CareTalk Podcast – Helping Grandma Stay Home

Vesta Healthcare CEO, Randy Klein, joins the show to discuss the problems with elderly care in the U.S.

David Williams:

Welcome to CARETALK, America’s home for incisive debate about healthcare business and policy. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. Who do we have today, David?

David Williams:

John, we have a special guest as they’re all special, but this one is particularly special, Randy Klein. He is the CEO of Vesta, and he is going to be talking to us about how they support caregivers in caring for the frail elderly among others. Welcome, Randy.

Randy Klein:

Thank you. Glad to be here.

David Williams:

John, listen. We’ve both been caregivers for elderly people. We’re getting into the category ourselves where caregiver may be needed for us as the elderly patient at some point. But let’s hear about somebody who… I’m really interested in reading up about Vesta and understanding about really the frail elderly, which seems to be the focus. And I guess my first question, Randy, to ask a reasonable question is, what are some of the current issues in care for the frail elderly population?

Randy Klein:

When it comes to the frail elderly population, there are a ton of issues that are out there. Multiple chronic conditions, access to care, health literacy, complicated Medicaid regimens… And when you start talking about the population that we’re focused on, which are people with chronic conditions and functional limitations, what you see is that that combination leads to substantially higher costs and lower quality results than you would have for a population that doesn’t have functional limitation. This is where, what we’re focused on, which is enabling caregivers to create better outcomes for the folks that they care for is, is really focused.

John Driscoll:

You know one of the interesting things, David, is that the fastest growing population in America is the over 80s. We have tens of thousands of people turning Medicare eligible every day. We’ve got this boom let of baby boomers turning 65, but actually the fastest growing population of the elderly who are all on government care largely and who we will all be paying for is actually in the even older groups. The over 70s, over 75s and over 80s. And it is not a population that we as an American society are really well set up to care for because we’ve so quickly moved from sort of a family structure where most people live near their aging parents and not every spouse works to one where almost all spouses are working and people are dispersed and yet there’s this very fast growing part of the population. So the frail elderly are increasingly going to be one of the larger communities accessing healthcare and costing us a lot of money going forward.

David Williams:

Well John, I have a little challenge with that and I want to ask Randy about it because on the one hand, the society is not set up for it. On the other hand, we have a lot of people are eligible for multiple programs, right? You have Medicare based on age. You have Medicaid based on income. I think family members can even be paid as caregivers. And it seems like there’s so much going on. So I don’t understand what the problem is.

Randy Klein:

Yeah. So you can have too much of a good thing and confusion that results from it. I would venture to say most people that are out there, even listening to this podcast, don’t fully understand the interplay between Medicare and Medicaid and don’t fully understand what a caregiver can do, what a personal care aid is, what a privately paid for aid is, and all these different categories there. And as a result, you end up with all sorts of gaps and overlaps. Without a doubt, there’s tons of coverage. That’s the exciting part. As John just mentioned, most very senior individuals will end up as dual eligibles, either because they’ve always been there because they spend down to it.

So the vast majority of us, if we’re lucky enough, are going to end up on both Medicare and Medicaid. That being said, actually accessing that care, having those folks from the physical health side of the world, your doctors and hospitals and nurses, working with those that are dealing with your functional side of your health, your long-term care, home care, community-based needs. That’s a pretty big bridge to span. And there’s lots of reasons why it’s difficult to do it.

John Driscoll:

Randy, tell us a little bit about exactly what Vesta is and who you currently serve.

Randy Klein:

We believe that caregivers and there’s 40 to 45 million caregivers out there, 2 million plus paid home care aids are the largest untapped, most powerful resource in the delivery system that there is. However, for a lot of reasons, they haven’t been accessed and leveraged in the way that they should be. So what we do is, is we empower those caregivers and enable them to create a world-class care outcomes at home. We do this through a combination of our technology and services. What our technology does is protocolizes an approach to both monitoring and intervening in events when they occur. So understanding both the client and the caregiver and what it takes for them to be safe at home. And then pairing that with a purpose-built clinical team that provides real-time guidance, tele-health and intervention to support those caregivers.

Caregivers, and we’ve all been them here, are the folks that have the greatest insights about what’s happening in the home. I’ll give you one quick stat. For somebody that has home care, they typically will have 150, this is from CMS, 150, 160 encounters with their home care provider in the course of a year, which compares massively to any other provider that’s out there. The problem is that home care aid doesn’t even have an NPI. So they know more about that patient than anybody else. And we listen to them, guide them and help them.

John Driscoll:

What is this NPI thing?

Randy Klein:

Yeah, so I went sort of a jargony there. They’re not technically a provider. So as we said, a moment ago, we’ve all been caregivers here. Unless I’m misinformed, none of us are actually practicing as clinicians. So our ability to access medical records to put information in, to diagnose, to treat, really to do anything other than just simply say, “Mom, doesn’t look good today. Something’s going on. I don’t like it. She’s not eating as normal. She’s had a fall. What the heck should I do?” We’re really, really good at that. And really, really bad at getting to somebody that actually can help and guide us.

