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      Brian Urban: [00:00:22]
      That is how you open a podcast. This is the Healthcare Rethink Podcast, the fastest growing podcast in tech data as a service and health equity. What a blended state that is. I'm your host, Brian Urban. And today we're joined by a very special guest, as we always are on the show, the chief commercial officer of In Bold Health, Brad Kindler. Brad is going to be telling us exactly who in bold health is what they're doing for the health care economy in terms of improving performance for providers these days, not just grading them and how exactly we're going to start transforming health care in the United States. So, Brad, welcome to the show.

      Brad Kimler: [00:01:08]
      Thank you, Brian. I'm excited to be here.

      Brian Urban: [00:01:12]
      Excellent. So, Brad, with every show that we do, we like to start off with some fun Q&A, some trivia, and knowing a bit about your background. I thought we could talk a little bit about health care, background of physicians and also a little bit of college trivia. You're a Brown University graduate. A little bit of a rival with my school, Dartmouth. So we'll do a little fun trivia and then we'll get to really know the man behind the leader and we'll get into the deep side of in bold health.

      Brad Kimler: [00:01:49]
      This is the forward to the most, Brian.

      Brian Urban: [00:01:51]
      This is I knew these are killers, though They'll be fun ones. So Brown University, it was established before Dartmouth. By how many years? Four years. Ten years or 65.

      Brad Kimler: [00:02:10]
      Wow, that's a tough one. I'm going to go with 65. It was hard to get people up into the upper woods of Hanover. I see.

      Brian Urban: [00:02:20]
      I was starting it off. All right. It was only four years. So he was by by four years. So I actually had him back 1769. And you guys were in 1765. So not not too far off there. All right. Question number two, how much did Nicholas Brown donate to the university in 1804, thus changing its name to Brown University from the original name, which was the College in English Colony of Rhode Island and Providence Plantations. So how much did Nicholas Brown donate? Was it 10,000? 100,000 or 5000?

      Brad Kimler: [00:03:02]
      I'm going to say 10,000. I don't remember the dollar amount, but I actually took a course that talked about the some of the ethics of that donation. It was fantastic.

      Brian Urban: [00:03:12]
      A very, very rich history into how the donation came about. In your close, it was actually $5,000. So you're oh for two right now you're going a couple of chances to pick back up. Just a few more questions. All right. We're going to talk sports here. So football, Dartmouth and Brown, in a couple of weeks, they're going to play each other for the 98th time. That is a lot of meetings. So who leads the series? Is that Dartmouth or is it brown?

      Brad Kimler: [00:03:39]
      I'm going to say that's Dartmouth.

      Brian Urban: [00:03:41]
      You'd be correct. Dartmouth is leading the series. 61 wins, 32 losses, four ties, which baffles me. But that's how they did it back in the day, I suppose. All right. So let's get into more of the medical side of our conversation. So in the US, approximately how many physicians are actively practicing medicine today? Is it 832,000? 1 million. Just over or 3 million?

      Brad Kimler: [00:04:11]
      It's. It's over 1 million.

      Brian Urban: [00:04:14]
      Direct. All right. He's on a roll now. Two, two, four, two, two, two. All right. Just over a million. All right. Researchers have data. The first hospital healing area, if you will, back to this approximate year. Was it 4000 B.C., 380 or 1395.

      Brad Kimler: [00:04:34]
      I'm going to say it's 380.

      Brian Urban: [00:04:37]
      Whew. A C+, 4000. B, c, that was. This was a very tough one. Very tough.

      Brad Kimler: [00:04:42]
      100 years. That's not close.

      Brian Urban: [00:04:46]
      A couple more we'll get we'll get into our conversation. I could do this probably all day. This is fun. Real easy one here, father of medicine, the father of really Western medicine. Was this Socrates, Hippocrates or Descartes?

      Brad Kimler: [00:05:05]
      I'm going to say it, Socrates.

      Brian Urban: [00:05:06]
      The hypocrite is no good.

