Episode 37: Improving the Effectiveness of Home-Based Care with Reverence CEO Lee Teslik
Value-based care is going to become more and more important over the next decade.
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In this episode you’ll discover:
How fragmentation in the healthcare system severely impacts the effectiveness of care
Why value-based care is essential to the optimization of home-based care
What causes staffing shortages and how to address these issues
Keep scrolling for a transcript of this episode.
Key Takeaways
There isn't a lot of coordination that readily happens between a hospital and a patient's primary care provider and specialists. A lot of things could go wrong as there are a lot of information breaks during the course of a discharge. There needs to be a broader action plan and a continual set of information which can be referred to in order to prevent mistakes happening down the line.
Anything you can do from a product standpoint that helps alleviate some of the challenges of the day to day is valuable.
Value based care is going to become more and more important over the next decade, as healthcare payment models need to continue to evolve to support the wave of care that's going to be required.
The staffing shortage is caused by healthcare systems not being able to provide enough value such that payment models can start evolving and people could get paid more. The key to solving this is developing new tech enabled care models, action plans, and the like that’s going to have an impact from a clinical perspective while also paying for itself.
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“One of the most important things our society can be doing over the next decade is essentially making sure that the care models are there and are clinically effective, and are also financially sustainable such that this group of people who will need more and more support will actually be able to get it.”
Connect With Lee Teslik
Website: https://www.reverencecare.com/
Read the transcript
Announcer (00:01):
You're listening to Decoding Healthcare Innovation with Carrie Nixon and Rebecca Gwilt, a podcast for novel and disruptive healthcare business leaders seeking to transform how we receive and experience healthcare.
Carrie Nixon (00:16):
Hello everyone. Welcome to another edition of Decoding Healthcare Innovation. I'm Carrie Nixon, and I'm really pleased to be joined today by Lee Teslik. Lee is the founder and CEO of Reverence Care, and I'm gonna ask Lee to tell us a little bit about his company in the digital health space and what motivated him to start it. Lee, give us some background.
Lee Teslik (00:41):
Thanks, Carrie. Well, first, thank you so much for having me. It's a pleasure to be here. So yeah, let me tell you a little bit about how I kind of came to the point of starting Reverence, and then we can dig in and I can tell you lots more about Reverence. So, Great. I'm coming from an operating background, so most recently was at Google and several years at McKinsey prior to that. My early career was actually all like public policy and writing type work. I was I was a speech writer for the Queen of Jordan for a while. A Funky gig <laugh> and fantastic. She's wonderful.
Carrie Nixon (01:17):
Wow! My suspicion is there are not a lot of healthcare founders that can say they were a speech writer to a queen.
Lee Teslik (01:22):
That is true. Yeah, that is true. <Laugh>. All of that in brief is what's up on my LinkedIn. But honestly, what got me to the point of starting Reverence is something that's not on my LinkedIn, which is that I had seen within my own family both some of the beauties and also the challenges of home-based care models. So I had a a grandmother who had very early onset Alzheimer's, like actually started manifesting when she was in her late forties, early fifties, so super early.
Carrie Nixon (02:04):
Oh wow.
Lee Teslik (02:05):
Yeah. which amongst other things actually meant that when she became sick, she was also quite young and healthy and so lived for a very long time out of their home. And required over 20 years of support out of her and my grandfather's home. The bulk of managing that overwhelmingly fell on my grandfather Papp. And he was heroic and did so much in support of my grandmother enabling her to grow old, get sicker in the comfort of their home, which I know meant a great deal to her. But it also took a big toll and it wasn't easy. And by the end they had had medical equipment in the home. They had a variety of nurse's aids and or nurses kind of coming in at different times to help support.
Lee Teslik (03:12):
And it was just a complex process. And I had kind of seen through that whole process both how wonderful it was for my grandmother that she was able to live out the remainder of her life in this setting that just made things very comfortable for her, frankly. It also I think was very reaffirming for my grandfather because through this horrible time, it gave him purpose, right. And you know this, this kind of work that he could lean into. But also the challenges, right? And, and it is a challenging setup for a variety of reasons that we can talk about more. And it, the more I started learning about the space it really became pretty clear to me that for a variety of reasons that we can talk more about that care model that my grandmother had access to.
