2024 EY Healthcare Entrepreneur of the Year: Eric Reimer's Journey to Innovating Kidney Care

<p>because at the end of the day you can tell members and providers anything you want to but if you don't change actual Behavior you're you're really not making a [Music] difference hello everyone this is Cole from the American Journal of healthcare strategy really exciting episode for you today I was scrolling on LinkedIn and I came acoss an incredible guest who recently won a very prestigious award and I wanted to invite them on so we reached out and they decided to come on and partner with us so we're really excited to introduce um them to you ER Eric can you please introduce yourself and your role uh and then of course I'll talk a little bit more about that award that you won I I'm Eric Ramer from Health map solution CEO and uh really proud to be here and excited about the podcast thank you so much again for Eric so this is just it's incredible for me as well when we started this podcast it was small many months ago and then now we've grown it and we get to have incredible guests like like you come on and this is a big deal the 2024 entrepreneur of the Year life sciences and health Award winner it's only one for that division uh in the entire country and as I understand from some of my colleagues there it's selected based on the state winners as well so you also won the state award before winning the national award right yeah so um I was approached uh early in the year in the Cal year about uh applying they encouraged me eron young encouraged me to apply we have no business relationship people always wonder you know do we work with them and audit or or whatnot we we don't um but they had heard about our great success and Then followed my career and a couple of other spots and invited uh me to uh apply for ernston young entrepreneur of the year uh it was a fascinating process it started with folks coming here on site to healthmap uh interviewing me asking me a few hours of worth of questions um eventually was uh named to be uh a regional finalist which was Florida and Puerto Rico I went over to spend some time with judges who were not from eron Young they were mostly independent judges that had won before other entrepreneurial folks and when they did that I spent and was interviewed by about 15 15 judges wow and so um spent a few hours there with them got on uh a number of videos that they took with us um we had to go through our financials with folks from there uh we had to uh we l i later learned they spoke to some of our customers and employees and past employees as as they they said they didn't want to be embarrassed they wanted to make sure the winners were well vetted uh so it really was um a wonderful honor and I I look at it as really an honor for two things it's it was a great honor for me uh felt like a little bit of a Lifetime Achievement Award I've been lucky enough to be a successful CEO three times over and been a chairman of of three uh very high growth private equity-backed healthcare companies uh it was a great acknowledgement and it felt it felt great to it's not usually about me so it was an interesting opportunity to have that recognition but clearly this doesn't happen without the incredible work that Health map Solutions is doing our growth the people that we care for the there's so many good people here we have when I came here four years ago we had 60 people now we have 600 plus Mission driven people who really really care about the members and the lives they're impacting and so I look at it really as a corporate wide award and an acknowledgement for the great work we're doing did you know and this is a personal question did you know when you started the process to get the award that it was going to be such an intense you know series of interviews and meetings and things like that not really I mean first of all I I'm pretty humble I didn't really think I'd get past Florida um you know I was very excited to do that and and to get to Florida um but yeah I didn't know exactly how many people i' would have to interview with and and the rigor and you know but honestly it made winning so much more rewarding because I really felt like I had accomplished something and uh the people at eron were so professional and welcoming throughout as much as they were grilling me they always made it feel like it was uh you know they were very respectful and and gave me an an opportunity to really put our story forward it's it's awesome that you you want huge congratulations and and I think it's just so interesting because there's so many startups in the life space and and you know a lot of these are successful in the healthcare space and you know when it comes to what you all do in the the chronic condition you manage it's so impactful but people often don't look in that direction so I think it's really important that they really went and evaluated these things um can you just tell us a little bit real quick for the audience who doesn't know H what do you all do at Health map solutions that has kind of won you this award so we care for north of 150,000 people that suffer from chronic kidney disease or endstage renal disease and so what does that mean we really provide them with the best care and we do that by giving them first a nurse Advocate and when I say nurse generically it can be a nurse it can be a social worker it can be a nutritionist um and then we also work with their Physicians to make sure that those members are getting the best care so we want our members to be very proactive they we want them to see their doctor more we want them to comply with their doctor's orders and take their medicines and and take their lab test Etc really to prevent hospitalizations and get having the disease go get out of control so that's really what we're about and we do it really with both technology and with the human side of uh of capital uh by putting great people alongside in front of both the members and the providers now when you came on the board of health map you were not the