From Risk to Reward: Healthmap Solutions' Strategic Expansion into 43 States and Beyond

<p>being compassionate providing empathy working first and foremost on behalf of the patient you know the rest of uh the business takes care of itself you know because the word word spreads and people know the difference between Health map and the other competitors that are in the marketplace today and we do things differently [Music] hello everyone this is Cole from the American Journal of healthc care strategy joined by a really special guest uh uh close colleague a friend of mine we've been working with for a while here uh Tom Gaffney of Health map Solutions Tom please introduce yourself and your role yeah hey Cole good to see you and thanks for uh the opportunity to uh to connect here uh I'm Tom Gaffney I'm the chief growth officer for health map Solutions um I joined Health map back in 2017 as a board advisor um and then spent uh working with Joe vam Adam the founder uh for a couple years and then in 2019 uh we were able to get some funding from winrose as you know um and they asked if I would uh you know take a full-time role as a chief growth officer which uh I was very happy to do so so I've been working with health map since the summer of 2019 I have responsibility for sales account management and marketing um and just really excited about all the great things that are happening with health map right now really appreciate you coming on and being willing to talk about this topic as well I know a lot of firms they like to keep their their kind of secret sauce uh secret but you're kind of willing to come on and share a little bit which I really appreciate because uh when Health Maps first brought their product to Market in 2016 things looked very very different than they do today and I think that's both politically but also culturally and also economically things are drastically different almost 10 years down the road however Health maps have been very consistent over these 10 years and in fact from what we've talked about they're providing more and more value to their customers as time goes along as a lot of firms are struggling to to do this um what what does that look like when you're speaking with your customers what does the value proposition look like between 2016 and where we are now yeah that that's a great question and you know what you're allowing me to reflect on where we've been uh at Health map for you know the last 5 years or so as I've been a part of the company but uh it's interesting you say even with all the market changes that have been occurring um changes in the uh the financials and changes in how delivery will be uh uh will be provided to our members uh the influence of AI and all this other great technology that's being brought to Market uh you know we have been pretty uh you know true to what we initially designed as a company in as a program back in uh 2013 and then bringing our first customer to Market in 2016 so as I'm thinking now Cole based on that question you know we uh you know we continue to have the same uh clinical and operational model uh obviously with some enhancements but we still have the uh you know the key themes of what was important to us when uh Joe vam Adam uh started the company in 2013 which was create a program that could uh be a population Health structured model which you know in 2013 we were the first kidney population Health Management Company to the marketplace um and we continue to be very much focused on uh population health and and it's been what's made us so successful uh additionally we were very focused on moving Upstream uh in the uh in the disease uh State progression and making sure that we had the opportunity to uh work with members early in the process obviously for any success of any uh you know chronic uh disease program or any disease in general the earlier you can identify uh that the patient is diagnosed the better opportunity there is for outcomes so we very much were focused and continue to be focused you know almost nine years after the fact in making sure that we're moving Upstream to uh you know be able to work with the members earlier in the uh C TKD progression uh which frankly is you know CKD stage three um and by doing that by focusing on CKD stage three it really allows us to have the biggest impact on uh the overall uh success of the kidney program because whereas historically most uh vendors were focused on the ESRD patients because that was the immediate uh pain point for health plans and other customers uh you know everyone knows that uh you know if you're truly going to slow the progression of the disease uh and it sometimes try to avoid uh the only way you're going to do that is to get with the patient early on in the process because with those stage three and Stage fours you can really make an impact but when you start to look at CKD stage five and ESRD you know by that time you know the patients are already too far down uh the path and uh they're really focused now on making sure that uh you know their um end stage is being managed effectively and they're compliant with it but you can never uh regress the uh the process of the disease state with uh kidney disease so you know we have stayed true to that and we think the biggest difference in health map compared to our competitors is that we are the experts in the earlier stages that doesn't mean that we're not managing and managing well the stage fours fives and esrs uh but we do know that we have something that's unique and important to our customers yeah and being that focused on the actual kind of Roi of each stage I think is really important right because we've seen this a lot of firms as AI has come out there's this temptation in the marketing and the messaging to shift away from what you know Health map has maybe originally done you guys could Rebrand and call yourself an AI firm but you haven't really done that right I've talked to Eric about Ai and the use of AI you guys are very much on the bleeding edge of Technology but you're remaining laser focused on especially