The Future of Primary Care

Please Note these transcripts are automatically generated and have some transciption errors

Tom Bunn: ISelect Fund is not soliciting investment or providing investment advice in any way whatsoever. This presentation is general industry research based on publicly available information. I select is a venture capital firm in St. Louis focused on companies in food, agriculture, and health.   iSelect invest at the forefront of innovation, seeking emerging problems, solutions and technologies. iSelect uses these deep dive presentations not only as a way to better engage with and understand new science and technology, but also engage with the experts and entrepreneurs who drive and change innovation in their respective fields.

Tom Bunn: Good morning everybody, and welcome to I Selects deep dive webinar series.  My name is Tom Bunn a Principle on the iSelect Ventures team, and I’m excited to walk you through today’s discussion. One area that we have been researching is primary care. A field of medicine that is often underutilized, under-resourced, and, underappreciated. Despite being the touchpoint for millions of Americans, including those with chronic diseases, primary care receives only about 5% of all healthcare spending.

And today we’ll discuss some of the challenges that primary care faces and hear some accounts from three experts in their fields working at the vanguard of primary care. So brief roadmap. We’ll start with some speaker introductions. Then I’ll give some brief background kind of setting the stage, and then we’ll get into the part of the, discussion with talking with our three very accomplished guests here today.

And then, as I mentioned, we will have some time for conversation in Q&A. So with that Brandy, do you mind giving a, brief overview? We can dive in into more of it when we go to your, slide here, but what’s your background?

Brandi Harless: Thank you so much for hosting this and it’s my first time meeting my fellow panelists, so it’s great to meet you as well.

I’m honored to be on this call with you all. So my background is actually in public health. That was my, first jaunt into my career. I have a master’s degree from Boston University School of Public Health. And in fact, I thought I would be doing global health work for most of my career. When I accidentally moved home to Kentucky about a little over a decade ago, I did some interesting things.

I was able to work for a primary care clinic when the Affordable Care Act was coming online. We were seeing an opportunity to expand access to primary care in our community. So we recruited a federally qualified health center here from Arkansas, expanded primary care pretty significantly through that model, a little over 10 million in investment in our region.

And actually Commonwealth Fund wrote an article about that at the time because we were trying to get as creative as possible in expanding care for our community. And then after that, I had the privilege of serving as the mayor of my hometown. And through all of that really realizing how hard it is to move the needle when it comes to preventing chronic disease.

And I have probably hours worth of stories to tell you from that experience. It’s probably a different webinar. It really led me to be more affirmed in our work at Prevent Scripps, where we are really focusing on how do we help primary care providers. Identify and treat patients around metabolic syndrome as our on ramp for patients in the prevention space.

So I am excited to, to be able to share a little bit more about what we’re doing and hear from, my fellow panelists. I do have a co-founder, Dr. Natalie Davis, who has practiced pediatrics for over 20 years. And when she and I came together at our, in our hometown, realizing the chronic disease issues were so prevalent.

We decided to form a company. And so we have, and I can’t wait to share a little bit more with you guys as we go along.

Tom Bunn: Awesome. Thanks for joining us, Brandy. Justin?

Justin Schreiber: Yeah. Hi everyone. I’m Justin Schreiber. I’m the chairman and c e of Life, md. I have to admit, I’m really jealous of Brandy’s background as a mayor.

That’s, really cool. My background was in the healthcare product world. I started off in the kind of advisory world, mostly with small public companies that. Needed to raise a lot of money and build kind of value in public markets to get their drugs approved. And through the f d A I was an early investor in life, OFD and that’s how I got involved in the telehealth and healthcare services world.

And I’ve been been putting my life into this for the last five years. And excited to tell everybody more about what we’re doing at Life md.

Tom Bunn: Fantastic. Thanks Justin. And last but not least, Dr. Steven Sproll. Do you mind giving a brief introduction?

Dr. Stephen Sproul: I’m glad to be here with everyone. I’m Steve Spro.

I’m the one without the business ex expertise that my fellow panelists have. I’m a family physician originally from Pennsylvania, but now in New Mexico. I’ve had a, long career working for different large healthcare organizations in various roles, but have a real interest in value-based care and team-based care, which is how I came to be medical director working with Oak Street now in Albuquerque, New Mexico trying to transform healthcare in the way we think it should be delivered.

Tom Bunn: Fantastic. Thank you Steven. So let’s get into it. As I mentioned, I’ll set the stage here a little bit. So I think we all have experience with primary care, but I think some of the, benefits are, non-obvious and, understated. There’s a lot of evidence of the HealthPRO promoting influence of primary care that’s been accumulating ever since researchers basically began distinguishing primary care from, other specialty mediums.

And there’s strong evidence that they, it delivers. Very good long-term health benefits. In fact there’s a study that shows that there’s a 19% lower odd odds of premature death than those who only see specialists. And generally there’s better health, outcomes and, it allows better prevention of illness and ultimately premature death.

From an economic standpoint, the benefits are, widespread. There’s evidence that for every $1 invested in primary care, there’s $13 saved in downstream costs associated with emergency visits, procedures hospitalizations. There’s good evidence that patients with a primary care provider save an estimated 33% on healthcare costs.

