This episode features an interview with Dr. Matt Resnick, Chief Medical Officer at Embold Health. He is a member of the founding executive team and led the development of measurement and analytic stacks. Today, he is responsible for growth and all go-to-market functions, leading a team in developing strategy and building products that align with market demands and deliver exceptional value. In this episode, Sasha sits down with Matt to discuss the importance of quality care measurement, how it can benefit both employees and employers, and how measurement tools change based on patient age.
This episode features an interview with Dr. Matt Resnick, Chief Medical Officer at Embold Health. He is a member of the founding executive team and led the development of measurement and analytic stacks. Today, he is responsible for growth and all go-to-market functions, leading a team in developing strategy and building products that align with market demands and deliver exceptional value.
In this episode, Sasha sits down with Matt to discuss the importance of quality care measurement, how it can benefit both employees and employers, and how measurement tools change based on patient age.
-------
“All of us spend countless hours, minutes researching all of the relatively superfluous purchases we make, like on Amazon. Yet, when it comes to finding a doctor, we trust our neighbors. The reality is most of us like our doctors and most of us don't have enough knowledge to know whether what we did was the right or the wrong thing. Even people who have bad outcomes actually like their doctors. The reality is we know if you walk in door A or door B, your likelihood of winding up on an operating table in a year with back pain is tenfold different.” – Matt Resnick
-------
Episode Timestamps:
*(01:15): Matt’s career background
*(07:18): Why quality care measurement is important
*(19:00): How Embold helps members find quality providers
*(29:49): How quality care measurement helps employers
*(34:04): How measurement tools change based on patient age
-------
Links:
Learn more about Embold Health
Connect with Sasha on LinkedIn
Learn more about Collective Health
Sasha Yamaguchi: Let's face it, healthcare is confusing and costs are continuing to rise. Employers are looking for ways to improve the health of their people and their bottom lines. The good news? Many leading companies are leveraging self funded health plans and innovative benefit solutions to do just that. Learn from some of the best minds in employee health.
Sasha Yamaguchi: Welcome to the Benefits Playbook, strategies for self-funded health plans. I'm your host, Sasha Yamaguchi. Commercial Leader at Collective Health. On today's episode, we are joined by Matt Resnick, Chief Medical Officer at Embold Health. He's a member of the founding executive team and led the development of measurement and analytics stacks.
Sasha Yamaguchi: Today, he is responsible for growth and all go to market functions, leading a team in developing strategy and building products that align with market demands and deliver exceptional value. Thank you, Matt, so much for being with us today.
Matt Resnick: Thank you, Sasha. Really excited to be here.
Sasha Yamaguchi: Great. And as you and I have talked about, there is so much to learn and hear about Embold.
Sasha Yamaguchi: Really excited for our audience. And I know we're going to talk about a lot of great things. I thought we could start first just with you personally, a little bit about your career, your background, when and how did you get into healthcare? And then of course, share with everyone exactly what you do at Embold.
Matt Resnick: Yeah, Sasha, glad to. So, native New Yorker, grew up in New York City and then, and then the northern suburbs of New York City. My dad is a medical oncologist. Interestingly, he worked in the New York metro area for quite some time and then actually left to, to work in drug development and brought to market a number of drugs.
Matt Resnick: Cancer drugs that we use today. So, you know, I had always thought, you know, and growing up that, that being a doc would be something I would do and, you know, sort of confirm that in, in college where I did a whole bunch of research, you know, in vascular biology and cancer biology. So ended up in medical school and, you know, I walked the desert of specialties to try to figure out what I was interested in.
Matt Resnick: And two things became really clear. One was I began to, you know, To have a deep appreciation for the complexity of the U. S. healthcare system and how it was financed. You know, and quite honestly, it took some time to acknowledge the fact that the system is hard to understand. Because there are things about the system that don't make a lot of sense.
Matt Resnick: Meaning understanding, really meaningfully, What you're likely to have done when you walk into the doctor's office, something that feels like really important, and yet, like, it's really hard to get that information. So that became, like, a real focus of what I was doing, you know, separately, started thinking about, well, you know, I like taking care of people, I like doing surgery, started thinking about, um, different specialties, and interestingly landed on urology as a specialty, and there's, there's two reasons for that.
Matt Resnick: One is became really interested in prostate cancer. Interestingly, you know, prostate cancer is a funny disease. It, it both, you know, is a huge source of morbidity and mortality for men and yet we overtreat a lot of prostate cancer. So it was this sort of paradoxical problem where we trying to thread the needle of identifying men who need treatment and sparing men that don't need treatment, the potential side effects and complications of treatment.
Matt Resnick: And then the second thing was that urologists, I thought almost by definition, have to have a sense of humor. So I found myself with a group of people who, you know, were, seemed to enjoy their day to day and seemed to enjoy their life and ended up moving to Nashville to finish training at Vanderbilt.
