Marty:
Okay, why don’t we get started here? Thank you all for taking time out of your busy schedules to join us here today for Engagement Health Group’s webinar. “Your sickest members aren’t getting the care they need”. My name is Marty Solomon, SVP of sales here at EHG, and speaking for our entire team here today we are so excited you joined us. Joining me here is Jack Curtis. CEO and co-founder at EHG and also, Dr. Jennifer Musick, President and also co-founder here at EHG. We also have 2 special guests from a company called Curus who we partner with that we will introduce you to a little later on.
Before we get started, a couple of quick housekeeping items. We will limit this webinar as we always do to 30 min because we respect how valuable your time is also we are recording this so you all can expect to receive a copy of this later on. So here is today’s agenda for our presentation, starting with a very quick overview of Engagement Health Group that I will walk you through right now. So Engagement Health Group was formed early last year by the merger of Corporate Health Partners, a wellness organization, and Engagement Health Group a clinical care organization that came together to form Engagement Health Group. We now offer with 40 years of combined experience virtually every solution available in the population health management industry.
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Health coaching is extremely important to us. It always has been. We offer virtually every type of coaching solution available in the marketplace. Including critical care management, we’ll be talking about right now. In terms of differentiators, it does start with our experience.
We’ve been doing this for a long time and we are true experts in this area. We know this industry and we know how to solve your issues.
The comprehensiveness of our solutions. Again, we offer virtually every solution available to give you one-stop shopping. Engagement is critically important to us. Heck, it’s the first word in the name of our organization, in terms of condition management and critical care management that we’re going to talk about today, 3-to-one ROI and we will guarantee that prospectively. So again, joining me here today is Jack Curtis. CEO and Co-founder at EHG.
Jack has a 20-year-long and distinguished career in the wellness industry at corporate health partners. Also with us today is our president and co-founder Jen Musick, Jen is a clinical pharmacist and she too has a 20-year-long career in the clinical management arena with health solutions. So it’s really now my pleasure to turn this over to Jack Curtis. Who will review with you the problem with most critical care management programs. Jack, why don’t you take it away?
Jack:
Thanks, Marty. I’d like to join you in saying thanks to all our guests as well. As we take a look at this slide, I’d like you to think for a second about your own life. Your family, friends, and clients who have maybe been in this situation. Where 5% of the people in any health plan are driving 60% of the health plan cost. What’s really going on with those patients? They’re typically facing multiple conditions. They have multiple providers and multiple prescriptions.
They’re missing work and time with family and friends wondering about their bills and how they’re going to pay them. They starting to feel like nothing’s working including the case management they’ve been experiencing. They’re losing hope and feeling anxious and depressed. If you do the math on this, you’ll find that they typically cost $200,000 per year on average, some are much more. So at the bottom, there’s this caption, what do I do now is often what they’re feeling. Just think about your own circle and people who have been in that situation. It’s not just my feeling there’s a study that came out from JD Power and it’s very recent, 2023 that found patients in this condition where their health is poor or fair, only 17% were even assigned to the case manager, and even with those, oftentimes these complex situations facing care fragmentation, they get poor outcomes, they get higher spending than they should and they’re the group that really needs help the most. When you’re looking at this kind of situation with only 17% were even assigned a case manager obviously the biggest problem is engagement.
It’s really about engagement without that it doesn’t matter if you have an effective solution if nobody’s engaged in it. If you do get people in, not only do they engage in the program, but you’ll find we can get them engaged in other aspects of the benefits that are appropriate for their needs and also they get more engaged in work. We’re able to get 89% on the average in our best practice clients through engagement. We talk about this engagement in almost every webinar, we will drill down on that later but after engagement, you really need an effective program. To address that, I’d like to introduce my partner and co-founder, Dr.
Jen Musick.
Jen:
Thank you, Jack. And thanks everyone for your time this afternoon. At EHG, all of our solutions are built on a foundation of our behavioral health coaching program and that includes our critical care management program.
Our critical care management program starts with relationships and engagement like all our coaching programs do. A multidisciplinary behavioral health coach in a multidisciplinary team engaged with the highest risk members regularly, daily if needed to design and deliver personalized care plans that include care coordination between providers and specialists will arrange second opinions and often referrals to centers of excellence. This model delivers impactful health outcomes that mitigate costs by decreasing ER visits, and lowering inpatient admissions and readmissions reducing stop loss coverage costs, and much more. Also yielding a return investment that’s 3 times the cost of avoidances that’s 3 times the investment.