      Brad Kimler: [00:05:10]
      You know what? I've got it, all right.

      Brian Urban: [00:05:12]
      It's probably a good time to say you're the only non MD of the board and the advisors and the leadership of In Bold Health. You are the strategic leader of all things, so I can't hold that against you in any way.

      Brad Kimler: [00:05:25]
      The rest of them can now. That's fantastic.

      Brian Urban: [00:05:27]
      Yeah. Thanks for thanks for playing a little bit just to open up our conversation. Brad So I want to get into who in bold health is Doctor Stein? Daniel Stein Amazing background with with medicine, also with business. And he's been on some podcast recently, but I want to get to know about you a little bit more in terms of how you've come to in bold. You've had a amazing background with Aon and the Health Plan advisory consultation world for decade, decade plus. And then you moved into Fidelity where the financial strategic leadership and then you sit on some boards too with some other organizations and now you're here, you're balancing so many things. So what took you to in bold? Let's start a little bit back and maybe even your aon days or a little bit more in the middle?

      Brad Kimler: [00:06:18]
      Yeah, no, I mean, I think it goes back to back before it was part of Aon, it was Hewitt Associates in the health care practice. I ran for the East Coast there, and I always advise large employers on what they could do to better manage their costs and deliver benefits to their employees. And I always struggled with a lot of the solutions that were in the market even then, because I thought that we weren't really addressing some of the root cause of what was creating some of the cost problems that were out there. And that root cause was always around variation. No variation in the way people get access to care. Variation in the way providers practice medicine. And so I was always looking for innovative solutions, even from that time. And when you fast forward to the point when I retired from Fidelity and I was just talking to different organizations about joining the board when I met Daniel and the team here, it involved it just seemed to go back to some of the stuff that's troubled me from the start. The fact that there was, until now, no way to identify which providers are staying more within the bounds of clinical guidelines and which ones are maybe overperforming or underperforming in various specialties. That got me excited and it made me an unsuccessful retiree.

      Brian Urban: [00:07:39]
      I like I've never heard that I'm a successful retiree. So clearly you're a lifelong learner and clearly you want to make a change. And that's who we talk to in the doers, the changemakers. So I love that you kicked it off that way. So, Brad, let's define in bold health. So who is in bold health today? You've had some great early successes, Mart partnership, most notable in the last year. But who are you today and where are you starting to see great success and where are you going?

      Brad Kimler: [00:08:10]
      Yeah, I mean, I think that the best way to think about it, there's been a lot of movement in the market place towards different ways of evaluating physician performance, and there's been an emphasis on trying to identify top performers. We think that that is interesting but not sufficient if you want to really get at the root cause. We think it's really important to identify who's performing really well, but it's even more important to identify ways for people that aren't performing well to get better. So as we built all of our modeling techniques and our entire business model has been around this notion that whoever we're sharing data with and partnering with on on our commercial projects, we want to make sure that that information is being used productively with the physician community and productively to us means that the data is transparent to them and they know what they need to do to improve. We don't think that any doctor goes to work thinking that they want to be a bad performer. We think that all that's missing sometimes is they don't have perspective on how they compare with their peers in a local marketplace.

      Brian Urban: [00:09:17]
      And that's very true. I think that stands for anyone practicing medicine or health service. You go in with best intentions. Everything that you've been supported from even the day before, your trainings, residency, everything. But it can't stop there. Your technology helps build upon that to improve quality. And I want to talk about quality in a moment. But really, let's start with your philosophy to data. So you mentioned transparency. Let's let's talk about in Bolds approach to data. What sources do you pull in from and how do you share that back out to your provider community?