Matt Resnick: Spent. You know, seven or eight years on, on faculty at Vanderbilt, you know, taking care of patients, you know, it built a research program really around what we do at Embold and, you know, kind of circumstantially met our CEO through a mutual mentor and friend in town in Nashville. And what became clear is we were both thinking about the same problem, you know, this meta problem of, you know, You know, what really constitutes health care quality?
Matt Resnick: How do we define quality, right? Quality is more than measuring, you know, the likelihood that you have a hemoglobin A1C test done. Quality is like, hey, look, are you going to someone with a higher propensity to deliver a wasteful service to you? Something that stands to create more harm than do you good.
Matt Resnick: And we aligned on this topic and, you know, I was writing papers and grants, he was trying to build a business around this and, you know, fast forward a handful of years, we're on this journey together. So it's been a lot of fun. It's, you know, exciting every day.
Sasha Yamaguchi: Well, that's great. I've got a couple thoughts.
Sasha Yamaguchi: One, I know a urologist and he is probably one of the funniest people I know. And so I love how you mentioned you do have to have a sense of humor. So that caught my attention. But a couple of thoughts I have on that, that we'll talk about as we go and why Understanding the quality and why it's important and how it helps members is going to be key to what we talk about.
Sasha Yamaguchi: So you've shared a little bit about why MBOLD and why you partnered together, but really I would love the audience to hear exactly what you all do, how you help members, providers, employers, and then of course for our brokers and consultants out there, they're looking at this option for their clients. So maybe just start with exactly what MBOLD does and how you interact with.
Sasha Yamaguchi: All of those.
Matt Resnick: Yeah. I love it. Our goals at Embold Health really are threefold. The first is we want to make it really easy for employees to get better care, and we can talk a little bit in, you know, over the course of our time together around what better care means to us. The second is we want to make it easy for employers to reward members for seeing those doctors that deliver better care reliably, right?
Matt Resnick: So creating the reason for people to make different choices about the docs that they see. And then lastly, and importantly, we want to help physicians and non physicians, providers get better at the care they deliver. You know, it's interesting when, when we were starting this business, we sort of see this problem, you know, in two phases.
Matt Resnick: One is this kind of near term solution of trying to, you know, get more people to providers that consistently deliver care that's aligned with the latest science and with clinical practice guidelines, right? So this idea of sorting providers and then building enablements to get people towards the top.
Matt Resnick: But what we realized was that that actually may create a different problem, you know, capacity problem. So, on the other hand, we actually want to make more better doctors, right? Like, we want to leverage the power of the analytics capabilities and tools we have, deliver that feedback to providers who quite honestly, like, we're, we believe, wake up every day to do the right thing.
Matt Resnick: No one who went through medical training wakes up in the morning and says, I'm going to see a whole bunch of patients today and I want to do the wrong thing. That is just not a thing in healthcare. The, the challenge is that like there's just this wholesale lack of feedback, you know, around the things that actually are decisions that people are making every day, right?
Matt Resnick: And we see that every single time we interface with the health system, clinical leader, individual doc on the front line. So for us, the goals we have are lofty. They're really changing the narrative, changing the way that. You know, members interact with the healthcare system, but also changing the way that providers, physicians, and non physicians actually deliver care in the practice.
Sasha Yamaguchi: Well, and that's fantastic. And I think hitting on both the employee member, but then also the provider, because I agree with you, that's the biggest part. I mean, they, when I think about doctors now, they have so much being thrown at them to learn the capacity, to your point about, we need. more and better doctors, right?
Sasha Yamaguchi: And help them be better. So I think that's great. So when you talk about the quality care component, that measurement, speak a little bit more about why is that important? And then I would love to touch on after that, you know, The provider portion of how we are working or how you're working with providers on what are you giving them?
Sasha Yamaguchi: What are you talking to them about? And then we'll talk about the member side.
Matt Resnick: It makes total sense. So, so I think our, our perspective is at the end of the day, quality is paramount. But taking a step back, I think there's really a first principles problem in healthcare, which is what does quality actually mean?
Matt Resnick: And what I would say, like to give a little bit of historical perspective, you know, quality measurement in the United States has really to date been limited. to primary care related activities, you know, is a large part of ACOs, pay for performance, downside risk arrangements. And specialists like me have really been left out, left out of these, right?
Matt Resnick: Left to do whatever candidly we want without a whole lot of measurement, you know, interrogation and oversight. And then second, it's, you know, measurements been really focused on process of care. and appropriateness of care and outcomes have really been hard to come by. So, so to us, the belief is that the way that we've measured quality historically really hasn't met the needs of those who are buying care institutionally.
Matt Resnick: So employers and health plans, right? Because it's really hard to make an argument with conventional primary care based quality measurement that there is a relationship between quality of care delivery and cost savings. So for us, as we think about what quality means, quality really means three different things, right?
Matt Resnick: The first is appropriateness of care. So are providers delivering care that's necessary and not delivering care for which the risk actually exceeds the benefit. But the second is effectiveness of care. So, so if we make the assumption that the care delivered was necessary, how well was it done, right? So if you're going to have a joint replacement, like, are you staying out of the hospital?
