Gregg Masters 00:08
PopHealth Week is brought to you by Health Innovation Media. Health Innovation Media brings your brand narrative alive via original or value-added digitally curated content for omnichannel distribution and engagement. Connect with us at www.PopUpStudio.productions. And welcome everyone. I’m Gregg Masters, Managing Director of Health Innovation Media and the producer and co-host of PopHealth Week. Joining me in the virtual studio is my partner, colleague, and lead co-host of PopHealth Week Fred Goldstein, President of Accountable Health, LLC. On today’s show, our guest is Nicole Bradberry Chief Executive Officer, and chairman of the board of the Florida Association of ACO’s, also known as FLAACOs. FLAACOs is the premier professional organization for ACOs throughout Florida, which provides education and collaboration in the fee-for-value health care space. Prior to launching FLAACOs, Nicole led the successful transition of Captify health to a specialty network benefits management solution prior to selling it to a large revenue cycle company Continuum Health Alliance, where she also served as their Chief Growth Officer. Nicole leverages her strategic relationships and strong leadership operations and technology background to develop innovative products and growth strategies for healthcare providers as they transition to value-based healthcare. She has led the strategy and design behind the development of scalable population health tools and the professional service model and enables physicians to successfully participate in value-based contracts. On today’s episode, we’ll learn more about recent developments both at FLAACOs and ValueH, including Nicole’s plans to innovate in the mental health space. So Fred, with that introduction over to you help us catch up with Nicole.
Fred Goldstein 02:04
Thanks so much, Greg. And Nicole. Welcome back to PopHealth Week.
Nicole Bradberry 02:07
Thanks for having me. Always great to connect with you guys.
Fred Goldstein 02:11
Yeah, it’s been a while we had a little lull in the action, I guess, not able to get you on during the COVID pandemic, etc. But it’s fantastic to be able to catch back up with you. So give us a little sense again about what you’re doing. And you’ve got a new group started the ValueH network, you’ve still got FLAACOs going along? What’s happening there?
Nicole Bradberry 02:28
Well, photos, as you know, we ended up having a virtual conference this year, like many others. You know, we even though we’re a small group, in comparison to a lot of larger conference forums, we thought it was just the practical and safe thing to do is just have a virtual, I think the conference went well, we had a lot of amazing speakers, amazing topics. And, you know, I do think we missed out on the great networking that we typically pull together at the conference. So I’m excited to announce that we are going to have an in person conference this year in November in Orlando are very excited about that.
Fred Goldstein 03:04
Fantastic. Yeah, really looking forward to that. It’s always been a great group of folks getting together incredible discussions, and really fantastic speakers. I know you’re early on in that, but I’m sure there’s much we’re going to hear about what’s happened. So what’s sort of been the impact on with COVID, the new administration, How are ACOs looking right now.
Nicole Bradberry 03:23
Well, I think direct contracting was, you know, something cool, and lots of people are embracing it allows a lot of new entrants in but I do think it makes ACOs nervous. What does that mean for for them? Even though I see it as an evolution, it was kind of the NextGen ACOs that evolved into direct contracting. But I do think the way they’re coming in the marketplace, the potential for the GO, even though they’ve they’ve paused that temporarily with the new administration, or it could be permanent, we don’t know. But, but I do think there is some nervousness around what DC means to a ACOs. One of the reasons, you know not to segue ahead of you, but we’ve created a network called ValueH network, which is going to aggregate ACOs in order for them to take on new and different contracts, you know, we let them delve into MA lets them delve into DC in an interesting way that we hope to bring to the marketplace that lets them do things like direct to employer, and we’re getting so much interest in that. But I think it’s kind of swaying some of the nervousness or mitigating I guess, better words, some of the nervousness that ACOs are having because of DC and maybe some that’s it might be coming out of this administration. Having said that, though, I do think that this administration might be backtracking and really listening to some of the ACOs concerns, and so it could end up being a good thing.
