Q&A: Think about Pediatrics CEO George Boghos

A Nashville-based medical group referred to as Think about Pediatrics is partnering with well being plans on a value-based fee mannequin that brings 24/7 medical, behavioral, and social care and assist into the houses of Medicaid-eligible kids with medical complexity and particular healthcare wants. The corporate’s CEO, George Boghos, M.B.A., not too long ago sat down with Healthcare Innovation to explain the issue his firm was shaped to resolve.

Previous to becoming a member of Think about Pediatrics 14 months in the past, Boghos co-founded and led AIM Clinics, which delivered evidence-based utilized behavioral evaluation companies to kids with autism and their households who’re from communities that have well being inequity.

Healthcare Innovation: May you discuss a number of the entry points in pediatrics that your organization is working to resolve? 

Boghos: Pediatrics typically is among the final locations for innovation in healthcare. My mom is a pediatrician, so I’ve grown round pediatrics my complete life. My statement is that pediatrics hasn’t developed one iota since I bear in mind my mother practising. It’s arrange properly to serve youngsters who’re typically wholesome. You go to a pediatrician a couple of occasions a 12 months and also you’re spending possibly 10 minutes along with your pediatrician, and that works for most youngsters. Who it does not work for is youngsters with persistent advanced medical circumstances. What that is led to is kids and their households using the emergency room at a really, very excessive fee – and sadly oftentimes being admitted to the hospital for utterly preventable causes, as a result of they have nowhere else to go.

What we’re saying is, let’s wrap round youngsters with medical complexities and their households a 24/7 digital first, in-home care mannequin by advanced care pediatricians, by nurse practitioners, by therapists, dietitians, paramedics, and social staff — a full interdisciplinary care group that’s actually investing time to get to know these youngsters and their caregivers, and catch issues preventatively by every day or weekly contact factors, but in addition be there 24/7 for these households once they want the assist. So in a nutshell that’s what we’re right here to do.

HCI: What sorts of circumstances do these kids are likely to have? 

Boghos: It’s the 1 to 2 p.c of youngsters who’ve these advanced persistent medical circumstances resembling extreme unmanaged bronchial asthma or diabetes, cystic fibrosis, cerebral palsy, and so they usually have psychological well being comorbidities to associate with that. In order that’s who we’re making an attempt to resolve this entry downside for.

HCI: And what’s the enterprise mannequin? Do you accomplice with payers?

Boghos: The way in which we do it’s a completely value-based inhabitants well being mannequin. We accomplice with Medicaid managed care organizations. We take full threat on the entire value of take care of these kids who qualify into our program, and we’re right here to handle their whole expertise and care journey. We’re not changing anyone that they are working with. Our youngsters have PCPs. They have specialists. They have a ton of assist, however we’re there to fill the gaps. And our main goal is to maintain youngsters more healthy and happier of their houses and out of the hospital once they do not have to be there.

HCI: You are explaining that this dietary supplements however does not change their current medical doctors. However do your suppliers must coordinate care with these conventional medical doctors they have already got — and the way is that details about what Think about has executed get shared with the kid’s common physician’s workplace and vice versa, so that everybody is on the identical web page? 

Boghos: That may be a essential level, as a result of quite a bit our youngsters and households have 5 to 10 totally different healthcare suppliers concerned of their care, and the very last thing we need to do is be an additional layer in that journey and complicate issues additional. So we have invested a ton in our know-how spine. We work with our households by our affected person app. We have a inhabitants well being software that we have developed internally. We make the most of an EMR and we’re plugged into well being info exchanges within the markets we’re in. We’ve acquired ad-hoc one-on-one knowledge integrations and connections with the massive suppliers, pediatrics teams and complicated care clinics the place we’re practising. We’re sharing that knowledge each day. Each time we have an encounter with a toddler the place we’re trying on the care plan that their specialists or pediatrician developed, we’re consulting with that pediatrician, and we’re sharing info so everyone’s within the loop.

HCI: I learn that your organization is working in Florida and Texas presently. Are you able to title a few the managed care organizations you’re employed with? 

Boghos: We’re working with Superior Well being Plan, which is Centene’s managed care plan in Texas, in addition to UnitedHealthcare Group Plan of Texas and UnitedHealthcare Group Plan of Florida.

HCI: Is there a selected cause you might be in these two states first? 

Boghos: There’s quite a bit that goes into it. Loads of the worth we deliver to our plan companions helps them innovate and remedy a necessity for a inhabitants that is tough to handle traditionally. So it is primarily based on states the place the plans have had issue caring for kids with medical complexity, and people states rose to the highest. Secondarily, we grow to be, an vital a part of the differentiation out there for well being plan companions, as a result of they’re trying to win bids or increase their market share in these states, and this might grow to be an vital differentiator for them.

