WEBVTT NOTE This file was generated by Descript 00:00:00.000 --> 00:00:04.230 Martin: We're super lucky today to be joined by Tim and Dr. 00:00:04.230 --> 00:00:09.990 Malick, um, CEO and CMO respectively of Hopscotch Primary Care. 00:00:10.200 --> 00:00:11.730 Rural Health has been a. 00:00:11.939 --> 00:00:16.589 Uh, in the news a lot lately, but the hopscotch primary care folks have been 00:00:16.589 --> 00:00:21.059 working on it for a lot longer than, um, the recent conversations on the 00:00:21.059 --> 00:00:22.739 Rural Health Transformation Program. 00:00:22.739 --> 00:00:25.709 So we're excited to get their view, hear more about the business and 00:00:25.709 --> 00:00:30.599 also, um, what's going on in the, the rural health care world at the moment. 00:00:31.049 --> 00:00:34.739 Um, first question for, for you two, I think is on the headwinds 00:00:34.739 --> 00:00:37.170 or unique challenges that rural. 00:00:37.575 --> 00:00:40.785 Um, healthcare and primary health or primary care have. 00:00:40.815 --> 00:00:43.845 So when I think about it, I think, you know, it's generally thought 00:00:43.845 --> 00:00:45.735 of as a, a hard business to be in. 00:00:46.095 --> 00:00:48.195 There's a worse payer mix. 00:00:48.225 --> 00:00:50.415 The labor markets a little bit worse. 00:00:50.415 --> 00:00:55.155 And so I'm curious to hear from you, like, what are those, those 00:00:55.155 --> 00:00:59.775 things that make rural primary care so challenging or difficult? 00:01:00.885 --> 00:01:01.905 Tim: Yeah, sure thing. 00:01:02.295 --> 00:01:04.155 Uh, first, really happy to be here today. 00:01:04.215 --> 00:01:08.475 Uh, been been a long time member of the community and, uh, serendipitous 00:01:08.475 --> 00:01:11.024 timing Last night, uh, a friend and colleague reached out who I 00:01:11.024 --> 00:01:14.835 talked to last year, and, uh, just she wanted advice on a job search. 00:01:14.895 --> 00:01:19.065 One of the things I told her was, you gotta subscribe to HTN, uh, see what's 00:01:19.065 --> 00:01:20.625 going on, see what's really happening. 00:01:20.850 --> 00:01:23.850 And she emailed me last night and said she actually got a job 00:01:23.850 --> 00:01:26.700 through someone she met through the community, and she was thrilled. 00:01:26.730 --> 00:01:29.940 It was a really high impact startup that she, it was like a 00:01:30.210 --> 00:01:32.490 fits really well for her passion. 00:01:32.490 --> 00:01:34.410 So, uh, shout out to Maeve. 00:01:34.440 --> 00:01:35.940 Really congratulations as well. 00:01:36.270 --> 00:01:37.710 Um, and, and you're right. 00:01:37.710 --> 00:01:42.030 We, we have been working on, uh, on building out a model that is well 00:01:42.030 --> 00:01:44.100 suited for rural for a number of years. 00:01:44.435 --> 00:01:48.215 And now the policy world is turning its attention to the, the problem and 00:01:48.545 --> 00:01:52.145 problems in, in rural are, are pretty well documented, but, but really 00:01:52.145 --> 00:01:58.085 underdressed, uh, from, from a sort of, and then that rolls up to a policy level. 00:01:58.355 --> 00:02:00.485 Uh, we think of it in a few categories. 00:02:00.915 --> 00:02:05.325 Access problems are at large, and you hear about hospitals shutting down hospitals, 00:02:05.385 --> 00:02:08.954 uh, access to hospital services, inpatient emergency, and the like. 00:02:09.255 --> 00:02:12.224 Primary care is a really important adjunct to that primary care. 00:02:12.375 --> 00:02:15.045 Short, if you look at the relevant HIPSA measures, sort of by any 00:02:15.045 --> 00:02:18.045 measure, almost every rural area has a, a serious shortage, 00:02:18.045 --> 00:02:19.695 structural shortage of primary care. 00:02:20.055 --> 00:02:22.964 There's a number of structural, structural problems, whether it's 00:02:22.964 --> 00:02:27.375 technology, drive time, and aging workforce, that is also driving the, 00:02:27.495 --> 00:02:29.175 the access challenges in primary care. 00:02:30.060 --> 00:02:32.610 Um, and then, uh, a very high disease burden. 00:02:32.610 --> 00:02:36.000 So all of the, the chronic diseases are significantly higher burden in 00:02:36.000 --> 00:02:40.380 rural, in the southeast, we have, uh, a number of other health burdens that 00:02:40.380 --> 00:02:41.850 we, that our patients are dealing with. 00:02:42.329 --> 00:02:45.810 Um, it, you know, from our perspective though, this, this is why we have 00:02:45.810 --> 00:02:47.700 built hopscotch the way we built it. 00:02:47.700 --> 00:02:51.630 It's a, it's a high touch, high tech enablement model and model that is 00:02:51.630 --> 00:02:53.490 directly solving the primary care. 00:02:53.805 --> 00:02:54.735 Access challenge. 00:02:54.735 --> 00:02:58.845 We are bringing, we are bringing providers to rural and small town communities in our 00:02:58.845 --> 00:03:00.615 launch market in western North Carolina. 00:03:00.885 --> 00:03:05.025 We're doing it in a way that excites our teams and helps us recruit 00:03:05.085 --> 00:03:07.185 and manage our clinical hubs. 00:03:07.545 --> 00:03:10.875 Uh, and this makes a, this makes a huge difference on the lives of our patients. 00:03:11.145 --> 00:03:14.385 Uh, and it's a, it's a, it's a great time to be building right now. 00:03:14.385 --> 00:03:18.675 Technology has changed dramatically where the cost structure of bringing services, 00:03:18.915 --> 00:03:20.340 whether it's virtual specialty care. 00:03:21.105 --> 00:03:24.045 Or extending the capabilities of our teams is dramatically easier 00:03:24.045 --> 00:03:25.334 than it was five years ago. 00:03:25.605 --> 00:03:29.445 And now there's this massive policy investment in, uh, the form of the Rural 00:03:29.445 --> 00:03:31.844 Health Transformation Fund, $50 billion. 00:03:31.844 --> 00:03:35.055 That's about 50 x per 50 x what the Innovation Center 00:03:35.055 --> 00:03:36.675 was on a per capita basis. 00:03:36.945 --> 00:03:41.834 So a truly massive investment in transformational care models, technology 00:03:41.834 --> 00:03:45.700 projects, uh, workforce development, and directly supporting access 00:03:45.760 --> 00:03:47.175 in the communities that we serve. 00:03:50.355 --> 00:03:54.735 Martin: And before we kind of zoom into your business and, and learn more about 00:03:54.735 --> 00:03:58.095 Hopscotch Primary Care, I was wondering if you could kind of talk to us a little 00:03:58.095 --> 00:04:02.295 bit about the Rural Health Transformation Program and just sort of philosophically 00:04:02.295 --> 00:04:06.585 given your vantage point as you know, working really deeply in this space, like. 00:04:06.670 --> 00:04:10.570 How, if you were, uh, uh, talking to a state, which I'm, I'm sure you are, 00:04:10.780 --> 00:04:14.380 um, about how they should, they should use this money for transformative 00:04:14.380 --> 00:04:18.040 purposes, not just backfilling what they're gonna lose from, from Medicaid. 00:04:18.220 --> 00:04:22.270 How would you think about, um, how should they think about that investment? 00:04:23.620 --> 00:04:27.160 Tim: Yeah, I think it's really important to take big swings here 00:04:27.160 --> 00:04:32.770 and to try to directly improve access, not attempt to paper over, 00:04:32.830 --> 00:04:34.210 uh, a system that isn't perfect. 00:04:35.220 --> 00:04:38.430 Working to not pour money into business as usual, essentially. 00:04:38.430 --> 00:04:42.150 And so to me that is, it starts with setting aggressive goals around 00:04:42.150 --> 00:04:46.200 improving access and improving actual health outcomes and mortality outcomes. 00:04:46.560 --> 00:04:51.030 Uh, it also starts with, uh, real thought about how you actually do that. 00:04:51.090 --> 00:04:55.230 And, uh, for what we do, uh, that's directly providing access to primary 00:04:55.230 --> 00:05:00.150 care makes a big impact on hospital utilization, on patient experience, 00:05:00.150 --> 00:05:02.460 on patient, really patient lives. 00:05:02.800 --> 00:05:04.240 Uh, and extends lives. 00:05:04.240 --> 00:05:07.990 And so we've seen, you know, on a practical level, a number of the states 00:05:07.990 --> 00:05:12.730 we've been talking to are setting goals and, uh, applying for funding around 00:05:13.030 --> 00:05:17.860 directly increasing the number of PCPs per 10,000 population in rural counties. 00:05:18.540 --> 00:05:22.680 We've seen significant investments in topping up and extending 00:05:22.680 --> 00:05:24.300 existing workforce programs. 00:05:24.300 --> 00:05:28.110 And so these are, you know, national Health service core like, or, uh, 00:05:28.110 --> 00:05:31.470 there's a program in North Carolina called the High Need Service Area Bonus 00:05:31.470 --> 00:05:33.000 Program for Mid-Career Physicians. 