Let's Super Charge Care Managment

Brian Urban:
Yes, this is the Healthcare Rethink podcast. I'm your host Brian Urban, and today we're getting bio, social, and psych with it today. We have the CEO of Holon Health. Joining us is Jason Herzog. Jason, thank you for joining our show.

Jason Herzog:
Brian, thank you for having me. Happy to be here.

Brian Urban:
This is going to be so much fun. We've already had a couple of adventures prior to, and now we finally have gotten into our recording and it is going to be a lot of fun. So Jason, you have a really interesting background and you've developed a really cool collaborative model at Holon Health, servicing a substance abuse disorder population and beyond. So I want to get into that. But first, let's get into Jason. Tell us a little bit about who Jason is before the executive title. I know you're a Chicago Booth guy by background, but there's so much more to you than just the LinkedIn profile. So take us through it. Who's Jason and how did you get into this work?

Jason Herzog:
Yeah. Well, before Booth, I was just a Midwest kid working for the Kansas City Royals as an usher and a diehard Chiefs fan. And then I went to Hallmark Cards and helped them do warm and fuzzy things.

Brian Urban:
I did not know that part of your background. So you got to be happy with the Super Bowl outcome, I would imagine.

Jason Herzog:
Absolutely. Two in a row. We're going for three.

Brian Urban:
Well, it's good to see a rebirth of sports culture in Kansas City with football, so that's very exciting. And for you, you've had a really interesting path, yourself and Dr. Traci Sweet. I think you've developed some really great tech. You're servicing a very high need population and you do it in a really interesting way. So obviously, Holon Health is growing, and it's growing in a really unique way. So I want to walk through the model a little bit with you. So you have a collaborative care model at Holon Health. So tell us who you are and what that model and approach is today.

Jason Herzog:
Certainly. So Dr. Sweet and I have been thinking about this idea for a number of years now. It was in late 2023 where we said, "Well, let's do this. Let's bring it to the market and let's give it a test run." And really, at the center of it is putting together a collaborative care model to help bridge gaps in care for people that are at the crossroads of criminal justice and healthcare that have substance use disorder. If you know anything about that population, they tend to have a low health literacy and they tend to visit the emergency room and go to hospital and be admitted into hospitals far more frequently than the rest of the population. So the idea is, if we can provide a little bit of health education, a little bit of preventative care, we can keep them out of the emergency room.

Brian Urban:
That right there I think speaks to not only the population you're serving but also where a lot of healthcare gaps and spend and probably right sizing utilization needs a lot of help too. So I'm so interested in the impact that you've made today. So I do want to get into the companion app, I think is really cool, I think from an engagement standpoint. But also, your work impacts directly to providers and how they can benefit from your technology and having a deeper patient relationship and maybe seeing things upstream too. So I want to talk about the stakeholders here. How is your impact in your tech being received to everyone else in the healthcare setting and even outside of the healthcare setting?

Jason Herzog:
So I think, let me take it from outside of the healthcare setting, the most obvious user that is seeing our tech outside of the healthcare setting are the courts. If you take a step back and if I asked you to imagine a person that's been arrested, if we close your eyes, so many of us are going to imagine an evil person that has committed a heinous crime. And at the end of the day, those people are there, but they're far, far and away the smaller group of the population, and most of the people that are there are there for something like disorderly conduct, theft, writing a bad check, prostitution. They're committing acts or criminal acts related to substance use or to fund their substance use. They're not necessarily bad people.
So as part of what the criminal justice system does is they try to take an alternative route versus the Graybar Motel and try to put them into a treatment model. And one of the challenges with that approach is that the criminal justice system doesn't get any information back on what's going on with that individual. So one of the great things that we've been able to do with our companion app is to simply just provide engagement data. So we're not really providing any clinical data, we're just letting the criminal justice system know, "Hey, Johnny's engaged, they're checking in, they're going to their appointments, they're doing what they're supposed to be doing," which makes that group really happy. I could go on from the client standpoint.

Brian Urban:
Yeah. Well, let's pause there for a sec, Jason. I think it's so interesting because when you think about the criminal justice system, I'm an outsider in terms of looking at the process, how lives are served, and they're of a vulnerable nature as well. I find your data and coordination back to that system so interesting because they would not see more of the story of individuals. They'll see the surface level information that's provided in front of them based off of judgments that have landed these individuals into a correctional facility, if that's the right terminology still, and an institution that they might be in. But you sharing back a connection into what crimes they might've committed as to why, that is extremely beneficial. I would imagine that it's having quite a societal impact, or at least your vision would have a really interesting societal impact, not just on health care but on preventing a lot of things as well. So was that ever the thought in the companion app being built out, is sharing that engagement model to get in front of a lot of things or prevent things from happening again at the individual level?

