Latest / Becker’s Healthcare Podcast / Rethinking Primary Care and Prevention with Dr. Kevin Neese

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Rethinking Primary Care and Prevention with Dr. Kevin Neese · Becker’s Healthcare Podcast

• 0:00
  - Welcome to the Becker's Healthcare Podcast. I'm Chris
• 0:02
  - Sosa, your host. And I'm gonna be joined
• 0:04
  - today by doctor Kevin Neece. He's co owner
• 0:06
  - of Helix Advanced Medicine in Indiana.
• 0:09
  - Doctor Neece, thank you for joining us today.
• 0:11
  - Thank you. Thank you for having me.
• 0:13
  - Well, Kevin, for those who are not familiar...
• 0:16
  - Those are our audience, I should say, who
• 0:18
  - are not necessarily familiar with you and your
• 0:20
  - health care journey. Could you give us a
• 0:22
  - little bit more
• 0:23
  - about your background?
• 0:25
  - Sure.
• 0:26
  - I had a little bit of a unusual
• 0:27
  - journey like some physicians. I went to undergrad
• 0:31
  - at Oral Roberts University
• 0:33
  - in Tulsa and then went to medical school
• 0:35
  - at Indiana University.
• 0:38
  - Went out in private practice for about five
• 0:41
  - to six years and then transitioned
• 0:43
  - to a new specialty that, was probably one
• 0:46
  - of the first in Indiana
• 0:48
  - called the hospitals, and that was over twenty
• 0:50
  - years ago.
• 0:51
  - While I started that program in Evansville,
• 0:55
  - went ahead and got my MBA at the
• 0:57
  - Olin School of Business at WashU in Saint
• 0:59
  - Louis,
• 1:01
  - and then started moving up through the the
• 1:04
  - chain,
• 1:05
  - into the c suite, was the chief medical
• 1:07
  - officer there at,
• 1:09
  - Saint Mary's Hospital, which was a level two
• 1:12
  - trauma center in Evansville,
• 1:14
  - and then became the chief operating officer.
• 1:17
  - And then,
• 1:18
  - got back into
• 1:20
  - clinical medicine. That was my original love and
• 1:24
  - became a hospitalist here in Indianapolis
• 1:27
  - and
• 1:29
  - started,
• 1:29
  - another business actually doing post acute care.
• 1:33
  - That business is called Novinza Healthcare
• 1:35
  - here in Indiana,
• 1:37
  - where we employ nurse practitioners and cover
• 1:40
  - nursing facilities all the way from Evansville up
• 1:42
  - to South Bend, here in Indiana.
• 1:46
  - And at this point, you know, I'm on,
• 1:49
  - short stop to third base in my career,
• 1:51
  - and,
• 1:52
  - you know, I thought I wanna do something
• 1:55
  - something
• 1:55
  - neat to beat my capstone and wanted to
• 1:59
  - get involved in
• 2:00
  - taking care and preventing
• 2:03
  - diseases instead of treating them acutely or
• 2:06
  - at the end of their course, which I've
• 2:08
  - been doing in the the nursing facilities.
• 2:11
  - So we started a new practice called Helix
• 2:13
  - Advanced Medicine to where we,
• 2:16
  - have an emphasis on prevention
• 2:18
  - and doing some pretty novel things.
• 2:21
  - And,
• 2:22
  - you know, the the emphasis of that was
• 2:23
  - actually, believe or not, reading
• 2:26
  - Peter or Tila's book,
• 2:28
  - called Outlive. It's been,
• 2:30
  - it's pretty instrumental.
• 2:31
  - And so I I think doing that, I've
• 2:33
  - been working with a nurse practitioner, and,
• 2:36
  - we've been thinking about doing this. And it's
• 2:38
  - where we are today.
• 2:40
  - Thanks for sharing that, Kevin. Yeah. You've been
• 2:42
  - all over the place, certainly. It's a journey
• 2:44
  - that is probably relatable to many people in
• 2:47
  - our audience today.
• 2:48
  - I love the baseball reference, by the way.
• 2:50
  - Can't have those enough, especially since we're in
• 2:52
  - the middle of the playoffs here in October.
• 2:54
  - But as you said,
• 2:56
  - you've served in a number of, leadership roles
• 2:59
  - in in hospitals and health systems,
• 3:01
  - including at Saint Mary's in in Evansville.
• 3:04
  - So what made you decide that now is
• 3:07
  - the right time to open Helix, which is
• 3:09
  - an outpatient internal medicine practice?