So as a result, what we tend to do, and this bears itself out in the data as well, is we tend to call 911. So when somebody has, this comes from Commonwealth Fund, when somebody has three or more chronic conditions, they have a high cost. When they have functional limitations, meaning needing assistance with activities of daily living and other such activities, their costs skyrocket. Go up about 70%. Their likelihood of having an adverse event goes up about three and a half times. The reason for that is that now you have somebody else, you have a new variable in, and that variable is somebody who is a human that sees what’s going on, gets scared and wants to help.

John Driscoll:

Just sort of kind of contextualizing it,` we’ve got a system that, a hundred years ago, relied on families that were local and usually an aging relative would be cared for by one of the older female spouses to often the oldest daughter. But we’ve got a system right now that is still relying on, in many cases, the oldest daughter, if you look at the AARP data around aging research. But often that daughter is working full time, is raising and responsible for their kids, and often their households healthcare and we’ve set up professionalized paid for system through healthcare and they’re disconnected. And I think what’s exciting about what you’re trying to do is connecting them. And obviously as CareCentrix, we’re super focused on leveraging that kind of a bridge to make sure that more people can get care in the home.

Because the thing that I think most people don’t realize is one of the fastest growing risks, mortality risks, is a visit to the hospital. So we can avoid visiting the healthcare system either through 911 or just because you’re lonely or hungry or you think that’s the only way to access the system is to go to a hospital. We can actually, I think, lower all cause mortality for the aging elderly people. And that’s what’s interesting but that bridge needs to be built. And so what is Vesta actually doing to build that bridge between the caregiver who is connected to supporting the, when you say functional needs, really the activities of daily living that we’re talking about what, what does Vesta actually do to kind of make that work?

Randy Klein:

Yeah, so we’ve created a two-sided approach where we work both with payers plans, as well as original Medicare and providers, meaning home care agencies and caregivers to bridge between the two sides. And what we do is we identify folks that have needs. This can be from either side of them. Bring them into our system, where we provide them with a setting of care provider that we call a home carist. So if you think about healthcare there’s different providers out there. There’s primary care, which focuses on community and wellness. There’s hospitalists, which focus on internal medicine in the hospital. There’s sniffist which focused on internal medicine in skilled nursing facilities. We are a setting of care provider that oversees care in the home for folks that have long-term home-based care needs. We then provide the care recipient and their caregivers with a technology that links them back to the home care.

John Driscoll:

But technology when you… Again, Randy, sorry to interrupt. But technology is like… Are you talking about a telephone? Are you talking about like activity monitoring? Are you talking about implantable chips? I mean David’s really into implantable chips, by the way.

David Williams:

Hey John. Okay. Listen a hammer is a tool to John. So I liked, what you pointed out before John about the trip to the hospital is itself very dangerous. I like how they talk about improving outcomes, reducing cost, but also increasing time at home. And I thought that was a really good positive measure of how somebody would look at it. But John, the thing is that in the past you had great, you had very caring people, but it was really just palliative care. And when I hear about technology, what I’m hearing now is that the home care provider they can still do the palliative care and perhaps better than anybody else, but they can also be connected through technology to the parts of the healthcare system that you do want to access. So you can actually do treatment, you can do monitoring and have more of an impact. So I think despite the fact you’re trying to beat Randy over the head with your technology. I think that’s what he’s trying to get at, but I’ll let him defend himself.

John Driscoll:

But don’t you think he should explain himself, as opposed to you trying to explain himself? I’m kind of embarrassed by you, David.

Randy Klein:

So we’re working on the Vesta cybernetics division. That’ll be coming out soon enough, but in the meantime, we’re using pretty standard stuff in the home. Medical alerts devices like “Help I’ve fallen and I can’t get up.” Connected blood pressure monitors. An application that goes on to caregivers phones that allows them to trigger real-time interventions around a workflow tool that our clinicians use to protocolize these approaches. So one of the big differences for somebody that’s working with, with Vesta versus being out there in the wild, when you’re working with Vesta as a caregiver, Vesta knows who you are. They know who your client is or patient or loved one, whoever it is. And they know what you’re supposed to do to help that person be safe. They can make sense of the signal that you’re seeing and then guide you as to how to resolve it and if you can’t resolve it with stuff that’s already been planned for help you go through a planful approach to avoid those unnecessary events.

David Williams:

Hey, John, Randy sounds like you. Saying all this stuff about being at home, et cetera, et cetera. Now I understand why you brought him on.

John Driscoll:

Well, I mean, come on. Wouldn’t you prefer.. To me you’re getting kind of up there in years, David. I think most of us would rather keep you at home and all of us would prefer to avoid the hospital.

David Williams:

It’s like work from home. I thought that WFH stood for work from hospital.

John Driscoll:

I think, Randy, maybe talk… Maybe you could share a little bit about, you and I share a long friendship, talk a little bit about what brought you to this particular job and maybe some personal experiences that aluminate why you think Vesta works.