Matt Resnick: Are you avoiding reoperation? Are you avoiding complication? Are you avoiding the ER, right? Are you avoiding prolonged opioid therapy or physical therapy, right? And then when it comes to cost, cost is actually interesting. And we can dig in this a little bit further. But, you know, in many ways, we've.
Matt Resnick: bifurcated quality and cost. Like, these are two separate things, they have to be separate, they're not overlapping. Interestingly, like, the link between quality and cost is waste. So, you know, as we talk about, sort of, cost transparency and unit price, you know, like implementing programs to have people make better decisions based on unit price, you know, our belief is that price Information without quality data is actually dangerous, right?
Matt Resnick: So, you know, telling someone, hey, you know, you need a two level lumbar laminectomy. Go to the guy across the street or the lady across the street who does this case in an ambulatory surgery center for a third of the price or less of the out of the outpatient hospital setting. That sounds great, but if that person's doing You know, on 80 percent of the people walking in the door, it isn't necessarily someone who is creating value for that patient and certainly not creating value for the health plan.
Matt Resnick: So, you know, as we think about cost, cost to us is longitudinal. It isn't exclusive of appropriateness of care, effectiveness of care. It actually includes those. Right? And we want it to. Right? I mean, that, to us, is how we think about, like, this idea of value.
Sasha Yamaguchi: Yeah. So, I love this. I would love to use an example that I remember from years ago, one of my medical directors I was working with.
Sasha Yamaguchi: So, I think what you're saying, and I would love for the audience to understand this, is, Members go to get, I think, back surgery is one of the most common, right? Sometimes you're going straight into getting back surgery, that's what the doctor says to do, the patient does that, and then they end up needing multiple surgeries.
Sasha Yamaguchi: Where, from the beginning, there could have been a different course. So I think what you're saying is, you know, where the three things make sense is, What's the appropriate care for that back injury or, or the pain, and then the cost, right, the longevity of the cost may be better if they're getting the right treatment up front because then they're not having to go back in and have multiple surgeries, etc.
Sasha Yamaguchi: But in my opinion, that's been the most common example. So if you can use that one, I think helping everyone understand. It's okay to not just go straight to surgery or straight to a certain provider, but finding the right quality provider and level of care.
Matt Resnick: That, Sasha, that's exactly right. You know, so if we walk this example out, right, you're someone with back pain, and this is actually a real story.
Matt Resnick: So I remember this vividly, someone who's very close to Embold said, Hey, look, my, my mom actually, you know, I got a phone call. As having back pain and went to a doc in Florida and they put her on the schedule for surgery next week. He said, look, I'm not a medical person. Like, I don't know, but like you all have opened my eyes to the fact that some of this surgery may be unnecessary.
Matt Resnick: Can you do me a favor? Can you like dig into this provider, what, you know, can come back, let me know. So we, we looked at it and, and it was interesting. What we found was that the, the person that we were investigating, the provider, tended to do a lot of surgery, but when they did it, they did a good job.
Matt Resnick: Meaning that, like, the outcomes they achieved were actually quite good. So I said, Hey, look, you know, what I would do if this was my mom is, you know, I would go see someone who's a little bit more circumspect, a little bit more conservative with how they manage back pain out of the gate, right? They do the things that we know are really hard, but work, like physical therapy.
Matt Resnick: Weight management. Behavioral health optimization, right? We know that people with behavioral health conditions that are unmanaged or undiagnosed do worse with any treatment for back pain. Certainly surgery. Comorbidity optimization. And I said, Hey, these are three or four folks that are in, you know, within 10, 10 miles or so of your mom's house.
Matt Resnick: I said, I would try to get her to see one of these people. So he said, great, thanks. I'll let you know. Get a phone call like 10 days later. Hey, just wanted to thank you. I said, okay, great. Whedon saw this other provider, he looked at the imaging, he looked at, did an exam, he said, hey listen, like, you don't need an operation, you need physical care.
Matt Resnick: So long story short is six weeks of physical therapy and totally pain free. And Sasha, the point that you're making actually is even more important, which is that in many cases there is this cascade of ongoing surgery, it's almost like a flywheel, right? The minute you destabilize someone's spine, those folks are at risk for additional operations in the future.
Matt Resnick: So, avoiding that initial surgery, insofar as it's possible. That's not to say that surgery can be avoided in everyone, it cannot. But for the people who can, you know, it isn't just near term savings, near term morbidity avoidance, complication avoidance. It's also long term, you know, this sort of flywheel, this cycle of surgery after surgery after surgery.
Matt Resnick: So, you're, you're spot on, you know, and I think back surgery is a great example, but what I'll say is that there are examples like this in every specialty and subspecialty in healthcare delivery. Areas where our evidence doesn't tell us, you know, whether conservative management or aggressive intervention, like, delivers a better outcome, right?
Matt Resnick: And that's, that's a challenge, right? We don't know the answer. So for us, the goal is really to identify providers that are doing the things on the front end. That potentially allow people to avoid the risk and the cost and the work absenteeism associated with back surgery or whatever equivalent that is for the clinical condition that that person has.