      Brad Kimler: [00:09:57]
      Yeah, So, so we use full data claim sets and we do that because we have a fairly sophisticated set of attribution models so that we can go back upstream from the initial point of diagnosis and follow the patient straight through all the treatments that have happened. We think that's really important because we don't want to just look at, let's use the example of arthroscopic surgery in the knee. It's really important to know who does that well. And it's really important to know, like if there are any complications that happens. But it's also really important to understand who does it disproportionately relative to others in the marketplace. Meaning, have you tried more conservative treatment methodologies? Are you doing other things to help coach the person through? And by doing that, in order to do that, you actually need to go upstream to the initial point of diagnosis and find out who's been involved all the way through. So it's a fairly sophisticated model.

      Brian Urban: [00:10:52]
      I love that. And you're just scratching the surface. And I think comparatively to where health grades and doctor rating sites have come, they miss this huge gray area. They miss out on really preference sensitive care that might be being executed by physicians, really working with patients and in doing the right steps to ensure healthy journeys with care and then health healthy outcomes as well. So I want to talk a little bit more about how your quality is achieved with your your technology so we can talk about it in the scenario. We could use the partnership of Walmart or any other examples that you like, but it's it's an employer employee facing tool. I think Walmart has adopted and has been very hands on with you all. How how is that working for the consumer patient and how's that working for the docs supporting all those those lives?

      Brad Kimler: [00:11:54]
      Yeah. So, so we've got a number of different applications depending on whether it's an employer or a health plan that wants to buy information, buy data from us. We're even involved in working with some direct primary care providers who want to understand who the higher performers are in their market, and your patients do higher performing specialists. So what we've done is we've got all this sophisticated modeling technique and then depending on the the application and the kind of client, we make that data available so that they can make better choices. So for a consumer or an individual patient, we tend to aggregate the data and put performance tranches out there. This is a high performer or this is a medium performer, low performer because they're not all that sophisticated as a user. But if there's somebody more sophisticated, like a primary care physician that really wants to dial in on how does that cardiologist perform on this particular procedure, on making the referral to, we can also make that kind of data available as well.

      Brian Urban: [00:12:55]
      I like that it's multiple lenses and it's user preference as well because it has to be like that. It can't just be one pane of of information. It's got to be.

      Brad Kimler: [00:13:05]
      A blunt instrument that doesn't really inform what's going to get better and what needs do, what needs to improve in the market. And I think when we do these things, we always do it from the same database. So we're always using the same measures. It's just that they've been aggregated different ways. But then you ask like, okay, so what does a doctor do with the information in a marketplace where we're operating, whether it's with a large employer client or a health plan, if they ask to understand how they've scored, we don't just give them the aggregate score, we give them the individual results so they can see all of the things that went into the assessment and how they compare to their peers in that marketplace. That's been our M.O. since day one, because we actually think that that's the only way we're going to get real competition for improvement in a marketplace. We've also learned, however, that that's not enough, because while doctors do want to understand how they perform and how they stack up to their peers, sometimes they don't necessarily understand what they can do in daily practice to start to change some of those outcomes. So we've also started putting together a series of how to guides or this is what you can change in your practice. As you start to see improvement in some of these areas relative to peers.

      Brian Urban: [00:14:22]
      I love where you're going right now, and I want to get deep into that. And I also want to talk about the services that you specifically help a health plan in terms of building a provider network. It's really almost like a precision type of technology. You're helping health plans to, I don't know, go to the table and maybe a negotiation or improvement down the value based care reimbursement methodology spectrum. There's so many things I think your technology is being used for in the health plan space, and I definitely want to get into that. But the question that that you left me with there is you're helping docs of all ages, of all backgrounds. How and they're very competitive in the US in terms of leading in innovation and technology adoption. How well has your technology been adopted by physicians? Have they has it been tough for them to say, Oh man, yeah, I am not performing the way that I think I am? Is it been a really hey, look in the mirror and we're going to help you approach. How's it been going so far?