So the solution really is the approach. It really is in the approach. Our delivery model is a personalized one-on-one approach. Participants will meet with their assigned health coach for confidential sessions every month. The most important step that a health coach can take is they help the high-risk member complete their registration and enroll in critical case management. The behavioral health coaches are responsible for working with the participant on support. Self-care behavior change impacts the members’ condition and also helps them navigate the critical care management program. Our expert multidisciplinary clinical care team is engaged in that model, to get to the cause of the problem and to bring best practices to bear for managing the condition without wasting resources. The engagement by the clinical team is personalized to the patient’s needs.
Our multidisciplinary team is comprised of a team of specialists all managed by the lead care coordinator. We know that the lack of success in healthcare and wellness is a result of member disengagement. You can have the best programming and resources, but if your members don’t engage these effective tools, you’ll be unable to truly help your members and meet your program objectives. How do we return relationships to healthcare and wellness? These relationships succeed in engaging your members and their providers.
I know from my personal experience as a health coach that employees don’t want to be sick. I’ve never sat across from a participant with diabetes who wants to be sick. It really starts by getting members engaged. Our health coaches build relationships with those who are sick. It starts by getting members engaged. Our health coaches build relationships and gain trust to engage. Our health coaches build relationships and gain trust to engage and guide your participants and gain trust to engage and guide your participants and members, to the right resources build relationships and gain trust to engage and guide your participants and members, to the right resources.
Let’s walk through a member’s journey back to health here. So it starts with education. So Henry’s health coach sees on the platform that he’s eligible for the critical care management program as she prepares for his upcoming visit. Jane discusses with Henry his risk factors and the benefit of the critical care management program during his scheduled health coaching session. Then Jane walks Henry through the online registration process, answering his questions as they arise. Upon completing registration, Jane will schedule Henry for his intake appointment with the critical care management team which will include Jane, Henry, and his critical case manager and Henry completes his intake appointment with the critical case management manager with the support of his health coach.
They gather all the necessary details which we know are sometimes extensive. So having that support is key. Upon completion of the intake, appointment Henry confirms his enrollment in the critical care management program.
Henry and his medical providers now started to receive the patient care plan recommended by the critical care management team. Henry also receives his schedule for future appointments with the critical care, team and the specialists that he will be seeing to get his condition under control. Henry is starting to feel better that he now has a team of advocates to help him get well and he no longer feels alone or confused about how to be well and how to manage his chronic disease. Looking forward to his next meeting with the critical care team to prep for his specialist visit. Henry then meets with his critical care team to prepare for his upcoming specialist visit. Now he feels informed and empowered to ensure he gets the most out of his upcoming specialist appointment. Henry then engages with his critical care management team from daily to a minimum of weekly depending on his personalized health care needs
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Henry slips during his enrollment in critical care management. He misses several appointments with his critical care team. He’s not adherent to his patient care plan. The health coach now can be a great conduit for re-engaging Henry and ensuring that he stays accountable to the critical care management program all the way back to that first step during education. That’s really where that relationship with the behavioral health coach is most crucial, right? It’s actually seeing that a behavioral health coach is an advocate and when things can have that trusted advisor to get re-engaged. The critical care management team then works with Henry Jane and his medical provider to move the care plan forward and solve Henry’s immediate needs while setting Henry up for success long term.
And then Jane, Henry’s health coach continues to check in with him monthly during his enrollment and critical care management program to keep that relationship and that support going and accountability. Henry then can transition back to health coaching for maintenance, she is transitioned successfully back to Jane.
So then at the end of the program, the ultimate goal is that Henry successfully completes his critical care management care plan. He’s feeling great and empowered to keep working with his health coach to stay on track with his diabetes and be well. Henry then graduates from critical care management and back to his. Routine healthcare and his health coaching program. There’s an alternate path sometimes team as we know these are these conditions are very complicated and expensive. There can be an alternate scenario where Henry’s made great progress but his critical care management team still feels that he needs some work to do to be on his way to long-term success. Henry because he’s had some success Henry does agree to reenroll in critical care management to continue to work with the critical care management team, the specialist, and his health coach. To get diabetes fully under control and prevent further negative complications and outcomes. He does know that this is best for him in the long run since he’s always already had benefits from the program.
The result of that entire journey is an engaged member wants to be guided to the right care at the right time.
