Adam Torres and Krista Smolda discuss outsourcing care.
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Show Notes:
Value Based Care is at a turning point. In this episode, Adam Torres and Krista Smolda, Chief Brand & Product Officer at CareTalk Health, explore Value Based Care and how CareTalk Health is helping its clients with outsourced care management.
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About CareTalk Health
CareTalk Health was born as a result of experienced leaders in the virtual call center operations space coming together for a greater cause than just making and taking sales and service calls. Their leadership team has spent decades scaling and managing large accounts to deliver business solutions in Sales and Customer Care, for companies like Amazon, Comcast, American Express, United, Disney, and Blue Cross Blue Shield, to name a few.
They decided that it’s time to do what they do best, but this time around, they would make a difference! Taking their combined knowledge, skills, intense work ethic, and entrepreneurial spirits, they knew that healthcare was the industry where they could make the greatest impact.
Like every team of entrepreneurs, they recognized a problem: A massive and rapidly growing population of Medicare patients with simply not enough physicians and nurses to care for them in person. That is where CareTalk Health’s CPO network solves this problem. They know that large-scale solutions in virtual care require working with a team that can efficiently operationalize the virtual experience and patient journey from engagement, to clinical encounters, to ongoing care, and billing. They are that team!
Full Unedited Transcript
Hey, I’d like to welcome you to another episode of Mission Matters. My name is Adam Torres, and if you’d like to apply to be a guest in the show, just head on over to MissionMatters. com and click on Be Our Guest to Apply. All right. So today I have Krista Smulda on the line, and she’s chief brand and product officer over at CareTalk Health.
Krista, welcome to the show. Thank you so much for having me. Adam. All right, Krista. So we got a lot to talk about today. So we’re going to talk about outsourcing care management for Medicare patients. We’re going to get into what you’re doing over at Care Talk Health. But just to get us kicked off, we’ll start this episode with what we like to call our Mission Matters Minute.
So Krista, at Mission Matters, our aim and our goal is to amplify stories for entrepreneurs, executives and experts. That’s our mission. Krista, what mission matters to you? Adam. Other than being a wonderful mother and, and producing children that are contributing members of society, a mission that matters to me is to really assure that what I’m doing, what we are doing over at CareTalk Health and building right now will be something that in the next five to 10 years becomes a common practice in health care.
We’re not in it just, you know, to ride on a fad or anything like that. You know, when ideas is. And so what we’re doing is real. It solves a problem in the health care system, which we’ll talk about later. So for me, it’s making sure that all the time and energy I’m putting in right now in creating solutions that solve problems are not just something that sticks around temporarily, that they actually become the norm.
And ultimately, Help the elderly population get the care and the attention that they deserve. So that was the mission that really matters to me. Amazing. Love bringing mission based individuals on the line to share why they do what they do, how they’re doing, and really what we can all learn from that so that we learn and grow together.
So great having you on. Just to kind of start at the beginning here, like when did you first get involved with healthcare? Like how did all of that, how did all that happen? It was the grace of God that got me into healthcare. I spent. I spent 15 years in the telecommunications industry. I was actually on Comcast for all of that time.
I was managing their outsourced call centers, then spent another five years doing the same thing for a large company. And, you know, I just got burnt out. I wanted to do something that would be more creative that would allow me to lead a little more, you know, a large organization, Comcast, you’re just, you’re just kind of small there.
And so I felt like it was time to leave. And I literally quit my job one day and I leaned on my network of people that I had, you know, built through the years. A lot of very intelligent entrepreneurs. There was a man named Donnie Gross, who I worked with at a previous life. And he’s the kind of person that if he calls you take the call.
Called me four years ago and he said, Hey, I have a business idea. I’ve always respected you. I think you’re very intelligent. Meet me in Delaware. And I want to present an opportunity or a business I want to start. And so I got in my car and I drove. And we had a great conversation and he introduced me into health care to actually start business that I’m in right now and I’m grateful to have been given the opportunity to, to learn a new business, but more importantly, to make a difference, you know, which goes back to the, the original mission.
Now, I know you’ve been in this business a bit, but if I can stay in those early days, just just a little bit longer, I’m curious as to other than obviously the business side of the opportunity, but a lot of times when an entrepreneur see something when you’re creating a business or something else, there’s a problem that you’re looking to solve.
