HIStalk Interviews Kevin Healy, CEO, ReferWell

Kevin Healy is CEO of ReferWell.

Tell me about yourself and the company.

I started in the CEO position at ReferWell in April of this year. Before that, I worked with a private equity group called Chicago Pacific Founders, where I was an operating partner and CEO for one of the portfolio companies that I helped build and get moving. Prior to that, I was with Optum for 12 years, where I led the sales and growth teams in Optum Insight at one point, Optum Health at one point, and Optum Rx at one point. I had the pleasure of sitting within all three pillars of Optum. Before that, I had several startups, build-ups that led to successful exits.

It has been a whirlwind of healthcare over the last 25 years. Before that, I was in the golf business, so it was an transformation, obviously, from golf to healthcare [laughs]. It has been a wonderful experience.

I love this business. I love ReferWell. What attracted me to ReferWell and pulled me out of retirement was the product itself, which was incredible. But just as important were the people in the company. The team was amazing, dedicated, smart, young, ambitious, and ready to go conquer the world and fix the healthcare system. I loved the energy and the product itself.

ReferWell is a simple company. We do one thing, and we do one thing very, very well. That is, we get people to the doctor. Companies, health plans, and hospitals spend thousands if not millions of dollars to find out who they need to outreach to. Then they spend lots of money to find out what happened to those patients after the outreach. But very little, if any, is spent on actually getting them to the doctor.

I liken us to a light bulb. The light bulb is big and bright, but without the filament in between, it doesn’t work very well. ReferWell is the filament that connects the two entities. Who do we have to reach out to and engage, and what has happened with those individuals? The big part is about what happens to them when they get to the doctor. We do that better than anybody else.

What are the patient barriers to making and keeping appointments and following through on referrals?

It’s an overwhelming issue. Close to 40% of all appointments go missed. Sometimes when an individual is at the doctor, the doctor says, “Mrs. Jones, you need to go to see a cardiologist” and hands her a list of cardiologists to call. Or you have to go see multiple doctors, so you get a list of multiple doctors to call. Sometimes they happen, but 40% of the time, they don’t happen. That’s a barrier of understanding who to call, not being able to reach them, not being able to find an appointment, or not having transportation to get there. Also, not really understanding why they need to go.

Part of our unique positioning in the marketplace is not only about technology, but about people. We believe that people, our care navigators, are an integral part of this process. It’s not just using an AI or an AI agent. We have real people talking to real people about real problems and real issues. That’s extremely important. We can never take that human touch out of health care, and we never want to. But we can support it with advanced technology.

Our proprietary scheduling platform allows us to schedule with our care navigators, or for a provider or a payer to schedule, at the time of communication, or at the touch point with the patient or the member of the health plan to be able to set an appointment at the time of engagement. It sounds so simple, and the amazing part is that it is a simple idea that is hard to execute. That’s where ReferWell comes in.

How can patients be helped to choose a specialist from that list that their doctor has provided?

The unique factor is that the federal government has been kind enough to rate health plans, and health plans have been kind enough to rate physicians and practices for quality of service and quality of outcome. It’s kind of a cost-quality equation that health plans, for example, apply to doctors. They a four- or five-star rating, just like health plans have a five-star rating. 

It allows us to filter based upon location, so the closest to the office of the physician that they’re visiting or closest to their home or their place of work. Then also by quality. The highest-quality cardiologist within a mile from my house, or two miles from my house, and these are the doctors that have available appointments in the next week or two weeks. Quality and location filtering has to be taken into account.

We have multiple sources of information that we absorb, so we can triangulate that information into who would be the best for this individual to go to. It gives them options.

We’re not making the clinical decisions. We’re letting the patient, the doctor’s office, or the health plan help them with those clinical decisions. We’re just offering up the information and telling them what’s available in terms of spots, schedule appointments, etc.

Provider directories have always been a challenge to maintain, so the patient calls down the list and finds doctors whose practice information and insurance acceptance isn’t current. Can that be automated, or does it always end up with someone making a phone call?

The answer is not as simple as one might think, but the progress has been significant. The feds have been all over provider data management, the information that is available to members of health plans of all types, Medicare Advantage, Medicaid, commercial, ACA lives, etc. Several organizations are out there that maintain correct information, and we contract with three of them.

We then have to decide which of the information is most accurate, and sometimes our team needs to make an outreach to find out which is correct if we have conflicting information. But that’s our job. That’s what we offer. Then we update the systems so that everybody has the correct information.

Provider data management has come a long way. It’s not perfect, but on the health plan side, there are fines for not having your provider data management up to date. We use some of the same companies that they use to inform our decision-making process.

It’s impossible, really. Doctors work in several offices, different times of day, different days of the week, different days of the month, across multiple communities, and all of that changes. It’s hard to have it 100% correct, but technology is helping more with that. The groups that we partner with are very, very good at keeping up their data, and that helps inform our decision-making as well.