In any given year compared to those who own C specialists. And as the old adage goes, ounce prevention is worth a pound of cure. And this holds true here. If everyone saw a primary care provider first for their care it would save the US an estimated 67 billion every year in, healthcare expenditures, which as we all know is, ballooning.

And in terms of satisfaction, this is also important. Reports have indicated that patients. Are 10% more satisfied with the quality of their care in the health system, broadly if they have a primary care provider.

And just looking at some of the numbers to, frame this. So there are about 209,000 primary care practicing primary care physicians in the us. As I mentioned, Primary care visits make up about fif 50% of all touchpoints with the US healthcare system. And 65 million Americans live in a primary care desert.

Where there adequate primary care resources? Most of these are in rural areas. We would love to talk about this a little bit more with some of our guests. And finally there’s a current and forecasted shortage of primary care providers. In the next 11 years, we could see a shortfall between 18,000, roughly 18,040 8,000 primary care physicians.

And the reasons for this are many, and we’ll, get into some of this because I think it’s a very big problem. But some of the reasons are lower compensation relative to other specialty fields. Onerous administrative tasks and paperwork. I, read a, study that showed that for every hour spent with patients, doctors spend almost double that in terms of admin and paperwork.

Another factor, of course, is the aging population, which sees which see doctors at, the rate of about three to four times out of younger people. And then finally as we’ve discussed in, this forum before, the increasing prevalence of chronic disease with six and 10 Americans suffering from one or more chronic diseases such as diabetes, cancer, heart disease, lung disease, or Alzheimer’s.

The, necessity for primary care goes up in concert with the increase in. Prevalence of, those chronic diseases.

So even though primary care accounts for about 50% of all physician office visits each year healthcare spending to two primary care, sorry about that is only about five to 7% of total healthcare expenditure. In terms of the, whole pie. So compare that with other developed nations.

Those are about 12 to 15% on primary care. If you go back to the statistic I, mentioned earlier that every dollar spent on primary care can benefit $13 in savings downstream. The incentives to get this number up and to increase innovation, technology, and focus on primary care is, pretty obvious.

So there have been recent industry moves. Primary care has been in the news a lot recently. There are a lot of large companies interested in, clinics that manage and treat patients with costly chronic conditions. The most talked about here perhaps was Amazon’s 3.9 billion acquisition of One Medical, which is a concierge, like medical like, model rather with virtual medical visits, wellness coaching apps.

They have about 180 offices in 25 states and, work with 8,000 employers to provide both in-person and virtual visits to their employees. That was in the news heavily last year. Another one is, cvs spent about 8 billion last year in purchasing signify health, which is almost like an Uber for doctors.

They can visit patients in homes and connect them with follow up services. And then finally, Walgreens Boots Alliance, a unit of Walgreens purchased for 9 billion Summit Health. Which has a, which has about 370 urgent care locations in, New York, New Jersey, on the east coast, as well as in central Oregon.

So with that framing in mind would love to get into highlighting Dr. Steven Sprall. Dr. Sprall, thanks for joining us. I, know you’ve worked in many different care settings. Would love if you could talk a little bit more about what brought you to your current work and value-based and, some of your experience in other care modalities.

Dr. Stephen Sproul: All right, thank you. Yes, I I a family physician for the first 20 years of my. Career. I practiced general family medicine including family medicine, obstetrics and then became much more interested in value-based care and team-based care. And in particularly did some additional certification in geriatrics and move more towards adult.

Medicine and geriatric care. And became increasingly convinced that we needed a mo a different model of care than the standard primary care model, which in which many primary care physicians are carrying over FIF for over 1500 patients in a year. And and seeing people every 10 or 15 minutes that what’s what led me to join Oak Street with their focus primarily on geriatric medicine and value-based care.

And joined them about four years ago as a medical director. Recently, a year and a half come to Albuqureque to open up a new market. In Albuquerque. And the, primary focus here is to go into areas where there’s. Need for primary care services where the, communities have been underserved.

And then they, our providers have a, panel size of about five to 600 patients. So we have more longer visits with patients and, more ability to touch our patients frequently and, focus on their needs. As highlighted here, we’ve expanded across the country and have over 160 60 centers available.

And then we also have a team of providers. So besides the medical provider providers we staff our centers with one RN per. Every two phy providers and behavioral health availability as well as community health and social work services. So I think it’s been a much better way to be delivering care for our older, more complex patients.

Tom Bunn: Thanks for that. We, talked a little bit about the challenges in, primary care physician recruitment. Do you see that as exaggerated? If not what, do you see as the main causes of a shortfall in, the recruitment of, primary care physicians?

Dr. Stephen Sproul: Yeah, I think that for a long time primary care was undervalued and we, in, in terms of our.

Medical school graduates not many were attracted to go into primary care. I think there has been a little bit of change in that recently. Most of the pa, most of the providers we see coming into Oak Street are, people who have a A mission in mind. They’re really looking to serve underserved populations or, and or adult medicine population.