00:05:33.485 --> 00:05:37.775 These are really significant and they allow us to directly, uh, to directly 00:05:37.775 --> 00:05:41.735 pass through funding and support our teams in, in tapping into funding that 00:05:41.735 --> 00:05:46.115 can help increase their compensation by very significantly versus what 00:05:46.115 --> 00:05:48.815 they could get in, uh, in urban areas. 00:05:49.115 --> 00:05:52.685 Uh, and then, you know, the, the challenges and that, that people 00:05:52.685 --> 00:05:54.395 don't wanna live in rural areas. 00:05:54.395 --> 00:05:55.415 A lot of physicians do. 00:05:55.655 --> 00:05:58.415 They just don't have access to, uh, the type of. 00:05:58.470 --> 00:06:01.740 Practice that they want to, that they want to work in, uh, that's something 00:06:01.740 --> 00:06:02.940 that we're able to do as well. 00:06:03.180 --> 00:06:05.970 And then for, you know, the non hopscotch, you didn't ask about hopscotch in that 00:06:05.970 --> 00:06:09.060 question, but like there's, there's a whole bunch of ideas and initiatives 00:06:09.060 --> 00:06:13.950 floating around in, uh, extending hospital care and bringing virtual specialty 00:06:13.950 --> 00:06:18.235 services to rural, uh, and building out better support for maternity care 00:06:18.630 --> 00:06:21.240 and, uh, and other shortage services. 00:06:21.540 --> 00:06:23.040 Uh, that, that I think you can. 00:06:23.435 --> 00:06:26.375 The, the key to me is just to try to, try to really move the needle on 00:06:26.375 --> 00:06:29.310 a couple of really important things rather than try to boil the ocean. 00:06:30.780 --> 00:06:34.335 Aditi: I'll just add to like what's so fascinating about this $50 00:06:34.335 --> 00:06:38.849 billion transformation fund is the money has to be spent very quickly. 00:06:39.000 --> 00:06:43.830 It's an, it is an a massive chunk of money that has to be spent very quickly, which 00:06:43.830 --> 00:06:47.969 means from a state perspective, you're looking at warp speed implementation. 00:06:48.240 --> 00:06:52.830 And one of the things that states really have to be able to measure up on is 00:06:52.860 --> 00:06:57.750 measurable impact that is sustainable beyond the five-year funding cliff. 00:06:57.750 --> 00:06:58.945 And that's where, to Tim's point. 00:06:59.490 --> 00:07:03.900 Investing in business as usual looks great for five years, but when you get 00:07:03.900 --> 00:07:05.940 to five years in a day, what happens? 00:07:06.030 --> 00:07:09.090 And so I think there's truly in the spirit of transformation, this 00:07:09.090 --> 00:07:13.470 opportunity to invest in ways that are super charging investments that can 00:07:13.470 --> 00:07:18.270 actually self sustain beyond those five years, like investments in primary care. 00:07:21.840 --> 00:07:23.910 Kevin: Tim, I, I wanted to pick up on, um. 00:07:24.330 --> 00:07:27.540 A comment you made about recruiting docs into, uh, rural areas. 00:07:27.540 --> 00:07:31.530 And I'd be curious, kinda as you think about Hopscotch model and entering 00:07:31.530 --> 00:07:35.730 a market like Asheville, like, could you walk me through, are you guys 00:07:35.730 --> 00:07:40.560 like creating a hopscotch tin in the market and are you bringing docs into 00:07:40.560 --> 00:07:43.390 that tin, employing those docs in the primary care clinics and then. 00:07:44.205 --> 00:07:47.175 How, like, how do you think about that recruiting conversation? 00:07:47.175 --> 00:07:51.195 Like, it strikes me that you could go the route of recruiting docs who have 00:07:51.195 --> 00:07:55.455 been in Asheville for a long time with new care model, new support, resources. 00:07:55.485 --> 00:08:00.465 You could go out of Asheville, bring in docs who are, you know, out of school, 00:08:00.465 --> 00:08:02.205 coming in, building out their panel. 00:08:02.355 --> 00:08:05.115 You could go to the like advanced care model startups. 00:08:05.115 --> 00:08:08.684 Like how do you think about what that doc looks like and what that 00:08:08.684 --> 00:08:10.515 pitch is like to them when it's like. 00:08:11.145 --> 00:08:13.455 To your point on, it's not that hard to recruit to rural areas. 00:08:13.455 --> 00:08:16.395 Like I, it wouldn't take me much convincing to move to Asheville 00:08:16.395 --> 00:08:17.565 and like go live in Asheville. 00:08:17.565 --> 00:08:21.164 But like, is Asheville representative of, like, how, how does that 00:08:21.164 --> 00:08:23.055 conversation work across rural markets? 00:08:23.715 --> 00:08:24.765 Tim: Yeah, great question. 00:08:24.825 --> 00:08:27.645 Um, and I'll, I'll take the first part of that and, uh, and 00:08:27.645 --> 00:08:28.664 working backwards a little bit. 00:08:28.664 --> 00:08:32.145 So I had a similar response to you when, uh, when I was contemplating, 00:08:32.145 --> 00:08:33.885 well, is, is Asheville really rural? 00:08:34.125 --> 00:08:38.355 Um, the, the c the communities we serve are not just Asheville, but are an an 00:08:38.355 --> 00:08:41.835 hour and an hour and a half drive in, in every direction from Asheville. 00:08:41.865 --> 00:08:45.975 So we are really in mountainous Appalachia and a, a number of small and 00:08:45.975 --> 00:08:47.625 midsize towns surrounding the region. 00:08:47.955 --> 00:08:51.315 Um, and, and so we, we have have a lot of. 00:08:51.645 --> 00:08:56.175 Reps, even in our first launch, uh, community, uh, where we have really gotten 00:08:56.175 --> 00:09:00.555 to understand what we need to serve these clinics and these, uh, these areas that, 00:09:00.615 --> 00:09:04.125 so that they can be successful both from a talent and from a care model perspective. 00:09:04.605 --> 00:09:08.805 Um, the, you know, there are a lot of communities like that look like 00:09:08.805 --> 00:09:11.954 Asheville that are, you know, sort of medium, medium-sized, medium-sized town 00:09:11.954 --> 00:09:13.089 surrounded by a lot of small towns. 00:09:13.785 --> 00:09:17.205 Uh, all over the Southeast and the Northeast and the, the southwest. 00:09:17.205 --> 00:09:20.235 So this is a, a pretty common dynamic as we've looked at where we 00:09:20.235 --> 00:09:25.125 go next and the, the, the question on like, how do we enter, how do we 00:09:25.125 --> 00:09:27.675 begin working with a a, a care team? 00:09:28.065 --> 00:09:31.965 Uh, we have found, uh, this was a, this was a light bulb for me 00:09:31.995 --> 00:09:33.015 that, that makes a lot of sense. 00:09:33.015 --> 00:09:34.755 You, you think about the decline of independent. 00:09:35.564 --> 00:09:38.834 Across the country, a very well understood story at this point. 00:09:38.834 --> 00:09:43.515 That's a combination of it and contracting and the difficulties 00:09:43.515 --> 00:09:45.105 of running relatively complicated. 00:09:45.435 --> 00:09:50.265 Small, small businesses at this point, um, that has hit rural especially hard, 00:09:50.505 --> 00:09:54.975 where physicians who have been, uh, leaders in their community and running 00:09:54.975 --> 00:09:58.214 solo or two member practices for 30 years. 00:09:59.295 --> 00:10:01.065 Don't have anyone to hand their practice off to. 00:10:01.065 --> 00:10:03.045 They, they can't find a succession plan. 00:10:03.405 --> 00:10:08.115 And so there's a lot of patients that are sort of on the verge of losing their, 00:10:08.115 --> 00:10:11.445 their family medicine doc who they, they haven't, they've known forever. 00:10:11.745 --> 00:10:14.355 Uh, and that that family medicine doc is already drowning. 00:10:14.675 --> 00:10:19.805 Uh, and so our opportunity and what we can provide to the, those physicians is 00:10:19.834 --> 00:10:23.915 a natural transition plant into a care model that is very appropriate for their 00:10:23.915 --> 00:10:27.814 patients, and that is very high touch, and that that makes a huge difference in their 00:10:27.814 --> 00:10:31.564 lives, as well as just the, the basics of continuing to provide access, right? 00:10:32.015 --> 00:10:35.975 Flip side is we can provide a place where physicians will want to 00:10:35.975 --> 00:10:39.035 work and not have to have the full responsibility for everything running. 00:10:39.390 --> 00:10:41.580 And it's a family medicine practice on their own. 00:10:42.030 --> 00:10:42.750 Um, and Dr. 00:10:42.750 --> 00:10:46.560 Malick has done a lot of thinking about how that, how that evolves as we begin 00:10:46.560 --> 00:10:50.700 to, uh, as we grow and as we, uh, wanna recruit more and more from both from 00:10:50.700 --> 00:10:53.760 the region and then from the, from other parts of the country writ large. 