Sasha Yamaguchi: Yeah, no, and I have so many follow up thoughts on this because that's what's important. One, members go to, they may go to a provider that says, Next week, go do the back surgery. They go and do it, right? They don't even think like the person that reached out to you, Hey, maybe there's other things that's first up.
Sasha Yamaguchi: My second thought you hit on was the behavioral aspect, because even if you need surgery, maybe there are steps that are going to help you recover better when you do have the surgery. So I thought that was an interesting point. And then the third thing is I keep thinking about the employer, right? Cause that's my world is.
Sasha Yamaguchi: Employers utilization. So one, you want your members to get the appropriate care with the right providers. But if you have a ton of employees just going straight to back surgery and then having to have more or whatever it may be. This is where it makes sense to start on the right path for as many members in their population as possible, right?
Matt Resnick: Couldn't agree more. I mean, I think this is what you highlighted is a couple of things. One is that there's a reality, which is today members, patients, employees have limited information upon which they can make decisions, right? And this is like, I'm going to just say our hope and belief is that in 5, 10, 15 years, we're going to look back on this and we're going to say, wow.
Matt Resnick: You know, all of us spend countless hours, minutes researching all of the relatively superfluous purchases we make, like, on Amazon. And yet when it comes to, like, finding a doctor, we, like, trust our neighbors. Literally. Like, we do no research. They can say, hey, you know, like, I had a great experience, you know, Resnick was funny, like, he made some jokes, you know, he sat down, he called himself by his first name, like, whatever it is.
Matt Resnick: But the reality is that, like, most of us like our doctors, and most of us don't have enough knowledge to know whether what we did was the right or the wrong thing. And, you know, even people who have bad outcomes actually like their doctors. It's kind of an interesting behavioral experiment. But the reality is, is that, like, we know If you walk in door A or door B, your likelihood of winding up on an operating table in a year with back pain is like tenfold different, right?
Matt Resnick: And that is, that to us is chance. Like, you're leaving what happens to you up to chance. And that level of chance, candidly, is just unacceptable. Like, that isn't okay. So, you know, to distill down to brass tacks, really what we're after is, like, we're trying to take the guesswork out, right? We're trying to deliver information to people who aren't, Sasha, like you or like me, people who think about these problems, like, day in, day out.
Matt Resnick: Like, we're trying to deliver this information to regular working people who are just trying to navigate a complex system in a way that they can consume to make better, more confident choices about the providers they're seeing. And the challenge here is that you're, the other thing you said, which I think was spot on, is that people choose their doctors and the doctors generally make recommendations about what they should have done.
Matt Resnick: It is a really unique person, really unique person, who says, yeah, I don't know, like, I'm gonna go, I'm gonna go get another opinion. Like, that just doesn't happen very much. It doesn't happen very much because, you know, it's hard. People feel unempowered, right? I feel, you know, when my car breaks, like, I go to a person to say, Hey, what do I do?
Matt Resnick: They tell me something and, you know, I look at the estimate and I say, Yeah, I guess this kind of makes sense. Although, like, 75 percent of the words are uninterpretable. Like, okay, let's do it. You know, in many ways, that's how I feel like most Americans, you know, sort of are in their healthcare space. They just don't feel empowered to take control.
Matt Resnick: So, in essence, what we're trying to do is help them take some of that control in a way that doesn't feel intimidating, that doesn't feel uncomfortable to them. You know, so, essentially, that's the goal.
Sasha Yamaguchi: I, well, and I love that exact summary of just trying to get the information to them and help them. So, the two parts to that, I would love for you, so tie it back to what Embold does.
Sasha Yamaguchi: In, I'm sure it's, you know, a lot of details here, but can you give a snapshot then of how a member Interacts, right, with and bold, and just how you help them on that journey of what we just talked about. You have somebody calling in, you know, they're trying to figure out something. How does it work?
Matt Resnick: Yeah, really good question. So variety of different ways. Where we started, and it's kind of an interesting irony or symmetry, I should say, is where we started really was as a measurement company. You know, our belief was, hey, if we could produce the best measurements, quality measurements in the market, people will use it.
Matt Resnick: And what we realized was that, you know, hey, that, that is partially true, right? But what it takes is actually delivering that measurement in a way that feels comfortable to people. So, so we, we interact with folks in, in really in a few ways. So the first is we build tools for members to use. You know, we call them digital navigation tools.
Matt Resnick: Some of them are static. You know, we've started. Leveraging, you know, conversational AI, in partnership with some of our customers to actually elicit more information from people, working under the belief that, that actually most people don't know what they need, right? They know that they have foot pain, right?
Matt Resnick: They know they have headaches, but like, they don't actually know whether they want to see a primary care doc or a neurologist or a neurosurgeon or a podiatrist, orthopedic surgeon, like no one really knows. So, so part of this is actually to try to, you know, work with them to elicit, well, you know, what have you done, tell me about your pain, have you seen anyone yet, you know, oh, wait, lo and behold, here's your benefits ecosystem, here's some options for you that may not be, hey, go to the podiatrist around the corner, or maybe, hey, have a virtual visit, here's a musculoskeletal solution, right?