Jason Herzog:
Brian, that is absolutely the thought. And on the criminal justice side, the thought is that we reduce time on probation, we reduce recidivism. That's a win-win. On the health care side, and you mentioned this earlier, we probably increase the frequency of utilization, but we take the dollar amount of utilization way down. An emergency room visit, $5,000 spend. A couple of visits with us and a few others, a couple hundred bucks each. That's a trade anyone's going to make any day of the week.

Brian Urban:
Any day. And I think that's such a hard ROI in terms of value realization that your tech and your process, in terms of a collaborative model, really brings to market. And I think beyond that, it's such a niche service that you all provide. We talk to a lot of great health tech entrepreneurs, maturing companies across the ecosystem on the Healthcare Rethink, but we've yet to really talk to an organization like yourselves because you are so unique. So I'm curious, Jason, with the companion app that you all have started to build out, the adoption track, I guess, are you feeling like, inside a healthcare setting, it's become more of an accepted technology or exchange of information for them to be able to use in an effective way? Or is it still in the growing stages right now?

Jason Herzog:
Yeah, we're still very new. We're still in MVP phase and have a little more work to do before we really tie it into the healthcare organizations that we're making some changes right now, that will allow that to happen in the coming months, which is very exciting for us. Well, based on the feedback we've had from them, I think they're really going to appreciate having some of this information at their fingertips from the healthcare side.

Brian Urban:
Yeah. I think that's been one of the biggest gaps I think about across the healthcare ecosystem, is an individual practitioner, healthcare provider professional, not seeing more of a person they're treating and just being stuck within the confines of a clinical encounter, a tribute or data element, in an EHR. So is the vision to integrate a lot of your data, and engagement data in particular, into an EHR plane? Or is it obviously the vision ahead, but is that where you're starting to track the opportunity? Or is it in a different way?

Jason Herzog:
We will absolutely be integrated with EHRs. It's a perfect fit. We can receive information from the EHR as well as send information into the EHR, which will provide, let's just say, a primary care physician with a holistic picture of that individual client, know where they've been, who they've seen, what they've done, what lessons they did on their own from home.

Brian Urban:
And then that's been the biggest gap. So I'm glad to hear that that's where the track is headed for Holon Health. So when I think about some other impact across the ecosystem here, Jason, I think the population you're looking at might have significant challenges, financial stability obviously, or even medical debt too. So is that a view that Holon Health takes, is a medical debt associated or debt associated that's maybe a variable component on how they were receiving a particular judgment related to a particular criminal activity? Is that something that's been factored in? Or is it purely still addressing some of the bigger social health issues: income, housing, avoiding relapse, and behavior change?

Jason Herzog:
Yeah, it's definitely more of the latter. Really, much of the population we have, even if they have medical debt, I don't think they acknowledge it. Just taking a step back, 70% of the people that are in the criminal justice system have a substance use disorder, 90% of them are on Medicaid. So a lot of them have just, the reason they've gone to the emergency room is because that's what they've known and because they know it's not going to cost them anything, Medicaid's going to cover the cost of it. So it's part of the culture really of that population.
So our focus is on helping them to think better about health care, engaging in preventative health care, addressing whatever their needs might be. Some of them have never been to a dentist, and it sounds small, but going to a dentist is a big deal and it can have a profound impact on a person's health. But that's engaging in small things like that to keep them out of the emergency room as well as teaching them that, by the way, if you need to get in touch with us, you pick up the app, you hit the button and maybe we can help you instead of you going to the emergency room for a rash. Because a lot of the reasons they go there are not emergency room reasons. So it's really just pointing them in the right direction.

Brian Urban:
It is so funny, Jason, because I think a lot of those across the healthcare ecosystem don't know a lot of the nuances that you're speaking to in the population that Holon Health serves, and not just the healthcare utilization but the variables that are connected to why they might be using health care and when they're using it, how long and what can be more right sized. And it's amazing that the companion portion of this is like an outlet for an individual to get help quicker than they think they could get help maybe downstream. So broadband access is something that popped in my head, wasn't going to get into this, but broadband access is, in terms of high reliable wifi connection that's improving across the US, it's different in rural hinterland areas other than urban. A lot of people have smart devices but may not be able to navigate certain tech. How easy is your companion app to navigate for an individual?