00:10:54.810 --> 00:10:56.220 Aditi: Yeah, agree with all of that. 00:10:56.220 --> 00:10:58.770 A couple things I'd add, just Kevin, to your question of 00:10:58.770 --> 00:11:00.360 like, where do folks come from? 00:11:00.600 --> 00:11:02.100 Are they native to Asheville? 00:11:02.100 --> 00:11:03.150 Are they relocating? 00:11:03.150 --> 00:11:04.140 We do a mix. 00:11:04.140 --> 00:11:05.430 We've done a mix. 00:11:05.850 --> 00:11:10.740 I'd say that the core components that we look for are clinical excellence, care 00:11:10.740 --> 00:11:14.670 model excellence, like somebody that can understand how to, how to operate in 00:11:14.670 --> 00:11:18.930 a, in a full risk provider environment, and then people leadership excellence. 00:11:19.605 --> 00:11:21.045 The what? 00:11:21.075 --> 00:11:22.875 What draws folks to us? 00:11:22.875 --> 00:11:26.505 I think where our value proposition to physicians and clinicians is 00:11:26.505 --> 00:11:28.065 the strongest is a couple things. 00:11:28.725 --> 00:11:34.845 One, we are, it's, it's way more fun, just literally like the day to day 00:11:34.845 --> 00:11:39.855 of working in a clinic where you are fully capitated because you're not on 00:11:39.855 --> 00:11:41.175 the fee for service treadmill, right? 00:11:41.175 --> 00:11:45.945 Like our, our docs are not seeing 30 patients a day with 2000 patient panels. 00:11:45.945 --> 00:11:48.345 So people have the time to actually get to know their patients. 00:11:48.525 --> 00:11:52.035 Like my favorite thing that our docs will say to me is, oh, this is how I've 00:11:52.035 --> 00:11:53.805 always wanted to practice medicine. 00:11:54.165 --> 00:11:55.455 Um, and the, the. 00:11:55.555 --> 00:11:56.695 The business model, right? 00:11:56.695 --> 00:12:00.175 The capitation, economics that underlie that makes that possible. 00:12:00.595 --> 00:12:02.635 Um, the other thing is the tooling. 00:12:02.635 --> 00:12:05.695 It's, you know, and, and Tim alluded to this, like this is not 00:12:05.695 --> 00:12:09.265 the independent and primary care practice that I grew up watching in 00:12:09.265 --> 00:12:10.885 the eighties and nineties, right? 00:12:10.885 --> 00:12:14.425 Where like, you work 80 hours a week, you are your own, you're your 00:12:14.425 --> 00:12:17.965 own contractor, you run your own payroll, you pay all the bills, right? 00:12:18.175 --> 00:12:20.245 Like we handle all of the back office stuff. 00:12:20.245 --> 00:12:22.975 But alongside that, again, because of the underlying 00:12:22.975 --> 00:12:24.235 capitation model, we're able to. 00:12:24.320 --> 00:12:26.900 Staff these clinics in a way that's really effective. 00:12:26.900 --> 00:12:30.200 And so it's both the staffing model and then the, the 00:12:30.200 --> 00:12:31.880 technology that underlies that. 00:12:31.880 --> 00:12:36.140 So I'm a huge believer having been a primary care doctor, like I saw patients 00:12:36.140 --> 00:12:40.940 in our Spruce Pine clinic two days ago, like the ability to have technology and 00:12:40.940 --> 00:12:45.410 tools that WIC away the administrative garbage, frankly, that is burning 00:12:45.410 --> 00:12:49.640 out doctors at unprecedented rates is something that we take really seriously. 00:12:49.640 --> 00:12:51.680 So that like that's how you actually make it both. 00:12:51.775 --> 00:12:55.615 There's an appeal to living in small towns and you know, like better cost 00:12:55.615 --> 00:12:59.275 of living, better work life balance, but coupled with a practice environment 00:12:59.275 --> 00:13:01.915 that actually is fun and sustainable. 00:13:02.905 --> 00:13:03.025 Martin: Yeah. 00:13:03.385 --> 00:13:05.454 Before we get into, oh, sorry. 00:13:05.454 --> 00:13:05.965 Before we get into. 00:13:07.005 --> 00:13:07.545 Care model. 00:13:07.875 --> 00:13:13.035 Um, I have another question on the human, human capital side of things. 00:13:13.035 --> 00:13:13.785 So, Dr. 00:13:13.785 --> 00:13:19.035 Malach, when we first spoke, you talked about these entry points to, um, 00:13:19.095 --> 00:13:20.415 like the, the different entry points. 00:13:20.415 --> 00:13:22.515 I was wondering if you could kind of share with the audience. 00:13:23.505 --> 00:13:27.255 The different routes that a doctor might take to, to considering a move, 00:13:27.345 --> 00:13:29.355 um, a move to something like hopscotch. 00:13:29.475 --> 00:13:30.075 Aditi: Yeah. 00:13:30.075 --> 00:13:33.855 I have often described, um, medical training or the medical profession of 00:13:33.855 --> 00:13:35.415 like, it's like being on the freeway. 00:13:35.745 --> 00:13:37.485 Freeway if you're on the West Coast highway, if you're 00:13:37.485 --> 00:13:38.325 on the east coast, right? 00:13:38.325 --> 00:13:40.605 But like, there are defined exit ramps. 00:13:40.905 --> 00:13:44.145 One of the most clearly defined exit ramps is when you come out of your 00:13:44.145 --> 00:13:46.125 postgraduate training or residency. 00:13:46.185 --> 00:13:48.075 So there's a, there's an off ramp there. 00:13:48.075 --> 00:13:48.315 'cause like. 00:13:48.569 --> 00:13:49.680 You gotta get a job, right? 00:13:49.770 --> 00:13:51.840 You're either getting a job or you're going onto additional 00:13:51.840 --> 00:13:54.420 training, like you're staying on the highway to go into fellowship. 00:13:54.630 --> 00:13:55.890 That's another exit ramp. 00:13:56.189 --> 00:13:59.670 And then beyond those two exit ramps, it's pretty stochastic. 00:13:59.699 --> 00:14:01.890 So it'll, you know, people will move for. 00:14:02.295 --> 00:14:05.115 A spouse is changing jobs, a family illness, right? 00:14:05.115 --> 00:14:09.915 Like the people move and obviously people, people change jobs, but the, the window of 00:14:09.915 --> 00:14:16.065 opportunity from a recruiting perspective is the widest open at those exit ramps. 00:14:16.065 --> 00:14:20.715 And so one of the things that we're really working hard to build is the pipeline and 00:14:20.715 --> 00:14:25.905 the partnerships, um, to be able to, you know, alongside our university partners 00:14:25.905 --> 00:14:27.435 or alongside folks that are actually. 00:14:27.480 --> 00:14:31.410 Training the next generation of clinicians to be a place where 00:14:31.410 --> 00:14:34.565 those people can actually then come and, and work for years to come. 00:14:38.775 --> 00:14:41.715 Kevin: One of the things I'd be, I'd be curious to pick up on and this, so we 00:14:41.745 --> 00:14:46.905 had town hall folks on a couple weeks ago fund and it's very AI centric forward 00:14:46.905 --> 00:14:49.305 and they, they talked hopscotch one. 00:14:50.270 --> 00:14:55.700 Kinda leading examples of, um, of what they think is going on in the ai AI space. 00:14:55.700 --> 00:14:58.580 And I'd be curious if you guys could share a little bit about how 00:14:58.580 --> 00:15:01.550 you think about that technology tooling, how AI is changing that. 00:15:01.550 --> 00:15:04.820 Obviously we, we read the news and hear about, you know, there's a, 00:15:05.330 --> 00:15:08.900 a group in South Carolina that's expanding, uh, their urgent care slash 00:15:08.900 --> 00:15:12.590 primary care model because there's more coding opportunities for them. 00:15:12.710 --> 00:15:13.100 Um. 00:15:13.740 --> 00:15:16.800 We hear a lot about ambient scribing and whatnot, but I'd be curious if 00:15:16.800 --> 00:15:20.550 there are, like how you may framework perspective, think about implementing 00:15:20.550 --> 00:15:24.060 AI as an organization and then if there are any tactical use cases that 00:15:24.060 --> 00:15:26.520 you could talk to where you've seen particularly strong impact of it. 00:15:28.500 --> 00:15:29.520 Tim: Yeah, for sure. 00:15:29.520 --> 00:15:31.470 I'll, I'll, I'll start and then, uh, Dr. 00:15:31.470 --> 00:15:34.770 Malick can, uh, can speak to some of our favorite clinical use cases. 00:15:36.245 --> 00:15:40.110 A, as I mentioned, we, we find it tremendously rewarding to be building 00:15:40.110 --> 00:15:43.770 these types of services and the supports for our, our, our clinical hubs right 00:15:43.770 --> 00:15:47.400 now, as opposed to several years ago because the technology is, yeah. 00:15:47.400 --> 00:15:51.030 Having fought the EMR battles for like two, two decades at this point where 00:15:51.030 --> 00:15:54.300 everyone was fighting every step of the way, it's creating friction and to like. 00:15:54.780 --> 00:15:56.670 It, it's, it's flipped on its head. 00:15:56.700 --> 00:16:01.020 We, we still have to go through really careful governance and implementation 00:16:01.020 --> 00:16:05.220 processes, but like we're, we're tr we're aiming for interventions that 00:16:05.220 --> 00:16:06.990 delight our care teams and our patients. 