Next slide, Marty. Our EHG condition management program delivers measurable results. We yield high engagement, so a hundred percent of our critical care, critical care members are engaged within the first 48 hours of the program. With high satisfaction, yielding 95% of participants are satisfied or extremely satisfied. 90% of members have one or more acute issues stabilized within the first 3 months and 80% of the critical care participants are transitioned back to their health coach after each serious health issue is identified, treated, and managed with their comprehensive patient care plan. As one of our trusted advisors set it back EHG’s critical care management program is a lot more than case management.
It is health coaching plus case management plus second opinions, centers of excellence, legal navigation, and pressure. Traditional case management truly is only clinical.
I’d now like to take a minute to introduce you to our guest speakers for today and our partners at Curious Health. Mark schlussel, CEO, and Jared Mort, CEO of Curus Health. Mark is a graduate of the University of Michigan Law School with an extensive background in healthcare law. He serves on the board of directors of numerous companies, has gained significant operational healthcare experience as the CEO of the Oakland Virtual Medical Center, is chairman of the Oakland University Board of Trustees, and is also executive chairman of Artemed. Jared. Lieutenant Colonel, Jared Mort has his MS and nursing from UT San Antonio received his MBA at Toro University of California, and has 20 plus year career in the United States Air Force. Thank you for your service, Jared. As a clinical nurse, flight nurse, master instructor, and so on, he is well qualified. He has served as the faculty at Wright State University College of Nursing and Health since 2012. Mark and Jared are going to take us through a Q&A session so we can learn more about Curus Health and our critical care management program. Mark and Jared, over to you.
Jared:
Well, Dr. Jen Musick. Thank you very much for this opportunity, and Marty, Jack, and the entire team. This is an honor to be here. The critical care management is so important because this is the tip of the iceberg of everything else you do. But they’re still that 5-8% like you said that are taken 60 to 70% of the the claims costs and the plan costs. So you’ve talked about a lot of things we do which was spot on, but what I wanted to do is just start with the success story. We had a middle-aged, 40-year-old who’s very healthy 2 young kids married, and she ended up with out of surprise a stage 4 metastatic breast cancer to the bone.
So the employer actually contacted Curus right away. And we swooped in there to do our thing. We got her second opinion and got her to a center of excellence that was appropriate for her diagnosis. We were able to start good evidence-based treatment for her. And shortly thereafter they decided she needs based on her genetics. A certain ID infusion that was going to help replace the bone as it generates from the, you know, the oncology immunotherapy and radiation. Well, that wasn’t covered by her insurance. So what Kuras did is we reached out to the insurance. We talked to them at great length and they added that drug to the formulary so there was no cost to our client. Not only that, but We were able to.
Look at all of her EOBs that came in and they come in very quickly in the first couple of weeks, the first month of treatment for something like cancer or immunotherapy, autoimmune, etc, renal disease. And so they were they were very nervous about it because they were looking at a lot of money that they were gonna owe. We said, look, let’s get your treatment going. Put all those bills and everything in a stack and at the end of the month we’ll get on Zoom we’ll go through it. And so we helped her with those. And found out that several bills never went to insurance. There were a couple of providers that never set foot in that hospital. So we were able to get those waved and we appealed a few and we saved them thousands of dollars within a first couple 2 months, 2 or 3 weeks. Not only that, but you know, diseases like cancer. It doesn’t just impact the patient. It also impacts their entire family. We identified early that the 2 small kids and the husband were having a horrible time dealing with the fight that their mom was going to go through. So we recommended that they accept some counseling for the family. And so long story short, after our involvement she is in remission. Thank God and so, you know, that’s one story, but, Mark, would you like to tell a different story of some of our successes?
Mark:
Sure, thanks, Jared, and thanks everybody for the opportunity to present to you. We had somebody who was actually a loyalist to a center of excellence. A CEO of a company he would go each year to his, Center of Excellence, which happened to be Mayo to get his yearly exam. And get his med set, etc. but he joined Curus because he thought he would like to have an organization that had his back. As he went through the process of aging and in that process, it became clear to our Chief Medical Officer that he had a unique lung problem and he advised our chief medical officer in a conversation that he was going to go to a Mayo because Mayo was the appropriate location for treatment of that disease, he thought.
Well, in our research, one of the things we do besides navigation and advocacy, is we do innovative things we look around to make sure where is the best choice for each illness. And quite frankly, uniquely, sometimes you find smaller hospitals without the national world reputation that may be better equipped. In this situation, that is exactly what was the case.