• 3:12
  - Yeah. Well, first of all, let me say
• 3:14
  - that hospitals are excellent at the things that
• 3:17
  - they were built for.
• 3:18
  - You know, the the crash, the admission, the
• 3:20
  - the procedures,
• 3:21
  - the specialty services.
• 3:23
  - And, you know, I've spent twenty five years
• 3:25
  - in that world through the medical staff operations,
• 3:28
  - the c suite, and hospital medicine.
• 3:30
  - I still respect it and, believe it or
• 3:32
  - not, still love it and,
• 3:34
  - oftentimes think,
• 3:36
  - very fondly of it and would, even... Wouldn't
• 3:38
  - mind going back in some respect.
• 3:41
  - But the problem is I I couldn't fix
• 3:44
  - from those seats,
• 3:46
  - where the ten to twenty years before the
• 3:48
  - crash that the patient was having.
• 3:51
  - And, again, to use Peter Taylor's words,
• 3:54
  - instead of pulling people out of the water,
• 3:56
  - you know, I've become more focused on finding
• 3:58
  - out if I can keep them from jumping
• 4:00
  - in upstream.
• 4:02
  - And so I opened up Helix because primary
• 4:04
  - care really is the only place prevention can
• 4:06
  - truly happen.
• 4:08
  - And and most panels
• 4:10
  - in primary care are too large to do
• 4:12
  - it.
• 4:13
  - And so I wanted a kind of a
• 4:14
  - real internist office where you do annual exams,
• 4:18
  - sick visits,
• 4:20
  - diabetes and blood pressure management, hospital follow-up,
• 4:23
  - nursing home follow-up
• 4:25
  - that also has the time and the tools
• 4:28
  - to work on health span. You know? The
• 4:30
  - the difference between the lifespan and the health
• 4:32
  - span to making people healthier.
• 4:34
  - So looking at their metabolic risk, their hormone
• 4:37
  - situation,
• 4:39
  - brain health, which has become
• 4:41
  - big news in the last two to five
• 4:43
  - years,
• 4:44
  - and in office diagnostics.
• 4:46
  - And as I alluded to, my nurse practitioner
• 4:48
  - and I have worked together for fifteen years
• 4:51
  - in the post acute care space.
• 4:53
  - And combined, we have about forty five years,
• 4:56
  - in medicine. And this is something I think
• 4:58
  - we both have a a passion about,
• 5:01
  - keeping people healthier and live longer. And, again,
• 5:04
  - I didn't leave the hospitals because I disliked
• 5:06
  - them. I I still have very fond relationship
• 5:09
  - with them.
• 5:10
  - But I I left because the outpatient internist
• 5:13
  - is really one of the few people who
• 5:14
  - can keep them out of the hospital.
• 5:17
  - I totally understand,
• 5:18
  - your approach toward,
• 5:21
  - hospitals and health systems, Kevin. I appreciate you
• 5:23
  - laying that out for us and just how
• 5:25
  - much
• 5:26
  - this decision,
• 5:28
  - you know, affected you and, you know, why
• 5:30
  - you made the one that you did now
• 5:32
  - in terms of
• 5:33
  - doing everything you can to keep patients out
• 5:35
  - of the hospital. I'm sure your patients
• 5:37
  - all appreciate
• 5:39
  - that very, very much.
• 5:41
  - So, Kevin, as we look at at Helix
• 5:43
  - itself,
• 5:44
  - from what I understand, and and you've laid
• 5:47
  - this out, I think, to some extent, that
• 5:49
  - there's primary care, there's optional concierge membership, there
• 5:52
  - are advanced programs.
• 5:53
  - So why build all three of these instead
• 5:55
  - of going fully concierge,
• 5:57
  - and how do you keep them from being
• 5:59
  - two tiered?
• 6:00
  - Yeah.
• 6:01
  - It... It's a good in-depth question. And, you
• 6:05
  - know, let me just say that going for
• 6:06
  - the concierge was my first thought, and it
• 6:08
  - would have been much simpler
• 6:10
  - and and more profitable if you're just looking
• 6:12
  - at the economics on day one.
• 6:14
  - But we we didn't do that for a
• 6:17
  - couple of reasons.
• 6:18
  - The Greenwood, South Indianapolis there still needs a
• 6:21
  - real in... Internalist office, and that's... I still
• 6:23
  - think there's a demand for that,
• 6:26
  - just
• 6:27
  - lack of primary care.
• 6:29
  - And a a lot of people want a
• 6:32
  - medical home that can't or don't want to
• 6:34
  - pay a membership,
• 6:36
  - and they shouldn't have to go to a
• 6:38
  - 2,500 patient panel to to get that service.