Randy Klein:

When I think about my own life there’s a couple of points where I can see sort of a pre and post. I was one of the caregivers for my grandmother. My grandmother passed away a couple of years ago at 102. She had an amazing life. She also had many issues of frailty there at the end. My mom and I were basically constantly on. And I think everybody can relate to this, we managed through texts and contacting her privately paid for aid and talking to her doctor. At one point, I actually had to hop on a plane and fly up to Rochester, New York, where she lived to get in front of her physician that wanted to cut open a 90 something year old woman and perform abdominal surgery on her. I’m like “There must be a better way here.” Just a absolutely crazy experience.

And when I joined here, one of the first things that I did was actually speak to her aid, a woman by the name of Gloria, about what we were doing. Her aid was and we weren’t in a position to support her directly at that point in time, but her aid was thrilled. She was like, “This is great. This is a team that will listen to me. They’ll help me. You know, it’s very hard for me to get the attention that I need to help take care of your grandmother.” Then we have replacement aids that would flow through. And that’s when I had a pretty good sense that we were onto something.

Fast forward to this past summer and one of my family members donated a kidney to another one of my family members. So we admitted both of them to Vesta. And part of that is because one of the challenges we had was getting attention from both the primary care and the transplant folks about what to do for the donor, right? And what to do when you got home. When we got through the donation process, when we got them onto Vesta, one of the things that my team did was connected with the transplant folks, connected with the primary care folks, got access to Epic, got to understand all of what we would need in order to get this person home safe and really took a huge burden off of me and the others around us, because we knew that we were going to be overwhelmed. Well, fast forward, the surgery was success. Discharge happened. Two days later, it’s Friday at 8:00 PM. And the donor gets a cough. Not a great situation, right? What are you going to do?

So we contact the on-call, as you might expect. And what the on-call says is, “Hold on, we’re going to get somebody back to you shortly.” In the meantime, I press the button on my caregiver app and I get to our clinical team. Our clinical team immediately says, “Hey, let us do a consult.” So they do a consult and this is, you know, telehealth 101 nothing particularly special there, but then what they do, that’s different is one they know me two they have access to all of the donor’s information and they are able to determine they need a physician level person to do an evaluation of what to do. There’s certain drugs they can and can’t be taken.

So we got to a Vesta medical director. The Vesta medical director looks at the record and concludes that this can probably be treated with an over-the-counter cough medicine. We do the over the counter and an hour later, the donor is fast asleep feeling well. I don’t hear back from on call until the next morning. That was a case where, as a caregiver, I got incredible service and an outcome, even with somebody that’s not core to, you know, our target sect. We’re not trying to do transplants today. It gives a sense of the ability to support a caregiver, to make things happen. That’s a pretty edge case for what we do.

John Driscoll:

What would happen, I mean, obviously it’s your company. You’re proud of that. Walk me through what happens if someone’s not there. If you don’t have anyone, if you don’t have access to Vesta or Vesta like services.

Randy Klein:

So that was my use case before. That was my use case with my grandmother. That was me texting with a home care aid, trying to reach her primary care after hours. Literally having to fly up to get the attention of a physician, you know, constantly being in a range of catch-up because I wasn’t in a place to impact or affect what was happening. I happened to believe that most caregivers, and I think that this is probably a pretty universal experience, if you were dealing with this situation that I was with the transplant, you would’ve called the on call. You wouldn’t have heard back in the on call. You would have called the on call again and you would have taken them into the ED because you’re really scared.

John Driscoll:

You would have gotten the recording it says, “If this is an emergency,” as is if you’re qualified to assess that, “Please go directly to the emergency room.” Because that’s what’s on everybody’s recording even before someone picks up.

Randy Klein:

At 10 o’clock on a Friday night where the person is in pain and you’re not quite sure what to do. You betcha. You’re going right in. And instead, the person in my life took some over the counter and got to have a good night’s sleep.

David Williams:

Randy, that’s a great story. And thinking about, especially during the pandemic, how challenging it’s been to be a caregiver or to be somebody who’s sort of ancillary to that. And I think the service probably even more valuable than just thinking about my own experience. John, should we wrap it up or do you want to beat Randy over the head one more time?

John Driscoll:

No, I think the only thing I’d say is that I think that there’s an emerging market for what CareCentrix does, what Vesta does. The ability to build those technology and human bridges and it’s got to be both, it’s got to include clinical, it’s got to include people and it’s got to leverage technology, to create what I think is going to be a much more civilized and healthy and happy aging at home, which is kind of whatever everyone wants. I mean, there’s 70, 80% of people would prefer to age and die at home and only 20% of the people really get the chance to do that. We waste trillions of dollars in excess medical care and costs, not just in healthcare costs, but in residential costs that are unnecessary. If we can continue to roll out these new pathways and I think leveraging technology is brilliant, Randy, that’s, as you know, I’m a big fan of that. And I’m just excited to have you on the show and share some of what you’ve been able to accomplish.

David Williams:

John. I think we have a subtitle for the show anyway, which is going to be called preaching to the converted. But in any case, that’s it for yet another edition of CARETALK. I’m David Williams, president of Health Business Group.

John Driscoll:

And I’m John Driscoll the CEO of CareCentrix. Like what you heard or didn’t please subscribe.