Fred Goldstein 04:51
Yeah, and you know, it’s interesting, you mentioned that Gregg and I had been talking about this a bit, this whole concept of, we’ve sort of seen this move from some employers obviously CMS to go into direct contracting, and you’ve had these ACOs, that some have been, obviously very successful, others less so. But sort of in a model that wasn’t quite as risk-taking, although it was moving that direction, and is that you sort of see that and also, obviously recognizing with your work in ValueH network, that it’s sort of jumping to that next step rather rapidly. And ACOs have an opportunity to play in that if they’re willing to get more into a direct contracting and risk-based model versus some of the earlier risk models based on improvement in various measures and outcomes.
Nicole Bradberry 05:34
I do, I think, you know, at first, I was kind of sitting back, trying to figure out what was really wildly different about direct contracting, versus some of the higher risk models and the pathways of success, certainly, pathway to success has pushed, you know, ACOs , especially the high revenue, ones to go to risk very quickly, the less high revenue had a little bit more leads, you know, runway to get there. then here comes direct contracting, where you’ve got, you know, lots of different parties able to come in and be part of, you know, payers, managed Medicaid technology companies that that want to go at risk that had enablement service versus just really MA, you know, traditional MA enablement companies, or going into direct contracts are very interesting, who’s coming into direct contracting. And for those ACOs that were ready to risk weren’t ready to go to risk, it’s like, do we do we partner with one of these VCs? What do we do, so that we don’t lose this infrastructure, network, etc, that we put together, you know, because if we don’t do something, see another interest are going to come in and pick off our doctors. And so it’s been, you know, there’s good, there’s bad and there’s some interesting movement. And you know, back to what I’m trying to do with ValueH Network, I’m open to help these ACOs stay in place, stay together, really with the focus on independent entrepreneurial providers. You know, we’re not really trying to recruit hospitals, we’re trying to go help these independent entrepreneurial providers, you’ve created ACOs, which is really that Florida marketplace come together and have power and negotiation with some of these theses coming in, and as well as some of these other interesting contracts.
Fred Goldstein 07:08
And when you talk about these value-based care and value-based contracting, it sounds like you’re getting more to direct risk-bearing based on you know, they’re going to take the the providers are going to take the risk, or maybe in partnership with a VC firm or something versus some of the earlier models, is that what you’re getting at,
Nicole Bradberry 07:26
yes, but trying to, you know with ValueH Network trying to help offload some of that risk. So allows the doctors to bring all of that great enablement, they’ve put together all of that infrastructure stay intact as an ACO or an MSO, or CIN whatever way they kind of formed, but come into a network that that that helps with that risk that offload some of that risk, and also bring some additional enablement, where it’s needed. And that’s really the premise behind ValueH Network. And, you know, and building off the FLAACOs relationships and the trust that that we’ve built there.
Fred Goldstein 07:57
So in terms of ValueH Network, it’s not just a group to get together like Flacco says, in a sense, it’s actually going to have some services and, and things it provides as well as being able to offload some of that financial risk.
Nicole Bradberry 08:11
Exactly. It’s first it’s pulling the network together. But instead of going out and recruiting individual doctors, we’re trying to go and in and bring together these entities, ACOs MSO, CINs, IPAs, who who have got some enablement, has some structure, you know, have leadership and all of that in a local area or in a broader area, and we want to leave that intact. So we want to be able to bring value to that level entities and and then allow them to share in as much risk as they want to take. So, you know, some will be willing to take more risk than others, but ValueH will supplement where where they need to help? And then along with that, wrap enablement tools on top of it.
Fred Goldstein 08:56
And for for those who may not be aware of it, can you define a CIN?
Nicole Bradberry 09:01
So clinically, integrated network, independent provider Association MSO is Management Service Organization, a new coin is vert is value service organization, of course, ACO, Accountable Care Organization, right. And so
Fred Goldstein 09:16
how is this different from something like an Aledade?