00:16:06.990 --> 00:16:10.650 And we're, we're having a pretty good track record on that at this point. 00:16:10.650 --> 00:16:12.870 And ambiance grads really are a game changer. 00:16:12.870 --> 00:16:15.270 Just the sheer amount of like, it, it's another. 00:16:15.930 --> 00:16:18.780 It shows up in our patient feedback and patients notice that their 00:16:18.780 --> 00:16:21.540 doctor's ta talking to them, not talking to the keyboard. 00:16:21.960 --> 00:16:26.460 Um, we, you know, by virtue of being in a, in a capitated business, we 00:16:26.460 --> 00:16:30.330 have the opportunity to leverage automation technology, including 00:16:30.330 --> 00:16:32.189 AI sort of across the full stack. 00:16:32.460 --> 00:16:36.540 So wherever we have significant administrative work going on, rote 00:16:36.540 --> 00:16:40.620 routine work, yes, with the care teams, but also with back office staff, all 00:16:40.620 --> 00:16:42.600 sharp prep, all sort of the entire. 00:16:42.975 --> 00:16:46.665 Uh, the entire flow before and after a patient visit, or even before and after 00:16:46.665 --> 00:16:50.445 we get a patient engaged with us, we have the ability to, uh, and have built 00:16:50.445 --> 00:16:55.725 a team that's capable and ready to deploy technology to dramatically simplify and, 00:16:55.815 --> 00:16:58.095 uh, leverage the every member of the team. 00:16:58.455 --> 00:17:00.945 Um, we, you know, I, I will tee up, uh, Dr. 00:17:00.945 --> 00:17:04.004 Malick to, to talk about one of my, this is not ai, but like one of my 00:17:04.004 --> 00:17:08.175 favorite solutions is this, like, it's always been a desire to have, uh, rapid 00:17:08.175 --> 00:17:10.125 virtual specialty consults available. 00:17:10.425 --> 00:17:15.044 We finally have solved it where like we can actually get consults from 20 00:17:15.044 --> 00:17:19.185 specialists to, to expand the, the scope of what a primary care doc can do in a 00:17:19.185 --> 00:17:21.014 visit within just a couple of minutes. 00:17:21.044 --> 00:17:22.425 And, and it's awesome. 00:17:22.514 --> 00:17:27.014 Uh, and, you know, really, uh, high support from the care teams and, and you 00:17:27.014 --> 00:17:31.125 can see like how it can save patients months of wait times in many cases. 00:17:32.864 --> 00:17:33.135 Aditi: Yeah. 00:17:33.405 --> 00:17:37.840 I'm happy to jump in maybe, um, Kevin, to the first part of your question of. 00:17:38.534 --> 00:17:40.604 Like framework for how to think about it. 00:17:40.935 --> 00:17:45.465 I think about it as AI is supercharges the care model. 00:17:45.465 --> 00:17:48.645 So there's, there is no substitute for human connection. 00:17:48.645 --> 00:17:52.064 Like, call, call me crazy and old fashioned about this. 00:17:52.064 --> 00:17:53.320 But like even in the era. 00:17:54.074 --> 00:17:57.554 Of ai, like we're not replacing the humans anytime soon. 00:17:57.704 --> 00:18:01.574 We are giving them additional teammates that can supercharge the 00:18:01.574 --> 00:18:04.424 best of clinical care alongside the best of human connection. 00:18:04.664 --> 00:18:09.074 And I think of like three specific domains where AI in the 00:18:09.074 --> 00:18:10.274 care model is really valuable. 00:18:10.274 --> 00:18:13.664 The first I I sort of talked about is just like cut out the administrative 00:18:13.664 --> 00:18:16.784 garbage that like takes up time that nobody wants to do, right? 00:18:16.784 --> 00:18:20.834 Like ai, ambient scribes are, I think the perfect example of that. 00:18:21.044 --> 00:18:23.144 Um, we've seen in our own data. 00:18:23.504 --> 00:18:24.074 Um. 00:18:24.810 --> 00:18:26.850 Over over 80%. 00:18:26.850 --> 00:18:32.159 I think it's about 85% of our PCPs use an ambient scribe over 80% of the time. 00:18:32.250 --> 00:18:33.930 It decreases pajama time. 00:18:33.930 --> 00:18:36.540 It decreases the amount of time they have to spend in the charts, right? 00:18:36.690 --> 00:18:39.240 It's like a rare case of a win-win win. 00:18:39.570 --> 00:18:43.860 Um, the second big bucket is around making care more effective, right? 00:18:44.100 --> 00:18:45.870 So we can now use ai. 00:18:46.330 --> 00:18:50.169 To level up and exceed the standard of care around chronic disease 00:18:50.169 --> 00:18:51.699 management and other things. 00:18:51.760 --> 00:18:56.800 And then the third is where, um, where, um, Tim left off around AI 00:18:56.800 --> 00:18:58.899 being able to supercharge access. 00:18:59.260 --> 00:19:04.840 Um, so, you know, like we, 20% of America lives in rural parts of the country. 00:19:04.840 --> 00:19:07.780 There are some people that'll tell you, oh, well the future of rural healthcare 00:19:07.780 --> 00:19:09.490 is like, everybody gets a chat bot. 00:19:10.199 --> 00:19:13.379 The, the hospitals will take care of all the procedures and like, you 00:19:13.379 --> 00:19:16.290 know, like you take, you stitch those two things together and like, great, 00:19:16.290 --> 00:19:17.969 you've now solved the access problem. 00:19:18.239 --> 00:19:21.899 Um, but like two days ago I had to, I had to drain an abscess. 00:19:21.899 --> 00:19:25.409 Like who does that in the world of AI chat bots and, and hospitals, right? 00:19:25.409 --> 00:19:29.429 Like there's, there has to be the primary care layer, like the primary 00:19:29.429 --> 00:19:31.110 care layer that's so important there. 00:19:31.320 --> 00:19:33.360 But what AI allows us to do is. 00:19:34.439 --> 00:19:37.259 For example, care managers become that much more effective, right? 00:19:37.259 --> 00:19:38.610 They can touch that many more people. 00:19:38.639 --> 00:19:38.729 Mm-hmm. 00:19:38.969 --> 00:19:41.219 Remote patient monitoring becomes that much more effective. 00:19:41.279 --> 00:19:45.689 And in the example Tim gave, we, we partner with a platform, not AI specific, 00:19:45.689 --> 00:19:50.850 but in the broader theme of technology and tooling where, um, our PCPs, our 00:19:50.850 --> 00:19:53.969 docs, nps, PAs, can pull out their phone. 00:19:54.200 --> 00:19:58.100 Type in what's colloquially known in medicine as a curbside consult 00:19:58.220 --> 00:20:01.820 and get a response from a board certified specialist in under a minute. 00:20:01.909 --> 00:20:05.540 And that saves the patient from having to drive, you know, an hour 00:20:05.540 --> 00:20:09.590 in any given direction, very often saves them a trip to the hospital. 00:20:09.590 --> 00:20:13.550 So takes cost out of the system, delights patients, improves access. 00:20:14.899 --> 00:20:18.020 Martin: That's a perfect lead in to my question, I guess, about 00:20:18.020 --> 00:20:19.790 your care model specifically. 00:20:19.790 --> 00:20:22.580 So if I'm thinking about a hopscotch primary care clinic. 00:20:23.070 --> 00:20:25.709 Um, what does that staffing look like? 00:20:25.709 --> 00:20:32.159 How is it, you know, how are you sort of geographically spread out in the area? 00:20:32.189 --> 00:20:34.290 How close is like one clinic to another? 00:20:34.649 --> 00:20:36.209 Um, and yeah, how do you staff it? 00:20:39.014 --> 00:20:43.665 Tim: Yeah, the, our existing footprint is generally in the region, Western 00:20:43.665 --> 00:20:49.185 North Carolina region, uh, 30 to 60 minutes, one removed from another. 00:20:49.185 --> 00:20:53.415 So we have pretty, we have solid density in the, the markets in which we operate. 00:20:53.415 --> 00:20:56.715 And, um, you know, I've been spending a lot of time around 00:20:56.745 --> 00:20:57.855 the rest of North Carolina. 00:20:58.115 --> 00:21:03.784 Um, uh, we, we have connectivity with, uh, with and really good visibility 00:21:03.784 --> 00:21:07.264 in the region, and so people I talk to in rally, almost inev inevitably. 00:21:07.725 --> 00:21:10.274 Have a parent or a relative who's one of our patients. 00:21:10.274 --> 00:21:14.264 And so we, it's been really important to us to go deep and to be, you know, 00:21:14.264 --> 00:21:18.585 a, a, you know, a good partner to the existing healthcare infrastructure and to 00:21:18.585 --> 00:21:20.865 be additive to, uh, to the access there. 00:21:21.165 --> 00:21:23.145 Um, we, uh, as Dr. 00:21:23.145 --> 00:21:26.115 Mallek mentioned, we spend a lot of time making sure that we are, 00:21:26.145 --> 00:21:29.865 uh, staffing our teams effectively and that we are bringing talented 00:21:29.955 --> 00:21:35.145 leaders into those teams and then, uh, supporting them well, uh, we, we do. 00:21:35.895 --> 00:21:41.205 We have, uh, generally call them three to four, uh, provider, 00:21:41.355 --> 00:21:42.915 uh, clinic hub locations. 00:21:42.915 --> 00:21:48.915 And so, uh, these can support, uh, Medicare panels of 2000 plus, uh, once 00:21:48.915 --> 00:21:50.804 they're fully at, uh, study state. 