Jason Herzog:
Well, that is a great question and was an important aspect of our architecture as we brought the app together, was to make it very user-friendly for this population. Given my experience of working with them and from Averhealth, I think that really led into setting up an app that was simple, only a few options to click on, makes it easy for individuals to find it, access it, get in and out, and do what they need to do for their day.

Brian Urban:
And there's a big psych component to that. So the substance abuse disorder population, when you think about stimulation cognitively, if you have a lot of distractions or a lot of things going on and it's too complicated to navigate, there's too many clicks or steps, you're going to lose an engagement opportunity with that individual. So that's where my curiosity was going, is how easy is it from a function standpoint. Obviously you've put a lot of thoughtfulness into that for the user. But then also on the back end, the information that you get and you're able to share from an engagement perspective to those downstream, the other stakeholders' clients, it seems it's made easy as well. It's not complicated information for them to sort through what insights might be helpful. Am I right with that too?

Jason Herzog:
You are absolutely right. We are serving up a very simple engagement score for the downstream parties to look at, review and know. So they can quickly look at a dashboard and see who's doing well and who's not and maybe who they want to follow up with. And for the client, we've just made it as easy as possible for them to get in and out and do what they need to do. And you hit the nail on the head. I think you said something about keeping it clean and not cluttered. That's exactly what we've done. You got to keep it simple. Embrace kiss, right?

Brian Urban:
Yeah, it reminds me of the Michael Scott days from The Office and him always using that phrase. But literally, it's a funny thing, you learn it a long time in business school, but it's almost a laughable thing, but that's the component. Sometimes it's the secret sauce to making things work, especially with a vulnerable, high sensitivity population that Holon Health is facing. So I'm curious, young company, you're gaining some great traction, you have a very strong ROI, and it seems like the sky is the limit, Jason, so I'm curious what makes Holon Health so special? And as I ask this, I'm thinking it's the care team associated with it, but is the care team, in your perspective, the biggest part of your growth opportunity that's ultimately going to impact all the lives you serve?

Jason Herzog:
Well, I think our care team is special. They're outstanding and they do a phenomenal job. In fact, we just completed a patient survey, and the feedback that we got back on the care team was outstanding, which you love to hear. Definitely, the patients were singing their praises and said that, "They actually show how much they care about me and they're really making a difference." The care team, as long as we can keep building, finding people like that and filling our culture with people that embrace caring and show empathy and understand this population, the sky's the limit on growth, but it'd also be our governor on growth because we need to find people like that. They're not robots, right? I can't just turn them out.
But I think what really differentiates us and sets us apart is the connection we make from the health plans to the criminal justice system. Right now, if you ask any health plan who's one of your most expensive populations, they're going to say people with substance use disorder, and they don't necessarily have a great conduit to identify those individuals and bring them into a treatment program. We formed a relationship with the courts where the courts are able to basically ... The courts are probably the best screening tool. They're coming through, they're identifying the people with a substance use disorder, and they're able to connect them with us, which allows us to engage with the health plans and help bridge that gap. So I think that's a big part of it.

I think the other big part of it is also bringing all the other community providers together. While we don't provide residential treatment, if there's a wait for residential treatment, we can provide some bridge care in the near term. It's not going to be anywhere near the same, but at least it keeps the patient engaged in treatment and so we can make more of a warm handoff if you want to kind of prime the patient for that residential treatment center.

Brian Urban:
As you were describing that, Jason, obviously this growth and the impact that you want to make in the population you serve is highly dependent on the partnerships you have with health plans, Medicaid managed care organizations. And when you were describing some of the community-oriented healthcare providers, I was thinking immediately about fairly qualified health centers. So is your work starting to take positioning with helping those types of health centers or is that in the vision forward? I'm curious of where they land on your radar.

Jason Herzog:
All of the above. We are absolutely working with them. We will be referring clients to the federal and community health centers, but in addition, we'll also be referring them to other community resources that are available for wherever we are from that standpoint.