Lee Teslik (04:11):
It is not something that we can really take for granted. And over the coming decade particularly as the baby boom generation gets older and starts requiring more and more support from a healthcare perspective, and frankly, overwhelmingly wants to receive that support wherever possible in the comfort of their own homes, that's a huge wave of demand. But the current system is not really set up to meet that demand for a bunch of reasons. So I just saw this big problem and really feels like a really important problem. One of the most important things our society can be doing over the next decade is essentially making sure that the care models are there and are clinically effective and are also financially sustainable such that this group of people who will need more and more support will actually be able to get it. So just having seen this personally, it really motivated me to go out and do something about it.
Carrie Nixon (05:16):
Yes, and that is frequently the case with with the folks that we interview on this podcast, and frankly, with most of the founders that I deal with in my law firm. People oftentimes through a personal experience see a problem starkly present itself and they wanna fix it. And honestly, I think that is one of the best motivators for having a company succeed that I've seen. And it certainly it certainly has driven my focus in healthcare law and innovation. I wanna touch a little bit on the fragmentation of the healthcare system. There just isn't a lot of coordination that readily happens between a hospital, a patient's primary care provider, and their specialists, right? Not to mention support services that are desperately needed in many cases around social determinants. Right? So tell me a little bit about how you've seen this impact overall patient care and what you, through your work at Reverence, see as the solution.
Lee Teslik (06:35):
Yeah, absolutely. So our platform at Reverence really does two things, and I'll talk through the lens of those two things. The first is we enable essentially better discharges to home based care. So when either in acute healthcare facility or a postacute, like a skilled nursing facility is discharging somebody and sending them into a home based care model, there's all sorts of potential for stuff to go wrong during that transition. And it becomes particularly important as value based care becomes more and more of a theme and a trend in the context of payment models. And I think that will become even more of a trend over the coming decade. So what we're seeing is just provider groups who really are starting to care a lot more about what happens after that discharge. And there are some fundamental ways where sort of information breaks during the course of that discharge.
Lee Teslik (07:38):
And we're setting out to solve some of those instances where information breaks. And then the other thing we're doing which I think is equally critical and gets at some of the challenges within the current system is we're trying to really substantially innovate on how scheduling specifically works. And we have an automated scheduling, like an AI powered automated scheduling platform that works to make sure that the right people are going into the home at the right time within the context of a broader care model. And that what they're actually doing within the home is the right stuff that's kind of connected back to objectives within the context of healthcare system and specifically within the context of value based care. So let me then use that as kind of a frame to answer your question. So I think on the first bit, so if you take a moment of discharge, I mean, that is a moment where a lot of stuff can go wrong.
Lee Teslik (08:38):
There's a set of information and typically a some form of database of information around a patient that may be sitting within a skilled nursing facility. And then that patient gets discharged and there is a discharge note, there's discharge paperwork that comes from the discharge nurse that kind of lays out a clinical plan for what needs to happen next, and then the person sent home and there's this piece of paper. But often at that point, everything just goes kind of awry because a, there's not a sort of broader action plan around that piece of paper. So the patient may have things like follow on appointments, but there are questions like, who's going to physically transport the patient to that follow on appoint. Right. Well, that's nowhere within the, the clinical care plan sometimes.
Carrie Nixon (09:40):
That's no joke either, right? They may be unable to be transported in a regular car, Right?
Lee Teslik (09:47):
Absolutely. Absolutely. So there are all these sort of operational challenges that are gnarly challenges that exist. And so our perspective is you need a broader action plan that encompasses a care plan, but also encompasses a bunch of other stuff. Yeah. And then in parallel, there's just like a really great opportunity for information specifically to breaks. So for instance, when the person is getting discharged from a post-acute care facility, what medications they're taking at that moment. Four days later, you don't know. There is all sorts of ability for, or all sorts of opportunities for that... they know what medications they're supposed to be taking but all of a sudden it's a new set of providers who are engaging with the patient who may not have the right sort of visibility into what was happening previously.
