[INTRODUCTION]
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[EPISODE]
Christopher Habig (00:38.961)
Welcome to Healthcare Americana, where we are unraveling the future of healthcare. One conversation at a time. I'm Christopher Habig, the CEO of Freedom Healthworks. And today we're diving into a topic that's crucial for anyone navigating the healthcare system, patient and really continuity of care navigation. Today, we'll be hearing from Doug Geinzer of High Performance Navigation and discussing the importance, really, of guiding patients through their healthcare journeys and really how direct primary care is making a monumental difference. I know I'm adding a little bit of clarification. I think I've said the word really multiple times already, but I want to emphasize the importance of getting back to basics when it comes to care navigation, because too many people and too many patients are lost, lonely, and abandoned when it comes to finding the right care for their needs. And God forbid they get tossed back into the system without anybody there in their pocket to help them go. And even the scariest thing I think I can imagine as healthcare is even going to a hospital alone. So the healthcare system obviously can be elaborate. Patients often feel, like I said, lost, lonely, abandoned, even overwhelmed. Finding the right doctor, understanding treatment options, managing costs, this is a very scary journey for a lot of people. Now we see a lot of people delay that journey or just don't go call their doctor or seek healthcare, which leads to a lot of other problems. But what if there was an easier way? What if there was a, and I use this word lightly, a better way of going about this? We're going to explore how care navigation is important to any patient journey and how the innovators in the direct primary care world offer yet another beacon of hope, simplifying the healthcare experience for patients and doctors alike.
Now, before I introduce our guest, get into this mindset. Imagine a healthcare model where the doctor-patient relationship is really at the heart of every decision. Where navigating care is straightforward and personalized. That is the promise of direct primary care, as so many of you already know. But to continue to understand why this is such a really mind blowing revolutionary concept and it's battling a lot of bad habits that we've instilled in ourselves and instilled in this industry. We have to understand and grasp the complexities of traditional patient navigation involves multiple stakeholders involves a lot of miscommunication documents flying back and forth. God forbid fax machines from insurance companies to health providers often leading to confusion and frustration.
So as I mentioned, and it's kind of delayed gratification, Doug Geinzer with High Performance Navigation. Doug, welcome to the show, and Doug, you've been at the forefront of enhancing patient care.
Doug Geinzer (03:38.674)
Thanks Chris. Great to be back with you. I think you and I were on an episode about two years ago we discovered. So it's great to be back on the show. I appreciate all the hard work that you put in and the education first and foremost that you're doing out there in the community.
Christopher Habig (03:51.609)
Absolutely. I think education is the biggest challenge that, you know, people like you and I and our listeners face when it comes to showing people, hey, there is a better way of doing things. You don't have to just put your barrier head in the sand like an ostrich when it sees a predator. There's OK. You can open your eyes. You can think clearly. And there's a lot of good that can come out of that. So, Doug, from your experience in healthcare, really innovation, navigation, all the all the multiple ways you've been helping out patients and physicians and providers. How would you describe the current challenge, challenges, I guess would be more accurate, in patient navigation within the traditional healthcare system, common obstacles that patients face?
Doug Geinzer (04:35.118)
Well, a lot of it comes down to access. I think the first building block, and that's one that you're working on that you're putting in place, is direct primary care. If a patient has access to adequate primary care, that primary care physician becomes your absolute best care navigator because they know what's going on within the patient, and then it's just a matter of identifying if they need specialty care, who is the best specialist to send that member to. And in our world, probably the more important part is making sure that it is affordable to the member. And a lot of the plan constructs that are out there today, these plans have high deductibles, high co-pays, and it's unaffordable for members to be able to access care. And I have found that if you stitch together direct primary care and direct specialty care with a good handoff, good care navigation, we could really crush the costs, make it affordable, and allow better access to care so we can improve health qualities across the board.
Christopher Habig (05:32.313)
I want to be clear with our audience. So when we're talking about care navigation, you know, in my mind, that means if I'm a DPC patient or a patient anywhere and I go see my primary care physician or provider like I should and not immediately go to the ER or go to the urgent care or whatever it is. If they do see it, say, Chris, all right, you need something that is outside the scope of our services here. I'm going to introduce you to the next specialist. I'm going to be there with you every single, you know, every single step of the way. If you have questions, text me. I will interpret those. Is that the same kind of concept of navigation that is in your mind? Are we talking to different languages?