      Brad Kimler: [00:15:30]
      So as we went to market, we went to market first with large employers and in those markets, that's where we did the outreach to the big systems to say, here's what's coming. This is what this employer is doing, this is how it's going to impact potential patient volumes and everything else. And we started sharing the information in advance of when any of these these changes hit that benefit plan or that particular employer's website. What we find in those markets is there's there's always the initial reaction, which is your data is wrong. I don't believe your algorithms. You've got the wrong guy. You can go through the whole list. But but because we're able to show them the data and where they perform relative because almost invariably they come around and say, okay, I get it, you guys are serious. You're not just taking random bites of information and trying to put a score. We actually won't give a score to a provider unless we have a very high degree of confidence that that score is accurate and precise. So in most markets we can only score about 70% of the providers and the specialties that we evaluate. We actually think that's a strength. And when the doctors understand that we're actually in this for improvement, not just a cherry pick, they tend to want to get more engaged. So this is rolled out in market after market. Initially it's met with skepticism and. You know, I wish you would get hit by a bus on the way out the door. But ultimately, I think they realized that we're serious about what we're doing and we're serious about trying to help. And we've seen improvement in some of the markets where we have high concentration, where the physicians have started to change some of the practices and what they're doing. And that's just the tip of the iceberg. As more health plans start to adopt this, we're going to start to see even more change and more acceptance of the methodology that we're using.

      Brian Urban: [00:17:22]
      That's really cool that you framed it like that. You you come at least the provider community, the health care system community from a statistical acumen. I like how you mentioned the the confidence intervals and to what your measures were in the the quality opportunity for improvement. And then you come at it at the partnership end. So it's it's really a more holistic approach, not just saying, hey, you're not doing good, you're saying, hey, there's areas to improve and here's how we measured it and here's the accuracy and our confidence and here's how we can help as a service and a partner going forward, a very locked arm partnership type of approach, it seems like. And obviously.

      Brad Kimler: [00:18:04]
      Yeah, we're open to feedback. I mean, there have been instances where the the head of a department or a particularly savvy physician said, look, I've looked at the way you guys are doing these measures. You might want to consider some different definitions of how you're including or excluding things. And we're open because we we don't think we know everything. And if we did, we probably not be useful in the marketplace. So we're constantly trying to learn and tweak our models so that they get better at what we're trying to achieve, which is giving physicians and the people that use them better insight into what needs to happen to.

      Brian Urban: [00:18:40]
      The humble approach to building the case and building a larger alliance. I love that and totally makes sense because none of us across the great United States here have all the answers to everything. It ranges across the ecosystem from innovation to data tech policy. And it comes down to the individual support you can provide a physician. So I love that. And we're going into the health plan space because we keep bouncing around with health plans. I want to know exactly how you're supporting health plans today. Their adoption of your tech and any great successes you've seen early on, because it's it's the collaboration that's really needed now between health plans that don't have a health care delivery entity that we need a collaboration between payers and providers. I hate those terms, but health care entities and health plans need to come together. So is your data and your tech helping to provide glue there? And just just open it up. I'll stop. I'll stop blabbering.

      Brad Kimler: [00:19:46]
      Yeah. No, no, I think that we're really excited because in our work with these large employers, we've started to establish a bit of a reputation and we've received a lot of inbound calls from health plans to say, Well, what is it you're doing? Is it going to be useful to us or not? There are a number of health plans that recognize that even though they have very sophisticated modeling on their own, they also have a little bit of a an objectivity problem with the physicians because they're in the unfortunate position of having to negotiate with the physicians and tell them what they need to do to improve. And I think that's one of the reasons why employers are attracted to us. We are solely on the objective evaluation side, and we're not in the business of negotiating with with health systems or health care providers. So that's sort of our entree into the plans. There's also a number of plans that while they're large, they're not large enough to have a really statistically valid sample of claims. So because we use a multi payer claims base, we can give them more insight into the performance in their local markets and then help them think about ever more refined tools to move members to high performers. But then to your point, start to use some of this data in their coaching and even in their contracting for purposes of value based care monitoring. How are people doing? We've got some we've got one health plan customer that's actually thinking about using some of our data to create sort of a gold card approach to say to a provider, Hey, we've seen the way you perform. You're really stellar at trying to stay in clinical guidelines and being thoughtful and conservative about the way you treat members. We don't think you need to go through the hoops of utilization review anymore. So while that's not in practice yet, that's something that we're starting to talk about. And I think our data is is a really good foundation for organizations that want to push the envelope.