Brian Urban:
Yeah, I think that's one of the interesting things, is the coordination that you offer. One thing I'm curious of as you're describing that too is some barriers. So staying engaged and contacting this population I would imagine is fairly difficult. So is there a partnership that you have that you're working through right now that you share contact information or the best modality to get in touch with an individual that you're hoping to help through the companion app or through care coordination? Is there a disruption with having the right contact information? Because I look at Medicaid and the unwinding of the public health emergency, and about 70% of enrollment fall throughs were because of administrative errors really related to physical addresses and phone numbers being incorrect. I'm curious if downstream that's impacted you all at this point or is it something you're working through right now?

Jason Herzog:
It has to some extent, because a lot of these individuals, especially if they're coming out of jail, if they didn't have a cell phone, they are set up on a program to get a cell phone and they end up with a brand new phone number, and they misplace that cell phone, they just get a new one and come up with a new number. Now, what we have tried to do is to make it very easy for them to find us and to reconnect with us. But we also, we've given them a reason to want to reconnect with us, not only just through good care, through the cognitive variable therapy, through the convenience of telehealth, but also through contingency management.
I don't know if you're familiar with contingency management, but it is a treatment modality for people with substance use disorder that's been around for decades, widely tested. The general practice of it has been to, "Okay, you've done well this week, put your name in a fishbowl and you get to have a drawing to see if you won a prize." Or if you participated in any of, if you have a Fitbit and they give you a shield, "Hey, you've won a new logo, you've made a new accomplishment," that's another form of contingency management.
So we're giving them very small financial rewards for doing things that they're already required to do, such as go to court, show up for probation. If we refer them to a treatment provider, if we refer them to a dentist and they show up for their dentist appointment, they get a financial reward. If they check in and complete a lesson in the application and provide a reflection on that lesson, then they get a small financial reward. So what we have found is, if they do lose their phone and they get a new phone number, they're coming back to us to get in touch with us. We may have to reset their login and change their contact information, but the contingency management works.

Brian Urban:
I think that's probably the hook that gets them back deeper engaged. It's probably that's worth contributing toward the longevity of the engagement that you all have with these individuals. It seems like every health plan I've talked to, they got the wrong phone number or physical address, especially if it's Medicaid lives. So for one part, it's comical. The other part is, how the heck we can fix it? And it's through a lot of really creative partners like yourselves that we're going to be able to advance deeper engagement with these populations. So it's good to see that that's starting to get fixed and it's not negatively impacting the work that you do, but you're actually helping bridge it back for health plans.

Jason Herzog:
We could actually be a data source for health plans on phone numbers. If they want an accurate phone number and address, we have it for them.

Brian Urban:
Yeah. Yeah. And that's the missing link. And I think the value that you add to the health plan is beyond just the population you serve, but it's also the data that you can kick back and help them refresh. So, Jason, very cool. I'm glad that we got deeper into that side because that was something I was curious about looking into Holon Health a little bit deeper. But I want to shift for a moment and let's go into our crystal ball here and look past 2024. Holon Health is in a very strong traction stage right now. You're showing growth, you're making an impact. What does Holon Health turn into past 2024, say three plus years down the road? What do you all look like and what's your greatest contribution?

Jason Herzog:
That's an exciting question. Let me take a step back to answer it though. In 2011, when I co-founded Averhealth, we grew at a very governed rate. It was at 40% a year for 12 years, but it was still gradual as we added state by state. Learned a lot from that. And I'm going to do Holon Health a little bit differently. I think instead of taking 12 years to get to a national platform, we'll probably be there in about three. In fact, currently building out the team and bringing on the leaders that will allow us to scale at a healthy clip. And having known the courts from Averhealth and having great relationships with them and also having some experience with the health plans allows you to reach out to the decision makers fairly quickly and make some good headway.

Brian Urban:
That is exciting. And the best thing is, you're seniored in this space, you know how to do it, you've been there, you've done that, and now you're pulling together a lot of partners internally and externally to speed up your impact. I am so excited to see the growth of Holon Health, what you contribute to the ecosystem and how you're helping, I hope millions, tens of millions of lives that have been in and out of the justice system and that need another chance at getting a quality life and back in society and contributing in a good way. So, so exciting, Jason.

Jason Herzog:
Couldn't have said it any better.

Brian Urban:
I'm a fan already, so I can't wait. If you ever go IPO, I'm buying stock. But Jason, you're just exciting to talk to. Love the mission. Thank you so much for joining our little show here today.

Jason Herzog:
You got it. Thank you, Brian. I really enjoyed it. Take care.

Brian Urban:
For more exciting excerpts and insights, please visit us at finthrive.com.