Doug Geinzer (06:13.422)
No, it's the same. So in my world, I spent the greater part of my career doing direct contracting. So building direct relationships between providers that want to deliver a higher level of care in a bundled arrangement. And what we discovered is without proper care navigation, those direct contracts don't get accessed.
And so therefore the plans don't find the cost containment that they're looking for. The plan members are coming out of pocket. So we really wanted to bridge that gap of how do we get a clean handoff from primary care to specialty care in any type of plan construct that a member may be in, whether it's a sharing ministry, whether it's a PPO plan, whether it's an RBP plan, but making sure that there's a handoff so you could keep the, the cost containment in place, waive the co-pays, waive the deductibles and co-insurance.
Most of our work is done where it's handed up to a care navigation firm, which may be staffed with nurses or some higher level clinical folks that will help that member seek and find where the bundled episodes of care are. I think the perfect, the trifecta will be how do we get primary care to make a peer-to-peer referral? Rather than it going back through the channels up to navigation and then back downstream to a specialty care because that's one more link in the chain that can break. And so we're on the journey of figuring out how do we link direct primary care, advanced primary care, whatever format that is, over to these bundled episodes where you could deliver a better health outcome for a lower price and save the entire ecosystem some hassle.
Christopher Habig (07:54.217)
Are you seeing any differences working with the direct primary care physicians and providers out there versus the insurance-based physicians and ease of communication back and forth in that scenario you just described?
Doug Geinzer (08:06.398)
Well, I think direct primary care physicians really have a better understanding of their patient needs. So they know what their restraints are and they really are looking out for the best interest of the patient because they're spending time with them. As were the fee for service practitioners, they're simply saying, hey, you're gonna need to see a specialist, look in the book, look in that referral guide so you could find it. And now the patients going through this thing going, hmm.
Ramirez, I like that name. Smith, I like that name. Oh, I once knew a John. And they're making a selection on that. As we're in the direct primary care world, it's the doctor saying, hey, here's three people that I could recommend. This one I know does a bundled episode of care and you're gonna be better served going there. And then the second part is really closing the loop.
So once that specialty care is delivered, how do we get a clean handoff of the outcomes from that surgical event, that higher level of treatment back to the primary care physician so they know and next time that they see that patient that they're able to communicate that and make sure that everything's going the right way.
Christopher Habig (09:10.441)
Now, I've always had the hypothesis that when it comes to referrals, especially with companies and health plans working on it, if I'm an HR professional company saying, hey, Doug, you got to go see Dr. X, Y, Z over there, I'm going to be saying, why should I trust you? I'm going to listen to my primary care physician. Again, assuming I have one, right? And I have that trust and relationship built on that. Have you seen any type of, oh, I guess, I guess patterns? Or any involvement from that standpoint where people are saying, hey, I understand that I need to get a new knee, but I want to go to the person that my doctor is recommending, not just some third party care navigator or not the physician or specialist that my HR team is recommending to me.
Doug Geinzer (10:00.562)
So there are some quality metricing tools that are starting to be used out there, where they're looking at the patient reported outcomes or the outcomes from the procedures, and they're able to steer based upon that.
We find that the independent physician that has ownership and some operational control of the ambulatory surgery center, they're able to deliver a higher quality of care just because of the team that's in that OR, the theater with them. So in our world, when a surgeon has a case, if they take that case to a hospital, they're being dealt the support team that the hospital administrator assigns them. So the hospital administrator saying, here's your anesthesiologist, here's your scrub tech, here's your first assist. And sometimes that surgeon, this is the first time them meeting their new team. As where when that surgeon takes the case to their surgery center, it's their team. So what does that do?
Many times it allows the patient to come out with less time under anesthesia, get ambulatory and walking and burning that anesthesia off a lot quicker. And that happens because of the instrument handling inside of the operating room, because that surgeon and his team, they've worked together so often and they've just built such a continuity of delivery of the instrument. So we find that to be much better than the traditional routes.