Aligned incentives would occur if providers benefitted from keeping their schedules full, but if they are employed, they may not see the value of being busier, or maybe their schedule’s already full so they don’t really care. How do practices view the idea of having the schedule availability their providers visible outside?

We look at it in a way that may be a bit hopeful, but I think that most physicians want to give great service to the people that they can provide service to. There is a sense of control with having their own schedules and opening it up seems like a little bit of a loss of control. But they also know that they have the opportunity to serve and work with more individuals. It always behooves them to keep their schedules full, even on the employed side, because they are incentivized to do so and they intuitively want to.

Getting access to schedules for providers has been a difficult process. One of the reasons is that we have so many different electronic health records out there. We have to integrate with them so that we can see what’s open and what schedules are available.

It’s difficult to get doctors to agree to allow people to see their schedules. But as more and more groups start to look at accountable care organizations and are going at risk for the care, care management, and the health and wellbeing of their patients, they are incentivized through financial rewards if they provide good service and have great quality outcomes. They are raising their star levels and want to get that word out there that they are a high-quality care center and can be counted on to have access and will provide quality care. 

It is an opportunity and a change of a mindset for providers as much as anything else, a little bit of relinquishing control. But for example, UnitedHealthcare has a gold card program that stack ranks people by quality of outcomes, and with that comes rewards. As part of that, I can imagine a day when they have ReferWell as their scheduler, and tell providers that we have to have access to your schedules to get the gold card program, either complete access or partial access via a ReferWell platform. Other health plans have the same type of program as well.

Our North Star at ReferWell, that Holy Grail for us, is having organizations recognize that engaging the providers and rewarding the providers for good behavior and good outcomes means that they will have a great partner. It changes the healthcare structure from fragmented to more of a synthesized, hospitality-like structure.

That’s where we’ve lost faith in our healthcare system. It’s fragmented. They don’t talk to each other. All of a sudden we can start talking to each other. Providers, payers, and hospitals are all talking to each other via scheduling mechanism.

It seems like a benign way to do this, but it’s amazing what it would mean in terms of how easy it would be to synthesize all three entities into a much more cohesive care management journey for an individual who has just left the hospital. How do I make my next appointment? Who do I make my next appointment with? Does my health plan know that I have my next appointment with them? That’s the dynamic that has to change. 

Is it more common that the clinician who makes the referral knows that the visit actually happened, or wants to know, or what its result was?

It is becoming more common for them to want to know. But it’s also more common that the patient understands that their primary care physician knows that they had an appointment at another facility or doctor, and maybe even what the outcome was of that particular appointment. It has always seemed odd to me that if something would happen to me and I end up in the hospital, my primary care physician, who has been looking over me for many, many years, has no idea that I’m in the hospital, because I’m not able to talk to them. Connectivity is needed that has not existed in the past. 

That becomes a comforting factor for a patient to understand that their doctor knows that these things have happened. They know what meds I’m on, no matter what doctor I go to. They know what services I’ve had. It makes it feel like the whole system is talking with each other. They can schedule the appointments and have the data from that appointment in their electronic medical record. They can talk to me about what transpired and how I feel since then. Or get in a better understanding about my overall health and wellbeing.

The patient is going to drive this. The patient is going to want their providers to have this information, and they will have a better overall experience when they do. Imagine if you called Marriott’s hotel reservation line to ask if they have a hotel in New York City. They say, “Yes we do, thanks for calling” and they hang up. Wait a minute, I’d like to make a reservation. That’s how healthcare is. You need to make the appointment and get scheduled. It has been barrier after barrier to do so. It’s a less cohesive an experience when they don’t have the information at the provider level. That just needs to end.

We aren’t saying that we are curing all the issues with healthcare, only that an integral part that has never existed is this connection point of getting people to the doctor, finding out what happened while they were there, and then providing the referring doctor with the information about what took place at the visit. It doesn’t seem like that big of a deal, but it is a meaningful and impactful overall consumer experience that is going to change.

How do you expect your business to be affected by changes in federal policy or in federal payment policies?

The government is doing a very good job in several areas. I know that’s not a popular statement to make. But when it comes to healthcare, the government is trying to drive hospitals and doctors towards this accountable care model. The accountable care model is all about payments, all about follow the money. But what they’re trying to do is follow the money, but also follow the outcomes. For us, that changes the dynamic of what’s required. The federal government is forcing our healthcare system to go in that direction. It has been tried and tried and tried. For provider practices with the ACO model, hospitals are getting in with the CMS TEAM model — Transforming Episode Accountability Model — under five different categories of care. 

It’s hard to say that the government has a heart sometimes [laughs], but they have a heart, it’s in the right place, and their heads are in the right place. We just have to put it in action, and I think we’re on the right path.

My six months at ReferWell has not disappointed. It’s such a wonderful little organization and been around for 10 years. It is finding its feet right now and I’m excited to be part of it.