      Brian Urban: [00:21:39]
      That's a great example of a very specific use of your data. And it kind of reminds me of a flashback. Good or bad, actually, to my Cigna days. So when I was with Cigna working in local markets, there was a gold member gold type of approach to physicians that were high performing that said, Hey, you don't have to go through all of these prior authorizations, referral processes that we clearly see. You're having good health outcomes and lower than your peers and total medical costs spend measures like that. So I love that that's being considered as how data can be used to support health care physicians that are really like anchor providers, anchor systems in a network that could drive lower cost health plans at the individual level and the employers like it's a trickle down win If health plans truly intend to use it like that. And they should. Obviously my my.

      Brad Kimler: [00:22:41]
      Bias, we think and we think they want to and we think they will as we talk to the plans, we get some pushback from people saying, well, you know, I don't know what your data would do. We already have these really great utilization management programs and we can say, yeah, but like we still see this huge variation with all these docs that are managed the same way. And I think in some respects, like you hate to say it, but I think that a lot of the the variation is just more indicative of which physicians have learned what keywords to use to justify a procedure. And and they're not trying to overtreat. They just know I want to provide this service to this patient. So I need to say these things to the health plan. And the reality is they don't understand that many of their peers wouldn't even be doing that procedure. And when they see that, then they'll start to ask different questions. Otherwise, I think there's this constant gamesmanship that again, is it's well intentioned because you think you're doing the right thing for the patient. But but you you don't know where you stack up relative to peers in a marketplace and how the clinical guidelines would would lead you maybe down a different path.

      Brian Urban: [00:23:53]
      I'm glad you said that because we recently just published an article in Health Care Dive, really talking about the huge accumulation of waste claims administration and adds up because of this tennis match, this game that goes back and forth, back and forth, trying to almost beat the system of what words a physician would have to use to get something approved, service, procedure, test, whatever. And we have to get beyond that. And I love that it's showing the comparison of do you have to play that game? Look at your peers. Maybe you do it this route. Maybe there's other procedures that are still leading toward better health outcomes. So you're you're taking the game here that's been around for a long time and you're flipping it, flipping it on its head. And I think you're changing the way health care is delivered and how, more importantly, our health care community is supported. We can't just simply push down and grade them. We've got to lift them up.

      Brad Kimler: [00:24:50]
      Now, people have health systems have a hard enough time getting staffing today anyway. I think it's much more of we've always taken the approach that. This is stuff that has to happen, but it has to happen in lockstep in all the three components. So it's the employers, the payers, the health plans themselves because they're kind of in the middle and then the health systems. And we've even found some health systems that are very interested in using this data because they may know how they perform under value based care arrangements, but they actually don't know why. They don't know which physicians are contributing and which ones aren't. And so we can we can provide a lot of insight. And as the market moves more towards value based care, I think we're in a really strong position to help guide some of those discussions and and really understand what what's it going to take within the system to get to the next level of providing more appropriate care at the right time?

      Brian Urban: [00:25:48]
      I love that you're almost contributing toward building a model or a profile of what is a high performing physician primary care specialty and how that contributes toward the advancement of value based care reimbursement methodologies. I think you are an accelerant in that space directly and indirectly. So that's so very cool. And Brad, I wanted to go down a nother sharp path here. So a lot of our our shows center around socioeconomic data, health equity, addressing disparities by race, ethnicity, gender, preferred language, the whole gamut. So I want to understand in the future, how are you going to support the health care community in supplying socioeconomic data or social health profiles? Maybe on top of improving the clinical side? Is is that in the works in the future? Is that something that's going to be core to the mission going forward?