HCI: Do you anticipate that in 2024 you will increase and scale up into different states?

Boghos: Sure, that’s our plan. We have loads of conversations occurring with a wide range of well being plan companions in Texas and Florida, in addition to in a wide range of different states. Our objective is to be in a pair extra states subsequent 12 months.

HCI: It looks like typically startup firms have a hen and egg downside the place a payer would need to see proof of high quality and ROI earlier than agreeing to a partnership, however it’s difficult to get there when you do not have that preliminary contract. How do you present them the worth of it earlier than you have truly executed it with a company of that measurement?

Boghos: In two methods. One is that a part of our founding group had executed this very factor. We’re speaking a few virtual-first, high-touch mannequin for kids with medical complexities inside a hospital system within the Midwest, and so they noticed nice outcomes doing it. Not solely by way of the satisfaction within the engagement of the households, but in addition by way of decreasing dramatically the pointless emergency room and hospital visits. So we had proof and knowledge factors, and revealed work being executed. However extra importantly, as a result of the mannequin is value-based in nature, we’re really placing our cash the place our mouth is. We’re taking full threat. If we’re not capable of ship outcomes, by way of enchancment on high quality measures and stopping pointless hospital visits and decreasing prices, the plan isn’t any worse off. In order that’s the fantastic thing about a full-risk mannequin. Among the plans are keen to belief us with that as a result of they know we’re completely aligned in doing the proper factor for the sufferers.

HCI: Did Think about get enterprise capital funding to start out up? 

Boghos: We had been based out of a gaggle referred to as Rubicon Founders, which is a Nashville-based enterprise incubator group made up of very skilled healthcare entrepreneurs and operators, who’re making an attempt to resolve huge issues in healthcare primarily by value-based care fashions.

HCI: May you discuss any outcomes you have seen early on in working with these managed care organizations? 

Boghos: We’re nonetheless early. We launched with our first plan accomplice in January of 2023. What we have been capable of accomplish is a fairly excessive engagement fee of the inhabitants we’re serving. So we’re presently taking up threat on shut to twenty,000 sufferers throughout these two states, Texas and Florida. We have been capable of have interaction a really giant proportion of them in a fairly brief time period. We contact base with our households, on common, about 4 occasions per 30 days. That is something from a chat on our app to a digital go to to an in-home go to. We have executed north of fifty,000 affected person interactions simply within the first 11 months.

Extra importantly, we have early claims outcomes, so we’re monitoring healthcare claims knowledge post-engagement with Think about versus pre-engagement, and what we’re seeing is roughly a 15 p.c discount in impatient quantity, and a few 20 p.c discount within the complete value of take care of these households, primarily pushed by prevention of pointless emergency division visits, which oftentimes flip into prolonged admissions into the hospital.

HCI: Is likely one of the challenges discovering the medical groups to assist scaling this up? 

Boghos: I believed it could be our greatest problem, however I have been pleasantly stunned with how properly we have been capable of entice actually superb teammates right here. And a giant a part of the reason being that is very totally different from something in pediatrics, proper. We have been capable of entice superior teammates out of the PICU or NICU in a hospital or out of conventional pediatrics practices who actually are craving for the chance to develop very, very long-term, deep relationships with households and caregivers in a virtual-first mannequin the place they’re actually capable of drive affect. As a substitute of a transactional sort of relationship in a hospital the place you are seeing a household at their worst, after which they’re discharged, and you do not see them once more, it is a very nice worth for our care groups to have the ability to take care of these households on a longitudinal foundation and kind these actually, actually deep relationships the place you are not constrained by deadlines of the 10-minute appointments.

The opposite fantastic thing about our mannequin is as a result of it is digital first, we’re serving youngsters in very rural areas as properly. We’re capable of have a group that is primarily based in Houston serve kids throughout your complete state of Texas, for instance. So by way of enhancing entry and well being fairness, but in addition permitting us to rent the proper expertise and the very best expertise and be capable of serve youngsters and never essentially inside driving distance is a very nice means for us to scale.

HCI: Do you suppose these virtual-first fashions are going to proceed to evolve and be highlighted as methods to deal with shortages and goal sources at sufferers who historically are underserved?

Boghos: I believe so, and I hope so. , we spent loads of time on our philosophy that digital care is rarely going to utterly change in-person care. However it may well dramatically increase it and dramatically enhance the entry points. If you consider a small PCP observe in a rural a part of Texas, we’re augmenting their means. We’re capable of be there 24/7 for these households inside minutes of once they want us. Bettering that entry concern is of big significance to us and I believe loads of virtual-first fashions are going to have the ability to try this to the betterment of the households, the sufferers and actually your complete healthcare system. So my hope is that we’ll see much more of those, not as a substitute for in-person care, however as a approach to dramatically increase the affect of in-person care.