• 6:40
  - And there are limited
• 6:43
  - panels here in South Indianapolis for that.
• 6:46
  - So
• 6:47
  - there are essentially three doors to the... This
• 6:50
  - practice. You know, the traditional primary care is
• 6:53
  - our floor, and we still see
• 6:56
  - basic internal medicine patients and build insurance for
• 6:59
  - that, do their annuals, their sick visits, chronic
• 7:01
  - disease prevention,
• 7:03
  - coordinate their visits to their specialty services.
• 7:06
  - But that concierge part of this is optional.
• 7:09
  - And as it does in most concierge practices,
• 7:12
  - it buys time and access.
• 7:14
  - But those longer visits,
• 7:17
  - priority scheduling when they have a problem, and
• 7:19
  - direct communication.
• 7:22
  - And so
• 7:23
  - you're buying a smaller panel designed to notice
• 7:26
  - changes early.
• 7:28
  - They have the... We have the time to
• 7:30
  - do that.
• 7:31
  - We also have the discounted add ons that
• 7:34
  - traditional things that CMS does not cover in
• 7:37
  - that pathway.
• 7:38
  - So we are doing some very basic aesthetic
• 7:42
  - services here on-site,
• 7:44
  - some three d infrared body scanning, some discount
• 7:47
  - skin care products, some imaging services here.
• 7:51
  - We also have some other advanced programs like
• 7:53
  - the bioidentical
• 7:54
  - hormone replacements,
• 7:56
  - the brain health, dementia prevention,
• 7:58
  - some weight management, performance testing, and and even
• 8:01
  - lipid management,
• 8:03
  - here.
• 8:04
  - So both services can sit
• 8:06
  - on the traditional practice or the concierge practice
• 8:10
  - as well.
• 8:11
  - And so they they live inside the medical
• 8:14
  - home,
• 8:15
  - to explain a little bit better. So the
• 8:16
  - person who's managing your blood pressure is the
• 8:19
  - same person who's reading their coronary calcium scores,
• 8:22
  - for example.
• 8:23
  - So that two tiered
• 8:24
  - care happens when
• 8:27
  - membership,
• 8:27
  - I think,
• 8:29
  - the the patient gets a different doctor, a
• 8:31
  - different standard, or a different chart, and that's
• 8:33
  - not the model here. I mean, we have
• 8:35
  - the same clinician,
• 8:37
  - one record, the same medicine,
• 8:40
  - and that membership buys access
• 8:42
  - and unhurried time,
• 8:45
  - not a better internist. And so
• 8:47
  - even if you're not in the concierge practice,
• 8:50
  - that clinical urgency, if they have a problem,
• 8:52
  - they're still gonna be seen fairly quickly.
• 8:55
  - But we still hold out time for,
• 8:58
  - people who want more of a
• 9:00
  - unhurried
• 9:02
  - doctor's
• 9:03
  - visit.
• 9:04
  - Makes lots of sense, Kevin. Thank you so
• 9:05
  - much for, defining that for us. So, Kevin,
• 9:08
  - as we look at value based care, certainly,
• 9:11
  - you have a background in this
• 9:13
  - from the last
• 9:14
  - few decades, really. Yeah. So what lessons are
• 9:17
  - you taking from that that you're applying to
• 9:19
  - Helix, and where do those lessons necessarily
• 9:22
  - not fit?
• 9:24
  - Yeah. Another good question.
• 9:26
  - I... I'm one of those people who when
• 9:28
  - they look at value based care, and I
• 9:29
  - know it's here, and I know it's here
• 9:31
  - to stay, and I know that's where the
• 9:32
  - process is moving. But it really has been
• 9:34
  - hit and miss,
• 9:36
  - you know, both in the hospital world, the
• 9:38
  - primary care practice, and and even in the
• 9:40
  - post acute care world.
• 9:42
  - It it has reduced spending,
• 9:44
  - like like in the reduction of post acute
• 9:46
  - days, the average admission... The average
• 9:50
  - length of stay now has been decreased two
• 9:52
  - to ten days.