Lee Teslik (10:44):
Sometimes you're dealing with in one instance they were taking a brand name medication, and in the other after the discharge, they're taking the generic, like sometimes they double dose because the, the medications have different names. Right. There are just things like this where having a continual set of information that can exist across both sides of that rubicon that moment of discharge can be super helpful in terms of preventing bad stuff from happening down the line. So that's, that's the first part I can then go on, on the scheduling side, but that's kind of the first way that we see potential for having impact here.
Carrie Nixon (11:29):
Yeah. I mean, so, so I wanna, I wanna focus on sort of the operations around this, right? A lot of times when we think about improving patient care, we think about it from the clinical perspective, right? But the, but the operations around that clinical care are incredibly important as well. And I hear that that is what you're trying to address to sort of smooth the path to make the clinical work happen more seamlessly and in a smoother way. And so, so I think I really like that, and I think that's an aspect that's, that's often overlooked. Tell me a little bit about who your customer is, because what I'm hearing you say is that you need to coordinate among a variety of different types of providers for a patient. And, and those providers may not already be connected to each other. So who is your customer and do you work for that customer as well as for the patient?
Lee Teslik (12:40):
Absolutely. So the, the customer could be one of two types of customers. There are both provider groups, so essentially the discharging entity. And specifically in instances where the discharging entity has some form of incentive financially or otherwise for care post-discharge to go well. So with, with the example of skilled nursing facilities a they will oftentimes get dinged if a patient gets discharged, but then bounces back into a skilled nursing facility or into an acute care setting within a certain amount of time. So they have an incentive there to innovate and make sure that what happens after the moment of discharge is the right set of stuff separately. Skilled nursing facilities specifically, but also health systems more generally, are more and more reconciling the notion that going forward, more of the reimbursement that comes for the work that they're doing is going to have some form of value based component to it.
Carrie Nixon (13:49):
Right.
Lee Teslik (13:49):
And frankly, given some of the challenges that exist right now within the business model of skilled nursing facilities, some skilled nursing facilities also see this as an opportunity, and an opportunity to really innovate on their preexisting business models and get into, for instance, risk bearing contracts with payer groups that they're working with, where they can say, actually, we do a really great job managing this moment of discharge, therefore we can take risk on a set of patients who might otherwise have worse outcomes. And we can do stuff where if we're then taking more of a capitated payment for for what happens with respect to that patient that we can actually move the needle. We can move the needle both in a clinical perspective and also from a cost perspective. So that's one set.
Lee Teslik (14:41):
And then separately, there are some specific payers for whom this is quite relevant. So things like dual-eligible special needs (D-SNP) plans, C-SNP plans such as chronic special needs, PACE programs. There are kind of a handful of sets of payers that are specifically more focused on some of these patients with chronic conditions where managing their care well out of the home and kind of moving the needle both from an outcomes perspective clinically and also from managing the care in a more financially sustainable way matters. So we're kind of engaging on both fronts there, if that makes sense.
Carrie Nixon (15:33):
So what I'm hearing is that that value based care and delivery models are really core to your business. We know we are not fully there yet in the US healthcare system. How do you navigate the fee for service realm that providers largely still exist in?
Lee Teslik (15:52):
Yep. So we work across provider groups who are working in a sort of fully risk bearing mode and also provider groups that are working fully fee for service at the moment. Particularly on the scheduling side, which I can tell you more about. We do think that value based care is gonna become more and more important over the next decade as healthcare payment models need to continue to evolve to support the wave of care that's going to be required. So we are particularly focused on that side also because I think it's just like what's needed for the system, but we do work fee for service as well. And on the fee for service side, part of what we do is help provider groups deploy their people effectively, whether that's clinical people or nonclinical people who are going into the home.