Matt Resnick: So, and then if they want to see someone, we bring the analytics to life by making really precision targeted recommendations. that leverage their network, that leverage their preferences, that leverage their location, that leverage, you know, other key factors that they're interested in leveraging. The other way that we work with employers and their members is actually through partners.
Matt Resnick: So, you know, one of the things we're really excited about is the work we're doing with, you know, Sacha with Collective. You know, the ability to help power the recommendations that come in a really multi channel way to members, whether it's through member services, whether it's through tier management, whether it's through, you know, collectives, digital assets, you know, so, so our belief is that we don't, I'm going to sound really glib here, but we don't care, you know, where the member gets the information.
Matt Resnick: Our goal is actually to create consistency for the member wherever the member goes. And our belief is that people want to receive the information in different ways. Meaning that, like, some of us want to use text, some of us want to use chatbot, you know, in web chat, some of us want to make a phone call, some of us want to authenticate into the health plan portal.
Matt Resnick: That's great. Like, our goal, our charge is actually to power all of those, so that, like, regardless of whether Member Karen wants to go to one place and Member Jason wants to go to another place, like, they get a consistent recommendation. The other way beyond sort of the recommendation engine and this navigation piece is network design.
Matt Resnick: So one of the things that we believe and we've seen results from is, look, you know, people are, you know, logical, rational actors. When you make it both easier and you make it desirable for them to make the decisions you want them to make, they make those decisions, right? There have been Nobel Prizes awarded for this in behavioral economics.
Matt Resnick: This is like not a new concept. So one of the things that we've done is worked with folks like Collective to create tier benefit designs around these analytics. So, you know, if we, if you want to see someone who's really outstanding, yeah, you know what, you're going to pay less out of pocket. And the return on investment of that delta is actually remarkable based on the fact that like, look, a spine operation costs 70, 000, right?
Matt Resnick: So avoiding one of those actually pays for a whole lot of, you know, co pays and co insurance differentials for office based services. Conversely, you know, we have some clients who want to penalize folks, right, for seeing folks that are underperforming. You want to see Resnick, and Resnick's a really underperforming urologic oncologist, urologist?
Matt Resnick: You can, but you're going to pay more on a pot, right? So, and believe it or not, right, perhaps not surprising, right, those plan designs work, right? Particularly when they're paired with, you know, Education and transparency and a whole lot of, you know, language that folks can understand around why, right? I mean, what's been impressive to me and what's been really interesting is that when you actually like sort of take a step back and explain to people.
Matt Resnick: Hey, look, like this isn't cost cutting. This isn't like we're trying to rebuild an HMO model from the early 90s. We actually know differences between these providers. This is what they are. And this is why we actually want you to see folks who really are delivering care that's aligned with what we know to be the best practice in 2024.
Matt Resnick: That works, right? So there's a variety of ways we work with employers and work with employees all kind of centered around this core thesis of, look, we want to make it easy and desirable for people to see the folks that we know to be delivering the right care.
Sasha Yamaguchi: That's fantastic. I love easier and desirable.
Sasha Yamaguchi: I circled that. I'm going to keep using that myself. I think one of the things you just mentioned, and so important as we're working with clients, is the communication. So of course, what's ironic is we're all trying to make it easier for members, but in their minds, things like this make it harder when in actuality we're trying to help them.
Sasha Yamaguchi: So I think that advice to employers of It is going to be a value to them, but you have to communicate on day one why it's a value, how it's going to help them, so they're not like, oh my god, such a complex plan design, right? So that, those are kind of my initial thoughts on that, of why that communication is really, really important.
Matt Resnick: There's an education that needs to happen, and you know, I mean, most of the people Who are receiving these communications are adults and like, like we're all adult learners, like repetition is helpful, right? You know, if not the first time, then it's the second or third time that people understand. So, so, you know, one of the things we often will do with our customers is actually create campaigns that really allow people into this world of understanding
Matt Resnick: of why quality is important and how the programs that the employer is putting into place are really driving towards quality and what that means for you and your family. You know, that's something that we found to be really successful, but you're right. You know, I mean, at the end of the day, part of this is putting a toe in the water with a little bit of disruption.
Matt Resnick: I, I think that there's a balance here between, you know, preserving a relationship with someone who we know isn't, Doing the best and disrupting that relationship and trying to move towards someone who's performing better. And, you know, I mean, I think there are different circumstances which merit different considerations.
Matt Resnick: I think one of the things that we've seen empirically is that, you know, for primary care, it's really hard to break those relationships, right? Probably appropriately, right? Meaning, you know, I mean, it's hard to find a primary care provider. People generally like them. It's hard to do that. I think on a specialty care perspective, it's a lot easier, right?
Matt Resnick: For many specialists, the relationship is episodic. Right? You're not seeing your urologist, you know, in perpetuity, you have a problem, they help fix the problem, you sort of go back to primary care. So, you know, it's trying to target those, like, new relationships where people are saying, oh, I need a orthopedic surgeon or I need a gastroenterologist or I need a cardiologist or I need a whatever, where we can really nudge people to the top with good reason and with savings for them.