Ideally, right? If you’re looking at there’s a or a niche or a community you’re looking to help as you were kind of tooling up and learning your knowledge on the health care side of things. It may be some of the opportunity areas. Did anything surprise you? Yeah. Yes. What surprised me was, well, first of all, I did more reading in the last four years than I did in the 16 years of schooling.
It’s heavy. It’s heavy learning a new, a new profession. I love that, that you did that, by the way. Thank you. And I’m like, is this really happening? Right? Like, are these people really going to be in trouble? You know, in 2030, 90 million. people that are over 65 and right now there’s 66 million. And by the way, at the same time, what’s happening is there’s a physician shortage, right?
I think at the end of the year will be 64, 000 that are just kind of leaving. That’ll be 86, 000 short in 2036. And so you go, okay, now I understand what the U. S. health care crisis really is. Not just like a headline that’s like quick, a quick blurb or something on Instagram. It’s real. Yes. People are getting sicker.
So that’s going up. And then the physicians and nurses available is going down. So this is where this, this this problem occurs. I also learned a lot about Medicare and the all of the services that are available to patients that unfortunately they can’t take advantage of because the doctors are too busy to give the extra services to patients.
And so, so, yeah, that was a problem that I thought, our company, which is, you know, a telehealth company, we can help solve that problem. You know, we can definitely make a dent in the in the problem. Yeah. And speaking of Medicare, I know that you can help more than Medicare patients with in your company.
But today I know we’re going to focus a bit on that side of the business, but I do like to preface that in the conversation that I know that you’re helping a lot of different areas, but we’ll probably get a little bit further into Medicare patients as well. But before we do that, maybe Let’s start with a broader discussion of just the care in general.
Maybe start with like value based care and just even what that means defining that because the term that thrown around a lot, but maybe not as much understanding as we’d like. Yeah, I definitely didn’t understand what it was on day one. I can tell you that. But basically what it is, it’s a health care delivery model and it tries the amounts when I say the amount.
I mean, the amount of money that the providers are making and for their services, but it directly correlates it to the value of the delivery of the services, right? So. It’s designed to focus on quality of care, provider performance, patient experience. It’s taking value and it’s putting more on that than there is on volume.
Okay, so there are actually quality measures that are out there now. Terms like KETA scores and CMS star ratings where providers, ACOs, organizations are scored on this this value that they’re bringing to the patients. It’s no longer about how many can you pump through the system? You know, are they repeatedly going to the hospital?
Are they getting better? Are they getting the time and attention that they need? Think of this as sort of like a report card, right? So if you have a bad grade on your report card, you’re not going to get paid as much money when you submit that claim, right? And so on the flip side, if you’re doing good and you have a good score, you’re going to get financially rewarded.
So providers are, their financial dependency is really, they’ve got to get down this value based care system. If they don’t, 2030 is the deadline. They’re, they’re going out of business. So yeah, that’s, that’s a problem. Yeah, that is a problem. And so what, so what happens next with this? Like if as people are not like, how are, how is the industry tooling up?
Like how are people like adjusting for this? So they’re adjusting in a few ways One of the ways we I think they should adjust I talked about the problem where there there’s too many sick people and not enough nurses and doctors to take care of them. Yeah, we would use a function like virtual.
Telehealth, take care of some of those problems for them. Some of those visits, everything needs to be in person, right? You can get a better grasp on how your patients are doing by by outsourcing some of those functions like doctor visits, nurse visits, right? Annual wellness visits, getting those quality scores up and outsourcing function to companies like actually care talk.
How is the concept of outsourcer been dealt with in the past versus now? I feel like now there’s a, there’s obviously a bigger need and maybe there were always was a need, right? But now it’s, it’s front and center. Like it has to be done for certain, for certain areas if they’re going to catch up, so I’m like, that’s for that problem that you’re mentioning.
Like, how has it been done in the past versus kind of like where it’s being done now? Cause I’m trying to understand, like, it seems to me like, and I’m not, I’ve never run a clinic, right? So it seems to me like it would be something that somebody would be like really warmly embracing, like, yeah, like a outsource, like let’s get, might be more efficient.
Let’s do this. Let’s do that. Let’s become more, even more profitable. Right. How has the industry look at it though, as a, as a, as a clinician or as somebody owning a clinic, like how does the industry look at that? So I think the, the functions that are being outsourced now. Are more administrative functions.