Nicole Bradberry 09:21
So it’s, you know, it’s not different in the premise. And as you know, I started a company called Orange Health that rebranded to Citra Health, which is the early predecessor of an Aledade or Caravan, you know, which are groups that aggregate doctors help share risk, bring enablement. I mean, it’s, it’s very similar, I guess the differences. We’re starting from Florida, we’re starting from the base of trust within the Florida Association of ACOs, those relationships that we’ve built over these years and saying, okay, let’s start in Florida, and let’s help all of these entities that exist, stay intact. And so I think the differences maybe Aledade and Caravan are still trying to recruit one doctor at a time or partner individually with an ACO to let that individual ACO take on a contract, where I think we’re a little bit different. And we’re trying to aggregate across ACOs across them across MSOs and bring them into one network in order to take one contract. But then ValueH can divide by those entities, why they would participate, what level of risk, they want to take what enablement tools, they may or may not need, you know, if the ACO is rocking and rolling, because they’ve got all the great stuff in place, then, you know, let’s let them continue to do that. But bring them the contracts, that gives them a richer upside. And so you know, everyone is different, but ValueH, will create conformity around how they receive data, how they receive, you know, information from all the different contracts.
Fred Goldstein 10:46
So when you talk about enablement, are you going to bring in a standardized IT system for that kind of stuff? Is that what you’re thinking about?
Nicole Bradberry 10:53
Well, so I, I, I don’t believe that you can take a group that might have 15, EMRs, and tried to standardize them into one, you know, that goes against kind of that independent entrepreneurial spirits. But certainly, we will provide analytics as a service and standard way. And we’ll try to, you know, integrate with whatever tools or tools that they already have, if they need some standard toolsets, we certainly will have them to offer, but we won’t require them. You know, ours is much more of a service enablement? How do we provide stuff to supplement and very ala carte fashion, what they have or have not in place, but the most important thing is we’re going to bring them contracts, they probably couldn’t get on their own.
Fred Goldstein 11:32
Got it? Got it. So you’ll serve as a marketing vehicle for them.
Nicole Bradberry 11:36
Yep, aggregator marketing vehicle and, and also help them manage risk. Got it?
Fred Goldstein 11:42
And so are there other groups involved with you now on this, you know, have you figured out whether you need, you know, financial support groups or VC companies or IT companies, you’ve chosen to work with you on this?
Nicole Bradberry 11:56
Well, the first thing we’ve been going after are contracts. And we’ve got three pretty significant contracts in flux right now that we’re about to finalize, most of those contracts come with some financial support in the early days. And and so we believe those will enable us to go and negotiate the deals for reinsurance and stop loss and things like that, that we’ll need to bring into the fold here. Some of them come with some of that already. And some of it will, we know that the revenue that comes with them will allow us to code get those and operate, we also bring in enablement partners. And some of them coming in and being part of this as they bring some not just capabilities, but some of the financial wherewithal to do this. And so it’s interesting, you know, as we’re putting this together, all the people that want to participate and see the value long term and are willing to invest.
Fred Goldstein 12:46
Yeah, fantastic, really great idea. And do you see this being something that you that each of the communities has their own, you know, brand within that community, etc? Are you going to do a powered by ValueH, or some other type of approach?
Nicole Bradberry 12:59
I think it’s, you know, the power by ValueH is the approach, you know, we want whoever the local leaders are, that created these entities, we want them to have autonomy and a lot of ways. In fact, you know, if they can go out and get contracts themselves that are better then they can stick with those. If not, they can, they can be part of the ValueH network for the contracts that serve them versus those that they’ve already negotiated. And so it’s very much of an ala carte kind of approach. If we help you great if we don’t keep on doing what you’re doing. We don’t want to intervene. They want to interfere.
Gregg Masters 13:32
And if you’re just tuning in to PopHealth Week, our guest is Nicole Bradberry, Chief Executive Officer and chairman of the board, the Florida Association, ACOs.