Sasha Yamaguchi: Right, you know, pay less out of pocket, have a better savings to them.
Sasha Yamaguchi: I think that's important. I was going to ask earlier two things. I assume specialty is where most of the interaction light lies, but for young populations of members coming in, how cool if this is in place and from day one, they get to a primary care through what you do
Sasha Yamaguchi: from the get go. I mean, and we start generations of new folks finding their first PCP, and they're doing it through something like Enbold. I just, uh, open thought on that, so.
Matt Resnick: Totally. I couldn't agree more. And people change jobs, people are new to plan, so what we've also found is that, you know, finding first PCP, New to plan, you know, new providers, new to market, new to geography, these are all opportunities to sort of intervene, you know, and what we found is that some of these, like, create opportunities for targeted communication, onboarding, new child, looking for pediatrician, right?
Matt Resnick: Like, there are life events that sort of lend themselves to this, so we found that those are particularly effective in driving both engagement. Right. So using some of the assets and tools that are made available to folks, but then also behavior change, right. To be clear, like we have measured the extent to which, you know, the behaviors and some of the technologies translate to differences in true behaviors and claims and their market.
Matt Resnick: Like there are material differences when people are exposed to some of this information in a way that's consumable, they make better choices, right. So in essence, part of the trick is getting their attention, getting their eyes on the thing. And then we know that once they do, they'll make a better choice.
Matt Resnick: It's the age old question of engagement. And I know you all do a ton of work in that space. We're doing the same. And I think there's opportunity to pair though that work to drive, you know, the outcomes that I think we and the plant sponsors.
Sasha Yamaguchi: Now, I've been in the industry about 26 years and engagement has been a pretty stable topic in different forms, right?
Sasha Yamaguchi: HSAs when they first came out, wellness programs, right? Provider quality now.
Matt Resnick: It's super interesting. I mean, we think about this. We talk about this a lot, as I'm sure you do. And one of the things that we believe, you know, in a lot of the, the product innovation that we're working on is really meant to do product driven invention, right?
Matt Resnick: Like how can we create products that people actually want to use? Not just that sort of hang off the ecosystem, but that, like, are truly integrated into, like, how someone lives their day. You know, I think we've got a lot of examples of that tell us it's really hard to get people to do different stuff, particularly in healthcare, right?
Matt Resnick: It's just hard. It's hard to know when to go to the thing. It's hard to know where, you know, where it is. Like people don't use healthcare every day.
Sasha Yamaguchi: They don't even know how to find the thing. Totally.
Matt Resnick: Yeah. How do we make the thing part of like your Just what you do, like the stuff you use on a daily basis.
Matt Resnick: And, you know, we're really lucky to have really thoughtful, innovative customers and partners that are, you know, both pushing us, but also like collaborating with us to figure out really neat and unique approaches to like, Getting this information in front of people through channels that they ordinarily would use, you know, on a day to day.
Matt Resnick: So, you know, more to come, but I think there's some opportunity here, particularly with the way that technology stacks have been built and, like, the ease of integration of different platforms.
Sasha Yamaguchi: Yeah, I agree. Let's switch to the employer side. So, You're working with an employer, you've put in what you do for the members, it's two years later, a year later, what type of data do you then share with the employer of how it's helping their employees, which is the most important part, but then how it's helping their utilization, and then if you want to share an example of two of what you've seen, but I would love for all the employers listening in to hear a little bit about what do you then share back with them and what have you seen as some of your results?
Matt Resnick: Yeah, great question. So we measure like the continuum of Utilization and engagement. So we'll start with looking at, okay, well, what are people doing in some of our technologies? And we've built a path to be able to link that utilization data to claims behaviors. So what we'll then be able to do is say, okay, how has that behavior inside of some of the technologies translated into differences in Like, the utilization of higher versus lower performing providers, right?
Matt Resnick: We know that there are differences in cost between those two, so we can then really seamlessly translate what that means in terms of savings to the plan. The other thing we're able to do is really deeply understand differences in clinical behaviors across the, like, continuum of the population, looking more specifically at the specialties and subspecialties that we measure.
Matt Resnick: Changes over time in like what it looks like for a patient with back pain, the different propensities to have back surgery versus conservative management, etc. You know, and I think one of the things that we pride ourselves on and we take very seriously is really working with our customers and partners to think through, well, what are the things that would be valuable to them?
Matt Resnick: You know, how can we create reporting that is both useful for them to understand their benefits ecosystem, their healthcare ecosystem, and what's useful to them and us to think through how we can jointly improve the program that we've put into place. And what I can say is that the results we've seen have been really interesting.
Matt Resnick: You know, what we know is that folks who use in built technologies are about 50 percent more likely to see a higher quality provider than folks who do not. You know, and we know this because we've actually conducted a wave randomized control trial that looked at it. And when folks use those higher quality providers, there's a whole series of like, of downstream benefits.