Because his, lung situation is a pulmonary problem it really would be better treated at Denver Jewish and we explained to him that at Denver Jewish which is primarily a pulmonary hospital. There are 4 specialists in the area of his disease concern and at Mayo, they had one specialist focused on that area with our suggestion he went off to Denver Jewish on this for this event. He visited and saw the head of the department and 3 of his associates. They reviewed the protocols and actually, they changed a number of his protocols. And as a result of that, when he returned to his home city, he called us.
And said he was feeling much better, he felt very confident, and he learned something very interesting. That even in centres of excellence there’s expertise and there’s also expertise in smaller unique boutique centers that focus on specific disease states.
And we are curious, as part of the critical care, we always focus on where’s the best choice based upon the circumstances of each individual client in our critical care management process. So, Jared, that’s what I think is one of the real messages of what we do at Curus.
Jared:
Yeah, those are great success stories, the other thing, Mark, I brought up briefly EOBs.
Most people aren’t really familiar. They should be, but they’re not. And would you mind elaborating on that just a little bit more?
Mark:
Thanks. You know what I find interesting about EOBs, the explanation of benefits. This is because they lead to a lot of confusion. We get calls from members who are curious and will say do I pay this? And the answer is no, this is not a bill. This is just an explanation of the benefits. So then, in fact, It’s just trying to tell you what your insurance company is going to pay. And interestingly, in a lot of situations, there’s secondary coverage. So you’ve got to be sure that both primary coverage and secondary coverage have been taken care of and also you’ve got to take a look at the individual. Have they met their co-pays and their deductibles? So that they’re not paying for something that quite frankly should be covered or is already been paid for because they made a partial payment the other interesting thing about EOBs is when you skin an EOB, you see the provider charges and they’re always at a very high number usually. And then you see what the provider was reimbursed and we’ve got a number of questions from a number of our members, patients.
Who says, what’s the differential here? How did this differential look here? I said, one is the number that the provider feels is appropriate billing and the second number is the number that the reimbursing organization, the insurance company, whether it be private pay or Medicare feels as an appropriate payment for that service and so historically, a lot of providers have worked very carefully to continue to increase their profile because by increasing their profile, historically, the reimbursements tend to go up. So that differential is a very important factor in considering what happens in EOBs but in the long and short of it, particularly for people who are receiving them, it initially is a set of confusions because people are concerned whether this is a bill, should it be paid, how much do I really owe and we spend a lot of time reassuring people that that’s not the case and there are occasions where we find significant an important errors in the billings and sometimes we have seen situations.
In fact, Jared had one where there was billing for a long issue and it was a billing from a pediatrician. So obviously there was a mistake in coding that occurred and as a result of that mistake encoding, We were able to rectify it, and reduce the ELB explanation, thus reducing the payments from both the insurance companies and the copay from the patient.
So it all worked out. But those are some of the things we run into regularly with the EOBs.
With that, I’d like to turn it back to the folks from EHG to conclude this wonderful program.
Thanks for the opportunity for us to present to you.
Jack:
Thanks, Mark and Jared, great stories, I think they truly speak to how critical care management is so much more than traditional case management. So thanks again for that and I’d like to share this voice of the customer from a participant perspective here. Just as a parting thought on the critical care management. As, a summary and conclusion of what we’ve talked about today. Again, I want to point out that it starts with engagement. It doesn’t matter how good Curus is if we can’t engage them and that’s a lot of the value of the trusted health coach to get them engaged and keep them engaged and help them even after Curus graduated them from the critical care program. Part of that is behavior modification, even closing gaps in care is behavior. So helping people to stay on the straight and narrow path. That will lead them to better health is an important part of what the health coach does. Last but certainly not least is the critical care management team to help these. Very sick people in their hour of need despite a very challenging healthcare system and really all of that’s needed if you wanna control cost. Again, it’s 60% of the health playing costs or sometimes higher. And if you can make savings there, it can pay for a whole population health management program. So, thanks again for being here. Looking ahead to what’s next in March, I’m excited about the opportunity to talk with you about population health management, and how to achieve and measure results. In May, we’ll talk about the missing ingredient in population health management and then. As promised, will drill deep into engagement in July because, without it, nothing else matters. Marty, I’ll turn it over to you.
Marty:
Wow, that was fantastic, Mark and Jared loved the Q&A session. That was super. Just like we promised, we are gonna keep this to 30 min. So I want to just close by saying thank you all for joining us here today. I hope you found this very informative. We will soon send you all a recording of this event. My name and number, or at least email is at the bottom here. Would love to hear from you if you have any further questions. Look forward to seeing you all again next month. Have a great afternoon and thank you so much for stopping by. Take care.