It does take some, dedication cuz these are very complex patients with a lot of both social and medical and mental health issues to deal with. It takes someone who really wants to do this kind of work. Thanks for that.

Tom Bunn: And,

to that end what is the typical patient profile of, a patient at Oak Street?

Dr. Stephen Sproul: I would say our average patients are, have anywhere from two to five chronic conditions. And they’re on Anywhere from 10 to 15 or more medications. And in addition to that, they have a lot of social social and mental health challenges as well.

Tom Bunn: Got it. Would you say that Oak Street is primarily in these primary care deserts or that’s a, goal of the company to be in underrepresented areas without primary care.

Dr. Stephen Sproul: Yeah, that’s been our our focus. We open centers that are in areas that have had a lack of primary care services, lack of, medical care, e even. We, serve a fair large large number of homeless transient as well as just fixed income patients.

Tom Bunn: And how is Oak Street using technology whether it’s remote care or eh, h r technology. Would love to hear how Oak Street’s using it and, what you think the, future of technology both at Oak Street and, in primary care looks like more broadly.

Dr. Stephen Sproul: Yeah. A large number of our patients are in a managed care insurance project product.

We are very focused on Population healthcare. So we have a electronic health record that’s really built and focused to help us do population healthcare. So that we’re not only addressing those patients who we’re seeing in the centers, but those who were responsible for, who are not engaged and not being seen in the center.

So we do a lot of outreach to To patients and trying to be sure that they they are getting the services that they need for preventive care and trying to engage them in making appointments and visiting. We provide transportation to our centers so that we can get them there, cause many of ’em are challenged with transportation issues.

And so most of our centers are e are in socioeconomically depressed areas in the cities

Tom Bunn: and in remote care specifically. It sounds like Oak Street’s using some of that but still room for growth there. Do you, are you optimistic about Remo remote care in general, or will there always be a, do you see always a place for kind of in-person brick and mortar primary care clinics?

Dr. Stephen Sproul: Yeah, I think there will be a need for personal contact and, direct laying on hands in, in the centers for with patients. I think the expanse of. Video and telehealth that occurred rapidly during the Covid crisis has, changed the way we look at how much we really need to be seeing patients.

So we’re offering both telehealth for progress visits and, problem visits when appropriate. We I, think there’s a tremendous opportunity here also to do Education and for the patients for self self-care and self-monitoring. The ability to collect data from patients from their home electronically, I think is a, huge opportunity here that we’ve not tapped into as much as we would like at this point, but have interest in doing so.

 

Tom Bunn: Great. Thank You. And you’ve worked in, both fee-for-service and, value-based care settings. Would love to hear compare and contrast to the two in terms of outcomes and, also in light of some of the sobering forecasts around the shortfall. You think value-based settings will entice more physicians?

Or do you think that the problem is likely to persist in spite of the, shift, gradual shift to value-based?

Dr. Stephen Sproul: I’m a fan of value-based care but my I really think value-based care aligns the incentives better than fee for service. And I’ve been, I’ve worked in both I think the incentives are to try to keep people happy keep them healthy, keep them from developing complications of their disease and, engaging them and having them motivated to, to improve their care.

I think it also offers an opportunity to provide services that for many of our patients in this country, they. They have economic challenges to attain those services. So I think that value-based cares is gonna be a huge Part of our healthcare system. I don’t think it’ll, completely replace a fee for service.

But I think that if we wanna have a health equity in this country, we’re gonna need to move more towards providing care through a value-based care that has aligned incentives for all, both the patients and the providers.

Tom Bunn: Oak received really high net savings out of 53 direct contracting entities.

They were the highest in, the 2021 performance year, and they also had amazing quality scores of a hundred percent. What do you attribute this to? H How is how do you see Oak Street relative to other similar entities and, what do you attribute the success of, the model to.

Dr. Stephen Sproul: I think we’ve we are a very data based system.

We do a lot of focus on being sure we’re hitting our quality metrics and providing feedback to our providers. Also providing a lot of support to providers for fulfilling those quality measures as well as The providing the care for the patients and documenting those that care.

I, think that the the focus on population health and, reaching out and engaging patients is been extremely helpful. Keeping people engaged and getting them in, and identifying issues and problems early. And addressing them where their needs are.

Tom Bunn: Awesome. I already see some questions tripling in, the q and a box for you, Dr. Spro. We’ll come, back to those. Great. But let’s move on to to, to Justin Schreiber from Life md. Justin, thanks very much for joining us today. We’d love, love, we’d love to hear the origin story. What, is Life MD and, how did you come to be the chairman and ceo E O?

Justin Schreiber: Sure. So Life MD is a 50 state telehealth company.

We work, we’re only cash pay. We don’t do anything with commercial insurance or managed care. The background is life and d started as a performance marketing platform back in 2015. I, had met the co-founder of the company, Stephan Gall, Lupe, through another investment that I made.

Just an amazing person and great work ethic and a marketing genius. And I had a lot of great relationships with proprietary over the counter products at the time in the healthcare world. And I initially was decided to back Stephan and. I was the initial most of the initial investment in the company came from me personally.