those like you said those earlier stages and trying to manage it correctly I have to ask has there ever been a Temptation from a growth perspective to uh you know add some AI terms or buzzwords into your uh messaging and marketing for your clients and why have you decided not to go heavy down that rout yeah I think a couple things Cole and absolutely we're we're using AI today if you look at our uh our technology platform which is proprietary um it's called Compass you know we do leverage and utilize uh Predictive Analytics and uh AI uh to effectively manage the uh patient needs uh you know within our organization but at the same time we also know that technology is important but so is the Hands-On face-to-face interaction that we need to do with the uh with the patients and with providers uh what's interesting and maybe for a different topic is uh you know you may be aware that we just announced an acquisition of a new uh company carum they are a digital technology uh you know platform that does amazing work and we're excited about the opportunity to utilize that technology and continue to grow our technology footprint um and doing that through AI so more to come on that but you know we are very much focused on using AI where AI is important but you know there's a lot of other things that need to occur and need to happen for Success um and those are the things that we're frankly F focused on today that's an excellent answer I appreciate that a lot so it's people first patients first providers all of the all of your clients who you're working with are the number one thing and then the Predictive Analytics giving them the best tools they can is really coming in short second place I think that's awesome I think that's a really good way of looking at things um and that kind of lends to my next question you're talking about how you partner with all these individuals really it's not just health plans but it's Health Systems providers acos and as you kind of mentioned it's patients you're partnering with at the end of the day it's people can you you uh give an example of how you've worked is you know I think of all the different populations the the special circumstances I also think a lot about the managing of risk can you give an example of how you've been able to develop these kind of Custom Care Pathways with your partners yeah you know for us uh and with all of our customers today we do utilize a value-based care approach um so when we talk about uh partnering on Pathways you know I specifically in my responsibility and really focused on how we can manage the pathway of economic success for our clients um so we in fact do use uh you know certainly uh you know full risk models whereas I think in 2019 when I was when I started working and uh uh with the initiation of the cures act and starting to begin to uh enroll membership uh ma membership uh in 2021 you know we were very much focused on you know we need to make sure that we have a successful Mar market and model that we can bring to our clients uh and in order to do that we wanted to make sure that we were uh focused on what it would take to be clinically successful for our clients and once we had the opportunity to uh you know uh provide predictable results year over-year understand what it would take for us to scale uh as we started to interact with uh more clients and ultimately what it would take for us to drive savings and also improve clinical outcomes um in additional to uh you know operational and service Excellence you know we then started to say okay we think we've locked it down we think we've got a really good model uh and that's why we're managing approximately about 160,000 kidney members today um is because we're doing a good job with that uh we then wanted to now say okay what what could we do for our clients that will make this you know even uh you grab more uh attention and get them involved with uh working with health map and that was really through looking at the uh economic model that we were bringing so we started off early on with an ASO based model where we would have a fee uh and then some gain share uh but in 2023 um actually 2022 we really started to lean in on it 2023 we established uh our model and executed we started to look at full risk and capitated models with our clients um and the majority of our clients today are asking for capitation they're asking for downside risk and we're able to take that for them uh with them um and the good thing about that coal is that you know we would never have had those conversations and moved into that economic model unless we knew we could uh Drive success uh in all other areas of our company and our program and we're able to do that so you I think that's been one of the biggest changes for us and something that's excited us and truly has been uh a driver of momentum for us when we're working with not just our health plan clients uh but those customers and health systems and acos that we're speaking with also and I I love the model I love the business model in general that we're trying to do the same thing at the journal we're trying to shift towards value based marketing or retake that but it's hard it's complicated and so first of all talking to you and Eric and the team it's awesome to hear about it because it's like a it's kind of a dream model right where you're able to really provide this amazing customized value value at the same time though it's not as simple as um you know somebody purchasing a package you know paying for the fee up front and then they get a set service it's a lot more kind of uh involved right it's involved and so I guess here's here's the question of that personally but also for the podcast your services work very well every all of your clients are very uh happy with them you're taking on the risk so there's little uh risk for somebody to to you know start working with you all uh so you could have tons of customers immediately and have this massive growth but you've been very methodical about how you've been growing the organization and balancing it