Fred Goldstein 13:43
And in terms of obviously ValueH, he has to have some sort of a revenue generation model. Is it something that will be on a per life basis? Are you looking at a risk-based basis for the organization itself, like an Aledade does or how much you work that
Nicole Bradberry 13:58
it’s both I mean, our ultimate goal is to participate in risk across the board, all these contracts, you know, we’ve got run rates negotiated so we can come in no risk and get to risk within a year. You know, we see the recruiting, the enablement, all of that stuff. There’s its own financial strain on top of the financial strain that the ACOs, and the doctors underneath them, we’ll get to it tonight. Everybody wins. Everybody gets fed in the food chain to make all this work and come together. And we’re, you know, we’re getting that through the contracts that we’re negotiating.
Fred Goldstein 14:30
Fantastic. I know also, you know, you’d mentioned just part of the call, you’ve started a new or are starting a new mental health crisis business. Tell us a bit about that.
Nicole Bradberry 14:40
Yes. So I’m very excited about that. You know, as you know, COVID has 4x mental health crisis in this country. It was already in crisis, I believe, you know, just in my work with ACOs and value-based healthcare. You know, one of the missing pieces has always been, you know, how much mental health affects traditional health and if you’re trying to move the needle on cost of care, you cannot leave out mental health. And then, you know, like I said, along comes COVID. And that just got worse and worse. And so, you know, as, as I’ve spent the last, you know, 10 years trying to move that needle, there’s never been a really good solution for mental health, there’s never been a good front door, it’s always been the ER or the hospital, which never led itself to a good result. So I’ve partnered with a couple people who also come value from a value-based health care background, and we are going to be building crisis mental health, urgent mental health care centers, we have five that we plan to put up in the next 24 months. And you know, maybe we can do another session that just goes deep on this model. It’s really exciting. And it’s, you know, I’m super passionate about it. But think of, you know, every major corner in the United States having mental health urgent crisis care, where it’s 24/7365 days, a year, that when you need help, you can come to us, you know, if it’s just a medbridge, you can be in and out in a couple hours, if you’re truly in crisis, and we know there’s a huge overlap with substance abuse. So it doesn’t matter, whatever the reason is, you’re in crisis, you can walk in our doors, and we will help you and we will not only get you out of crisis, we will, you know, hold your hand basically, until we get you to where you need to be long term. And hopefully, a lot of those people are just, you know, a good handoff, back to primary care with primary care, having support from us. And then where you know, that 20%, maybe 30%, that needs to go to more long-term escalated care will will bridge you until we get you there. And so it’s really exciting, it’s we become a new front door, that’s empathetic, that has the resources to help these people immediately. This is our only focus, and at a much different price point than what happens when you go to an ER who really the ER just doesn’t know how to handle these patients and, and does the really no long term service. And also, it’s just huge cost for our overall health care system.
Fred Goldstein 17:09
Yeah, obviously mental health, some major, major burden, brain health, some people referred to it or behavioral health. And so you’re actually looking at setting up like an urgent care center. But for behavioral health,
Nicole Bradberry 17:23
urgent care and crisis care, and the difference is, the urgent care, you will be in and out in a couple hours, you know, hopefully, last but max a couple hours. So crisis care, we can keep you up to 24 hours. And and that’s where, you know, you know, we just we do everything we can to get you out of crisis and get you to the next place you need to be. And that’s anybody it’s, you know, the police could pick up someone on the side of the street or in Florida, you could be Baker Acted, and instead of going to a place that really doesn’t understand how to help you the ER, they can come to us we’ll get we’ll keep you true to care for you for those 24 hours, and then get you to a place that that is your next step and in helping you get better.
Fred Goldstein 18:07
And so this this entity, these these centers would contract with health plans, I assume, and other payers,
Nicole Bradberry 18:14
they would Yes, Medicaid managed care, commercial, it everybody who needs help, can come to one of these centers, and honestly, even uninsured, because we believe that, you know, there should be no barrier to getting help and uninsured is just a cost of business. And we hope to, you know, supplement maybe with grants and other funding for those uninsured, but we don’t want to be turning anybody away that needs help. That’s the model. That’s the model. That’s the vision. That’s the passion, front door for everybody.