Matt Resnick: You know, we've seen 35 percent reduction in early hip or knee replacement. We've seen 65 percent reductions in the use of opioid therapy, unnecessarily. And perhaps not surprisingly, that translates into material savings. Right, so on a yearly basis for spine care, when someone sees a high quality spine provider, that care costs 45 percent less, right?
Matt Resnick: Hard stuff. And it isn't because we're like doing you to price arbitrage. It isn't because we're shifting people from, you know, A to B. It's because we're sending them to folks who like are the second doc in that example that I gave earlier. They're saying, Hey, look, like, you know, you don't actually need this right now.
Matt Resnick: Like let's try these things, right? Yeah, they're hard. You know, don't get me wrong. Yeah, it's probably not what many of those patients want to hear. Like, you got to do this hard work, but it's the right thing. So, you know, I mean, I think it's been candidly been really exciting to see some of these results.
Matt Resnick: I think our customers have been really excited about them and, you know, we see that as the beginning of a journey, you know, for us and for many of our customers.
Sasha Yamaguchi: The more I hear you talk about the examples and the data, I mean, it's just incredible. And even to your point about the opioid, right, the downstream effects, I mean, what you're doing, it's not just at the doctor level, but it's so many other things that then helps the member
Sasha Yamaguchi: get the right treatment, maybe take the right medication. It's just. So many things that are positive for them. It's really extraordinary. One question I would think that I would love to know, there's so many companies now, right? A lot of startups, a lot of gaming, right? Gaming companies coming out where their population, I remember having a client many, many years ago where the average age was, I think, 27 for the whole company, right?
Sasha Yamaguchi: I assume, even though there are a young population, they may not be needing the hip in the back, but I would love for you to share with everyone that Embold can also help and provide tools, even when it's a company with a younger average age. I would love your thoughts on that and what you would share around that.
Matt Resnick: Yeah, it's really interesting. I mean, we are really lucky in that we have customers at really, like, Both ends of the continuum of age and, you know, retail versus technology versus transportation. Like we sort of, you know, have a whole like distribution of customers. And you know, what I would say is that back to this sort of like first goal of creating the measurement, like the measurement is no different, but what we've actually tried to do is use the product offerings and how they're delivered to meet different populations in different ways.
Matt Resnick: Right. 27 year old engineers. probably don't want to sit on a hold to talk to someone. They want to be able to self service. They want to be able to dig into the information. So we've created the ability for them to do that. Whereas a 63 year old retail worker may feel less empowered to self service and, you know, may want to call member services or care navigation at a plan.
Matt Resnick: And we've set that up to be able to allow that person to use the tools and analytics on that member's behalf to make recommendations that are driven. So, you know, what I would say is our perspective here, Sasha, is that there isn't a one size fits all. Like, there is not a solution that, like, is the perfect solution for every employer given the fact that every employer's population is somewhat different.
Matt Resnick: And, you know, the way that I think we've been successful to date is by acknowledging that and being willing to roll up our sleeves with our customers, with their plan partners, and saying, how can we make this work in a way that works for your organization? That's easy. You know, for implementation, that's a lift we do, right?
Matt Resnick: That's not, hey, you want to do all these complex integrations, great, like you're going to have to do that. No, that's like work we take on with the partner ecosystem. So you know, a hundred percent, uh, I think that's right. And I think there's opportunities to continue to improve the way we're doing that.
Sasha Yamaguchi: That's great. I guess last kind of main question, I want to go back to the provider side for a minute. You've got a provider that is not falling into, to the green tier, right? Let's say they're red, they're yellow. How is that interaction of, I really do want to be a green doc. I want to be that. So what feedback are you sharing?
Sasha Yamaguchi: What conversations are you having? Because to your point you made kind of in the opening, you are also trying to help providers be, right, have more better providers available. So share a little bit about that, the work you do with providers.
Matt Resnick: Yeah, when we started, I would say we, we maybe were a little naive.
Matt Resnick: Not maybe, we were a little naive. To say that we always had this vision of sharing data with providers. And our belief was that, hey, if we share these data, like, they'll just get better. There's two reasons why that doesn't happen. And both are important. The first is that, you know, I'm a doc. We, we all like, it's hard for us to believe.
Matt Resnick: That we're not exceptional at everything. Like that's just like, we are hyper competitive. We all like are confident that we're doing the right thing. So there's this like trust factor. Hey, why should I trust you? And, you know, candidly, we've gone to great lengths to make our analytics trustworthy. Right.
Matt Resnick: We work with. our subject matter experts, scientific advisory board on the front end. We've published our methodology and results in the peer reviewed literature, some of the JAMA, New England Journal of Medicine Journal. And quite honestly, we opened the hood to providers. And I think that's the, like, the biggest sign of, like, faceability and confidence.
Matt Resnick: It's like, hey, look, like, you want to understand, let's review it. So the first is getting past this, like, trust factor. And I think we've spent quite a bit of time and we have a really talented team of people who does that. And I would say one of the ways we've done that is with a fair amount of humility.