uh how do you do that how have you figured out what balance to maintain this quality in this interaction with your customers while also you know not slowing down on growth that that's a really good question and I would say that um in retrospect and looking back to uh you know when we first really started to get Traction in 2020 bringing on new customers you know we wanted to make sure that we uh we were we're being methodical as you mentioned uh but ensuring that we're also being you know we were being slow enough that we were going to be able to take the time to effectively um Implement our program and ensure that it was delivering on all of the components of the program that our clients would expect such as you know providing savings driving outcomes making sure there were strong NPS scores uh you know making sure that uh you know we could go ahead and take risk um and make sure that that risk was effectively managed um so I think that was the let's go steady and slow but at the same time we need to go fast because it was an extremely competitive space and it still is today uh but literally there were uh clients uh looking for vendors uh you know on a regular basis and there was a market that essentially anybody that needed a kidney vendor could go find a kidney vendor the challenge was were you going to find a kidney member that was a or I'm sorry a kidney vendor that was a good uh kidney vendor one that could be sustainable uh and provide ultimately what the customer is looking for which is not just savings but overall Improvement and enhancements to the clinical model so we we were able to do that uh and I think how we did it is we were very uh strategic and thoughtful about the types of customers we wanted to work with so you know every customer isn't a good customer for health map uh so we would in fact make sure that we were very clear on what types of health plans we're looking to work on uh work with you know what was the line of business that we wanted to focus on what was the geographical footprint where we were already managing membership and it could uh it could Implement uh an easy uh you know go live for our customers um what else are we able to do as it relates to quality improvement and working very uh you know closely with our customers or what about looking at uh you know starting with acos and us trying to bring very much a value based uh Focus for the acos that were still unsure what that meant uh for themselves in what the future would look like was it going to be an mssp model was it going to be a reach model so there was a lot that we needed to uh be thoughtful about and bring to Market that would also allow us to continue to uh you know I would say accelerate effectively uh our pipeline where we could go ahead and continue to bring new customers on uh every year with the hope that you know each year we're going to have the opportunity to implement at least you know two to three new customers a year for you know for you know as long as we think that there's opportunity uh to manage these kidney population and there's tremendous need out there right I was just doing I mean I'm sure you've seen the research yourself but I've been doing research on a lot of regional totally Integrated Network and top expenses usually always kidney right above everything else by uh in some cases uh you know hundreds of millions of dollars in some of these major metropolitan areas so it's it's a serious problem right and I think the the loss is there but at the other end what you're saying the quality problems are there as well right A lot of these plans they're suffering under the burden of the kidney cost and it makes them reduce their quality and whe they can offer their members and then they start losing Stars ratings or whatever else and so I think that's we've seen you know in talking privately with you and Eric and all of them times where you guys have come in and it's gone from a failing plan to a plan that's been successful and I think like what you're saying it's because you kind of choose your clients right you're not just you know uh selling a product you're really uh kind of this interesting blend uh and and I wanted to ask about this too personally uh what do you classify Health map Solutions as yourself because I know it's a it's a vendor of of the software that's proprietary but at the same time there's Consulting there's this expertise right you have Eric uh and and Joe as CEO and president who have experience from mellin Ware centine I mean your executive team is incredible so you're not offering just a product I mean this is really beyond that yeah yeah so what's interesting is that uh all members of our elt the executive leadership team have either worked with a Health Plan uh or they've been delivering Health Plan services uh through a vendor solution uh much like you know uh traditional uh Benefit Management uh services so you know we've been able to take that uh experience and expertise and because we know what it takes to be successful in a Managed Care environment um and our our health system today still is looking and wanting that Managed Care touch um it's allowed us to go ahead and uh assess okay what's important to the client the health plan the health system the ACO and because we've been in there and we've been doing these Services uh you know before or we've been making decisions as elt members that were Executives at Health Plans uh you know we really believe that our uh our model is different excuse me especially when we look at the structure of our leadership uh because if you think about our competitive space most of our competitors came from the dapoli they came from either Dita or fcus uh but we were an independent that uh really looked and identified that there's an issue in the marketplace we think we know what the issue is um and we're going to focus on that issue uh and by removing and being unattached from any historical um you know work that had been done in the uh you know dialysis space I think it gave us a very fresh and new approach to look at how we