We scaled the business from 2015 to 2019 to about a 10 million run rate with some patented over-the-counter products that we launched. And then in 2019 a, neighbor of mine, finance and online pharmacy and Ro and him started running ads. For the lifestyle telemedicine offerings on the tv.

And what I realized is that we could back then we, I realized that we could, easily kind of partner the, physician component and the pharmacy component was somewhat of a commodity. And lifed had this amazing capability at the time of patient acquisition.

And so in 2019, we refocused the entire company on telehealth. We acquired a cloud-based telehealth platform. We launched with a very similar offering to what most of you’re familiar with in the men’s health. Business, mostly ed, hair loss and dermatology. Really like a lifestyle telemedicine model.

Launched the business really proud of how we launched the bi, launched the business with a fraction of the capital of anybody else. Any other company that I’ve seen in, telehealth, it’s grown the way. We have probably had a half a million dollars of cash in the, on the balance sheet, and we launched against bunch of companies with hundreds of millions of dollars.

We grew the, business the, team did an amazing job at, scaling the telemedicine business, and then the following year really my what I realized is that the, real, what we really needed to do for patients was offer them longitudinal care and I really just had this vision for a direct to consumer cash pay, virtual primary care offering.

And that was when I said to the technology team in addition to this kind of async, telemedicine tech stack that we have let’s think long term, let’s really once we, have this massive number of patients that’s coming into life MD for these more lifestyle oriented conditions, many of these people have underlying health conditions that are causing things like ed.

Many of them are telling us in their intake process that they haven’t had a primary care visit in three years, or certainly some of them. We can offer amazing care to these people and, we can do it at an affordable price. And it’s, of course going to be much more convenient than what they’re currently getting.

So that’s how we ended up to where we are today. We we have a, if you want me to just do you want me to take through these things here, Tom, and just talk about Sure. It’s a differentiator. Yeah look, we’re we, work across all 50 states. We have a a big business right now, about a hundred.

The telehealth business is about a hundred million. In annual revenue. Business is just about profitable. Put a lot of emphasis on compliance at Life md we have a medical group, which we’re really proud of that internally is. All of our primary care stuff is done by somewhere between 15 and 20 full-time.

Medical doctors and nurse practitioners, most of them are licensed across the country which gives us a lot of flexibility. We’re also integrated with many of these multiple third party physician networks that have really unlimited doctors, although we’ll, talk more about this in the next slide.

My, my belief is our model at Life MD is providing just in Incre an incredible experience for the patient. Making sure that our doctors are are thrilled with what they’re doing. Have plenty of time to treat patients, building a great culture and our affiliated medical group.

And that’s that’s, the biggest differentiator, and that’s what ultimately is going to, I think enable lifed to keep competing in what is a very competitive space. We put a lot of work in technology. I think that the, technology platform that we have is demonstrated by the number of we’ve 15,000 daily patient impressions on our platform.

We’re filling thousands of prescriptions every day. We have 120 to 150 person, just fluctuates a little bit, but a, big patient care center in Greenville, South Carolina. That adds another very personal element to our offerings. And then maybe we can go to the next slide, Tom, if you want performance marketing, which is something we kind of address in this slide as well, which is patient engagement and acquisition.

But if you can’t. What I think a lot of venture backed companies are finding in the telehealth space is that they just don’t have the money for acquisition and they can’t be competitive and they can’t make the unit economics work. You need to have amazing doctors in order to have great retention.

Which that’s one of the first things here is you’ll see like this. These are my four things that I think are necessary. To have a scalable virtual primary care business that’s that’s, creating an amazing experience for patients and can stand the test of time.

And I think Life MD has really checked all of these boxes which, is why I am so confident in the company’s ability to scale in in what is a, very competitive space with a lot of different players. I’ll just say one more thing about our providers and the product that we offer.

I, I tried to get a slide for you to show everybody you know, what based on our actual reviews, but every patient reviews their experience with le with their lifed provider. Following their consult and it’s a scale of zero to five stars. It’s very difficult when you look through these reviews to find something that’s even a 4.7.

Patients that see our doctors are having an incredible experience. And I think that’s one of the big the most important things as we scale, is maintaining that amazing culture that we have in our affiliated medical group. Maintaining that sense of camaraderie.

They’re regular meetups and as, the business continues to grow, I think that’s something that really focused on making sure that happens. Offering comprehensive care is another thing that’s, super important. At Life MD from day one, we put a lot of work into integrating different diagnostic services companies and, we have a 50 state imaging partner.

We do a lot in the wellness space as well. And we have a lot of integrations, which we’ll talk about on the next, which I, can talk about on the next slide. Yeah, this is this is a big big part I think of us, of just being able to offer the type of care we do across the country is integrating with third parties.

We’ve integr we’ve integrated with multiple pharmacies across the country and multiple, we’re working with some very big healthcare commercialization partners and data companies. Right now we’re integrated with the hub. And and, then as you can see, we have some big integrations planned for later this year.