00:21:51.195 --> 00:21:53.804 Um, but they, you know, it takes, it takes time to grow. 00:21:53.955 --> 00:21:56.534 One of the unique features of these markets that's sort of obvious 00:21:56.534 --> 00:21:57.409 when you think about it is like. 00:21:58.094 --> 00:22:02.294 There is such care desert, uh, nature to these areas that, uh, 00:22:02.594 --> 00:22:04.004 they, there's a lot of demand. 00:22:04.064 --> 00:22:08.445 You open up, people will come to grand openings, people will come, take tours, 00:22:08.745 --> 00:22:12.225 have partnerships with the YMCA, we do a variety of community events. 00:22:12.554 --> 00:22:15.495 So it's an, it's a model where it's unusually easy to get people in 00:22:15.495 --> 00:22:18.975 the door, and then you demonstrate that you can provide a good. 00:22:19.375 --> 00:22:22.555 Quality service, and they're, they're very engaged and loyal. 00:22:22.555 --> 00:22:24.985 Once they get to know our teams, many of them have relationships 00:22:24.985 --> 00:22:28.795 with our care teams that predated, uh, predated our clinics. 00:22:29.065 --> 00:22:33.325 Uh, but you know, that, that, that shows up and we can really establish 00:22:33.325 --> 00:22:37.195 long-term relationships and, uh, get to know our patients very well, manage 00:22:37.195 --> 00:22:38.725 them better and better over time. 00:22:39.115 --> 00:22:39.835 Um, Dr. 00:22:39.835 --> 00:22:43.615 Mal, is there anything you wanna call out about, uh, staffing or anything that's 00:22:43.615 --> 00:22:45.745 different from, uh, your prior experience? 00:22:46.014 --> 00:22:46.495 Aditi: Um. 00:22:46.790 --> 00:22:48.470 Um, yes. 00:22:48.500 --> 00:22:51.800 So what, what I'll say is just like within a, within a given clinic, just 00:22:51.800 --> 00:22:57.139 maybe bring it to life, um, a medical director alongside an operational leader. 00:22:57.170 --> 00:23:00.409 It's important to us because we do track metrics really closely. 00:23:00.409 --> 00:23:03.740 So you've got somebody who wears that clinical leadership hat alongside somebody 00:23:03.740 --> 00:23:05.330 who wears the operational leadership. 00:23:06.105 --> 00:23:10.185 Um, the two to four PCPs typically. 00:23:10.395 --> 00:23:13.845 And then we have, um, not necessarily co-located in the clinic, but 00:23:13.845 --> 00:23:16.754 sort of quasi decentralized or hybrid across the region. 00:23:17.085 --> 00:23:21.615 Transitions of care nurses, case management, nurses, um, community 00:23:21.615 --> 00:23:23.595 health workers, um, and the like. 00:23:23.595 --> 00:23:27.105 And so that, that's what allows us to be able to do not just. 00:23:27.915 --> 00:23:32.745 Um, good primary care on the medical side, but to be able to get ahead 00:23:32.804 --> 00:23:37.215 of very often the social issues that can land people in the hospital or 00:23:37.215 --> 00:23:39.405 lead to, um, utilization downstream. 00:23:39.405 --> 00:23:40.754 So very much a team-based model. 00:23:41.774 --> 00:23:45.824 Martin: And given the rural nature of the business, how do you think about, 00:23:45.884 --> 00:23:49.394 you know, like referring to hospital, like the curbside consult seems like 00:23:49.394 --> 00:23:51.284 a great application of technology. 00:23:51.284 --> 00:23:53.445 I would imagine though there's still times when someone needs 00:23:53.445 --> 00:23:54.735 to like go to the hospital. 00:23:54.975 --> 00:23:57.554 How do you think about, you know, as a capitated provider, 00:23:57.854 --> 00:24:00.165 building out that referral network? 00:24:02.324 --> 00:24:03.675 Aditi: Yeah, I'm hap I'm happy to start. 00:24:03.824 --> 00:24:07.364 It's very much a partnership driven and so like you're absolutely right. 00:24:07.364 --> 00:24:09.824 You can, you can, a cardiologist can tell you how to. 00:24:10.229 --> 00:24:14.070 Titrate a beta blocker, but like you can't cast someone over the phone, right? 00:24:14.310 --> 00:24:16.500 So there, there are things that you're always gonna need to go, 00:24:16.800 --> 00:24:19.320 um, to a hospital setting for. 00:24:19.620 --> 00:24:25.290 Um, and we, um, we have around each of our clinics and sort of in the 00:24:25.290 --> 00:24:29.459 broader region, um, great relationships with our health system partners. 00:24:29.459 --> 00:24:34.320 And so, um, we're continuing to build out or continuing to think about, 00:24:34.649 --> 00:24:37.050 uh, preferred networks of sorts. 00:24:37.050 --> 00:24:38.909 But we have some of that already in place. 00:24:39.975 --> 00:24:40.815 Tim, what would you add? 00:24:42.675 --> 00:24:44.805 Tim: No, I mean, I think that's right, that you, obviously you 00:24:44.805 --> 00:24:48.225 have limited options in, uh, in rural parts of the country. 00:24:48.225 --> 00:24:50.024 So you, you work with what you've got. 00:24:50.024 --> 00:24:52.665 But, uh, I think establishing relationships so that there's 00:24:52.665 --> 00:24:56.985 continuous care management and follow up after, after any, uh, inpatient 00:24:56.985 --> 00:24:59.639 or acute utilization is, uh, it's really important part of what we do. 00:25:01.884 --> 00:25:05.370 Kevin: So now that we've got two minutes left, I wanna tee up one last really big 00:25:05.370 --> 00:25:09.749 meaty topic, which is value-based payments and how all of this gets compensated. 00:25:09.749 --> 00:25:14.249 I, you know, conceptually I've got this mental model of this country 00:25:14.249 --> 00:25:16.949 doesn't pay independent primary care and off across the board. 00:25:16.949 --> 00:25:19.169 Rural health, that problem is exacerbated. 00:25:19.499 --> 00:25:21.509 So the, the model is generally underwater. 00:25:21.509 --> 00:25:23.789 That's part of what causes the financial problems. 00:25:24.029 --> 00:25:27.149 That's where it makes sense that cap, global cap contracts come into play 00:25:27.149 --> 00:25:29.339 to help with that economic structure. 00:25:29.745 --> 00:25:33.225 I'm sure you guys have seen public markets, private companies, the issues 00:25:33.225 --> 00:25:37.455 with V 28, global cap models, the kind of retreat from that, and now this 00:25:37.455 --> 00:25:40.095 like more thoughtful entry into risk. 00:25:40.095 --> 00:25:44.475 I'd be curious if you guys could share how you're thinking about supporting 00:25:44.475 --> 00:25:47.955 primary care payment models, what percent of the business is global cap, 00:25:47.955 --> 00:25:53.115 how you think about kind of what ideal unity economics look like from your 00:25:53.115 --> 00:25:54.495 perspective supporting primary care. 00:25:56.280 --> 00:25:58.470 Tim: Yeah, no, I, I think that's exactly right. 00:25:58.470 --> 00:26:01.439 And so we, the way we think about it, it's a co a couple things I 00:26:01.439 --> 00:26:04.770 point out, like one, we're, we're an entirely post to V 28 business. 00:26:04.800 --> 00:26:08.490 Uh, we, we really have, uh, scaled up only over the last couple of years. 00:26:08.790 --> 00:26:10.710 And, uh, neither Dr. 00:26:10.710 --> 00:26:14.129 Malick nor I joined this business because we are interested in being 00:26:14.129 --> 00:26:16.919 like the best coding operation, right? 00:26:16.919 --> 00:26:19.500 Like it's important to fully understand our patients. 00:26:19.830 --> 00:26:21.300 Our patients have very serious. 00:26:21.644 --> 00:26:22.245 Problems. 00:26:22.245 --> 00:26:26.235 And, uh, it's essential to have a risk adjustment system that rewards, 00:26:26.264 --> 00:26:29.774 uh, rewards capitated providers for taking care of sick patients. 00:26:29.774 --> 00:26:33.764 And I think that we're, uh, we see that, that the V 28 world 00:26:33.764 --> 00:26:37.394 works just fine for that, and the economics work very well for rural. 00:26:37.675 --> 00:26:41.304 Regions because you have lower costs of inputs, you have lower cost of real 00:26:41.304 --> 00:26:45.115 estate, uh, and a variety of other contributors that, that are tougher 00:26:45.115 --> 00:26:48.115 to deal with in urban, including what we talked about earlier of the, the 00:26:48.115 --> 00:26:51.385 demand side dynamics of patients, uh, are loyal once you prove that 00:26:51.385 --> 00:26:52.554 you can take good care of them. 00:26:53.125 --> 00:26:56.125 Um, a broader, broadening the lens a little bit, I think that. 00:26:56.514 --> 00:27:01.375 Uh, the, we have, we're in sort of a trough of a cycle right now where, 00:27:01.465 --> 00:27:04.735 uh, the, there's been a number of strategic challenges at the, the 00:27:04.735 --> 00:27:06.024 highest levels of the industry. 