can do things differently um and that's certainly what has driven uh our model I think you mentioned a little bit earlier Cole about uh you know all the things that you know we've been able to do to uh create a model that's successful one of the things that you mentioned and I just want to reinforce it is when we're looking at kidney disease and we have a patient that is diagnosed we're not just looking at the kidney disease we're looking at all the comorbidities for the patients you know essentially every patient that has uh chronic kidney disease also has hypertension or diabetes and in most cases have have both of those um so it's important for us as an organization not just to be laser focused on the kidneys although that's our that's our bread and butter but for us to uh provide a very quality uh model uh we've got to be able to look at the whole patient and you know we spend a lot of time managing with those patients on their comorbidities not just on what we're seeing from kidney perspective I was just uh reviewing some research on different mortality prediction models for my uh PhD curriculum and um they brought in a lot of diff difficult points I'm not an expert on this probably never will be I'm learning about it slowly is this proprietary technology that you have is that what allows you to look at that more holistic view because I know a lot of the models out there for kidney disease especially it's very limiting it doesn't include usually more than one or two kind of comorbidities in there yeah a absolutely it is uh because when our company started in 2013 um even back then uh you know the company was focused on identifying uh you know claims analytics that would help uh you know uh would would help providers utilize uh what we have learned from the data so it was very much a different Focus uh in 2013 than where we are today but it was the foundation it was still that compass proprietary uh platform that now we uh we have processed millions and millions and millions of claims through our system uh and again when you look at uh technology that has machine learning and the opportunity to uh really go deep and long in what it would look like for us to manage patients needs yeah it's been huge for us Cole and I would say it is something that's unique and it's different from what we see with our competitors now take what I've just shared with you with all of that information we have enom Encompass and now marry that with what we're going to have with carum the company we uh we acquired you know from a digital uh technology AI uh perspective and we really have a lot of opportunity to leverage um in the marketplace for our providers our patients and our customers yeah that's tremendous tremendous and and that's one of the questions I have as well one of the last questions is is the leadership again the decisions you're making I love and it's you know as a MBA student I'm really kind of learning from you as Business Leaders what is a strategic decision or pivot that as uh you know executive leadership team you all have have come in N that's been really impressive yeah um I've talked about it a lot but I'd say it again I think the uh the decision for us to move to a new economic model in uh 2022 23 was was important for us uh you know today we're managing probably somewhere between you know for 5 billion in medical spend um and we're taking risk uh on that spend so you know there's there's a lot that goes into uh not just assuming that risk but being able to manage that risk so I think first and foremost you know uh Eric gree are our CEO if uh people know about Eric and his his background in history Eric's a guy that has uh been around and is expert with capitation and has been doing that for years so not a surprise to me when and uh Eric joined the company and uh we were looking at our um strategic map what the future would look like is related to the economic model but I also think another component of it is in the beginning of 2024 we started to look at our clinical model again although we have the foundational footprint of what we created in 2019 and continue to have as the key pillars of our business uh you know we also know that there needs to be change and need to be enhancements at times and those enhancements come in a lot of different ways some are technology uh based some are um Personnel based some are modelbased and we did go ahead and start to look at a change to our operational model where we're now using a regional model that allows for our resources that are feeding on the street in the local markets meeting with our customers meeting with the members and the providers um and allowing us to EST establish a very strong relationship within that local market Healthcare is local so we want to make sure that uh you know we're we're meeting our customers uh where they want us to meet with we meet them we're we're meeting with them in the local markets where there are you know there are uh economic and political implications in different markets and we want to make sure that we're there understanding what those uh implications are and what we can do to help mitigate those challenges um and continue to drive a successful model is an example of that the office in Puerto Rico where you're because that's one of the things that I try to talk about with people is in-person businesses are complex feed on the ground is challenging it's like whenever I talk to Startup Founders I always shy away from in-person businesses personally because it's like oh my goodness you have to manage all this uh stuff but that project has been very rewarding the Press was incredible from it uh everyone seems to be talking about it well is that an example of that kind of boots on the ground mentality it is and I'm impressed that you you you know that so uh yeah that was a big that was a big win for us uh when we were able to uh you know have the opportunity to contract with Trip s which is Blue Cross buid Puerto Rico um and you know from not having anything but uh you know a few guys from the mainland that were