Tom Bunn: Awesome. Thanks for that. Comprehensive overview. What are you seeing in terms of, utilization? I guess maybe backing up a little bit, so the, business model is, basically more accessible concierge medicine. Maybe there’s a, more there’s a better way of, describing what you’re up to.

But is that is that fair? Is it’s, a monthly fee for the primary care side.

Justin Schreiber: I would call it affordable concierge care. We don’t use the word concierge medicine a lot really what, our offerings are. We have most, of our patients are, paying per consult to see one of our physicians and then they pay a very very low, affordable kind of monthly platform fee to access the various tools in our, the various tools on our platform.

And things like prescription drug discounts, et cetera. Got it.

Tom Bunn: And the, last slide I think was great in terms of you’re targeting a comprehensive approach. Would love to hear broadly about the industry and where, your where, life MD’s, blind spots may be. Maybe that’s included in, a roadmap, but where, does this model fall short, if at all?

Justin Schreiber: Look, I think the most important thing for us as a business is figuring out how to clearly communicate to patients what the value proposition is and of a cash pay primary care model like this. And we’re, targeting Tom Fit the 50% of America that’s on a high deductible health plan.

That, that doesn’t trust a has problems accessing a, great primary care provider in a lot of markets. And B, when they walk in, oftentimes they don’t know what they’re gonna get billed. They’re scared of it. They oftentimes don’t go to see a doctor because they’re worried about what they’re gonna get billed, and they know they have this big out-of-pocket financial responsibility.

So I look, I think the most important thing for life Ofd is. Is figuring out as we grow, like how do we communicate to some small percentage right of Americans that you can pay. $39 a month to life MD have a longitudinal relationship with an amazing medical doctor or nurse practitioner that really understands your health, that can take care of a lot of your annual and routine lab work when it’s needed.

You can save money on over-the-counter and prescription medications without using your insurance card if you desire. And for the cost of what it would for the cost of taking your family to McDonald’s. Like you actually can have access. You can. It’s like having a doctor in the family, we like to say.

And so I think that’s the most important thing for us. Many Americans are still used to whipping out their insurance card and going through that process and I think that we need to. We need to continue to like, to help people understand why they should spend money on a product, on a service like Life md.

Awesome. And

Tom Bunn: then in terms of life MD’s relationship with its doctors you mentioned this before, but are you seeing better physician satisfaction and is this kind of a full-time gig for these doctors or are they in clinics elsewhere and, this is a side, hustle, or how does that, shake out?

Justin Schreiber: Yeah, that’s a good question. None of the doctors on our primary care platform that are, they’re all doing sync consults. None of them work for other companies other than Life md, so they’re all full-time W2 employees. We, I think I, personally feel very strongly that you, have to have that in order to have the doctors be and, the providers be incentivized.

To, spend sufficient time with the patient and provide the the, level of care that we want them to provide. As far as the burnout thing I think that I, actually was chatting with some of my doctors yesterday after you and I talked about that Tom and I asked them this question.

Look, their response was, We, when we were working in a brick and mortar clinic, we were a lot more burned out. And we had all, we had a big commute to and from the office every day. We had a lot less time to see our family that from, this mo I think that almost any of our doctors or nurse practitioners would say that their quality of life is much better working for Life md.

And we also do a lot to really encourage. Them to to spend time, even if it’s virtually with, other providers. We do weekly trainings. We do in-person meetups, which like we’re doing one in March where we fly all the doctors in, they spend a couple days together. So we haven’t seen that burnout, but I think it’s something that obviously as our business scales, I mean we’re compared to a lot of these bigger telehealth operations, life, MD’s, very small still.

So it’s something that. We really need to focus on as a company of maintaining that what I think is a very amazing culture and extremely high levels of satisfaction among our physicians. Almost every single physician we’ve ever hired has been from a, referral from one of the physicians that works for us.

We pay them better than other telehealth companies. Treat them better than certainly all of the big telehealth companies. I shouldn’t say all the big, but many of the big direct competitors in, the kind of telemedicine space. That’s where we’ve seen a lot of our, physician flow.

And they all tell me that life MD treats doctors amazing. One of our biggest pres, one of our biggest competitors, calls their physicians prescribers, not doctors. And we’re, it’s just, that’s not how, that’s just life MD we believe that the only way we’re gonna be successful is by having an amazing service.

And these doctors are, and nurse practitioners are, our service, right? So we, make a big investment in them. Awesome. And one final point before

Tom Bunn: we jump over to Brandy, just in terms of mental and behavioral health a lot of research has shown that the, easiest access point for this telehealth market is in that space.

Are you guys covering that or is that, do you leave that to other players, specifically targeting mental and behavioral?

Justin Schreiber: So I made the strategic decision to not really build a, 50 state mental health business for two reasons. One, it was, I thought it during the pandemic, it was the most crowded part of the direct to consumer telehealth market.

So acquisition was very difficult. And secondly, like just the, I just wasn’t, a lot of the providers that we were seeing in groups that were approaching us and we could have partnered with just didn’t feel like we could really deliver amazing care. They just, we just never found the right partner.