For example, Hey, we’ve got a bunch of people that we have to get in. Let’s have some other company make a bunch of phone calls and get these people to show up for their appointments, right? To book the appointment. And would you say that’s the, just for context, would you say that’s the bottom of the, not bottom, but like one of the most basic services that might be a better way to word it.
Yeah. Yeah, it is. But I’m just trying to understand it. Go ahead, please. Yeah, I don’t think it’s about, you know, how has it been done then versus now? I think it’s for doctors anyway. And for health care organizations that have patients, there’s a trust factor where they are hesitant to outside. Yeah, I understand for a nurse visit.
And so that is where, you know, really having an organization that like, and I’m going to tell care to all California, we come from California. Yeah. large organizations. We also have people that really understand health care and we understand the importance of the doctor and the office practice having to after the interaction occurs with our doctor or nurse.
To have that information given back to them so that the continuity of care is kept throughout the process. What are some of the, so, help, help become a shopper, if you will, with me. What are some of the things that if there was a checklist of things, because you did mention one or two just now, but if there was a checklist and the doctor or clinician or somebody’s Watching this and they’re saying, you know, we should really consider this.
What are you being in the space? What are some maybe things that they should be looking for and whomever is going to be their outsourcer. So there’s three things that come to mind. Number one, if we’re speaking of this, you know, value based care. Yep. Quality scores, right? Hey, let’s get the good. There’s a lot of open gaps in care.
What we call gaps in care, you know, is all revolving around preventative things. Like, did they get their annual wellness visit? Did they get their colonoscopy, you know, booked? Are they getting their A1C’s measured? Are they monitoring their taking their medicine properly? So a gap in care is something that if it’s not checked off and it’s not done, the score, the score becomes lower.
And so gaps in care, not all of them, but a lot of gaps in care can be outsourced to someone virtually to just kind of check the box and get it done. One, I think the other thing, the other service that that doctors and healthcare organizations should be taking advantage of is chronic care management, patient monitoring, because what chronic care management came out in 2014, believe it or not.
Why did Medicare think chronic care management was a service that they should cover? Because of what I previously said before patients with chronic disease, it’s over 75 percent of the Medicare population has two or more chronic conditions. So it’s a lot of people. It’s a fact that they require. More time, more attention, more talking to in between doctor visits.
But again, the doctors don’t have time. So the chronic care management program basically says, Hey, doctors. We’re going to let you spend an extra 20, 40 or 60 minutes a month with the community population and you can bill for it and we’ll pay you. That’s wonderful, right? I’m a doctor. I think that’s a great service, but I don’t have time.
I can’t document the process correctly. I don’t have the staff to do it. And so they just kind of have not participated. And what you get with chronic care management is patients get monthly check in calls, they get a minimum of 20 minutes of conversation, they get a care plan developed for them, they get 24 by 7 access to a nurse, nutritional guidance assistance scheduling appointments, care coordination.
Yeah. And, and one last thing that is very important. He’s combating loneliness. You know, the ability to speak with someone other than your doctor every three months or when you’re visiting, you know, is very, very, very valuable service. So that’s chronic care management believe every person that is eligible for that on Medicare should be participating in a program like that, especially because it is covered.
And correct me if I’m off on this, but my understanding is that like some of the reasons why those even even the remote patient monitoring the point is to increase the, you know, the quality of living for the patients and to, and also it can drive down costs because maybe some of those with the remote patient monitoring, for example, maybe if they can catch something faster.
You can be a smaller problem that can be dealt with maybe inexpensively if we’re talking about like the cost of medical, you know, care versus, you know, letting something go and they’re not being monitored. Sometimes happens that now something that could have been smaller can become something very severe or, you know, more costly since we’re talking about cost to treat over the long haul.
Am I off on that or is that kind of the, I’m just trying to. No, it’s about early intervention. I mean, monitoring is wonderful. Patients can get a device and every single day their vitals can be monitored. Their weight can be monitored. They don’t have to be in front of a doctor. The one that I love is a continuous glucose monitor for people with diabetes.
I mean, before it was, you know, in order to know if you’re, Okay. blood sugar spike or dropped with prick the finger. Get in touch with your doctor. Hopefully it’s not Sunday or Saturday. Yes. Yes. Put a CGM on your arm. And that thing is constantly giving those readings. And, you know, you could give it to the patient, you could give it to the caregiver, but you could also give it to a team over here.
