Today we listen to a conversation that began at the North Carolina Hospital Association’s winter meeting between Bamboo Health Senior Director of Growth, Ellen Solomon, and CHESS Director of Value-based Operations, Rachel Holder. Ellen and Rachel get together for the podcast to continue the discussion on the topic of Navigating Value-based Care through Real Time Intelligence.

RH: Thanks so much, Ellen, for joining us today. So can you give us a really brief introduction about yourself, your role, and tell us a little bit about Bamboo Health?

ES: Yeah, sure. Thank you so much for having me, Rachel. It was great getting to chat with you at the North Carolina Healthcare Association winter meeting. But for folks that don't know me, my name is Ellen Solomon. I'm senior director of National Health System growth at Bamboo Health. I've been here for six years and I currently live in Charlotte, but I always love calling out to my North Carolina customers. I was born and raised in a small town of Reidsville, NC And so in terms of what we do, folks in North Carolina may remember us as patient ping or Appriss Health. We've since come together and rebranded as Bamboo Health back in 2021. And I'll first start again with sort of who we are at a very high level and then I'll go into North Carolina as well as obviously how we work with you guys, Rachel. But in one sentence, Bamboo Health is an intelligent care collaboration network across all 50 states. The problem we work to solve is that as you know better than me, healthcare was built on silos. Those silos could be the EMR that you use, your geographic location, state lines or the setting of care, whether that's acute post, acute, ambulatory. And those silos make engaging patients and coordinating care in real time very difficult. And even more difficult when you're actually trying to bend the cost curve and improve patient outcomes like readmissions, Ed utilization, post acute length of stay and many others. And so in short, I compare Bamboo Health to expedia.com. You have all these hotel chains, you have all these airline companies that are competing for your business. They operate their own platforms, their own tools and they don't really want to share with each other. But Expedia brings them together in a really simple way and that's where Bamboo Health sits. And so today in North Carolina, we support our customers really in three use cases. The first one which we'll drill into more I believe in, in this discussion and how chess uses Bamboo is we enable value based care use cases through our engaged admission discharge and transfer or ADT network. And in North Carolina specifically over 80% of the hospitals in the state participate. We have over 800 post acutes, over 50 provider organizations. And this actually started back in 2017 when we partnered with NCHA who's really been instrumental in helping us build out this ENGAGE network. That network does extend to all 50 states. Secondly, we partner with the state of North Carolina as well as 45 other states to support prescription drug monitoring or PDMP program to help continue to curb the opioid epidemic. And then lastly, we're rolling out a behavioral health referral network also known as BH scan in the state. So I think the, So what their common thread between all those use cases is it's real time actionable and through an engaged network. And so Rachel, I know when we spoke at NCHA, Chess has been such a long standing bamboo partner. You all have really been with us from the beginning. I'd love if you could share more about some of the challenges you're hearing from your value partners as they're transitioning into more risk and value based care.

RH: Yeah. Thanks so much Ellen. So I think gone are the days that just a high AWV rate and some Flyers, some patient driven Flyers are enough to move the needle and value based care things have matured quite a bit and with that the tactics that we have with our value partners have to mature as well. So at this point I think all of our value partners regardless of size, regardless of region that they're at within the state, they're all trying to grapple with kind of three major things right now. How do you identify patients at risk and risk can be couple of different things there, patients that are at risk of mortality, patients that are at risk of you know acute events related to chronic conditions, patients that are at risk of non adherence for some of the metrics that were held to and how do we identify that before it's too late to intervene. So once we have that cohort, that population that we know that we want to impact, how do we actually change the direction that they're going in? What tools do we have that can improve engagement with that population? How do we get them more involved in their own health care? How do we get them the appropriate chronic support that they need and also making sure that that improved engagement is timely to when they actually need it? In addition to that, we don't want the touches that we have with these patients to just improve their outcomes in that specific area. How do we make all of those engagements count so that, you know, patients can have more autonomy in their healthcare so that they're on the right path and they get more out of life at this stage as they kind of enter that final chapter. So that's a that's a complicated problem to solve. Unfortunately, there are a couple of different ways that we do that right now. We have some predictive analytics that we're leveraging our data team on. We have some other vendor relationships that help with a lot of that and we're kind of always iterating on this. We have some new patient engagement tools that I don't want to foreshadow too much here, but that's going to be coming in 2024 that hopefully will help to impact some of that and also improve collaboration with the provider. So really looking forward to that. I think that this is kind of the next level of maturity and value based care and are really excited to be a part of that. So Ellen, I know that we had just talked about some of the use cases for Bamboo and specifically patient Ping, but we've had a lot of interaction with you in the past. We know that you know you all are one of the best ADT notification vendors out there. We use you really regularly for visibility for from a readmissions and ED utilization standpoint and know that you have a lot of relationships as well in the North Carolina market. So in this area, what other challenges are you all hearing about from health systems and how are you helping to impact those?

