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The Health Guardianship Podcast is an ongoing dialogue with healthcare professionals, policy experts, and innovators who are unraveling the complexities of the US healthcare system in order to create new solutions to guard health. Join the conversation and become part of the health guardianship movement!
Candice Ehler
Josh Taylor: [00:00:00] All right. Well, very excited to have a conversation today with both Firouz and Candice. Firouz, you now actually being in the interviewee seat and what we're talking about today is what health guardianship is in the context of working with members. We've talked a lot about the philosophy and the approach of health guardianship.
But today we really want to talk about some of the stories and the ways that we've been able to impact care on a member level. And Candice is part of our guardian team. Candice, maybe you can get us started by giving us a bit of your background and how you came to Bowtie to be part of the health guardianship team.
Candice Ehler: Yeah, so I've been in the healthcare space as a nurse for about 14 years now with various experience from long term care, skilled units, case management, correctional nursing, pediatrics to mental health. About halfway through my nursing career, I had a special interest in health coaching, so I obtained additional education and certifications and health coaching and behavioral [00:01:00] and habit change.
And then I came on board with Bowtie about a year and a half ago, creating our in house health coaching program and now, being a part of our first virtual healthy weight clinic.
Josh Taylor: Great. What would you say is a big difference, in the way that you're able to deliver care as a part of the health guardianship team versus your previous experience?
Candice Ehler: I would say thinking back into my previous experience in my nursing career and comparing it to my experience now as a guardian, time, is the biggest thing that stands out to me. It's a big culture change from that rush, hurried conversation. As nurses, we're the educators of the healthcare space and we rarely have that time to spend with the patients and as a guardian with Bowtie, I get time to cultivate those relationships and provide the education.
Josh Taylor: What are some of the things that you are able to [00:02:00] do now that you have that space that you previously were not able to, or even just maybe you mentioned education, are there specific items that you're able to walk alongside a member with?
Candice Ehler: Yeah, oftentimes, think of it this way, if you're in a brick and mortar institution as a nurse, in former positions I've been in where a patient is newly diagnosed with something they're told by the nurse, okay, you need to make diet changes.
You need to make nutritional changes. You need to change your lifestyle. Here's an educational handout to take home and do that. They're told the what, but not the how, and in this position, I'm able to spend the necessary time with them to not only tell them what they need to do, but how to do it. And I see a lot more success with that.
Josh Taylor: Yeah. I think a lot of people have that relationship with a physician where they're told now go be released into your care plan, but there's [00:03:00] not a lot of practical follow up and coming alongside them. Are there things that you are able to do in some of those follow ups when it comes to diet nutrition that are typically hard or challenging for members?
Candice Ehler: Yeah, so working with them on a more consistent basis, taking that time to follow up weekly with them, seeing where their obstacles may be lying. There's a lot of factors that play into the patient's ability, financial situation, circumstances, their home life, whatever obstacles they may be facing that you're not aware of, and that short time spent with them when you hand them these instructions or this care plan.
And so, you know, I'm able in this scenario to follow up with them weekly and kind of figure out what are those day to day and week to week obstacles that they're facing that can help them make changes.
Josh Taylor: You gotta love hearing this from Candice. This is the reason why, you know, you built Health Guardianship.
What, what stands out to you when you hear Candice [00:04:00] talking about just spending the time with members to actually solve their problems?
Firouz D.: Right. At the heart of the integration is really that time. Time to listen to the The member, understand the concern, as Candace said, understand how and why this happens, because most people want to be healthy.
None of us get upset and say wow I'm going to go and become diabetic because it's so much fun to inject yourself. No, most people want to be healthy. It's just they need a guardian, hand holding to understand what their issues are and how you can basically be educated and a course could be reset because at the end of the day, again, the philosophy we follow at Bowtie is people could be their best health guardians or the protectors of health if they have the non bias correct information delivered in a non hurried fashion.
And that [00:05:00] is what's really what we do.
Josh Taylor: Well, I think a lot of people that are used to getting care inside of the sick care system know that there's a rush. They know that there's a hurriedness to some of the appointments because you, there's, it's hard to ignore when you feel rushed coming in and out of a doctor's office.
Firouz D.: There is a rush. It's because the service of those wonderful nurses and doctors have become the subservient to the financial interest of a financial institution called hospitals and healthcare system with all their fancy names and fancy buildings. But at the end, they have formed an assembly line, taking advantage of the professional and the skills that the providers have to deliver that financial arms.
None of these services, none of these systems. They basically incentivize people for solving problems, patient's problems. They incentivize for creating clinical volume. So this is not a random event that is happening in [00:06:00] guardianship. We have reversed his business model. We say we want to actually spend the time solve people's problem.
