Chronic Care Management Strategy & Vision with Jon-Michial Carter, ChartSpan

Speaker A: Hello, this is Chase Marble with the Community Health center podcast. Thank you so much for joining in. We have a great guest on today to discuss the amazing topics within Health Center World of Chronic Care Management and advanced Primary Care management. Uh, but before we get started, want to introduce my co host.

Speaker B: Yeah, it's great to have everybody again and all of our listeners. You know, we appreciate you all so much. My name's Dawson Nemo and Chase's co host and Jason Chase. Didn't venture down yet, but we've, uh, got an incredible guest lined up for you today. We've got Mr. John Michael from Chartspan. John, I'd like to turn it over to you. Can you just give us a brief high level background on yourself? And of course, I don't know how you wouldn't be familiar with Chartspan, but just give him a background on Chartspan as well, if you would.

Speaker C: Yeah, you bet. Chase Dawson, it's a treat to be with you and happy to talk about this important part of healthcare, uh, care management. So, as you said, my name is John Michael Carter. I founded the company chartspan about 12 years ago with my brother. My brother was a 20 year practicing clinician. I am a serial entrepreneur who understands how to build companies. And so together we built Chartspan into the largest provider of care management programs in the United States. Chartspan itself focuses on just that, under the Medicare umbrella, leveraging our capabilities to take a health system or a practice's patients and under general supervision, Incident two, proactive preventative care for patients each month for the providers of that practice or that health system. I'm lucky. I get to spend most of my days as Chief Growth Officer with a lot of smart hospital executives and practice administrators and providers and physicians around the country talking about the challenges of running these programs, how to implement them, uh, what success and failure can sometimes look like. And I have a really good team around me and it's one of the reasons for our success.

Speaker A: That's incredible, John. And uh, one thing I would like to visit on too, for those that don't know any of the health centers that are listening in, that don't know what is chronic care management and advanced primary care management. And why is this so important for the federally qualified health centers in our country?

Speaker C: Medicare understands that providers today spend almost all of their time in reactive sick care mode. We prevent very little in this country. We react when somebody is sick or has a high acuity event. When are we practicing prevention? During the day? Do you go see the doctor for no reason, just in case Something in the future might happen. Probably not. It's not just healthcare's problem, it's society's problem. We talk about prevention, we talk about being proactive, but we do very little to do that. That's what Medicare recognized years ago. That's why they launched these care management programs. You'll hear ccm, Chronic Care Management, you'll hear the new one, apcm, Advanced Primary Care Management. There are more coming. And so the whole premise of these programs is let's not wait for the patient to get sick. They may have chronic conditions or they may be perfectly healthy, but let's engage them in a regular cadence every single month and prevent the exacerbation of the chronic conditions they have or the ones that they may get in the future. And when you look at the claims data, when you look at the proof, you don't need narratives, you don't need conjecture. We have the data now. There has never been a more effective value based care program. And what's great about these programs, as most people know, especially FQHCs, and you don't have to go out on the limb and risk millions of dollars in capital to see if you can be successful. You get paid fee for service upfront and then long term, where you're taking on risk, where you have value based contracts, you reduce the total cost of care. And the claims data shows that. And if you're participating in the benefits of that, then you will get paid a second time for reducing that cost of care.

Speaker A: It's amazing. And you mentioned something really important there, that Medicare and the government structure around this was able to recognize that. I think that's a true paradigm shift from the reactive to the proactive management of care, especially in the chronic care management space. I assume that's something that's been happening over the last few years. And as you've seen that opportunity, it's probably really impacted the patients that our health centers are serving through Chart Spanish.

Speaker C: Absolutely. And we need more of it. This is a great example of how it can work, but we need more of it. You know what's interesting? You know who struggles with this concept the most? Not Medicare, not patients, but providers and physicians. It seems counterintuitive to them that there is an E and M encounter, there's an engagement, there's a reimbursement that we're paid for, when nothing's on fire, the patient's not sick. And so you culturally have to understand we're flipping from reaction to prevention. And yes, Medicare is more than willing to pay you for low level care coordination activities every month because they know that taxpayers benefit when you're doing that kind of thing. And we're not paying for admissions and readmissions and expensive high acuity procedures. So it's taking a minute for healthcare to realize the value here. And it's interesting when you look at the three constituents, taxpayers and Medicare, providers and physicians, and then patients, the ones that are slowest to embrace this are definitely providers and physicians.

Speaker B: Wow, John, uh, Michael, that's some really good insight and not something right that I would have thought about that. The providers and clinicians are the hardest party to convince to do this. It just seems crazy to me. But hey, you're out there in the field every day and dealing with it and training folks. So let me ask you this, John. Michael, why would a health center utilize a third party partner such as yourself, Charge Span or CCM or apcm? Why would that be something they would want to do?

Speaker C: And let's be clear, it ranges the gamut of size. We're engaged with some of the largest health systems in the country, and I have some of the smallest single practitioner practices in the country. In urban markets, rural markets, large FQHCs, small FQHCs, it's across the gamut. They're leveraging third parties. And here's why. These programs are much more than just the clinical encounter. If that's all this was, you just need a nurse and an application in EPIC or ECW or a spreadsheet, you wouldn't need us. The hardest part of running these programs are all the things that happen in the periphery. Parsing data out to look for eligibility, compliance, patient education, enrollment, quality assurance, technical infrastructure. Our company has spent more than $150 million building the country's leading care management platform. And very little of uh, it has gone into the clinical piece of it. It's all the things that are tertiary that we often neglect, that we don't think about. If you ask me what is the source of your number one customer over the last decade, you know who it is. It's somebody that's tried to run the program themselves. And what they found out is they have terrible utilization because it's really hard to get patients compelled to consent. And many of them have a copay to pay to be in these programs. I always say the co pay and deductibles associated with these programs are, uh, the bane of my existence. But I also say in the same breath, you want a litmus test of, uh, whether you're any good at engaging Patients and satisfying them. Make them pay you every month to be in a program and you'll find out real quickly whether you're good at it. It's one of the things that we really excel at. It's one of the reasons we've been so successful in partnering with more than 200 health systems and practices around the country. These programs are incredibly hard to run, they're incredibly capital intensive, and rarely is there anybody on your team that has ever stood up a large scale Medicare enrollment operation. Because what you're really good as a practice is delivering clinical care, not all those other things. We show up with all that infrastructure and I'd like to say pretty good nurses who know how to run these programs and we manage them really well. And it's one of the reasons why so many practices choose to partner with us.