Christopher Habig (11:21.333)
So what I'm hearing is that when physicians are accessible and there's not this middleman in the way, it's not just these patients are lonely in their journey. This is more of a shared journey for the patient who needs it. And it's not it's kind of like having the doctor in the family. I know it's kind of an old cliche, but I like that shared journey aspect of it because, you know, like I did in my introduction, like I think the biggest thing facing patients in healthcare in the U.S. right now is a lack of trust.
And anybody who's used it has felt that loneliness and they've been abandoned. And it's like, who do I ask questions to? Why? Why am I only meeting my surgeon 15 minutes before I go under and they're going to open me up and then there's no follow up afterwards? Like it is it's so transactional that you just kind of feel dirty about it. And so to have a shared journey, I think is very, very powerful with that. And it sounds like, you know, even stepping into the DPC world, it enhances that shared journey even more to have that warm embrace of every step along the way for a patient.
Doug Geinzer (12:27.622)
Yeah, proper care navigation just, it lessens the length of the chain. So it's a handoff from a primary care to a specialist and really collaborating on what's going on. Hey, this member's been experiencing this type of pain, it's a hernia repair, here's what I think is gonna need to happen. And many times it also allows the member to get the care that they need much quicker.
So we all hear about these access challenges, many of which are caused by, and I don't wanna get into the pre-authorization barriers that are out there, but in a direct relationship, a lot of that goes away because everybody's looking out for the best interest of the patient. And that's what healthcare is all about. We seem to neglect that part in the care journey nowadays.
Christopher Habig (13:18.021)
I want to talk about some tools that enhance the care journey. You know, we put people in each kind of step along the way and we should. But there's some tools that are coming on board and online that, you know, it'd be a lot more difficult to do this 20, 30, 40, 50 years ago than it is right now. So I want to get your perspective on technology. And I'm going to say a dirty four letter word here, data and what role they play in this modern patient journey from your standpoint.
Doug Geinzer (13:51.79)
So it's all about the data in my world. If you have clean data, then there's an easy handoff, but it's a matter of how do you get that data structured? So when it is handed off, you know, I always use this in just a personnel file record. So think of you and I, your name's Chris, that never is going to change in the database, whether it's first name, F name, first underscore name, surname, whatever that is, it's still Chris.
And so getting that data in a structured format to hand off to the provider just allows for a higher level of care across the boards.
The other part with the data as well is we're building some quality tools now that allow us to take the patient record and risk stratify to make sure that they are seeing the right surgeon at the right time in the right point of care or the right site of care because not all surgeons are the same just as not all populations are the same. So when you are able to do better matching between the patient and the surgeon or the provider, a higher level of care just comes out naturally. And a lot of that is done through the data.
Christopher Habig (14:59.497)
So that's the data side. And I am personally a steadfast firm believer that technology and new tools, they're coming in healthcare. And I'm kind of indirectly hinting at telemedicine and all these different types of communication tools is a supplement and not a replacement for a solid doctor patient relationship. Have you seen the evolution of technology come to fruit from your standpoint, whether it's communication between offices, communications with doctors and patients, how has that enhanced or even inhibited, you know, that shared patient journey that we've been discussing earlier?
Doug Geinzer (15:36.818)
You know, just in the course of the last, probably four to six weeks, I've met with a couple different tech plays where they are empowering the patient to gather all of their prior health records. It's almost a gamification where they're reaching out and it's extracting their medical records from hospitals and surgery centers and imaging centers, and it's bringing it into a personal health record that the patient owns, and then he or she could share that with whom they choose to.
For a period of time that they would like to. But what's more important is when you have all that data gathered into one central point and you apply a little bit of AI to it, you could start seeing things that need to be seen. Maybe it is too many of the wrong medications that are being prescribed that are interfering with one another, or, wow, we've been treating this symptom, but this is the real core problem if we just address that, all of this other care would go away. And you wouldn't have that if you didn't have the ability to extract the personnel records or the EHR records from all of these past providers. And now when that patient maybe leaves a health plan, they could take their records with them. I think that's where the power's gonna come out.