Fred Goldstein 18:46
And what do you see about staffing these that could be staffed by psychiatrists, psychologists, social workers, a team,
Nicole Bradberry 18:53
it’s every Center has about 80 staff, and, you know, led by one psychiatrist, we have therapists, we have, you know, behavioral health specialists, we have peers, peers, are an amazingly critical resource. These are people that have been in their shoes that have been through similar experiences, know how to navigate some of those social determinants of health, which are so important to getting people better. You know, and so it’s the gamut of everybody that you need, in order to address mental health, mental health crisis,
Fred Goldstein 19:28
right, you talk about 80 staff, it’s pretty big center, you’re looking at putting beds in there and things like that, getting licenses. So it’s,
Nicole Bradberry 19:35
it’s an outpatient facility. So the licensing, you know, is is not as rigorous as you think. It’s a different concept in that we have a large room that has 15 kind of chairs, but they’re flat, you know, think of like dialysis chairs, so they’re comfortable, people can relax, but they’re open. And so you know, they’re they’re much easier to manage. We’re constantly moving from one patient to the next, you know, you’ve got a team that can work very team focused. And it also takes away some of the, the bad stuff that’s always been around behavioral health where people are locked in separate rooms. And, you know, they don’t have people to talk with and, and so this model is very unique, very empathetic, and it works. It works.
Fred Goldstein 20:22
Got it? And there’s, are you going to integrate any other technologies in this? Or is it going to be mostly a face to face come to the center.
Nicole Bradberry 20:29
So, you know, we’ll certainly have some tele-psych, you know, it’s more because you need it in this day and age, but also, it’s we see it as very much of support for primary care, you know, a lot of these patients start in primary care, and the doctor just doesn’t know what to do with them when they score high on the on the, you know, the behavioral health, depression testing as primary care does. And so, you know, we want to use tele-psych to bridge that relationship. But really, it’s these are brick and mortar in person clinics. And, and the technology that we’re going to build is really about connecting to the ecosystem. So how can we make sure that you know, we’ve got someone that’s homeless, so we were connected to homeless shelters, and a very easy way to find a bed for them? You know, if someone you know, needs transportation, how do we connect within our platform, so that’s an easy thing to do to get transportation for them, you know, home, into our clinics, etc. So there’s all kinds of things that we’re thinking of deploying in order to bring that ecosystem that needs to help these folks and, and solve for some of the social determinants of health. You know, we’re building in our platform. And of course, we’ll have a traditional EMR and rev-cycle and all those things that you have to run a clinic. But the innovation is really around a platform that that connects that ecosystem.
Fred Goldstein 21:56
And have you chosen locations for these?
Nicole Bradberry 21:59
We have, you know, I’d love to come back where I can talk to you a little more in detail. We know because we’ve got some leases resigning and, and plans in place, but we haven’t, you know, finalized all of this. And maybe when we get a little bit closer, which is probably the next 30 days, I can go into more of that detail.
Fred Goldstein 22:17
Yeah, fascinating idea. I’d love to get some, you know, more insights on once you get it going, is this something Nicole, you’ve sort of worked up or you bring in a group of investors, how’s that setup?
Nicole Bradberry 22:30
So I have two partners. And one of my partners is the CEO, and he brought us in by myself in that third partner, you probably know, him, he ran the largest ACO business in the country, Jeff Site bite. And then the other partner is Adrian, who I worked with at Heritage, and also she was part of, you know, Universal American, but you know, Jeff found this model, you know, there’s other people in the country doing crisis, you know, they’re doing a little bit different than, than our approach, but we’ve got enough of a model that we know that this will work, and we pulled it together. But I would say if anybody deserves the credit for kind of coming up with this, it would be Jeff
Fred Goldstein 23:09
fascinating. So, you know, I’ve got about five or so minutes left, what’s been the impact, obviously, we’re, we’re hopefully beginning to come out a bit of the COVID era or the for the last year, what’s been the impact on ACOss etc.