ES: Yeah, I love what you said about patient engagement, identifying high risk patients. I think two big things that I've heard most recently even in the past couple months, I'll touch on. One is that it's no longer just about having data that tells you where your patients are going in real time. Now that's still not always easy in every case, but there's generally more data out there because of TEFKA Q hens, HIES different interoperability structures. The challenge folks face is how can they make that data simple, actionable when it matters. And also to your point, Rachel, layering predictive indicators on top like rising risk so that providers can get ahead of crisis and get ahead of patients becoming their highest utilizers in the 1st place. But that sounds simple, but it's actually very hard, especially when care coordinators that are boots on the ground doing the work are already so resource constrained and in a staffing crisis. And the last thing these people need is more data, a new tool, a new module that they have to go hunt for information in. I think one thing we know for sure and that I've spoken with your team about is 5% of patients account for over 50% of healthcare cost in this country. Those are the needles in the haystack. You not only need real time data to identify these patients in time, but these health systems and these ACOs need a simple way to your point, engage these patients, manage them and track them through the continuum so they don't slip through the cracks. Secondly, I think one other big challenge I've heard recently is health systems and Rachel, I think you'll actually touch on this at the end, they're really investing in HealthEquity and community based programs, community health workers especially with the ACO reach model. And the biggest question I get is how can we more effectively engage all of these providers in the community so they can truly serve as an extension of that ACO or that health systems care team. You know, a couple months ago I was actually at another conference in Ohio and an executive at a health system there shared that over 90% of care happens outside of the four walls of the health system. Now that's not the same in terms of where cost come from of course, but with so much that happens outside of the four walls of the health system with community based organizations, behavioral health entities, paramedicine programs, federally qualified healthcare centers, post acute in home, my list could certainly go on and on. The question I get is how can we truly rally this group together so we can all impact the shared patients that we each touch. And this is really hard for any vendor or any health system to do. And what I can tell you Rachel, is like the answer is not forcing them to log into a platform and send information to you. What you need is a shared network that provides value to each and every person, a part of that care continuum that touches the patient so that there's truly a what's in it for me or so that they want to use that tool. That value could be simply having awareness of all these different external relationships that the patient has. That value could also be that each of those entities now know in real time when their patients back in the emergency room, back in the hospital. And that's when you have everyone working together on a shared platform and you see outcomes like reducing cost of care, reducing readmissions and reducing Ed utilization. And so Rachel, I know in our conversations with you and others on your team, you guys are really focused on engaging the community, specifically on the post acute side. And CHESS has seen a lot of success with a number of different programs like the sniff 3 day waiver. Can you share a little bit more about how you're really bringing the post acute community together on shared patients to drive, drive those outcomes?

RH: Yeah, absolutely. So Ellen, we actually have a very seasoned clinical teams. I want to give a lot of credit there. We have some previous sniff administrators. We have some oncology nurses that have since kind of moved to administration. We have currently practicing providers on that side and all of that fortunately when they came to CHESS, they already had a lot of long standing relationships within some of the kind of regional post acute network side. So with that we've been able to leverage a lot of their relationships to form kind of strong bonds, collaboration opportunities with local sniffs and hospices to help kind of intervene for these patients post discharge and then you know further down the line from a Hospice and palliative care standpoint as well. So I do want to touch specifically on that three day sniff waiver that you brought up. So we've had a lot of experience with that over the last five to six years. You know the three day sniff waiver was a component of the next Gen. model, the CMI or CMMI next Gen. model a few years back that had since sunset. But we have recently stood back up the three day sniff waiver as a part of our ACA reach model. We've already seen a lot of success there. It's a heavy administrative lift to get that off the the ground. But we have you know been able to place a number of patients even since the start of the year in a more appropriate side of care because of that waiver for patients with skilled therapy needs, patients that are coming directly out of the Ed that might have had falls and you know inpatient is not necessarily the most appropriate site for them. We're able to directly place them with a sniff. We've seen a lot of good patient outcomes so far, nothing definitive enough that we can share here, but are really excited about the trajectory of that program. We also have a really strong relationship with some local hospices. I do want to speak specifically about one with Mountain Valley Hospice. I think that Maria Hayes was actually just a podcast guest here, so I'll speak a little bit about that. Our clinical team has been working really closely with her and a couple of our clients to stand up a program that would allow for better collaboration between the Hospice, the provider, our care coordinators. So that we can make sure to intervene on behalf of that patient, make sure that they're getting some of the advanced care planning discussions, having some discussions about what they want their last chapter to look like earlier, so that we can help to empower them to meet those goals. This is just in the process of being stood up. So are really excited about what's to come there. I don't want to foreshadow too much and take away from the clinical team's experience, but I do want to say that we've already started to see some really good patient outcomes with some of those Hospice collaborations. So, Ellen, yeah, thank you so much for that question. I know that you also operate very heavily in the post acute space and that's been a very heavy focus for Bamboo Health in the last few months. So can you tell us a little bit about what you're hearing from your customers, the ways that they're engaging with their community partners and the post acute and other spaces?