00:27:06.325 --> 00:27:10.405 Um, but as we look over a period of decades, going back even to the nineties 00:27:10.405 --> 00:27:13.945 and before, we think the best primary care businesses have generally been 00:27:13.945 --> 00:27:15.835 built on a capitated infrastructure. 00:27:16.360 --> 00:27:20.050 Uh, it, it is what really aligns incentives and provides resources to 00:27:20.110 --> 00:27:24.729 overcome what you described accurately of the historic underpayment to primary care. 00:27:24.999 --> 00:27:28.780 Uh, but, but we've seen consistently in, you know, whether California, 00:27:28.780 --> 00:27:32.709 Pennsylvania, Wisconsin, Tennessee, that the best primary care and group 00:27:32.709 --> 00:27:35.860 practice models have been built on this type of infrastructure. 00:27:36.100 --> 00:27:39.969 And we are, we see ourselves as bringing that type that, that best in 00:27:39.969 --> 00:27:44.199 industry standard to rural communities starting in Western North Carolina. 00:27:45.929 --> 00:27:47.219 Martin: Kevin, I'll just interject quickly. 00:27:47.219 --> 00:27:50.280 I think we have them for 15 more minutes so we can Oh, we do? 00:27:50.729 --> 00:27:51.030 Yes. 00:27:51.510 --> 00:27:52.770 Kevin: I thought we were done at the bottom of the hour. 00:27:52.919 --> 00:27:53.250 Perfect. 00:27:53.459 --> 00:27:58.050 Martin: Um, which is great because there's, I think a lot of, of things 00:27:58.050 --> 00:27:59.459 we can talk about on this question. 00:27:59.459 --> 00:28:01.830 I'm taking that broader lens. 00:28:01.830 --> 00:28:05.760 Can you kind of talk a little bit about your payer mix, um, and how you sort 00:28:05.760 --> 00:28:08.729 of, is it, is it mostly on the MA side? 00:28:08.729 --> 00:28:12.479 Do you do Medicaid and are you doing taking risk on Medicaid patients? 00:28:12.689 --> 00:28:14.219 Can you give us kind of a flavor for that? 00:28:14.579 --> 00:28:19.139 Tim: Yeah, our, our clinical model is senior focused, and so the, the core of 00:28:19.139 --> 00:28:23.819 our work right now is in, uh, Medicare and Medicare Advantage patients, and so we, 00:28:23.819 --> 00:28:26.064 we do take risk across our entire MA book. 00:28:26.699 --> 00:28:30.509 Um, we have, uh, above 50% penetration and Medicare Advantage 00:28:30.509 --> 00:28:31.709 in Western North Carolina. 00:28:32.070 --> 00:28:34.139 Uh, and we are also in the REACH program. 00:28:34.139 --> 00:28:38.939 So, uh, between those two, we, we have very full, full saturation 00:28:38.939 --> 00:28:42.300 of our Medicare panel for the, the type of contracts we need. 00:28:42.629 --> 00:28:48.449 Um, we do also, uh, care for, uh, some Medicaid patients and some under 65 00:28:48.449 --> 00:28:52.800 commercial patients, um, in, in areas where we have either made a practice 00:28:52.800 --> 00:28:55.229 acquisition transition, um, and where. 00:28:55.879 --> 00:28:59.090 We have, uh, maintained continuity of care for those patients. 00:29:01.729 --> 00:29:04.729 Kevin: I'd be curious what that looks like having, having worked on some 00:29:04.729 --> 00:29:07.219 of these models before and thinking about like, you know, the grand 00:29:07.219 --> 00:29:12.320 opening events in the community, whatnot, and how, how that shows up 00:29:12.320 --> 00:29:13.459 in the community and feels for Doc. 00:29:13.459 --> 00:29:17.239 Like, if somebody comes in and says, Hey, like, I want care from you guys. 00:29:18.314 --> 00:29:21.134 How do you, how do you navigate that dynamic when it's, you 00:29:21.134 --> 00:29:23.354 know, somebody under 65 whatnot? 00:29:23.354 --> 00:29:24.854 Like, what, what are your docs doing? 00:29:24.854 --> 00:29:26.294 Are they still seeing patients? 00:29:26.564 --> 00:29:27.975 How does that work in local communities? 00:29:27.975 --> 00:29:28.064 Sure. 00:29:28.874 --> 00:29:29.114 Tim: Yeah. 00:29:29.114 --> 00:29:31.665 I think this is a little bit of a, a now versus what could be 00:29:31.665 --> 00:29:33.044 in the future question as well. 00:29:33.044 --> 00:29:37.725 Like we, we have a, you know, we were really focused, uh, intently on proving 00:29:37.935 --> 00:29:41.294 that our care model works for the populations for which it was designed, 00:29:41.294 --> 00:29:44.114 which is, which is the Medicare and pri, you know, primarily the over 00:29:44.114 --> 00:29:46.634 65 Medicare and duals population. 00:29:46.909 --> 00:29:49.819 Uh, that, that's been a tremendous amount of work and, uh, and we're 00:29:49.819 --> 00:29:52.879 really seeing the results of that right now in terms of performance. 00:29:52.909 --> 00:29:55.549 Extremely high performance on quality ratings, extremely high 00:29:55.549 --> 00:29:58.549 patient satisfaction, extremely strong improvement on MLR. 00:29:58.909 --> 00:30:03.709 Um, we do see as I'm, as I mentioned, a number of patients that are not in our, 00:30:03.709 --> 00:30:05.899 our sort of risk comparing contracts. 00:30:05.899 --> 00:30:09.229 And so, um, the, and we, you know, do our, our darned best 00:30:09.229 --> 00:30:10.159 for those patients as well. 00:30:10.679 --> 00:30:15.269 Um, in general, like, you know, community and, uh, other family medicine 00:30:15.269 --> 00:30:18.899 practices are happy to have support and happy to have additional capacity. 00:30:19.169 --> 00:30:22.620 And so I see us as, uh, you know, just like we're not trying to take on, 00:30:22.649 --> 00:30:24.539 uh, all hospital services ourselves. 00:30:24.539 --> 00:30:25.659 What, what we're working on right now. 00:30:26.350 --> 00:30:29.439 Is a major need, uh, care for seniors with chronic, with a 00:30:29.439 --> 00:30:31.059 variety of chronic conditions. 00:30:31.389 --> 00:30:35.319 Um, over time I do hope to roll in additional, uh, service lines that 00:30:35.319 --> 00:30:36.759 we can really focus on growing. 00:30:37.029 --> 00:30:39.610 Um, and that's an ongoing conversation with the state and 00:30:39.610 --> 00:30:41.049 with our, uh, payer partners. 00:30:44.409 --> 00:30:46.449 Martin: I'd be curious to hear a little bit, I feel like. 00:30:46.844 --> 00:30:51.675 You know, when we talk to folks who are taking, taking risk, it's like for a, in 00:30:51.675 --> 00:30:55.665 a normal risk con, or not a normal risk contract, but in a, like the, the typical 00:30:55.665 --> 00:31:01.304 risk contract, a lot of the game is like, how do we avoid admissions and, uh, 00:31:01.304 --> 00:31:04.094 unneeded or unnecessary ER utilization? 00:31:04.274 --> 00:31:09.344 I'm curious if there's any kind of discrepancies or, or oddities specific 00:31:09.344 --> 00:31:13.874 to the rural population that make that, that different or, or more challenging. 00:31:15.165 --> 00:31:15.465 Dr. 00:31:15.465 --> 00:31:16.754 Malik, do you wanna take this one first? 00:31:16.754 --> 00:31:18.014 Aditi: Yeah, I'm, I'm happy to. 00:31:18.014 --> 00:31:19.844 It's largely pretty similar. 00:31:19.844 --> 00:31:23.024 I mean, if you think about to Tim's point, so many of the, so many 00:31:23.024 --> 00:31:24.104 of the communities that we serve. 00:31:24.975 --> 00:31:30.525 Prior to our arrival, the primary point of access into care was a hospital. 00:31:31.035 --> 00:31:35.805 And so you, we see tremendous impact of our care model just by 00:31:35.805 --> 00:31:38.655 catching people sort of upstream and in a different site of care. 00:31:38.655 --> 00:31:43.245 And so spot on that, on the utilization side, like the familiar drivers that you 00:31:43.245 --> 00:31:47.325 pointed out of keeping folks out of the emergency department and keeping 'em outta 00:31:47.325 --> 00:31:50.085 the hospital is really important, I think. 00:31:50.295 --> 00:31:54.315 The, so it's, it's a similar set of patterns as what you might see, let's 00:31:54.315 --> 00:31:59.205 say, in a more urban area, but it's, it's amplified in a rural area because there 00:31:59.205 --> 00:32:01.335 are limited access points into care. 00:32:01.605 --> 00:32:05.895 I'd say beyond that, the other thing we focus a lot about is. 00:32:06.584 --> 00:32:11.534 Expanding the, the full scope of primary care so we can be the place where our 00:32:11.534 --> 00:32:13.814 patients get the most comprehensive care. 00:32:13.814 --> 00:32:15.945 So I gave you that abscess example, right? 00:32:16.155 --> 00:32:19.995 Could a like, you know, if you were in a, like I, I trained in Boston. 00:32:19.995 --> 00:32:23.625 In Boston, you would send that to a general surgeon, but we don't need to, 00:32:23.685 --> 00:32:25.270 we have, we have the ability to do that. 00:32:25.975 --> 00:32:27.385 Within our four walls. 