It’s something that moving forward we’re gonna look at. And what I would like to do at Life MD is partner that up with there’s a number of fairly large 50 state mental health providers now that are all virtual that. Already have all of the big national contracts in place with payers.

And so that’s those are some conversations that we’re starting to have now. I, see us partnering the mental health component. We do provide some light mental health therapy the sts through our platform, the president of our medical group as a. Board certified psychiatrist is double board service.

I double board double. He’s licensed in, psychiatry and family medicine. So it’s something that’s on our radar, but we just chose not to focus in that area.

Tom Bunn: Awesome. Really great perspective. Thank you Justin. Moving over to, Brandy. Just as a, as people know our, this is from a metabolic health presentation.

We did, as many of we’re at Isec, we’re very interested in, metabolic health and specifically targeting metabolic syndrome which is a precursor or, upstream of many of our chronic diseases, heart disease, cancer, Alzheimer’s others. And Brandy and Pravin Scripps are targeting this head on and really excited to have, met her over the last.

A few months. And Brandy, thanks for joining us today and would love to hear a little bit about kinda the origin story and, why your approach is different and needed.

Brandi Harless: Yeah, absolutely. Thank you. And I just have to say, Justin, I cringed when you said one of your competitors calls their provider’s prescribers who.

That’s, a trick. That’s a tough one. I so for us in particular, I was thinking back through our origin story in particular literally was my, co-founder Dr. Davis, when she moved home to western Kentucky and was seeing patients every day realized very quickly that her patients were getting to a chronic disease diagnosis quicker than, She remembered when she lived back in Western Kentucky before and, actually quicker than her patients up in St.

Louis, cuz where she was at the time. And so what she kept realizing was these patients would come in and say I really wanna do something about my risks. I wanna do something about my health. And she would say, okay Typical kind of patient interaction, right? Here’s the Mediterranean diet on a piece of paper, or here’s a resource that I’m gonna refer you to out in the community that can help you make a lifestyle change or do whatever you need to do around your health behavior.

And she realized, you know what? First of all, I’m sending these patients out of my door to someone else to do that, and I’d like to be caring for them in this way. And secondly, just the opportunity to embed that kind of mentality. And culture into her practice. So she found me. At the time I was actually helping entrepreneurs start businesses as a little side gig and ended up running a clinic, as I mentioned before and running for office.

And then she approached me and said, Hey, let’s do this together. And I think oftentimes back to one of my very first courses in grad school, which has about now been a while ago. Where the professor gives us that me that classic metaphor of the kids in the river. And there’s some adults down at the bottom of the river scooping kids out, trying to save them.

And finally someone says, Hey, wait a second, let’s go up to the top and figure out why these kids are being thrown in the river in the first place. And that’s what I think about on a day-to-day basis, when we’re doing the work we do. I like to describe it as you think about a typical kind of generic patient panel and, Dr.

Spr you mentioned working with that kind of later stage multiple chronic condition patient. Those are patients that I’m so thankful that companies like Oak Street and others have tried to figure out how do we care for those complicated patients. My, my dad is one of those complicated patients, so thankful that service and those management programs are out there and available that I can’t help but think about.

What are we doing when that patient was five years younger, 10 years younger, 15 years younger? When those risks started showing up, right? Right now in primary care, we don’t have a whole lot of ways to identify those patients when those risks are showing up. We have some population health kinds of things.

We try to do preventative screenings. We talk about a lot around cancers and things like that. The reason why we landed on metabolic syndrome is because we finally realized that truly is a way for us to start looking at these patients 15, 20 years younger, and to find some of those markers that might be leading them down that path to heart disease, diabetes, hypertension.

So what we’ve created is really compared to the programs that we’ve heard from today, ours is really modular because our goal is to get to any primary care provider in any model that wants to help their patients, identify the patient first, diagnose that patient with metabolic syndrome, and then help through a series of evidence-based practices help those patients with behavior change over time.

The thing that dawns on me is as we’re shifting from this fee for service model to value-based care, we are truly asking our providers to take on the responsibility of their patient behaviors. I’ll, I remember very succinctly during the Affordable Care Act days when I, every single provider I talked to was, Oh my goodness.

Where are we headed? I’m about to have to be in charge of my patient’s everyday lifestyle choices, and that’s a very scary thing. What I got excited about after Covid and during Covid was I think finally the public health community and the medical community started talking more. Because the truth of the matter is the public health community has solved for some of these things.

Why else do you think We have programs in public health departments and community health centers because public health has done a ton of research over the decades to really understand how we can help patients. I. And medicine is, medicine. And medicine does such a good job of that point-to-point, patient PRI provider care.

And when I saw the partnership starting to form, I got more excited because I think we have an opportunity truly to embed those best practices into a primary care setting. So what we do holistically is we can, we created what I like to call a. Prevention service line. When we talked to our providers during customer discovery years ago, this idea of this has to embed into my practice very seamlessly, or I’m not doing a single other thing, right?

We talked about burnout, we talked about paperwork, we talked about all of those things. On top of that, though, What we also realize and, Dr. Spr is the expert on the call here, but why do you choose primary care? As a physician coming through residency and coming through medical school, you have a bunch of choices.

