HIStalk Interviews Jay Mason

Jay Mason is CEO and chairman of My Health Direct of Brookfield, WI.

Tell me about My Health Direct.

We’re a SaaS access management platform that broadly and seamlessly connects patients to healthcare appointments throughout either an entire community or an entire network. Think of it as OpenTable for healthcare.

It’s utilized by hospitals, the managed care plans, and state health initiatives to reduce unnecessary ER visits, to improve continuity of care with patients, and to correspondingly improve access to care for the patients. Those patients are primarily uninsured or covered by Medicaid or maybe one of their other public program counterparts.

Access management systems often do eligibility checking and other revenue cycle functions. Is that different than My Health Direct?

Yes. We take the term ‘access’ literally. We’re talking about access to health appointments and access to care versus access in a broader sense like revenue cycle management programs.

Talk about the ED overcrowding issue.

Two big articles just came out, one in USA Today and the other in The Washington Post. They coincidentally came out on the same day and speak to the same issue: there’s a tremendous amount of overcrowding in the ERs today.

People believe that’s principally due to uninsured patients. Studies show that’s not the case. Unfortunately, uninsured patients avoid care until it’s really bad. They get it when it’s absolutely necessary.

The drivers in overuse of emergency departments within the urban setting is patients who don’t have the knowledge and the skills and the resources to know what their options are to get care like you and I, who may be commercially insured. Not knowing what their options are, they’re going to the ER. The majority of times, it’s for for non-emergency conditions. They’re using it as a clinic.

We aggregate the appointment availability in the entire community with the community clinics and other participating physicians on a real-time basis. We make it available via a search engine through My Health Direct’s Web site for those people who are interacting with the patient. 

A discharge planner or a nurse or physician in the ER who’s interacting might say, “We put a cast on your arm, but we need to get that thing taken off in four weeks. Instead of you coming back to the ER to take it off, let me find you an appointment in your neighborhood and schedule that appointment now so we can get your cast off.”

It’s amazing how many appointments show up to do things just like that — to get a script filled or a cast taken off or sutures removed. We all know the right setting for that stuff is an ambulatory setting, hopefully a low-cost one or at least one with a lower cost than the hospital ER.

Practices never seem to be open during convenient hours, with nobody staying open past 5:00 or 6:00 p.m. Is there really enough capacity in the system to handle patients who don’t have the luxury of going during normal working hours?

You would be amazed how much capacity there is in a community. When we first started this thing four years ago, we really thought the problem is probably there are just not enough appointments.

What we found is there’s a ton of locations and they’re not very efficient as far as their model is concerned. We find a lot of unused and inefficient capacity in a community where we’re able to collect it, aggregate it, and drive volume to it and maximize the efficiency of what might be smaller community clinics or free clinics or independent docs.

The advantage to the clinic is that our system allows them to really operate. My Health Direct is a front-end revenue cycle management tool. A clinic might say, “Gee, I really need about 45% of my practice to be Medicaid. I’m willing to take 15% charity and the rest has to be cash.” They can load that into our system and we actually deliver that payer mix according to what their requirements are. It allows a doc to manage their portfolio of community-based care and know they’re not going to be inundated with something that they don’t want.

Specialists stopped taking ED call because they couldn’t get any paying patients. Do specialists and imaging centers really want to compete for ED referrals?

Their fear is that they’re going to get too much bad business. I don’t want to be inundated, as a PCP or a specialist, with too many charity patients. I’m willing to take my fair share, but don’t give me more than I think is reasonable.

That’s the problem is a lot of physicians, a lot of centers, elect not to participate because of either that experience or that fear. So, we said, “What a minute. If there’s a way to do a load-leveling or logistics management here and spread it widely and appropriately and allow the physician to have control.”

Who pays for your service?

We’re a community-based solution ultimately. Our clients are made up of hospitals, managed care plans, and then various public access programs or the initiatives. Those are all customers, currently, that pay for services with My Health Direct.

Who recruits the providers who will take the referrals?

