Q&A: Think about Pediatrics CEO George Boghos

A Nashville-based medical group known as Think about Pediatrics is partnering with well being plans on a value-based cost mannequin that brings 24/7 medical, behavioral, and social care and help into the properties of Medicaid-eligible youngsters 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 youngsters with autism and their households who’re from communities that have well being inequity.

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

Boghos: Pediatrics usually is likely one of the final locations for innovation in healthcare. My mom is a pediatrician, so I’ve grown round pediatrics my entire 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 children who’re usually wholesome. You go to a pediatrician a number of instances a yr and also you’re spending possibly 10 minutes along with your pediatrician, and that works for most children. Who it does not work for is children with power advanced medical circumstances. What that is led to is youngsters and their households using the emergency room at a really, very excessive charge – 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 children 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 employees — a full interdisciplinary care staff that’s actually investing time to get to know these children and their caregivers, and catch issues preventatively by way of each day or weekly contact factors, but additionally be there 24/7 for these households after they want the help. So in a nutshell that’s what we’re right here to do.

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

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

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

Boghos: The best way we do it’s a wholly value-based inhabitants well being mannequin. We accomplice with Medicaid managed care organizations. We take full danger on the whole price of take care of these youngsters who qualify into our program, and we’re right here to handle their total 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 help, however we’re there to fill the gaps. And our major intention is to maintain children more healthy and happier of their properties and out of the hospital after they do not should be there.

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

Boghos: That could be a essential level, as a result of rather a lot our youngsters and households have 5 to 10 totally different healthcare suppliers concerned of their care, and the very last thing we wish to do is be an additional layer in that journey and complicate issues additional. So we have invested a ton in our expertise spine. We work with our households by way of 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 data exchanges within the markets we’re in. We’ve received ad-hoc one-on-one knowledge integrations and connections with the large suppliers, pediatrics teams and complicated care clinics the place we’re practising. We’re sharing that knowledge each day. Each time we have got an encounter with a baby the place we’re wanting on the care plan that their specialists or pediatrician developed, we’re consulting with that pediatrician, and we’re sharing data so everyone’s within the loop.

HCI: I learn that your organization is working in Florida and Texas presently. Are you able to identify 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 Neighborhood Plan of Texas and UnitedHealthcare Neighborhood Plan of Florida.

HCI: Is there a specific cause you’re in these two states first? 

Boghos: There’s rather a lot that goes into it. A whole lot of the worth we convey to our plan companions helps them innovate and clear up a necessity for a inhabitants that is troublesome to handle traditionally. So it is based mostly on states the place the plans have had problem caring for kids with medical complexity, and people states rose to the highest. Secondarily, we turn into, an vital a part of the differentiation available in the market for well being plan companions, as a result of they’re seeking to win bids or develop their market share in these states, and this might turn into an vital differentiator for them.

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

Boghos: Sure, that’s our plan. We have quite a lot 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 yr. 

HCI: It looks like typically startup firms have a rooster and egg drawback the place a payer would wish 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 carried out it with a corporation of that measurement?

Boghos: In two methods. One is that a part of our founding staff had carried out this very factor. We’re speaking a couple of 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 additionally by way of lowering dramatically the pointless emergency room and hospital visits. So we had proof and knowledge factors, and printed work being carried out. 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 danger. If we’re not in a position to ship outcomes, by way of enchancment on high quality measures and stopping pointless hospital visits and lowering prices, the plan isn’t any worse off. In order that’s the great thing about a full-risk mannequin. A few of the plans are prepared 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 begin up? 

Boghos: We have been based out of a bunch known 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 way of value-based care fashions. 

HCI: Might 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 in a position to accomplish is a fairly excessive engagement charge of the inhabitants we’re serving. So we’re presently taking over danger on shut to twenty,000 sufferers throughout these two states, Texas and Florida. We have been in a position to have interaction a really massive proportion of them in a fairly quick time frame. We contact base with our households, on common, about 4 instances per thirty days. That is something from a chat on our app to a digital go to to an in-home go to. We have carried out north of fifty,000 affected person interactions simply within the first 11 months. 

Extra importantly, we have got 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 % discount in impatient quantity, and a couple of 20 % discount within the whole price 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 scientific groups to help scaling this up? 

Boghos: I believed it could be our largest problem, however I have been pleasantly shocked with how properly we have been in a position to appeal to actually wonderful teammates right here. And an enormous a part of the reason being that is very totally different from something in pediatrics, proper. We have been in a position to appeal to 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 in a position to drive influence. As an alternative 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 cut-off dates of the 10-minute appointments. 

The opposite great thing about our mannequin is as a result of it is digital first, we’re serving children in very rural areas as properly. We’re in a position to have a staff that is based mostly in Houston serve youngsters throughout your entire state of Texas, for instance. So by way of enhancing entry and well being fairness, but additionally permitting us to rent the proper expertise and the most effective expertise and be capable to serve children 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 assets at sufferers who historically are underserved?

Boghos: I believe so, and I hope so. You recognize, we spent quite a lot of time on our philosophy that digital care isn’t going to utterly exchange in-person care. However it could dramatically increase it and dramatically enhance the entry points. If you consider a small PCP apply in a rural a part of Texas, we’re augmenting their capacity. We’re in a position to be there 24/7 for these households inside minutes of after they want us. Enhancing that entry situation is of big significance to us and I believe quite a lot of virtual-first fashions are going to have the ability to try this to the betterment of the households, the sufferers and actually your entire 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 strategy to dramatically increase the influence of in-person care.