Matt Resnick: Right, to say, hey look, what we're trying to do here is really hard, like, help us understand where we didn't get it right. Right, because what we then are able to do is take that feedback and when appropriate, incorporate it into how we iterate on our measurement. I think the second part of this, which is also interesting, is many frontline providers are not as familiar with quality improvement as you would expect.
Matt Resnick: Like, they know what they do, they don't necessarily know how to change what they do to accommodate this measurement system. So one of the things that we've done is we've built toolkits for providers to say, Hey, look, like, we know that it's really hard. We know that you've been doing this for 20 years.
Matt Resnick: Like, Here's some, you know, here's some ways that, like, in clinic today. Like, steps you can take to make improvements in the set of measures for which you underperform so that the next time we talk, like, those measures look quite a bit better than they do today. And again, we have no, you know, we will work with providers as much as they want to try to get there.
Matt Resnick: So our experience has really been one of, you know, there's kind of this predictable mistrust initially. I think we've had quite a bit of success, you know, working through that in partnership with the providers. And I think what we realized is that, look, like we can learn from the provider community and they can learn from us too.
Matt Resnick: And it creates this mutual flywheel that we think has been really, really helpful and really productive.
Sasha Yamaguchi: I mean, it's the whole help me help you, right? One thing you mentioned that, that I hit on, so I was thinking about a new doctor and I think you said there's new providers that may not know. And it made me think of, especially if new providers are being mentored, right, by someone that has done it a certain way.
Sasha Yamaguchi: So I go back to the back surgery. You're mentoring under Dr. A that always goes straight to surgery? You may do the same, and then the cycle continues. I feel like your information helps these newer providers know that there's alternative ways.
Matt Resnick: I think that's totally right. I just, you know, I mean, there's this, there's a reality, which is that, you know, I'll use myself as an example.
Matt Resnick: I mean, I spent almost a decade at a big academic medical center, highly sophisticated biomedical informatics program, and candidly got very little, like, feedback on my own clinical performance. And I knew what I would bill, I knew what, how many RVUs I did, but like, I didn't really know, you know, whether my readmission rate after prostate cancer surgery was higher than my peers, I didn't know whether my positive margin rate was higher than my peers, I didn't know whether patients who I operated on with bladder cancer were more likely to get treated with additional therapies, I didn't know whether I was using way more low value genetic tests than my peers.
Matt Resnick: So, you know, to think that the average orthopedic surgeon or Obstetrician in West Texas, for example, like knows how they compare to their peers. It's just not real, it's just not happening. And, you know, I think that's the, like, that's the core opportunity. And I think you're right. I mean, look, I think there's an opportunity here to do something totally unique and different.
Matt Resnick: You know, I wouldn't say that this is like where we are now, but. To create in some way, not like the imprinting and training to say, Hey, this is how it's done. Continue to do this here to forth, but to say, Hey, look, like there's an opportunity to connect people. And there's been some work done on this for surgical coaching, actually.
Matt Resnick: Interestingly, in the Northern Midwest, you know, around, Hey, can we take surgeons who look like they, you know, are having some technical challenges with some operations and have them coached up, right? Just like athletes, no different. And there's been some promising work in that. I think there's been a lot of work around.
Matt Resnick: Like, clinical judgment, candidly. Like, hey, what should I do for this patient? So, you know, I think it's, it's a really interesting space. My take is that technology can help enable some of this. How exactly, don't know yet, but so many enablements coming down the pike. Where I feel like having, you know, a technology layer that can help folks with, Best practice with latest evidence.
Matt Resnick: You know, it's something that really is possible in 2024, if you know.
Sasha Yamaguchi: Yeah. That's great. And to your point, even the best, there's information that can help them, right? You made an athlete comment, and I immediately thought about Michael Jordan, the best basketball player of all time, had Tim Grover right by his side for 15 years straight working with him, right?
Sasha Yamaguchi: 100%. No matter how good you are, there's data, there's information that can help you do even better. So, this was all fantastic. I could keep talking. Is there anything you want to share about Embold before we wrap up? But I have a feeling we may need a, an episode two because there's so much more to get to.
Matt Resnick: I'll, I'll save it for, uh, for episode two. No, this has been, Socrates, it's been great. Really, really enjoyed it. And, you know, looking forward to working more closely together.
Sasha Yamaguchi: Agreed. I'm very excited that Collective Health and Embold are partnering together. So tell everyone where they can find information on Embold.
Matt Resnick: Yeah, so emboldhealth.com, a lot of great information, happy to get in touch. You know, there's a variety of ways to get in touch on the website and can go from there.
Sasha Yamaguchi: Perfect. Well, I appreciate you being here today, and I cannot wait for everyone to, to reach out, to learn more about Embold, and really appreciate you being with us.
Matt Resnick: Thanks very much, Sasha. Appreciate it.
Producer: This podcast is brought to you by Collective Health, a health benefits solution that guides employees toward healthier lives and companies toward healthier bottom lines. Check us out at collectivehealth.com.