But the intention of that is to solve people's problem rather than putting people and our providers on the treadmill because physicians have to see 50 60 patients a day, or what I'm saying with they don't. In the sick care model they do.
Josh Taylor: Yeah, let's pick up on that. Outcomes, Candice, when you're working with a member, how are you measuring outcomes for them inside of their care plan?
Or how are you collaboratively developing those maybe with the, with the member?
Candice Ehler: All members that embark in a care journey or health care plan will have a goal that we are working toward with that particular. And we take a more personalized approach, which is something that also differs from the sick care system and what I have experienced in the past is we're able to spend the time to kind of personalize their journey [00:07:00] specific to their needs and circumstances and for every member that's going to look a little bit different.
Um, In terms of measuring their progress and the outcome.
Josh Taylor: So if somebody was saying to you, Hey, I, you know, would love to be eating healthier, but our budget can't really help us get to some of the foods that may be on your list, how would you work with somebody, uh, to develop a care plan that responds to their budget?
Candice Ehler: Absolutely. So, first I'm going to evaluate what their current situation is. What are, you know, your current foods. But in, we are going to look at what their baseline is, where are they starting and where can we make the small changes that we can build upon from there?
Josh Taylor: What are some of the things that you look for as somebody who's a nutritionist and like getting somebody to take that behavior change, right?
Those small incremental steps. What are some of the things that you're looking for in that conversation?
Candice Ehler: Yeah, so, when I work with most of our members, we are looking at [00:08:00] what we refer to as James Clear's book, Atomic Habits. But it’s the idea that it’s, those small, small little changes at a time can make a huge impact, especially when it comes to your health and wellness.
So when we take the time to show them, it doesn't have to be this big gigantic change, and they don't have to go out and spend all of this money if it's not in their budget on all of these healthy foods and things like that. I'm helping them identify, okay, this is what you're currently doing. This is where we can make those small little changes that are going to add up to a huger impact on your health and wellness.
If they come to me with a desire to have better labs, maybe a healthier weight, we're looking to see where they can make those little tiny changes. Those atomic habits, the small things that lead up to bigger change.
Josh Taylor: Firouz, one of the things that you often talk about is asking the deeper question, taking the actual time with the member, not just addressing maybe the concern that the member had brought to you, but to ask a little bit, maybe one or two layers [00:09:00] deeper.
Can you talk about a couple of situations or working with members that maybe even you've experienced of the benefits of having more time with a member?
Firouz D.: Sure. So I'd make an example of a simple back pain. If a member gets up in the morning and has a back pain. If this person's dad passed from a bony metastasis of a cancer, prostate cancer, X cancer to his bone, and the first symptom of that was a back pain that his dad woke up, that back pain triggers a totally different neural Signaling system into that person and a person whose brother was an athlete that every morning gets up with the back pain.
Just oops, the stretching goes home, right? Surely, 180 degree. Our job as caregivers, as healers, as providers, guardians to understand that connection, and that is where this, uh, basically deep [00:10:00] questioning, uh, uh, Basically provides us the more complex the issues are, the more multifactorial are, and which is now is getting there.
Our job is to really find those connections and based on our training and skills and so forth to understand how we can navigate between these points and bring it to that one major root cause event that if you remove that, if you fix that, the rest of them will fall into the path of kind of getting fixed, uh, with a little bit of work.
So it will be more of a downhill rather than an uphill battle.
Josh Taylor: Candice, you were shaking your head, agreeing emphatically with what he was saying. Anything to add there?
Candice Ehler: Absolutely. Couldn't have said it better myself. Yeah, that's the basis of the work we are doing here where we're finding that root cause, we're taking and going back to the time factor again.
We are actually spending the time with the member to determine what, [00:11:00] not only what their problems are that they're coming to us with, but what is the root cause and how can we be proactive about mitigating that risk?
Josh Taylor: You actually had shared earlier a patient member that you were meeting with and actually I think Firouz, you were with Candice in this particular exchange and this woman was getting emotional.
Could you share that story, that impact? Sure.
Candice Ehler: Absolutely. So we had a member that had reached out. She was a newer member and she was kind of not really on board with guardianship at first. She was kind of, you know, I've been everywhere. I've seen all of these providers. Nobody's been able to help me.
I have all of these symptoms of illness. It's been going on for quite some time. Nobody's able to figure out what's the cause, what's going on with me. And she said, I'm open to meeting with one of your physicians, but I don't. Know that it would be helpful. [00:12:00] And so we connected her with FD and him and I actually met with her together via video visit. And we were able to just listen to her. We spent the time to let her explain what she had been through, what type of symptoms she had been experiencing, what type of treatment she had been to so far, what type of provider she's seen. We spent a whole hour with her, listening, in a visit, and we came up with a plan for out of that visit.