We have provider relations folks who go out in concert with our clients. A hospital ER might say, “Look, there are six clinics within two miles of here.” They identify them and they work with us to get in front of those clinics and we can put them on a managed care plan. Then they say, “Yes, these are contracted facilities. We’d like to get these 37 clinic locations on.”

They identify, we work with them. We go together and we get them on the system. It’s a SaaS model, so this is a pretty easy implementation process for clinics.

Does your system go out in real time and poll the locations for open scheduling slots? How does that work?

We’ve got two methodologies to gather that information. Low-tech and high-tech, for lack of better terms.

The low-tech solution is there are, unfortunately, still a fair number of practices that are operating either on paper or an Excel database. We give those clinics our SaaS scheduling module that they can use to run their practice. It’s a nice improvement for them. It’s not a full PM system. It’s not intended to be, but for small practices who really are struggling to get to that next step, it’s a nice tool. We can maximize the throughput even though they may be a small clinic.

Or, for a higher-tech solution, we’ve built spiders into the major practice management systems. We can drop those in and, on a real-time basis, read the calendars of those major practice management systems.

How do you assure that they won’t be double-booked, once in your system and again on paper?

A lot of the low-tech practices actually do most of their business via walk-in. They don’t do a lot of appointment making, probably because they don’t have a practice management system to schedule it. A lot of the FQHCs — the Federally Qualified Health Centers — probably 80% of their business is walk-in, so we’re not running into scheduling conflicts on the low-tech solution because generally speaking, as I said, they’re working on a first-come, first-served basis.

Some people might not want to be seen by a doctor who’s so available that he or she will take automatically scheduled ED patients. Who makes the quality decision on the providers?

The hospitals, when they’re the client. They’re controlling what clinics are on the system and what clinics they want to interact with. Similarly, the managed care plans are doing that. We don’t have a quality assurance process to make the determination what clinics are in or not. It’s our partners, really, that are directing that.

Is there feedback? Let’s say it’s a hospital ED that makes the appointment. Do they know or care that the person actually kept the appointment?

Oh, yes, absolutely. It’s critically important. We really designed this thing on the floor of the ER with the help of a lot of overworked, underpaid nurses. Some of the feedback we got was that they want to increase the show rate. They want to make sure that people are showing for these appointments.

We’ve been able to document that we’ve increased the show rate tenfold from the old system — the old system being the nurse hands you a piece of paper with a couple of clinic names on it and says, “You need to go to one of these.” About 5-8% of the time, patients will actually follow up. The other, they’re not doing anything, and unfortunately, they show up back at the ER with complications to their conditions.

We confirm appointments with each clinic. At the end of every week, we ask the clinic, “Hey, here are the 42 patients we sent you. Please click this box and let us know if they showed, if they didn’t show, or if they rescheduled.” We aggregate all that data and feed it back to the hospitals and the health plans.

Why would they be more likely to show through your system? Because they’ve already got a confirmed appointment versus “Go make yourself an appointment?”

To a degree. Some of the criteria we use to find an appointment are obviously pair-typed. If this is a Medicaid patient, we need to find a physician who’s taking not only Medicaid in general, but who’s contracted with the plan that they’re in. That’s the first cut.

Then we look at the neighborhood they’re in. We want to get in close proximity to their home. We look at provider language. Many times that’s a barrier, so we add that. If public transportation is needed, we make sure that the provider offices that we’re selecting are on a bus or a light rail route. We have other criteria such as provider gender or religion, if that’s a preference for the patient.

You take all those things combined, much like OpenTable does. You find a provider that’s most culturally competent to what the patient’s needs are. That, and getting a confirmed appointment that’s printed off in the consumer’s language are the game-changers that allow us to find the right location. That’s why we’re getting the show rates that we are.

Unlike OpenTable, just so I’m clear, the patient themselves is not interacting with your system. Is that correct?

Not today. We are in Beta with a couple of clients and we’re opening up a direct-to-consumer tool as well. Not for Medicaid patients, but actually for commercially insured patients.

If you did that, would you follow the OpenTable model of allowing people to rate their satisfaction?

Yes. We’ve got a feedback loop built in.