founder but you did steer the direction towards the the kidney management why did you choose that direction where did you see the need because personally right I would not have come up with with this as the area to head in and yet you've impacted so many lives so where did you identify that Gap in the market yeah so we the business was started really to be a technology shop and an actuary shop really helping private Equity uh healthcare companies kind of get off the ground and it was you know cash flow positive right away because it was more of a Consulting shop but as the chairman I said to the founders we really need to pick a space rather than empowering other people to go after certain spaces in health care we should really pick a space have that conviction and and then build build the technology and the uh and the business model for ourselves and uh Joe vadam our president was really the person who pick kidney and there was a couple reasons why so the first thing was he looked back and he talked about his days at Weare and said some of the smartest people in healthc Care Management would attack serious problems and one thing that they always did was punt on and Stage renal disease they they just said there's really not much you can do there's a duopoly and cinius and Devita providing uh dialysis and the folks need it just sort of leave it alone we'll go after other spaces so that was one thing that ated with him and he he thought about the problem and then the second was at care Centrics the other business I had run uh Joe worked for me we got asked a lot because we used to provide care in the home uh post discharge we would get asked a lot about home dialysis and could we administer home dialysis would it be a big savings we didn't go into that space But it again Joe said a lot of really smart people thinking there's there's no way to really manage this better and so he went about talking to some nephrologists and trying to see what they thought about the problem and what the nephologist said is you don't want to manage endstage renal disease itself really to make an impact on dialysis cost in America you have to go backwards and you have to find folks that are earlier stage CKD members earlier stage chronic kidney disease members so that you can slow down the progression and stop people from getting dialysis at all and it is one of the disease states where you really can stop progression we do it all the time we we will look at pre and post we have about 30% less disease progression when we're managing it and you do that again by finding stage threes and fours and fives and the way it works is a higher number means you're getting closer to dialysis five being the highest right before dialysis and so th those folks are really chronic kidney disease members are suffering from a range of comorbidities most of them in addition to the kidney disease have heart disease issues that you know cardiac they also suffer from diabetes quite often and so the best way that to manage those threes um in particular is to work with both the primary care physicians and then try to get them into the right specialist make sure that they're treating all their comorbidities and you're doing those things to slow down the progression of the disease how many years are we talking when you say slowing down the progression of the disease right what's the timeline looking like for that so what we do is we look at the full population of members before we came in what percentage of those moved to the following stage each year then we look at it during our management so we're really looking at year by year uh but we can we find we can stabilize people in stage three for many many years uh which is wonderful it's lifechanging I mean besides the fact that you're clearly saving material cost for the health plan the members not having to enter dialysis which is a very very cumbersome treatment that really becomes all encompassing to a member they they go into the clinics which is most often what happens three times a week they're sitting in a chair for multiple hours a day they're not able to hold a job they're not able to travel Etc but if you go backwards and you treat these folks um you can just have make such a difference in their lives it's it's very interesting that this approach has not been taken before or at least not taken effectively because I you know I think of the patient experience is tremendous probably the quality improvement on this is tremendous because like you're saying this dialysis is very cumbersome I had a friend who did home dialysis and even that you know people talk about home dialysis is how much better it is but it's not easy for the the patient or the member and then I'm also thinking about the high touch nature of this because you're saying you're assigning a nav a nurse navigator to them that's going to work with them on this has that do you think improved the the kind of customer experience or you know the cap scores things like that since they're they're in such high contact yeah so a couple questions in there I'll go back to the first one which is why haven't people done this I think in healthcare and and I've been associate with a lot of these companies you deal with the most acute issue right you deal with um very expensive surgeries dialysis for example is one of the most expensive things somebody can get so so naturally everyone focuses on dialysis if you've look at this space from ckd3 chronic kidney disease 3 all the way to ESRD and you define that as the population we're managing only about 10% of the spend is dialysis which is surprising to people 60% of the spend is facility costs people going into inpatient settings so really the way to attack it is on the inpatient side and again I think most people saw the the shiny object as dialysis went there tried to take 5% or so out of of dialysis spend and again if it's only 10% of the spend and you take 5% out you're not moving the needle at all but to go backwards you know I think that everyone is starting to realize that