She started health coaching with me. We did a, we just did a simple. Three month journey, and we were doing her wrapping it all up at the end of the three months. What we call our final assessment video visit. She was moved to tears and that visit, and she said, I've never felt heard anywhere like I did here with you guys. She was so emotionally moved by that.
Firouz D.: So, Josh, as you could see in through this assembly line management of people's health problems that the current [00:13:00] secure system has imposed. We have also created a subculture. That the patients don't expect better, because we have desensitized them to rapid zip, zip, zip, zip.
But we are looking at this. Candace said, we're looking at the root causes and the how we can mitigate the risk to A. Prevent this issue to go anything further. B. to identify the root causes so we can prevent if there is other contributing factors to basically to shut off and not to contribute anymore.
Whereas the, again, on the aim of the sick care is the more you get to the far side of this side of the post event, the more subspecialized you become, the more subspecialty service you can deliver.
Josh Taylor: Well, and we've been talking about virtual care, but and in the virtual primary care environment, but guardianship [00:14:00] surrounds people when they're meeting with those specialists inside of the hospital.
Because obviously there are a certain percentage of cases that do require surgery. They do require seeing a specialist in person. Candace, Firouz, can you talk about what guardianship is like in those cases? The fact that you're still surrounding the member.
Firouz D.: To me, again, it's like a, the, the stem and the branches, right?
We are the, is the coordinator versus It's like the, your, your base camp. Right? The guardianship is really the base camp and the guardians are the short paths in this example. So at the base camp, you need to be fed, you need to be kept warm and so forth in a climber example, but on a day you need to go to the
Peak A versus Peak B, right? Peak A being the orthopedist, Peak B being, you know, cardiologist. When you go, basically go there, if you need us to be there, we will be with you to interpret [00:15:00] what the requirements of that visit is virtually. It is just a matter of really bringing another screen online to satisfy the need of the member.
And then all that information gets floated back into the base camp. So when you come and rest at night, We know what your experience was at the peak A versus the peak B, and how did it influence, frankly, your health and your desire for going to a peak C or not? Right. So I can take this to a medical examples is let me take you an example of a patient with prostate cancer. It’s the most common male cancer is within the areas of my expertise.
Next step is to do a biopsy or not to do a biopsy to diagnose whether this person has cancer or not. And after they have established, and I'm getting the shortcut of it because all this throughout this, there are branches and decision makings. Next In this heard conversation, no one spends with the patient.[00:16:00]
Person needs guidance and consult with someone who knows them at the base camp level. Every man with the prostate cancer in this process in the United States currently, majority of them, are left to their own. Because the primary care has three minutes to see. Yes, you have PSA. I'm going to send you to urologist.
You go to urologist. They just say, perhaps you're not bringing in kind of absorbing and integrating all decisions about the my life, the major decision and leave alone the stress that the patient is. Oh, my God, I have a cancer. Now I need to go and sort out my list of my life with my family, with my children.
All that stuff is totally left unattended in the current sick care system.
Josh Taylor: Any stories around how you've been supporting or walk alongside members that you want to share?
Firouz D.: I'll give you one example. Again, the whole concept of the base camp. We had a [00:17:00] member who injured her ankle and went to one of the emergency rooms of the one of the big hospital systems. They examined him and they said there's no fracture, no open wound.
They put a little splinter on her and they said now for us to we're identify what kind of injuries you have. We need an MRI. We don't have an MRI in this facility, so we are gonna send you with an ambulance to the main campus to basically do MRI in our system. And remember, thank goodness he called us, they said, this is what they say.
We say, well, you don't have a basic, this is not directed by your injury. Your injury is. It is not basically significant. You have a splinter. You don't need to go to another facility with an ambulance that will cost you 10-15,000 dollars and you don't need to go to get MRI in their main campus. Here it is. We made an appointment for you for an MRI tomorrow morning at an independent facility for 1/10th of that other place.
[00:18:00] And we made an appointment for you after your MRI with an orthopedic surgeon within one single phone call. We saved the person another day of a spend, you know, going with the ambulance to another main hospital and we saved him probably close to 20,000 Dollars. Uh, that that system was basically imposing on this person.
And that's why, as Candace will attest, we've had a very significant engagement and responsiveness compared to the alternatives that, you know, you just give a lecture to people and send them to the to the next appointment. Significant and both engagement and good results.
Josh Taylor: All right, thanks guys so much for the time today and for giving a little bit more of a window into what health guardianship is and how members are really surrounded and supported. Excited to dive into some more stories on a future episode.