And so there is this altruistic, you mentioned mission-based mi, mission minded providers. There is this sense that primary care providers are more mission-minded because they chose that frontline choice. Knowing the salary limitations, the overworked nature of primary care. And so we found that if we could truly solve for that clinical embedding issue and the time problem, then we could have some big impact on helping these providers, their care teams and their patients, truly put together a program or a service line, as I like to call it.

So what we do right now is we help. The providers identify patients that are not only at risk or possible candidates for metabolic syndrome diagnosis, but we also make sure that we’re finding patients who are motivated and ready. So we use validated survey instrument instruments to make sure that when that patient and that provider are face-to-face talking about this opportunity, that it is a good moment to be having that conversation.

Our providers early on said to me, I’m not a salesperson. I’m not here to sell a program to a provi, to a patient. If they’re ready to do something, I wanna be ready to help them. So after that piece, as soon as the patient completes our survey in real time we, score those validated instruments, ship them into the patient chart in real time.

So as that patient’s right in front of that provider, they can pull up the transcripts assessment, see the results of that. We actually provide a recommendation, yes, this patient’s ready work on enrolling them in one of our programs. No they’re not. Maybe next time. And so right now we use I think someone mentioned remote patient monitoring.

We’ve actually taken this very saturated commercial commodity trend right now and applied it to primary prevention. And so we ship a, scale and a kit actually with a water bottle and a refrigerator magnet with a my healthy plate and a lot of resources to the patient’s home as their starter kit.

And then we’ve used those remote patient monitoring fee for service opportunities to generate revenue for our. Practices. And what’s interesting is every clinic’s different. Some clinics have a nurse practitioner actually making those phone calls monthly and checking in on patients. Some of our providers have said, you know what?

I like the idea of breaking up my day and not just seeing patients back to back. I’d like to make these calls myself. So they’ve actually embedded it into their own workflow. But it’s up to the care team, how the care team wants to do that. A lot of the companies that we know about that are doing an chronic care management, R P M, again, great companies, they’re building these kind of call centers, right?

To do this work on behalf of the primary care or the, or their customers. We have found that our care teams really want to be embedding this practice into their clinics, and they are willing to figure that out. For themselves and using our technology, we can really help streamline that process, make it simple for them so it’s not this big burden of finding reports and figuring out what to do and how to call and what to say.

So we help support them over time. So we’ve essentially created this, our, in our entry to the market was really around fee for service, knowing that the majority of primary care providers that we’re gonna talk to are still being incentivized in a fee-for-service model. But lately what we’ve really been seeing is this opportunity around quality.

And I know in the value-based world, that’s really where the game is. However, I was telling Tom yesterday, one of the things that we are running into is the, clinics that are doing like B M I screening and counseling or checking a1 CS and monitoring A1C reductions or blood pressure reductions, especially on the B M I side.

They’ll tell me we really just check a box when we see A B M I and talk about a low carb diet. And the question we always have is now what, how are we actually making an impact on these patients? And so using our program, they are able to do that for the long haul of the patients. I’ll just wrap up and j add one more thing.

The af the a f P actually released a survey last year and they took Thetic, they took 11 of the recommendations from the United States Preventive Services Task Force and ask their providers their membership. What, do you need most? Are you able to accomplish these? What are you missing? What is trending?

And overwhelmingly until they’re surprised, they even admitted in the report, overwhelmingly their family practice. PR practitioner said, we need more support in assessing and intervening around diet, nutrition, physical activity, tobacco use. That is interesting. At this time, this was an October 22 report that they released.

So to me it says our primary care clinics are thinking about this. They want to be doing something about this. And one other caveat I’ll say is we oftentimes partner with a chronic care management company or an RPM company doing congestive heart failure work. Because what we find is we’re not competitors.

We’re actually focused on this earlier opportunity with these earlier patients, both disease and age typically. And we’re able to, if they a few of them get through us, they make it into those other programs. So it becomes a really good opportunity for partnership. I’ll stop there and see what questions that came up, Tom, as I was talking.

Awesome.

Tom Bunn: Thank you. Brandy, can you what, is the, technology you’re using and, three part question I can repeat this if you need. What, can you talk a little bit more about specifically what the technology is what the utilization it looks like from a daily patient, weekly, et cetera.

And then what, impact or what efficacy sort of traction patient data you’re

Brandi Harless: seeing. Yeah, absolutely. We’ve really just put together a whole suite of digital health technologies from patient web-based assessments to direct messaging to make sure that report gets into the E H r to a bunch of patient engagement opportunities down the line through native apps and Bluetooth connected scales, things like that.

One thing that we’re working on right now that I’m really excited about, if you guys are, if anyone’s tracking the teca. Guidelines and regulations that are changing pretty rapidly this year, hopefully we’re gonna be going right in the industry from this kind of treatment purpose of use, access to medical records, to an individual access, which is going to be very exciting because for us, one of the challenges we have is around this diagnosis of metabolic syndrome.