Christopher Habig (16:51.861)
I love the idea that it's really the democratization of your own data, which if you really stop and think about what I just said there, doesn't make any sense. This is my personal data, yet I have to fight kicking and screaming to grab it and have to have these tools like you just said, this technology to be able to get it all in there. And you know, I shake my head because I hear a lot of stories of patients that were like, yeah, before I came into, you know, visited the FreedomDoc world of direct primary care, I got my patient records and there were so many things wrong there, you know, from my name was misspelled. So go back to what you said about being able to see all the different Chris's in the system. And if there's an I before the R and all kind of stuff, like that's going to foul up the data. Like how do I know that this is all accurate information? And I love talking to doctors when they say, yeah, I put the I put their chart right up on the big screen TV in my office and say does this look right?
And many times they'll say, well, actually, my mom died of XYZ or my dad actually did have diabetes, whatever it is, and just build that whole picture of it. But I'm thrilled to hear that there's a lot of tools out there that people are going to have control of their data again. If they want to, again, I always got to leave it up to John Q. Public to say, hey, this is actually something that I want to have here. So I want to stay on that thread there.
So from the technology standpoint of really democratizing the patient data. How does that play into the whole care navigation journey when you have a lot of different touch points with somebody? Are there eyes, multiple sets of eyes looking into this and saying this person needs to go to this surgeon? And I know you mentioned that earlier, just lead us a little bit more into how that process works and how your team is making decisions to get people in front of the right person.
Doug Geinzer (18:53.486)
Yeah, so a lot of times when you're getting a referral that a member needs a type of surgery, again, clear difference whether they're a 65-year-old couch potato or whether they're a 44 year old athlete as to which surgeon they're going to go to and the medical record is going To present all of that and it's the same that's true whether they're a smoker whether they have asthma whether they have COPD Whether they're diabetic or high blood pressure. So it the transfer of that information and gives the surgeon what they need To make sure that they're delivering the highest level of care to the patient and in our world. We're now starting to do surgeon selection based upon the data that's handed off to us, because again, every surgeon approaches different things a different way. Sometimes it's robotic, sometimes it's laparoscopic, sometimes it's open. And a lot of that's gonna be based upon the health of that member before we get there. So having those records in advance is extremely powerful.
Christopher Habig (19:52.437)
I guess what a lot of what it comes down to and what I'm hearing is that you still give people options. So you're not coming out and dictating, hey, you got to go see this person because that's what your health plan works. You know, that's who your health plan works with. But you're still bringing that patient in there and they're going to rely on their care team to say, this is the best decision. Let's go ahead and make and move forward with it, which I think is huge because too many people get in trouble because they feel railroaded down one path or the other. And I think we've all been there from, you know, in the in the in the old days, seeing an employed physician, a hospital and they send you down the hall to the NTE or send you upstairs to the specialist and you just, you kind of go have this lemming mentality that you're just going to follow the orders and go where you need to go. But your team is presenting options. And I think that is a massive, massive improvement in really in my book and innovation in healthcare.
Doug Geinzer (20:49.222)
Yeah, in our world, so a good care navigator is going to present the patient, the member, a couple of different options. So again, we drive utilization by waiving copay, co-deductible, co-insurance and making healthcare affordable to the member, but sometimes members go, is that just cheap care and are you sending me to some surgeon that's in a basement somewhere and are they high quality? So we need to come back and say, look, you could go to your PPO network and be prepared to pay 20% out of pocket for this level of care. But here are two other surgeons. Here are their surgeon rankings. On a scale of 1 to 100, they're ranking at 80 and 90, as were the PPO surgeon that you may have been referred to by your other physician is ranking a 20. And so it's a lower quality surgeon by the data, and it's going to cost you more out of pocket, and you're more likely to have a recurrence or a higher infection rate, because their infection rate is X, as where this surgeon's infection rate is Y. So it gives the member choice, which they need to have, because this is a big decision for them to make, but it's using the data to allow them to make an educated choice.
Christopher Habig (22:00.885)
I totally understand that. Now, I feel like you're, you're legging into, hey, here's a real actual success story. So give us, you don't have to use any names or do anything like that, but give us a real life scenario where your team was able to, you know, get somebody the care they needed, and it was super easy, and they were so happy, and they're like, oh my gosh, this is a world of difference from what I've experienced in the past.