Lee Teslik (16:42):
How do you make sure that they are being deployed in a way that essentially as a starting point feels good for everybody involved? So feels good for the family, feels good for the practitioners themselves who are being deployed, whether that's a care aid or a nurse or whomever. Retention is a big problem within this group at the moment. And anything you can do from a product standpoint that helps alleviate some of the challenges of the day to day is valuable. And then also feels good from the provider group perspective, and oftentimes what feels good from the provider group perspective is when we can essentially help them capture more demand. I mean, there are such staffing challenges at the moment that there are a lot of dropped shifts, no shows, or late requests that the provider group is unable to fill.
Lee Teslik (17:33):
Well, with better technology, it becomes much more straightforward to fill some of those shifts, and that's just like directly going to the top line from a demand perspective. So, so that, and that is purely fee for service, although we also think it's relevant in a value based care model, because if you think about it even if we're only talking about cost outcomes and not clinical at all, if a care aid doesn't turn up, there are times when the patient just goes into the ER, right? And from a cost perspective, that's a disaster. So there's a lot you can do from a scheduling perspective that is relevant on the fee for service side, but there's also a lot you can do that's relevant on the value based care side.
Carrie Nixon (18:22):
Yeah. But Lee, you mentioned you raised an issue that we've been hearing a lot about these days, and that is staffing shortages due in part, I think, to sort of simply like lack of enough people capacity to fill the roles, but also due to provider burnout, frankly. Right now in Minnesota at the time of this recording, we have 15,000 nurses striking around the state, and the cost to health systems is tremendous. So what, what can we do to address this and what role does Reverence care play in addressing it?
Lee Teslik (19:06):
So I can answer this on two levels and I'll answer on both. The first is the sort of more macro like what's actually at the root of this problem. And the second is what can we do in the immediate term. So I think that it's all interrelated in terms of what's at the root of the problem in that I personally see the staffing shortages that exist at the moment as fundamentally driven by the work that's being done within the healthcare system at present, not adding enough value such that payment models can start evolving such that people get paid more, and this is where I think that technology can play a really awesome role because I think as we start developing new tech enabled care models, action plans, et cetera, that's going to have an impact from a clinical perspective and also from a cost perspective that will pay for itself such that reimbursement models will need to evolve.
Lee Teslik (20:15):
So I think you will have a trend over the coming decade where, as one example, non-clinical cares start getting paid more because with the right tech supporting their work, they're actually able to have more impact in the home than they are at the moment. So I think that's actually core to solving the problem from a macro perspective. Now I do think there's a lot that can be done in the immediate term. Like that's that's a problem that's gonna take years to fully crack. It's already starting, but it's but it's gonna take years to get there. I think in the immediate term, there's actually a lot that can be done to alleviate these challenges without solving those more macro problems. And so one of our kind of core theses at Reverence is that, is that solving staffing requires kind of two things happening at once.
Lee Teslik (21:14):
Yes, there's a need for this sort of like, right, get more people strategy if you will, which is obviously like what a lot of provider groups are turning to. And you see a lot of care agencies or nursing groups who are just actively poaching from one another and like trying really hard with sign on bonuses and other kind of incentives, trying to just get more people into their own in-house group and also working with a lot more third party groups, which by the way can be quite expensive. But there's this big focus on kind of how do we get more people. What we would say at Reverence is yes, that's important. You need the right hiring strategy. We're not gonna tell you that you don't, but there's a whole lot more that can be done to essentially optimize this really precious resource that you already have at your disposal, which is your current workforce.
Lee Teslik (22:08):
And so simultaneously figuring out a mode of scheduling that gets the most out of your existing workforce in terms of maximizing the number of shifts that you're able to cover with a fixed number of people, but also and critically does so in a way that feels good for the people being deployed because retention is such a problem at the moment, right? And if you have a leaky bucket of care aids or nurses or providers, whatever form of provider we're talking about, if you have a leaky bucket of practitioners it's gonna be really hard to hire enough people. We actually have a white paper that we've recently put out on this that kind of goes through some of the math that, if your attrition rates are anywhere close to what's industry average at this point, like what it actually takes to hire in a manner that will propel your growth.