You know, that is. A clinical resource that’s watching and can at any time intervene and say, Hey, I’m seeing something wrong. What’s going on? Oh, forgot to take your medicine. You know, that’s the number one thing. So, so yeah, remote patient monitoring is a really, really wonderful, valuable service. And you mentioned also talking to talking to somebody like the human interaction, the human side of things like obviously I’m a podcast or some a voice person, right?
I got these here. These things in my ears all day long. I’m when I’m talking to people. So I value voice. What does that mean though for the Medicare patient? Like the human voice? Like, what does that mean to them? Yeah, I think, you know, To my 22 year old, my 18 year old, they probably don’t care to speak that they could do everything online and, and, and be because they’re in text to text, right?
There you go. Yes. But we know for a fact that the Medicare poption population needs to talk to people. We have proof of it that it matters. Even, I mean, some things can be, can be done. Of course, of course, book an appointment, get a script. But when you’re discussing someone’s health, Or wanting to really understand how they’re feeling, which is what we do when we monthly check in, you have to talk to them.
I mean, how many times do we, do we not send a text? Cause we’re not sure it’s going to be interpreted properly. And so same things apply here. And to hear those signs, right? Like depression, sad, like happy, like you get, cause just like any relationship, the more you, you know, you can kind of tell what’s up, what’s going on sometimes, right?
Yeah, you sound like you’re having trouble breathing. Is everything okay? Oh, I just steps. Do you normally and you can get into deeper conversations. The other thing is on the patient side, you know if they’re experiencing if they’re alone and they’re 85 years old and they don’t have to ask and it is Sunday or it’s eight o’clock at night.
You need to just speak with someone that is a professional certified me. To hear a soothing voice of a nurse you know, we actually dedicate nurses when they participate in chronic care management. We give them a dedicated nurse. If that nurse is not available or working, they can talk to someone else.
But, you know, sometimes it’s just about hearing nurse Bonnie tell you that’s okay, that’s not, or hearing nurse Bonnie say, You should probably get to the E. R. You know, that’s also enough. Most of the times that’s not the case and we can identify what’s happening. But when they hear the voice, you know, it helps them as well.
It’s mutual for the doctor as well as the patient. Yeah. Speaking specifically about CareTalk Health, is there a specific segment of the medical community, whether it’s, you know, size of clinic, hospital, or where, like, help me understand who in general are typically the best fit to work with CareTalk Health and the professionals.
Yeah, so, so there’s a right now who we’re working with and then there’s a who were in deep conversations with about to work with. So who we’re working with now are more, you know, we’re acquiring our, our patients through organizations that have. you know, see members, customers or patients. We’re working with right now device companies.
I talked about the glucose monitor. We work with pill dispensing company to do medication adherence, work with pharmacies to start to have some of these services in their pharmacy. But but the kind of I’ll go to what’s next is working with the organizations that really play more into the mission that I talked about before, which was those value based care contracts, like the payers, the ACOs, the healthcare systems that engage with us and make us a part of their strategic vision and their model going forward.
So we, we are in deep conversations right now with some key players and. That really ultimately is where the most impact will be made. The other thing about our organization is we we have a national NPI. So if needed, we can build Medicare directly in all 50 states, have physicians and nurses. in all 50 states.
So companies that are large and need to scale need to scale quickly. We have the ability to do that if needed. That’s a very unique offering that we have that’s different than some of our competitors. Amazing. Krista, this has been a lot of fun having you on the show today. I know some people are watching, listening to this that would want, may want to follow up and connect with your team and learn more.
How do people connect with CareTalk Health? Just go to caretalkhealth. com and there’s a section where you can fill out a form for contact us and someone will get back to you right away. And if you want to connect with me, please do that. I accept all connections and it’s krista small dot on linkedin.
Amazing. And for everybody watching or listening to this, of course, we will put the website. So care talk health. show notes so that you can just click on the link and head right on over. And speaking of the audience, if this is your first time with mission matters and you haven’t done it yet, hit that subscribe or follow button.
This is a daily show each and every day. We’re bringing you new content, new stories, and hopefully new inspiration to help you along the way in your journey as well. So again, hit that subscribe or follow button and Krista. So happy to have you on. Thank you again for making some time for us. Thank you so much, Adam.