building relationships in Puerto Rico uh we were able to win the contract uh and very quickly we had to set up a service center and we had to hire hire uh a very strong group of individuals to manage the uh 20,000 uh Puerto Ricans that are on the island today um and we did it successfully we hired somewhere between 70 to 80 employees uh we built a uh a facility uh Service Center that's out there I happened to be in Puerto Rico last week speaking with new customer opportunities because of all the great work that was done in Puerto Rico by uh you know our Puerto Rico team uh and the SE success T that they've been bringing to the market it's really you know uh if you look at what we had to do in Puerto Rico it's you know it's on steroids by 10 what we have to do in the mainland with other markets you know we had to go out and build culture we had to make sure that we could build trust and all that stuff does not come easy uh and when you look at uh something like Hawaii or Puerto Rico and the islands that uh you know are not quite sure uh you know who's coming from uh the main to the island or these people that we can trust uh that's a different Dynamic that we needed to uh get over and by hiring the right people in the local market we were able to do that and we're driving tremendous results today for uh you know for our customer on on the island yeah that is awesome I mean 80 people too wow that must that must feel really good to be part of doing that that must be awesome yeah absolutely and you know at the end of the day we all step back and say what are we really in this for um and we're in this for uh you know the patients and you know it's funny because we have uh I have a woman that is working with me right now uh that was a uh provider relations representative um and when we had closed the business on um on the uh Trip s business uh she had reached out to me as an employee in our on our company in the provider arm of the uh the organization and she had said you know from Hearts I just want to thank you uh on behalf of my family for bringing this program to Puerto Rico because I have three family members that are in stage renal disease who do not know how they're going to live uh you know without having to support needed and healthmap now can help me help my uh my family get better and she now is a part of my account management team that's working uh on the island uh supporting uh with account management for our customer there and it's just a great example I mean that's exactly at the end of the day you know what we want to be known for and if we can be known for uh you know being compassionate providing empathy working first and foremost on behalf of the patient you know the rest of uh the differently and we like to think the difference we bring uh is ensuring that we're pro providing high quality services to our members first and foremost as a lot of us uh in the insurance industry we're going to be going through our cap season soon in March uh April I'm sure hearing about a vendor where your uh members would actually be happy about is something new and I'm sure that uh very excites many people right because as we're going through these uh interviews with our members we're hearing a lot of people saying oh this vender isn't working or it's confusing and then we know as well especially our dual snip members which many of them suffer from CKD uh they can't get enough touch points we don't interact with them enough right it's so I think that that's probably uh gonna touch a lot of our our audience and I'll ask one last question um I talked with Eric you know four or five months ago when we first began talking uh and he said you know big things on the horizon uh I asked him what the future plans were he goes you know stay stay tuned stay tuned and so now we've seen the acquisition we've seen AI progress more and more uh what is the future can you share a little bit of a maybe like one thing that's going to be coming up with health map Solutions in the future yeah I think uh first I would say the future is very bright um and uh without giving specifics um you know we're talking about growth on this podcast right now we're going to experience some very uh you know remarkable growth uh you know in 2025 um that will be able to bring uh you know new members uh to our kidney program in 25 and 26 uh but I can say that you will see some pretty big improvements U as it relates to our footprint uh today we're managing you know 43 states in the country by the end of this year we'll have all states covered um and I will say that you'll see us uh you know we'll go north of 200,000 kidney members uh and then some um so I'll I'll leave it at that but uh hopefully I can come back and talk to you you know six months from now and tell you about all the great progress that we've been making absolutely I'm excited for you to have another two billion uh under management there well we're going to be approaching uh the size of some of these Equity firms out there right that's awesome um good for you great thank you yeah thanks for coming on Tom I really appreciate it I appreciate your your advice a will personally and then for our audience this is not just advice for people in the the CKD space this is advice for entrepreneurs business owners Executives Etc because it's a model to follow really um so thank you again and yeah Let's uh meet up again in a couple months and uh do a checkin on what's happened yeah let me see F Cole you know you guys are doing a great job you and particularly are doing a great job so I'm you know I feel honored to be able to uh you know be on this podcast and be able to interact with you uh you know if people want to look at growth uh you know look at where you were you know a year ago and look at where you are now uh you guys are an organization that is being recognized um and you know people want to talk to you and that's a a great thing but it's through you know the hard work and efforts that you and your team have uh have driven so congratulations to you also oh thank you th you're so kind</p>