Speaker B: So there's, there's no doubt that you're the expert in the field and you guys have done your research and you've got the team, you've got the backing, got the infrastructure, the programs X, Y and Z. No doubt about that, right? Second follow up question to that. How quickly do patients and health centers experience the benefits of a successful implementation of the program is that, you know, three months, four months. Can you expand on that? What would that look like?

Speaker C: So our average time from the time we sign an agreement to the time we go live is 44 days. So within six weeks the program is stood up and within 90 days we'll maximize enrollment. So within a matter of months that you can count on one hand, you are driving new revenue into the FQHC practice. Patients are delighted with concierge level nurse access. Providers are delighted because now they have additional clinical support to deal with low acuity events like chronic care management, and they can focus at the top of their license on high acuity events and what they do every day in the practice. And patients enjoy better managed care and we all benefit when you lower the total cost of care.

Speaker A: It's truly incredible. And I think seeing the CCM UM model, seeing the APCM model makes perfect sense. And when we continue to look in the Future, as more CHCs continue to filter into this model and continue to provide that care to the community and the patients they serve. I'm really curious, what, what's next for chargespan and what's next for the impact that you're gonna continue making on CHCs? Where do we go from here?

Speaker C: So we think a lot about how to be a platform, not just a single source service provider. Certainly as the founder of the company and the CEO for more than a decade. I was singularly focused on a culture as I built the company that I didn't wanna add a bunch of service lines and product lines. I woke up every day saying our goal is to be the best in the United States at uh, providing a single solution around care management programs. I don't know that we ever woke up one day and say we accomplished it because every day we push ourselves to be better. But I think we certainly are in the conversation, if not certainly the biggest and what's even more important is to be the best. Now we're thinking about adding additional service and product lines. So we think RPM remote patient monitoring is a wonderful fit with care management. Running them as two separate programs is flawed. And the data shows that whether you look at poor utilization, higher costs that are necessary, low longevity of patients, when you're fatiguing them with multiple programs for the same patient in the same month, they need to be combined. So I think you'll be hearing some noise from us in the industry in the coming months about adding important value based care service lines that that number one, prioritize the patient and number two, support our partners, our clinical partners, our providers, health systems and practices and help drive additional revenue for them while balancing the need to improve patient outcomes.

Speaker A: It's amazing. So looking at different service lines that go just so well with CCM and APCM and something else I think you mentioned on John Michael that's so important is the culture of the organization to be the best, to always get better. And I truly believe you see that within your organization when you invest in, to your people, into the organization then they are going to go invest into those that you serve, whether it's your clinics, your patients, et cetera. So truly, truly applaud uh, you for just focusing so heavily on culture as you continued to grow into one of the best chronic care management facilities in the country.

Speaker C: I appreciate that Chase. It means a lot to us.

Speaker A: So after today's conversation, if I'm a community health center and I'm interested in learning more, I'm interested in, in referring my CMO into an area to learn more about CCM or APCM or even Chartspan, after today's conversation, what is that best avenue to take? Where should I go from here?

Speaker C: Sure, we make it easy. So just go to Chartspan's website, chartspan.com and there's tons of content and tons of learning there and we make it easy for you to just reach out to us and have one of Our subject matter experts get in contact with you and you know, we try to sit down and you can't. This is not some sort of homogenized, off the shelf solution. You have to listen to each customer and tailor the program for them and what works for them and understand what are their objectives, what are their priorities. And with FQHCs, they've got 2x the number of struggles and challenges. As a traditional practice and as the largest provider of these programs for FQHCs, we get that, we understand that. So it's really a low pressure way to spend time with me or our subject matter experts and talk about what you're trying to accomplish. How can we build a custom program that works for you and do it transparently? Because I think uh, where there's apprehension so often for an FQHC is they don't want to get into a long term agreement with a partner who has such a big impact on their practice without getting to spend time with them. Our average time with a client is months, sometimes six months before we ever get to an agreement because we spend a lot of time doing a technical assessment, a uh, client readiness assessment, a uh, data scoping exercise time with your rev cycle and billers. We want to get all the stakeholders at the table and see if it's the right fit. And if it's not, it's not. And if it is, it's because we both know it is. Because we dated for a long time before we got married. And that's our approach to our partnerships and how we do business at Chartspan.

Speaker A: That's incredible. That's incredible. It's going to be a win, win situation for the clinic, for the providers, for the patients that you're serving for Chargepan. It's going to be a situation where you understand that the need is there, you understand that the service can be provided and with all of your data and underwriting into it, it's going to be an easy decision to move forward.

Speaker C: We certainly hope so and we endeavor to do so. Awesome.

Speaker A: Uh, well, John Michael, we greatly appreciate your time today on coming in to talk about ccm, talking about apcm, talking about the organization that you were able to co found and continue to build on with your culture and employees all across the country. And just thank you for making the impact you do on our community health centers and thank you for making the impact you do on the patients that they serve.

Speaker C: Thank you for the thoughtful questions and I appreciate the time together.