that some of the lwh hanging fruit has been taken in healthcare and to really make a difference on ongoing cost in in our society you really have to go after the chronically ill and that's frankly a lot harder um than putting in a prior authorization on a surgery and making sure something meets medical necessity criteria um and again I'm not saying that doesn't have value I've done that in the past too but it's this is a lot more complicated you're really building this longitudinal relationship with a member and then asking them to do things today that may not show up in your in the savings you know for six months or a year or two years and so you need the health plan to buy into that as well but I think the health plans understand now that that value proposition you mentioned your second question was um having a nurse Advocate is that helpful so what we do is we really want to meet the member and the physician if you will where they are so there is a large range of members when you start talking about ckd3 all the way to ESRD members some of those folks are homebound some of those folks are employed at a company like mine that are coming to work you know 50 hours a week they're very there's a very different range and they all have different comorbidities Etc so you've got to figure out a way to take your systems use technology to First build a customized care plan because again you're dealing with the whole member not just with kidney disease when at least we are and so that really requires you to build a customized care plan that's one of the things that you you have to be able to do um you also have to be able to work with the doctors that they Trust and you know this is an unbelievable stat and and shocks a lot of people but stage three kidney members only about 50% have ever seen a nephologist and in stage fours and fives even it's only about 60% wow a lot of these folks are getting their care through a PCP or a cardiologist or endocrinologist um or some combination thereof and so you've got to work with the with those doctors as as well trying to get that member to see a nephologist when when uh they need to but also not dismissing the PCP they have a critical role to play if you if you go back to what I was saying for stage three the probably the most important thing you could do is really manage those comorbidity well and no one's in a spot to do that better than the PCP because they see all the things that's members going through and so putting that connection back to the PCP even when when a specialist is involved is critically important we we don't see our competitors doing that uh quite quite like we are um and then even with the way we work with members we tie trade our interventions so there are folks in our industry that will say we have a great app if you go on the App you know technolog is going to solve your challenges and and and almost coach you and then you have other folks all the other the other stream that say we're going to send somebody into your home a nurse or even a doctor they're going to work with you and care for you um really we see this variety of needs and the only way to do this scale and actually um produce a return on investment for the health plans that are funding the the this program is really to tie trate the intervention based on need so every member has different needs some folks need that care in the home some folks just need a digital touch point but quite often it's it's a complimentary of those things maybe it's the first visit uh becomes a home visit or a call with one of our nurses but maybe they need a nightly reminder to take their meds having a nurse uh come to the home and remind someone that we haven't seen them refill their prescription is is it not a great use of a nurse's time or the members time there's an easier way to communicate with them quickly and effectively and that's what we do we really customize our solution and more and more I talk about how it's not people or technology it's people empowered by technology um and the complement of those two and and really the intelligence that we use is what's the best touch Point what's the best timing what's the best medium what's the best message that really changes Behavior because at the end of the day you can tell members and providers anything you want to but if you don't change actual Behavior you're you're really not making a difference I I am really impressed with the approach and I think we're going to have to have you and your team on future episodes to discuss this because it's a very unique approach it's a very intelligent approach and it's also efficient and that's something that really interests me um I have a lot of different questions I I could ask I I think one of the things that that my my colleague had said to me his name is Alex he's on very popular in LinkedIn he said you know we need to figure out how to make staying healthy uh profitable compared to always treating that really kind of end end case scenario and that kind of seems like what you're doing is you're making preventive care customized and efficient even though it's not preventive because they still are you know stage three four and five but you're able to reduce the getting to that you know really negative area do you think that and I guess this is the big question why do you think or why can't we do kidney stage two and one what are the the limits there and that probably is just my kind of clinical ignorance but why did you choose use three four and five as the stages yeah in in a perfect world everybody should be on top of their diet and their exercise and their uh their the care that they give themselves right they should be doing their annual Wellness visits Etc we we cut off at three to ESRD really because there's a significant return on investment right if you're going to get people to be in the doctor more and take their labs and get on the right Ms there has to be a starting point a baseline of cost in which you can you can reduce in order to pay for the proactive care so to speak