ES: Yeah, absolutely. And I think it's a good segue from the discussion around like just engaging the community broadly because these are the providers that are going to help ultimately, again, serve as an extension of the care team to move the needle on those outcomes. I'll give a customer story instead of talking for as long as I did last time. But to give you an example, so we have a customer in North Carolina that implemented this program called ED Uturn and it's truly as it sounds. And we've since actually had this program expand to health systems and customers in other states. And the problem they were solving is how can we improve Ed throughput, reduce Ed length of stay, reduce overall Ed utilization and redirect patients to alternative care settings, whether that's home health, sniff, urgent care, primary care, so that they can get out of the hospital faster and go to a lower cost care setting. And so this, this customer came to Bamboo and they said, hey, can you tell me whenever a patient steps foot in my hospital that has a relationship with an external provider that would not be in my electronic medical record, that could be a patient that's active on home health and who is the home health branch that they're active with. It could be a patient that recently discharged from a sniff. And to your point, Rachel, you know, maybe they are eligible for the three day waiver or maybe they discharged from a sniff 2 weeks ago and they could go back to that sniff without a three midnight stay. Or maybe it's a patient that's attributed to a federally qualified healthcare center or FQHC. Or lastly, even a patient that's attributed to another ACO. And so the health system said we want to partner with these other external providers so that if the patient is stable, we can get them out of the emergency room quickly and safely to an alternative lower cost, safer setting of care. And what was really cool about this Edu turn program is it wasn't just that the hospital knew the moment the patient stepped foot in the Ed that was active on XYZ Home Health, the community providers also were getting a ping and they were notified, hey, my patient's back in the emergency room. And that's where that magic of care collaboration really happens, where both the community and the providers at the point of care are able to collaborate on these shared patients. And in nine months with this particular customer in North Carolina, they redirected over 100 patients that otherwise would have sat in the Ed for longer than they'd like, possibly been placed in observation or even readmitted because these are really sick and vulnerable patients. But that was a very powerful story about how the community rallying together really moved the needle on those outcomes they were solving for. And so, Rachel, I think, you know, it's been wonderful getting to talk with you again here. It was wonderful to talk to you at the NCHA winter meeting. Y'all have been such a good customer of bamboo health and you're obviously a wealth of knowledge in the industry simply because of all of your track record of performance and shared savings and outcomes. I'd love to know what are you most excited about the future of value based care.

RH: Yeah, Ellen, so I could probably spend all day here because I think there's a lot of really interesting things happening in the space that I think everyone's excited about. But I want to focus specifically on two areas that coincidentally also touch on ACO reach. So social determinants of health and HealthEquity. We have been talking about social determinants of health for decades at this point. But there have been a lot of movements made and a lot of progress in this area that's been really exciting to see. And I think everyone in the space is really interested to see where that's going to continue to move. So there are some more robust robust screening processes and kind of like acute and ambulatory spaces out there that's now leading to better coordination on the practice side. We're able to connect patients to the resources they need in a more efficient way, in a way that's more patient centered. So all of that's hopefully leading to better outcomes for them. There are also better tools for patient identification. We don't necessarily have to go through a full social terms of health screening. There's a lot of predictive information out there that we just talked about that you know, based on where the the patient is based, based on some other kind of clinical risk factors, we can identify that this patient might be at risk from a transportation standpoint, from a food scarcity standpoint. And we're able to engage with that patient in a more meaningful way without requiring such a kind of heavy administrative lift. There's also a lot more tools out there to better collaborate with community resources. I think Aunt Bertha Unite us there are there are a couple of tools that have been out there for a number of years, but we're seeing more and more kind of innovation, technology heavy vendors that are coming into this space. I'm really excited to see what happens there. It seems like from an end user perspective that's really improving collaboration and follow up to make sure that there are no gaps for patients once they once they start to be engaged with some of these community resources. I think all of that's going to hopefully impact some of these patients social terms of health long term. And then very related to that, HealthEquity has seen a lot of movements in this space. I think we've been talking about this since I first started with CHESS, but we're finally starting to see models mimic some of the talking points of kind of thought leaders in the area. So we've got a lot of CMS and CMMI models that are coming out that are now requiring HealthEquity components. Traditional MA payers are starting to add on to that a little bit and...