Doug Geinzer (22:24.53)
So the easiest one, and it's not a particular case, it's a case that I hear every single day, is a member that's been in need of a knee replacement or a hip replacement that has been delaying care because they just didn't have $7,000 or $10,000 in their bank account to cover their member financial responsibility. And so they go along, crutching and their HA shots aren't working as well, the cortisone's not working, they're debilitated, they can't play with their grandkids, then all of a sudden their employer rolls out this new plan that allows for navigation to care providers that will waive all of that member financial responsibility and now the member can afford that knee replacement. They go, they get it taken care of.
They're back to work three, four weeks later. They're back to productivity. They're back to life. And we get calls going, thank you. I was able to pick up my grandkids for the first time in two years. That's making a difference. That's what the delivery of healthcare should be about is how do we improve the lives of our members and not make healthcare so much a business, but really the delivery of healthcare.
Christopher Habig (23:35.021)
Powerful. Every day, everyday occurrences. Doug, in closing here, you know, looking ahead, how do you how do you really envision? And I'm going to call this an evolution of patient navigation. How do you see this playing out in the next few years? Next few? Well, I won't go next few decades, but the next couple of years, like what are we going to see in your world as we move forward?
Doug Geinzer (24:00.514)
So I think more and more plans are realizing the importance of care navigation. It's personalizing medicine. It's allowing members to have a 1-800 number to call their nurse, to call their doctor, whatever that is, and that person on the other end of the line is looking out for the patient's best interest. I think it's gonna be a two-step process. Right now we're seeing more and more care navigation happening. I wouldn't say at the TPA level. There's care navigators that are being formed, but there's a difference. There's those that are just doing appointment setting and skinning a network, which isn't as effective as looking at the quality measures and really finding cost containment opportunities. I think it's gonna start there. And I think as the direct primary care movement continues to mature, that we're gonna find some hybrid model that's gonna allow that primary care physician to also become the care navigator to these lower cost, higher quality solutions, because that's where the magic happens. When it becomes a peer-to-peer referral, rather than a peer to a customer service rep upstream to a navigator that may or may not have a clinical background to get something booked. And then you have to close the loop by getting those records back to primary care. Where if it's a pure clean handoff, then everybody wins in that situation.
Christopher Habig (25:25.469)
Bottom line, navigating healthcare, you have options. It isn't as daunting of a journey, but maybe there's some employer in some HR departments that you can kind of elbow in the ribs there to say, let's go work with companies like Doug's company here. Is that the bottom line?
Doug Geinzer (25:43.226)
You know, we're here to help any way we can. At the end of the day, I wanna take care of patients. I wanna get them the care that they need. I'm blessed that I've got one heck of a network of specialists and when friends and family have a need, they call me and I'm able to navigate, get them in within days. You can't do that in the traditional system. So it's like, how do you take what I've been able to do for my friends and family and make that scalable? Where the common average ordinary Joe has the same level of access. They're getting healthier and the cost of healthcare goes down because as a country we can't afford where healthcare is right now being the, you know, 20% of GDP, $4.4 trillion is being spent and half of that is fraud, waste and abuse. How do we eliminate that? Proper care navigation.
Christopher Habig (26:29.489)
In our world with direct primary care, working with great people such as you, Doug, and High Performance Navigation. I think we're already seeing that shift towards a more patient-centric approach. So, Doug Geinzer, High Performance Navigation. Doug, thanks for sharing your expertise and insights with us today.
Doug Geinzer (26:47.186)
Chris, thanks for having me.
Christopher Habig (26:50.025)
That's going to do it for today's episode. Thank you for tuning in to all of our fantastic listeners. If you're intrigued by the potential of DPC or what Doug and I talked about today and want to learn more about simplifying your healthcare journey, subscribe to Healthcare Americana and visit our website HealthcareAmericana.com. Share this episode with somebody who you think might benefit from hearing it and let's continue to make healthcare more accessible to everyone. Once again, I am your host, Christopher Habig. CEO of Freedom Healthworks. Thanks for listening.
[OUTRO]
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[END]