00:32:27.385 --> 00:32:31.465 And so it's, it's both a shift on inpatient utilization, but also really 00:32:31.465 --> 00:32:36.024 maximizing the scope of comprehensive services available in primary care. 00:32:36.085 --> 00:32:39.145 And we see the same cost pressure that, you know, I think everybody 00:32:39.145 --> 00:32:41.155 like Mercer will tell you this. 00:32:41.155 --> 00:32:42.774 Any big employer will tell you this, right? 00:32:42.774 --> 00:32:46.225 Like, um, uh, part B drugs, right? 00:32:46.225 --> 00:32:49.135 Like specialty pharmacy is an area we have to look into. 00:32:49.314 --> 00:32:52.794 And that again, is not, it's not so much that it's different in a rural 00:32:52.794 --> 00:32:54.294 area, it's just, I think the way you. 00:32:54.614 --> 00:32:57.704 Solve for, it looks different for us than the way you might 00:32:57.704 --> 00:32:59.174 solve it in a more urban area. 00:33:02.864 --> 00:33:03.164 Martin: Yeah. 00:33:05.264 --> 00:33:09.944 Um, Kevin, it looks like you had a question, or maybe 00:33:09.944 --> 00:33:12.644 he's frozen, looks frozen. 00:33:12.704 --> 00:33:14.414 Uh, it looks like he's frozen. 00:33:15.074 --> 00:33:21.074 So one of the other questions that I had, um, is I, it feels like in the. 00:33:21.659 --> 00:33:24.209 Rural Health Transformation program application. 00:33:24.209 --> 00:33:27.959 There was a lot of talk about advanced scope of practice for, or 00:33:27.959 --> 00:33:29.610 like a changing scope of practice. 00:33:29.759 --> 00:33:32.820 I'm curious what this looks like in North Carolina and just sort of 00:33:32.820 --> 00:33:37.229 generally what's your philosophy on, uh, you know, nurse practitioners, 00:33:37.229 --> 00:33:41.909 physician assistants, pharmacists and, and, and, and apps like that? 00:33:43.410 --> 00:33:43.709 Tim: Dr. 00:33:43.709 --> 00:33:44.430 Malick, you start. 00:33:44.430 --> 00:33:45.629 I've got some thoughts as well. 00:33:45.720 --> 00:33:49.169 Aditi: Yeah, I mean, like, I, I say this as a physician, and this will 00:33:49.169 --> 00:33:51.360 probably be a controversial thing to say. 00:33:51.360 --> 00:33:53.550 Maybe it won't, like there aren't enough doctors. 00:33:53.820 --> 00:33:57.209 So like if, if we continue to live in a world where we say, 00:33:57.660 --> 00:34:01.020 well, doctors are the only people that can provide this care, like. 00:34:01.439 --> 00:34:04.050 First of all, too expensive and not enough of us, right? 00:34:04.050 --> 00:34:07.320 So we're just headed towards like, there's a very obvious supply and 00:34:07.320 --> 00:34:09.390 demand mismatch problem there. 00:34:09.630 --> 00:34:12.330 Um, that when left unchecked is only gonna cause. 00:34:12.825 --> 00:34:18.225 Like continuing, um, continuing upward cost pressure and access problems 00:34:18.225 --> 00:34:19.785 that we already find ourselves in. 00:34:19.785 --> 00:34:23.715 And so I, you know, when you, when you zoom out, I don't think 00:34:23.715 --> 00:34:25.125 there is any better option. 00:34:25.125 --> 00:34:28.425 And I say this having been a policymaker, like there, I don't think there is a 00:34:28.425 --> 00:34:32.835 better option than to say we need to think thoughtfully about how we expand. 00:34:33.570 --> 00:34:37.800 Scope of practice and making sure that people can operate at the top of, 00:34:37.980 --> 00:34:40.050 top of scope and top, top of license. 00:34:40.050 --> 00:34:43.530 And so when I, you know, our, our model certainly we have wonderful nurse 00:34:43.530 --> 00:34:48.330 practitioners, physician assistants on our teams in North Carolina. 00:34:48.330 --> 00:34:53.880 The, um, the certification bodies require a supervising physician and there's this 00:34:53.880 --> 00:34:56.070 very state by state as you no doubt know. 00:34:56.280 --> 00:34:57.960 Um, but hey, welcome back Kevin. 00:34:58.250 --> 00:35:01.580 We were just talking about, um, scope of practice for advanced practice 00:35:01.580 --> 00:35:07.130 practitioners, um, and the, in North Carolina there's requirements at, at, 00:35:07.190 --> 00:35:11.420 uh, the certification bodies that are at the state level around supervising 00:35:11.420 --> 00:35:15.320 physician and frequency of case reviews and that sort of thing that we have 00:35:15.320 --> 00:35:19.370 sort of baked into our model, but also allows us kind of flexibility as we enter 00:35:19.370 --> 00:35:21.230 different markets in different states. 00:35:21.230 --> 00:35:24.980 But like globally, I don't see a way outside of. 00:35:25.365 --> 00:35:30.255 The access shortages that we find ourselves in beyond being able to, uh, 00:35:30.645 --> 00:35:35.685 broaden scope of practice with appropriate oversight and supervision, um, to make 00:35:35.685 --> 00:35:36.850 sure people get the access they need. 00:35:39.150 --> 00:35:41.730 Tim: Yeah, I would, I would agree to all of that. 00:35:41.730 --> 00:35:45.540 I, I think CMS has been very intentionally, really, this is 00:35:45.540 --> 00:35:47.130 like a multi-decade project, right? 00:35:47.130 --> 00:35:51.780 With CMS, uh, wanting states to figure out a way to expand scope consistently 00:35:51.990 --> 00:35:54.330 for, uh, for non-physician practitioners. 00:35:54.330 --> 00:36:00.000 And, and we certainly do prefer the expanded scope rules, uh, while respecting 00:36:00.000 --> 00:36:03.480 that there, there's a whole bunch of state equities and considerations that come up. 00:36:03.690 --> 00:36:06.660 Uh, but the, the CMS process has, it has really. 00:36:06.955 --> 00:36:10.675 Ignited a lot of, uh, vociferous conversations in the states 00:36:10.675 --> 00:36:11.845 that we're, that we've seen. 00:36:12.115 --> 00:36:15.715 Um, I think you've seen that in, in, uh, the handful of policy areas 00:36:15.715 --> 00:36:17.785 that that CMS identified as well. 00:36:17.995 --> 00:36:20.425 Uh, they, they, they're taking on certificate of need. 00:36:20.425 --> 00:36:24.415 They're, they're looking at promoting healthy behaviors and exercise programs. 00:36:24.745 --> 00:36:27.355 Um, but I, I think that that is having its intended effect. 00:36:27.355 --> 00:36:32.365 There's a lot of, uh, a lot of, uh, policy discussions happening in state 00:36:32.395 --> 00:36:35.665 legislatures and, uh, administrations right now on these exact topics. 00:36:36.885 --> 00:36:39.615 Oh, the the other, the one other thing I would say is we are huge 00:36:39.615 --> 00:36:41.985 proponents, and this is a real pain point bordering four states. 00:36:42.855 --> 00:36:47.835 Of, uh, we, we need to make it dramatically easier to get licensed 00:36:47.835 --> 00:36:49.845 in a state that you are adjacent to. 00:36:49.845 --> 00:36:53.385 And North Carolina has seen policy progress on this last summer that 00:36:53.385 --> 00:36:56.175 they're joining, uh, one of the, the big interstate compacts for 00:36:56.175 --> 00:36:58.665 physicians and nurse practitioners. 00:36:58.845 --> 00:37:02.145 Uh, but like, it's just way too hard to recruit someone from Tennessee to 00:37:02.175 --> 00:37:06.375 get them to drive 30 minutes over the border in North Carolina, get a license. 00:37:06.375 --> 00:37:08.325 It, it takes like six months. 00:37:08.325 --> 00:37:10.425 And this isn't like a North Carolina only issue. 00:37:11.910 --> 00:37:14.100 Aditi: It took me six months to get a North Carolina license. 00:37:14.250 --> 00:37:17.250 I've been licensed in five other states, and it still took six months. 00:37:17.340 --> 00:37:21.150 And so to Tim's point, right, like if, again, like we're staring down 00:37:21.150 --> 00:37:24.720 the barrel of, of an access problem, but we, and for a good reason, I'm not 00:37:24.720 --> 00:37:28.410 saying we need to blow up licensing, but you know, the idea of somebody 00:37:28.410 --> 00:37:32.490 has been licensed, credentialed and has a relatively impeccable record, 00:37:32.490 --> 00:37:36.390 it should be much faster than it is in practicality for that person to be 00:37:36.390 --> 00:37:37.890 able to ramp up in a different state. 00:37:39.300 --> 00:37:43.380 Kevin: Can I ask what, what actually takes the six months in a process like that? 00:37:43.380 --> 00:37:45.900 Like is it just waiting on an approval? 00:37:45.900 --> 00:37:47.800 Like where, where is, where does that time go? 00:37:49.275 --> 00:37:52.935 Aditi: Um, yeah, again, from like painful personal experience. 00:37:53.415 --> 00:37:57.915 So, um, uh, first of all, you submit every document ever about you. 00:37:58.490 --> 00:37:58.910 Mm-hmm. 00:37:58.995 --> 00:38:04.155 Um, so like from, you know, age 18 to, you don't need to guess how old I am, 00:38:04.155 --> 00:38:05.655 but it's, you know, it's been some time. 00:38:06.015 --> 00:38:08.445 Um, and then you wait. 00:38:08.985 --> 00:38:12.825 Maybe you get a, maybe you get an email or a phone call that says, uh, Dr. 00:38:12.825 --> 00:38:16.965 Mulik, we see that you didn't submit this thing from when you trained at blah, blah, 00:38:16.965 --> 00:38:20.595 blah place, or, you know, so there's, there's some amount of follow up around 00:38:20.625 --> 00:38:24.525 just what I imagine is a documentation checklist, frankly, on their side. 00:38:24.525 --> 00:38:29.895 And then I think it's an incredibly human labor intensive process. 