      Brad Kimler: [00:26:53]
      So so we've got one slight struggle in that all the data that we do, the analytics on is is de-identified. So, so we don't necessarily know a lot about the patients. We know if it's the same patient that we can track through, but we don't know a lot of the indicative data about that patient. However, we've already been working with some of our largest clients because they they value these same kinds of initiatives to identify, well, what can we help with? And so we've taken a slightly different path. We do know a lot more about the physicians because that's not blinded. We know who they are. We know a lot about their background. So so we've looked at access to quality or value based providers based on zip codes. Right. And so a lot of times when you talk about access and managed care, you're doing the zip code match and everything else. We've started to dial in on Oak. But if you're in a major metropolitan area but you live in a zip code that is more likely to be associated with lower socioeconomic status, What are your odds of getting access to a high quality within easy commute, which is probably a bus or a walk? Right. And what we found is there's very often it would be hard to get access even if you had insurance coverage to a high quality physician in your local marketplace, because they're just not practicing there. So we're we're working with some of our partners, whether it's health plans or even some of our investors have a big interest in this to try to identify how to get some of that information out there and publish on that as well. But we've call it sort of a quality desert that exists in the health care systems in some of these cities or in rural locations. A lot of people think it's a rural problem, but it's a problem in urban markets as well.

      Brian Urban: [00:28:43]
      I'm glad that you're sharing your approach to addressing sdoh or improving health equity that helps the physicians recognize how they can do this better, because your specialty is supporting the quality improvement of doctors and supplying them with the right information, the right time, and improving their ability to improve. Is your is your is your stick. And I think this is a cool path to going down that stock route is the zip code analysis. It's the access side of it. So that's really cool. Brad, I know in bold is young and growing and you're finding ways to impact the health care economy from top to bottom. So it's so very cool. So I have one compelling question to wrap up our conversation here. So in bold health, fast forward me 24, maybe 36 months. What do you think your biggest impacts to the health care world health plan? World maybe the whole ecosystem will be you have a top list of in your crystal ball what you think is going to happen, How in bold is really going to make an impact?

      Brad Kimler: [00:29:56]
      Yeah, I mean, I think where we'd like to be is in a scenario where all of the constituents that we are talking about today, the patients, the payers, whether it's employers or health plans and the systems have kind of come together on an agreement on how do you measure physician performance, clinical performance. And they're all starting to use this common database which is involved to build on different techniques for improving performance, but also for steering member volume to the most appropriate, making better matches for members at the time that they need the care. And there's a wide range of technologies that can be deployed against that. But the first thing that has to happen is people have to agree that there's a common foundation for improvement and the methodology is is all about improvement. It's not about some sort of creating a competition for a scarce resource, because if that's all you do, I've identified the three top performers in Boston. It's going to be really hard to get an appointment and it's going to be really hard for anybody to care about who's the second best. So we're really trying to create an ecosystem that's based on our data being a little bit more ubiquitous and then have all of the different constituencies use it to their best advantage. But again, the whole point has to be medical improvement and performance in the market.

      Brian Urban: [00:31:23]
      I love that. That is the altruistic mission I was hoping to come through in our conversation. But it is it's it's it is a resource, a life resource, health care that you want to make available across the board by improving physician and port improvement. If you improve health care, you can improve access, you improve health outcomes. It's just a better society overall. And that's kind of the utopian vision. I imagine, as you were sharing that.

      Brad Kimler: [00:31:53]
      I think it's a much I think it's a rich and it's hard to argue with it too, right? It's very hard to argue.

      Brian Urban: [00:31:59]
      It is, and I would never be one to argue with it, just continue to support it. I loved our conversation today. Brad, thank you so much for joining our little show.

      Brad Kimler: [00:32:10]
      Thank you for having me. I enjoyed it too. Except for the quiz at the right.

      Brian Urban: [00:32:15]
      I'll tell you, we interviewed a couple of physicians, a couple of past episodes, and they did way worse than you. So you're you're you're above average for sure. And a true pleasure to chat with today, Brad. So thank you again for joining the show. And for more excerpts and insights from our episode, please visit finthrive.com.

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