With OpenTable, you see reviews and the price range and all the other factors that made their experience whatever it was. That would be interesting, where you didn’t have just anonymous reviewers, but those who actually confirmed their appointments just as someone made the OpenTable reservation.

That’s where we’re going. That’s kind of the future for the second half of this year is we want to be able to use it in an advocate model like we are today. Someone using it on behalf of a patient, be it an ER staff member or a managed care caseworker.

Ultimately, we want to get this into the consumer’s hands. It’s an easy to use tool that, for a hospital or health system, can help move market share. For the consumer, is a great differentiator in the market. I mean, everybody always complains, “Gee, it’s easier for me to order a book on Amazon or order tickets for a movie than it is for me to communicate in any way with my doctor. Why can’t I just get the appointment that I need?” That’s really where we’re heading with the next phase of our evolution.

You had a CMS contract with the State of Connecticut to reduce inappropriate ED visits. What was the result of that?

CMS provided some grants to states a couple of years ago. We were working with the State of Connecticut to write their grant and they were fortunate enough to get that.

We’re working with the state, the primary care association, the hospital association. We’ve picked about eight clinics and six hospitals throughout the state that were in desperate need of what we do, and it’s worked out great. We’ve been able to move those non-emergent patients — either if they’re triaged, or for follow-up care — to community clinics. We’ve got a tremendous show rate. It’s worked particularly well. It’s one of the more successful CMS-funded initiatives.

If you were going to use that, or other experience as a selling point, what are the numbers that would get someone’s attention to the strategic use of My Health Direct?

On a visceral basis, the ER staff knows what the problem is. They know they’re overcrowded. They know they have non-emergent patients. They know these people aren’t showing where they should show. Just intuitively, what we do makes sense. I think that’s one of the reasons why we’ve been as successful as we are is we’re a pretty simple tool that’s very effective.

But we have done studies with our clients and have found that there is a hard ROI, and that we’ve been able to, because of moving those patients, reduce subsequent ER visits. Additionally, we’ve been able to reduce inpatient confinements because we’ve got those people connected to what we’ll refer to as a Medical Home.

There’s got to be some quality impact as well. Obviously, if the no-show rate goes down when you make an appointment right in front of someone, that whole compliance issue then comes into play. Not just for what it costs or where they go; but whether they get treated at all.

Absolutely. There are clinical aspects along with operational efficiency aspects and financial aspects to what we’re able to do.

How do you think the whole ED visit and referral pattern will change with whatever healthcare reform changes?

Unfortunately, that is the elephant in the room. There have been a lot of studies. I mentioned the studies that were referenced by the two articles this week, but Medicaid patients are four times as likely to use the ER than a commercially insured patient. They’re using it for a majority of their visits for non-emergent care.

If they reduce Medicaid reimbursement, the result of that is fewer physicians are going to participate in those contracts. If you’re going to increase the rolls of Medicaid recipients by 30 million-plus, you are equally going to see a substantial increase in ER visits. You’re going to have a much bigger gap of supply and demand than we do today.

Today, it’s really significant. I think that’s the unintended consequence of reform is that we’re going to see our ER visits, which last year was 121 million ER visits in the country – it  could easily hit 150-160 million visits.

The other trend that’s occurring is that urban hospitals are closing at an alarming rate and so are their ERs. Not only have we seen a substantial increase in ER visits, but we’ve seen a corresponding decrease in the number of ERs. Compounding that with reform and what is going to happen with Medicaid usage, it’s a big issue, a very big issue.

More patients will have insurance, so I assume more providers will accept their referrals. However, it might be a golden opportunity to educate patients about how to properly use healthcare resources since they’re suddenly more desirable with insurance.

If they’re privately or commercially insured, the studies are indicating that those people are connecting with much higher frequency to their primary care physician. It’s the Medicaid population that we really need to think outside of the box and try to find ways to fully engage them in their care and trying to do that early and often.

I think that’s going to be our biggest challenge is the economy and the country. You have to try to engage those people so they’re not using the ER inappropriately and they are getting the care that they need.