00:38:29.895 --> 00:38:34.215 So like, like talk about things that are ripe for automation possibility, right? 00:38:34.215 --> 00:38:38.055 Like it is literally a human that I, I imagine sits there and reviews. 00:38:39.210 --> 00:38:44.460 Scores and scores of pages now for individual applications. 00:38:44.520 --> 00:38:49.230 Um, and so I, my sense is the bottleneck is just like entirely labor shortage or 00:38:49.230 --> 00:38:51.300 just the sheer volume of time it takes. 00:38:52.035 --> 00:38:52.325 Kevin: Yeah. 00:38:53.825 --> 00:38:54.525 The things you learn. 00:38:55.830 --> 00:38:56.610 Aditi: Yeah, that's right. 00:38:57.420 --> 00:39:01.530 Kevin: One of the, um, topics I'm curious about in the industry these days is 00:39:01.530 --> 00:39:03.330 kind of the, like going back to the. 00:39:03.915 --> 00:39:08.055 Flow of VBC dollars, um, and tying it to compensation model of physicians, like 00:39:08.055 --> 00:39:13.395 how the, the, the VBC performance actually impacts comp for providers in these 00:39:13.395 --> 00:39:17.025 practices and the types of conversations you're having with those providers 00:39:17.025 --> 00:39:20.925 around, here's what the model is, here's how you drive performance in the model. 00:39:21.255 --> 00:39:23.865 And, you know, I, I know some practices share savings with their 00:39:23.865 --> 00:39:26.565 providers and like, how do you guys think about that philosophically? 00:39:26.565 --> 00:39:30.375 What are the conversations you're having with docs and the practices about. 00:39:30.705 --> 00:39:33.255 What these VP C models mean, what performance means and 00:39:33.404 --> 00:39:34.605 how does that impact comp? 00:39:36.134 --> 00:39:36.375 Tim: Yeah. 00:39:36.375 --> 00:39:40.485 I, I will start on this one 'cause I, I want to, you know, intentionally 00:39:40.485 --> 00:39:43.545 keep this relatively high level, uh, 'cause some of this stuff is obviously 00:39:43.545 --> 00:39:44.805 sensitive for our team members. 00:39:44.955 --> 00:39:45.045 Sure. 00:39:45.075 --> 00:39:47.445 I, I think it's really important to me that we pay our teams. 00:39:48.120 --> 00:39:52.320 That we pay our teams well and fairly and that we, when we all 00:39:52.320 --> 00:39:55.380 succeed, then everyone should be compensated accordingly. 00:39:55.650 --> 00:39:58.530 And that will mean different things for different parts of the care 00:39:58.530 --> 00:40:00.780 team and different parts of the management team and what, what we 00:40:00.780 --> 00:40:02.370 call our clinic support center. 00:40:02.760 --> 00:40:08.040 Uh, so I think that getting alignment at appropriate levels around, uh, whether 00:40:08.040 --> 00:40:12.240 it's, uh, performing on a, a particular clinical initiative for care team members, 00:40:12.240 --> 00:40:15.420 and it could be a welcome coordinator, someone who's really driving patient. 00:40:16.395 --> 00:40:19.455 With our care teams, uh, might have appropriate incentives 00:40:19.455 --> 00:40:21.975 attached to something that's discreet within a quarter. 00:40:22.215 --> 00:40:26.025 Uh, versus I think it's also important to roll up for, uh, for 00:40:26.025 --> 00:40:30.674 clinicians who are really impactful in affecting overall, uh, mar market 00:40:30.674 --> 00:40:32.355 or community or hubs performance. 00:40:32.625 --> 00:40:36.735 Uh, they should also be compensated for success on those metrics as well. 00:40:36.735 --> 00:40:38.355 That might be much more longer term. 00:40:38.355 --> 00:40:39.884 They might be multi-year in nature. 00:40:39.884 --> 00:40:40.154 Right. 00:40:40.154 --> 00:40:42.960 So it is something we talk, we spend a lot of time talking about. 00:40:43.405 --> 00:40:47.815 Because I think it's really important, one, just to, to be, to be fair, and two, 00:40:48.055 --> 00:40:50.635 uh, to be very aligned, uh, economically. 00:40:50.845 --> 00:40:54.205 Uh, but then two, to have a really attractive, uh, value proposition so 00:40:54.205 --> 00:40:58.285 that we're, uh, paying, paying well in the market, and then ideally with the 00:40:58.285 --> 00:41:01.915 help of those public subsidies, leveling up significantly what our team members 00:41:01.915 --> 00:41:06.565 could get if, uh, working with us versus, uh, working with a, uh, someone 00:41:06.565 --> 00:41:08.575 in, in Chattanooga or, or Charlotte. 00:41:09.450 --> 00:41:10.770 Aditi: I wanna draw a contrast here. 00:41:10.800 --> 00:41:14.880 'cause I worked in a large health system that was part of an A CO model and one 00:41:14.880 --> 00:41:18.990 of the biggest failures of the payment. 00:41:19.905 --> 00:41:23.295 Funds flow in that model is your, like, think about the 00:41:23.295 --> 00:41:24.495 behavioral economics of it. 00:41:24.675 --> 00:41:28.455 You're relying on the provider at the point of care to be doing 00:41:28.455 --> 00:41:29.595 all the right things, right? 00:41:29.595 --> 00:41:32.745 Keeping people out of the hospital, doing all the quality screenings, like 00:41:32.865 --> 00:41:37.215 checking all of the boxes for what we all believe to be high value care. 00:41:37.455 --> 00:41:39.885 They reap none of the rewards of that, right? 00:41:39.885 --> 00:41:43.935 Because the a CO gets the money and you know, and maybe you get a check. 00:41:44.125 --> 00:41:47.785 Six months later, you're not sure what metrics it was tied to, right. 00:41:47.785 --> 00:41:53.875 But so the, the people doing the work are not the people that benefit financially 00:41:53.995 --> 00:41:56.125 from positive outcomes of that work. 00:41:56.125 --> 00:41:59.665 And so, to Tim's point, one of the things that we take very seriously is 00:41:59.995 --> 00:42:04.555 an alignment of incentives around the outcomes that we know are gonna be 00:42:04.795 --> 00:42:07.674 best for the care model, best for the business, and making sure that those 00:42:07.674 --> 00:42:09.865 incentives translate at all levels. 00:42:12.435 --> 00:42:14.715 Martin: Now we are actually at time. 00:42:14.925 --> 00:42:18.705 Um, and so I want to first of all thank you both, but for people who are 00:42:18.705 --> 00:42:21.825 curious and want to follow the Hop Scots story, how can people get in touch? 00:42:21.825 --> 00:42:23.595 Where can people find you on the internet? 00:42:25.065 --> 00:42:26.175 Tim: Yeah, look, look us up. 00:42:26.175 --> 00:42:27.825 Hop Scot's Primary care. 00:42:27.945 --> 00:42:28.755 Uh, Dr. 00:42:28.755 --> 00:42:32.775 Mallek has an increasingly prominent social media presence on LinkedIn. 00:42:32.835 --> 00:42:34.245 Uh, I'm trying to keep up. 00:42:34.635 --> 00:42:39.405 Uh, and, uh, you know, we'll, uh, we, we've got a few other social channels, but 00:42:39.405 --> 00:42:43.605 at LinkedIn and, uh, and our, our website hopscotch, uh, primary care, uh, which I 00:42:43.605 --> 00:42:47.175 think is actually, and this is, uh, it's uh, I believe we are at Hello Hopscotch. 00:42:47.175 --> 00:42:49.455 Am am I right on the public facing version of that? 00:42:49.725 --> 00:42:50.625 Aditi: We are indeed. 00:42:50.625 --> 00:42:51.735 I'm also chuckling, Martin. 00:42:51.735 --> 00:42:54.255 'cause like generally it's not hard to find people on the internet. 00:42:54.480 --> 00:42:59.160 But, but yes, um, LinkedIn or hello hot scotch.com 00:42:59.160 --> 00:43:00.090 would be lovely. 00:43:00.150 --> 00:43:01.860 Um, yeah, please do reach out. 00:43:01.860 --> 00:43:04.980 Would love, um, would love follow ups as, as you can tell. 00:43:04.980 --> 00:43:08.160 Um, we love talking about this, like always happy to chat. 00:43:08.190 --> 00:43:11.460 Um, Tim and I are former government officials, like always happy to chat. 00:43:11.460 --> 00:43:12.330 Government programs. 00:43:12.330 --> 00:43:13.200 Happy to chat. 00:43:13.440 --> 00:43:14.700 Um, happy to chat. 00:43:14.700 --> 00:43:16.650 Rural Health, happy to chat Hopscotch. 00:43:16.740 --> 00:43:17.940 Appreciate you guys for the time. 00:43:18.630 --> 00:43:18.930 Martin: Yeah, 00:43:19.140 --> 00:43:19.680 Kevin: thank you guys. 00:43:19.680 --> 00:43:20.310 Thanks so much. 00:43:20.310 --> 00:43:20.550 Thank you 00:43:20.550 --> 00:43:21.270 Martin: so much to chat. 00:43:21.270 --> 00:43:21.330 Bye. 00:43:21.570 --> 00:43:21.960 See you, 00:43:21.985 --> 00:43:22.205 Aditi: bye.