Lee Teslik (23:15):
And so what our technology does is basically like help with that second thing, the scheduling technology specifically is help with that. Second thing, how do you get the most out of your existing workforce? And frankly, how do you do it in a way that gives them more control over their day to day, gives them more control over their own scheduling? Oftentimes when care aides are leaving their jobs, and particularly going to other industries, one of the core reasons that they cite is just a lack of flexibility in their day to day and a lack of control. And they're getting these sort of constant last minute panic bomb requests from their scheduler trying to like, beg, borrow, steal four hours of their time because they had another dropped shift. And it turns out that's pretty stressful and add that onto a variety of other reasons why the job is pretty stressful.
Lee Teslik (24:07):
And that's the kind of thing that can prompt people to leave. Meanwhile, you also have situations where somebody might have capacity on a given Wednesday night when they wouldn't normally be free, but this specific Wednesday night, their kids are with the grandparents and so they have this window of availability and they would love to pick up a couple extra shifts, but it's not in the sort of static schedule that the care agency will typically have on hand. Right. So there's a lot that can be done to kind of capture some of that like latent supply that may already exist within your own system and also do it in a way that that that helps keep people around
Carrie Nixon (24:55):
Sure, sure. Yeah. It's almost sort of an Uber or Lyft analogy, right? Where drivers may have time to go out and drive at an unexpected time. Right. And, and the connection is made like with the driver and the customer through technology. And it seems like this is sort of a similar, a similar model.
Lee Teslik (25:18):
Absolutely. And I would say it is like Uber or Lyft Plus in that there are a whole lot of other criteria that need to go into making the appropriate match in terms of scheduling in this environment. So our scheduling product has a 40 factor algorithm that takes into consideration stuff like, has the caregiver worked with this family before? Have they expressed preference for working with his family again in the future? Do they speak the right language? If the family has expressed a gender preference, are they the right gender? What's their credentialing? What trainings have they taken? How does that map to the specific needs of the family? Etcetera. So there's like a bunch of stuff. How geographically far are they from where the family is? There's a bunch of stuff that goes into having a thoughtful approach to scheduling. And so we're, we're really excited because I do think there's a whole lot that can be done that kind of builds on the status quo here and helps provider groups in what is a legitimately difficult time from a staffing perspective kind of do things better.
Carrie Nixon (26:37):
Well, Lee, this has been really interesting. I'm a huge advocate of home based care. I love the work that you're doing in smoothing that around the edges, that really neat. Before we wrap, just give us a sense of sort of where Reverence Care is in its life cycle. I know you're a fairly early stage company, but where are you now and what do you see in the next six months? And then anything else you'd like to leave us with?
Lee Teslik (27:04):
Yeah, no, absolutely. So it's funny actually, the first thing we did as a company was buy another company.
Carrie Nixon (27:10):
Oh, wow.
Lee Teslik (27:12):
So our automated scheduling platform is a company that had existed for several years in the UK and was actually working with the National Health Service over in the UK. And we wound up acquiring them and their technology. So while Reverence is a relatively new company here, we launched with a technology that was commercially proven and had a track record out in the market. So it in that sense that, that's great. Cause it means we're not sitting on our hands doing a bunch of build. We are simultaneously now partnering with kind of two forms of of provider groups. One is as I mentioned entities that are discharging folks into home based care. And the other is really any provider group that is sending people into home based care settings and wants to optimize how they're thinking about workforce and how they're thinking about deployments and how they're thinking about automated scheduling. So we're doing both of those things simultaneously at this point. And getting great market feedback and feeling good.
Carrie Nixon (28:29):
Excellent. That is a good place to be, no doubt. So thank you so much for taking the time to join us today. I have really enjoyed learning about Reverence Care and I am looking forward to seeing your progress going forward.
Lee Teslik (28:41):
Thank you. Thank you so much for having me.
Carrie Nixon (28:44):
All right, everyone, please join us for another episode of Decoding Healthcare Innovation two weeks from now. Take care.
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