Nicole Bradberry 23:26
You know, the physician groups that are underneath ACOs, which is, you know, a lot, but, you know, our, our independent practices, certainly, you know, people not going to the doctor impacted financially, their ability to, to keep their clinics running, some of it was by choice, because they they, you know, didn’t know if they could service patients, and a lot of them shut her doors. I think ACOs is actually helped people keep a lot of doors open and keep caring for patients. I think, telehealth, certainly, you know, telehealth grew probably by 10 years ahead of what it would have done on its own, because of COVID. And I don’t see that, you know, going back to pre COVID days, I think you’re gonna see a lot of patients who, who like that, who, you know, especially people that can’t, you know, always get to the doctor, we’ll probably utilize that more, because now we’ve proven it works. But I also think, Well, I mean, to wrap that up, I think, you know, they’ve certainly been impacted ACOs underscored the the the need for ACOs for entities that really can look at these populations be proactive on who needed to come in, who needed to be touched, because we really had to prioritize care when care was being kind of reduced because we were trying to keep people at home and not out and about and certainly not in health care settings where other people were sick. And so I think, you know, it really underscored how important ACOs Accountable Care value-based healthcare have been and so you know, if anything, it’s done that but I do think from a financial perspective, because people haven’t gone to the hospital at the rate that they did before. You know, That did anybody taking risk or in shared savings models, even though they might have gotten hurt on the front end? Because the delivery system on the front end slowed down. I think on the back end, everybody that’s been involved, this model has kind of financially been okay, because of the risk side of that. So overall, I think this year has just propelled the value of value based healthcare.
Fred Goldstein 25:22
Yeah, I think your you know, your point on the tele-health, the growth has been phenomenal. Obviously, it backed off some after the first couple months, I was actually putting together a presentation on telehealth in primary care for a group and it’s just amazing looking at those numbers. And it’ll be interesting to see how that changes the model going forward. Just as you’re talking about with this new front door, you’re creating for behavioral health. You know, how much the tele-health is just an add on to a practice or does it used to transform the whole approach? So be interesting to watch that as we go forward?
Nicole Bradberry 25:56
I agree. And I think I think the genies out of the bottle for sure.
Fred Goldstein 26:00
Yeah. Totally. And clearly, I think, you know, telehealth, one of things obviously, everyone had to do was was get us to, you know, get payment for that. So I think the movement to value-based care makes telehealth even more important. And so you know, I appreciate obviously your time today discussing telehealth discussing the the new behavioral health launch are always innovating, Nicole, and clearly Gregg and I are looking forward to heading out to your conference hopefully in November.
Nicole Bradberry 26:26
for sure you you are you’re part of the original crew. We couldn’t do it without you.
Fred Goldstein 26:32
Well, thanks so much. Really appreciate you coming on PopHealth Week and giving us some new insights into your new new new programs around ValueH network and the mental health area. So greatly appreciated. Nicole,
Nicole Bradberry 26:44
always great to catch up with you guys and I can’t wait till November to see in person.
Fred Goldstein 26:48
Thanks back to you, Gregg.
Gregg Masters 26:50
And thank you, for that is the last word for today’s broadcast. I want to thank Nicole Bradberry chief executive officer and chairman of the board of the Florida Association of ACOs for her time and insights today. For more information on her work go to www.flaacos.com or follow her on Twitter at @NicoleBradberry and @FLAACOs respectively. And finally, if you’re enjoying our work at PopHealth Week, please consider subscribing to our channel on the podcast platform of your choice and do follow us on twitter by @PopHealthWeek. For my colleague Fred Goldstein. Nicole Bradberry. This is Gregg Master saying bye now.