what Apple just did. Say, "Here's what we're going to do." Don't do what everyone's doing, which is, "Here's what we're going to do. Here's what we could do in two years, in five years, in 10 years." Show how you're valuable right now." And to people that are looking at tech, same thing. Ask those questions. Is this going to bring value to your workflow, to your patients, whoever? Is that going to bring value in the present right now? "Yes," focus on that and make your determinations based off that and just let's leave all the future for the profits, which I am not one.
 
Brian Urban:
 
[01:07:30]
I love it. And quick, I have to say, a quick tease. Mendel's also spinning up another podcast. He's going to go on tour. It's going to be called What's Under the Yamaka. He's talking to the biggest Jewish by faith leaders across the healthcare ecosystem, finding out the secrets, how they've come to the top and it's going to be a funny podcast. You can find out if that's real one or not.
 
Mendel Erlenwei:

Our first guest, we're going to go down the line. Brian's going to put on the yamaka with secrets underneath.
 
Brian Urban:
 
[01:08:00]
All right, let's get on a final word here with the Eduardo Garcia. So Eddie, let's get a final word from you. From all of your experiences across consulting and now really pursuing your personal passions and also being a fractional advisor in strategy as well to startups, how are you helping leaders think about investments, short-term gain, long-range planning in terms of social care technologies?
 
Mendel Erlenwei:
[01:08:30]

[01:09:00]
Well, there's a lot of things to think about in terms of how you would approach that, but I think the first thing that comes to mind to me is if you're a healthcare leader out there, always assume that your healthcare system best. Don't let anybody else, especially a vendor, come in and tell you that they know your system better than you do. That's the first thing. I would say, in addition to that, there's always this, I think the dichotomy between healthcare and technology and what problems is technology going to solve for healthcare and this continuous cycle that we've been talking about where there's a hyping up of, "There's a new technology and we think it's going to fix all these things," and then inevitably, it's the realization of that and so on and so forth.

[01:09:30]
And those cycles will continue, I don't think they will end, but at the end of the day, it takes partnerships, and not just partnerships between organizations, but within organizations for things to happen. So if we're talking about social health and if we're talking about bringing to life a specific, whether it be a new service or something that addresses the needs based on data that we know from SDoH, how do we get the right people in the room from day one to work together, right?

[01:10:00]
And it's not just the people within the organization and I know I gave a lot of heat to IT people, and certainly, that was not my intent. So how do you get the right people from IT, from the business, from strategic partnerships, from your ecosystem? Maybe you have a venture's arm. How many healthcare organizations have a venture's arm out there looking for new and innovative things? How do you get the right mix of people from the beginning to try to then address the problem statement the best possible way so that you can come up with solutions that are ultimately wholesome, right? We talk about whole-person health as the end goal. Well, how could you provide whole-person health if you're not addressing the problem holistically?
 
[01:10:30]

[01:11:00]
I think that would be the two biggest pieces of advice that I would bring to people, and especially when looking at how you're making your investments and how you're allocating your budgets from a yearly basis., yes, you're going to have to tend to the technical debt. It's like, how do you say, the external debt or the, sorry, I'm blanking on the term, the yearly debt that countries have. Yes, you have to deal with it. Yes, you have to deal with technical debt, but you also have to allocate some money to new things and you also have to allocate some money to actually growing those partnerships and ecosystems, so you can have the right people in the room from the beginning to address the problem.
 
Brian Urban:

I love it. Day one, get your strategy right? No one knows your healthcare organization better than you. This has been an amazing set of advice, the conversation we've had in the heart of Miami, Florida on our first stop on the social care technology tour. We're on here with The Healthcare Rethink Podcast. Gentlemen, thank you so much for joining the show. I got to give you a round applause ...
 
Andrew Parker:
Thank you.
 
Brian Urban:
... for being on here.
 
Andrew Parker:
Thank you.
 
[01:11:30]
Brian Urban:
Hey, we just wrapped our first stop on The Healthcare Rethink Tour here in Miami, Florida. Amazing panel that we have. Please continue to follow our tour across the country. We have Dallas, we have San Diego, we have Boston, we have Nashville coming up, so keep your eyes and ears tuned to The Healthcare Rethink Podcast. Who knows, maybe we'll see you in person too.