so you know we're taking the impatient facility cost I mentioned is 60% of the cost we're taking that down 20 to 30% for our customers that funds a lot of this uh program and a lot of that care it would be tough to do our program for CKD ones and twos and and produce an Roi what we have suggested because we do get asked that sometimes by by plans is we can do some of what we would call monitoring where we're giving the digital tools to members so they can they can manage things we're also then look at claims and look at um events that tell us that person is really one of the highest utilizers one or two and and likely to progress and then we could jump in so we could do a modified program on the ones and twos and make it make sense probably you know you you'd have to really limit the labor expense in order to make the turn on investment makes sense right so so it's all kind of looking at things from that Roi approach which is also really important you know one of the the things that I always say is I love my mph colleagues but we need to kind of combine the public health with the financial approach to make sure that we can sustain the systems and what a smart approach that you're taking with this I have to ask you before we conclude it's kind of a selfish question but you know you've come into and led various organizations very successfully any advice for individuals who are looking to kind of grow a company to this size or looking to innovate within this space any core values as a leader any advice like that you can give us well I love giving advice um so uh happy to do so I mean the core values we have at our company we tell folks it's not enough to just present information you have to go above and beyond you have to make the connection with someone as an example you get a sense when you're talking to someone if you say we really want you to go see a nephologist you know and make an appointment are they really going to do that or do they need some some handholding if so let's go ahead and help schedule that for them let's find and make a referral for them um if if they're not taking their meds a lot of times they know they're not taking their meds there's a reason make sure you're asking the right questions and if the question if the answer is I can't get to the pharmacy let's work with them to figure out how to do that so that's one constant Improvement you know I think a lot of folks are are always fearful of saying that they don't have it perfect we're not perfect none of us are perfect our model isn't perfect the only way to really figure out how to do better is asking the Frontline people who talk to members and providers how would we do better and so we do that all the time and we reward people for coming forward with with h advice and opinions and I think you should constantly solicit advice and opinions and then decide what's useful and what's not useful I think ultimately though it comes down to being ethical hardworking resilient um and I think you know the way you you bring those values to a company you have to start by bringing them yourself right I think you have to be a leader that walks the walk and I I think that it that starts there I think the hirings that you that you do um it h and the promotions it has to be people that represent those core values so it's really that you're putting your money where your mouth is you're showing what you really uh reward and then I spent a lot of time with the high Potentials in our company it's probably the thing I I like best mentoring them and making sure that they get guidance and making sure that they ask questions and making sure that they get feedback so I think that that's all really important as far as when you're starting a company advice um you know the first thing I'd say is it's rarely linear you know people come out with a business plan and they think about a a business and how it's going to go and and quite often you've got to wig and wag and move around and change things and you know you have a year where you think you're right on top of things and then you take a setb back for a half a year and then you got to jump ahead two years and you've just got to know and be prepared that you've got this long journey ahead of you and that you've got it once you've got to have the resources and you've got to have the mentality that you're going to stick that out um otherwise you're probably not best in starting that business right if I know people who are like I'm going to start a business it's got to be successful in three or four years or I'm out just I would say whatever you think it's going to take put a couple years on that and have make sure you have that Financial staying power and the and the mentality and the endurance to to to do that um I I I have there was a business plan I wrote years ago I won't mention the company that's very successful multi-billion dollar company now and you know if you look at that first business plan and what it's doing now they're very different you know it got running it got into a space but they pivoted they changed the business model and um it's it's it's not a flaw that you're changing the business model it's what makes you a great entrepreneur that you're willing to change the business model to meet the need of of the of the market that is really powerful advice I have seen those things uh myself in not all of them of course I don't have nearly as much experience as you but I I see how applicable they are that focusing on on you yourself as a leader having those core values leading as kind of the the person that that you really want your employees to to look up to that's so important uh thank you so much Eric excellent advice from the the ernston young 2024 entrepreneur of the year really appreciate it and I really am excited to to have you back on again and talk more about these topics I'm very intrigued by it I think the audience will as well really appreciate your time love to come back straight I love talking about such a great business and and proud to be leading it</p>