Metabolic syndrome is a multiple factors, and the data is typically very disparate. So you’re talking about having to get a, lipid you, had it on your slide prior. Having to get the cholesterol, having to get a waist circumference, which who does that in their practices these days. And then that glucose measure and then a blood pressure measure.

So that data typically is not showing up all in one panel saying, Hey, check out this patient. They might be at risk. And so one thing that we’re excited about is partnering with A company that’s able to go grab those records at the patient’s consent, pull them back together, our system will be able to analyze that, figure out if this patient truly has a risk, and show it back to the provider.

So if you can imagine sitting in front of your patient and seeing, here’s the five criteria. They are out of range for two or three of those. I need to take a look at this and see if they possibly have metabolic syndrome. The reason this matters is because in order to do remote patient monitoring, you have to have a chronic condition.

And so this is a way to catch that group of patients that might not be diabetic, but that have an opportunity. So from an impact perspective, to get back to your actual question we assess. It’s typically about a third of the patients on a schedule every day that end up completing an assessment.

We’ve assessed almost 5,000 patients to date. We’ve triaged a little over half of that, meaning that they are eligible for one of our programs, and then we’ve enrolled quite a few patients into our programs and seen some great outcomes. These are very, these are preliminary. We like to call. These are patients that are on our program for six months-ish.

And so if you think about who I’m talking about here, we’re talking about this group of patients that are at risk for chronic condition. The gold standard is a 5% weight loss reduction is what can really make an impact on these patients when they’re pre disease harder when you have a diagnosis, right?

But easier prior. So we are always looking at that as a kpi. Who are we helping to get to that 5%. So you can see here 32% of our patients have lost the 5% or more. We like to track that process indicator of the one to four cause we think they’re on their way. 47% have lost one to 4%. We’ve seen a 13% reduction in systolic blood pressure and a 12% reduction in diastolic.

Half these patients are. Early, hypertensive save one half of them are pre-hypertensive. And so very meaningful in the sense of are we how are we truly keeping them from moving into progression of disease and or preventing or delaying altogether.

Tom Bunn: Fantastic. Thank you very much for that overview, Brandy.

We just have a few minutes left and there are several questions that have come in. Thank you for the audience Questions so far. We have one from Ander. I, apologize. I’m not sure how to pronounce your last name but Ander asks Dr. Sproll, from a physician’s perspective, what is the downside of clinics shifting to value-based care?

Ask a different way. If we are looking at an investment with that thesis, what should we especially pay attention to?

Dr. Stephen Sproul: Yeah, I think that It’s the downside to shifting value-based care. I I think we, have been in a mode of fee for service and we’re very used to and understanding how to do that. And I think that it takes a practice being interested in Population health interested in collecting the data information and then also being active in what Brandy said around identifying potential risks for patients early in trying to modify risks because the value the value and value-based care is keeping.

Identifying issues, addressing them early and, keeping people from having complications and being sicker. It’s a different mind frame from when I was in the fee for service world where we were just consumed with treating disease.

Tom Bunn: Thanks for that, Dr. Scroll. Tom Kroll asks, With 10 to 15 meds per patient, does Oak Street use pharmacists? If so, how?

Dr. Stephen Sproul: Yes, we do. We do have pharmacists on our employed in our organization. Pharmacists are. Involved in helping us identify any potential interactions and risks with medications. But they also help us do some outreach to patients around mead adherence. Tracking whether patients are filling their prescriptions and, staying on their medications.

Tom Bunn: Great. Sig Moore asks Brandy, where is Pravin Scripps focused on expansion at this point.

Brandi Harless: Yeah, great question. We are on a daily basis onboarding new providers. That’s just our goal. And, we’re in Kentucky and so we’re focused on the geographic region that is within reach to us right now.

Although we are definitely in conversations with several health systems and even some payers. That are interested in utilizing our services and added benefit to their providers and their network or even in, in the health system, figuring this out. As, Dr. Spr mentioned in the value-based side.

I think as this continues to shift from the fee for service to value we’re going to see more and more interest because when you take on risk for a patient panel right now most of those patient panels have chronic conditions and you’re starting at that point. But as this value-based approach expands, and more of those patient panels are the general population, we’re gonna see a lot of interests, I would say.

So health systems a big interest for us. Part possible partnerships with pilot with payers. And then, yes, we actually are actively in the capital raise right now.

Tom Bunn: Fantastic. Thanks for the questions, Dave, and thank you, Brandy. If there are no other questions I wanna thank everyone in attendance for, joining today.

This video will, this webinar will be available for replay, as I mentioned. We’ll be on YouTube within the next few days. Please share subscribe to our feed. And if you’re interested in learning more you can find more of these deep dive webinars on our website. There’s a lot of good thought leadership there.

Other good, content, other webinars in different forums. And last but certainly not least, thank you Brandy, Justin and, Dr. Sproll for your time this morning. And hope to speak with all of you very soon. Thank you. Really

Dr. Stephen Sproul: enjoyed you, Tom.

Brandi Harless: Great to meet you all.

Justin Schreiber: Thanks.