• 9:53
  - But the the national programs that would simply
• 9:56
  - hold a percentage of the SNF's payment have
• 9:59
  - not really moved readmissions at all, and that's
• 10:02
  - one of the biggest things that they look
• 10:04
  - at. And that environment is very complex. And
• 10:07
  - what I've seen is that the actual reductions
• 10:09
  - in
• 10:10
  - hospital readmissions
• 10:12
  - that you do see are in the high
• 10:14
  - needs ACL and the ISNIP patients. That's the
• 10:16
  - institutional special needs plan
• 10:19
  - where those reductions have been moving patients
• 10:22
  - really back to a DNR and no hospitalization
• 10:24
  - status. And that's where they really,
• 10:26
  - I think, move the needle a little bit.
• 10:29
  - So I sometimes question if that's the definition
• 10:32
  - of quality that we traditionally want to move
• 10:34
  - toward.
• 10:35
  - But I do know it's the proxy now,
• 10:37
  - and we have to really deal with it.
• 10:39
  - But what I've learned from that whole process
• 10:41
  - that I'm trying to apply here at Helix
• 10:43
  - is the discipline.
• 10:45
  - You know? Knowing the the panel, knowing who
• 10:48
  - your patients are, finding those risk early,
• 10:50
  - close the loop, measure what the plan is
• 10:52
  - actually
• 10:54
  - happening. So in the hospital and post acute
• 10:57
  - work,
• 10:58
  - the expensive event is never surprised if you
• 11:01
  - really look. So you're looking at weight changes,
• 11:04
  - unfilled diuretics,
• 11:06
  - nursing home fevers that could have been treated
• 11:08
  - on-site.
• 11:09
  - Those are processes that,
• 11:11
  - kinda dressed up as utilization. At Helix,
• 11:14
  - now we're looking more for the risk before
• 11:17
  - the event. So we're looking at APOB levels
• 11:19
  - when they dictate aggressive lowering coronary calcium scores
• 11:22
  - when it changes the conversation
• 11:25
  - and looking to to screen someone's cognition ten
• 11:28
  - to twenty years before it becomes obvious. Just
• 11:31
  - did that actually thirty minutes before we met
• 11:33
  - today,
• 11:34
  - to to patients.
• 11:36
  - So we're trying to coordinate labs,
• 11:38
  - especially follow-up
• 11:40
  - so that the patient is not their own
• 11:42
  - project manager here.
• 11:44
  - And
• 11:46
  - we'd like to think of that as value
• 11:47
  - based thinking, you know, whether
• 11:50
  - without really needing a shared savings contract.
• 11:54
  - Now where it doesn't fit in our practice,
• 11:56
  - and and that is I don't wanna let
• 11:58
  - quality dashboards become the visit. I think we've
• 12:01
  - looked at HEDIS and, you know, for example,
• 12:04
  - just pulling out one of the HEDIS things
• 12:06
  - that you're supposed to follow, and that is
• 12:08
  - if someone has been on a statin. Yeah.
• 12:10
  - You're really not even looking at what the
• 12:12
  - result of that statin is if they're taking
• 12:14
  - the drug and if you really move their
• 12:16
  - equal b levels.
• 12:19
  - So
• 12:20
  - we don't want,
• 12:22
  - those things to really dictate our visits. We
• 12:24
  - will actually wanna see these measures
• 12:27
  - moving. So the... These measures that I think
• 12:29
  - are out there in the ACLs and in
• 12:32
  - value based care are really useful floors, but
• 12:34
  - I always feel that they're terrible ceilings.
• 12:37
  - They they measure what's easy to pull from
• 12:39
  - claims, but don't really measure what we have
• 12:42
  - found the right lipid particle to measure and
• 12:44
  - whether their grip strength is falling or
• 12:47
  - whether that person can really climb stairs
• 12:50
  - and have a VO two max that will
• 12:52
  - dictate what their functional capacity is gonna be
• 12:54
  - when they're 70 years old.
• 12:57
  - So
• 12:58
  - I I think value based care taught me
• 13:00
  - to measure, did not teach me to pretend
• 13:02
  - a metric is the same thing as as
• 13:04
  - a life that we're following here. So our
• 13:07
  - focus, I think, will be to improve lifespan
• 13:09
  - and health span and keep people healthy and
• 13:11
  - out of the hospital.
• 13:13
  - We'll participate in the value based
• 13:16
  - metrics. But, again, I I think we're gonna
• 13:18
  - look at those as the floor, not the
• 13:20
  - ceiling.
• 13:21
  - Kevin, thank you so much. I love that
• 13:22
  - level of detail you just provided us. You
• 13:25
  - know, really a perspective that, you know, maybe
• 13:27
  - our audience doesn't see all the time as
• 13:29
  - someone who's now in your position and has
• 13:31
  - come from the hospital and health system
• 13:34
  - universe, let's say.
• 13:36
  - I do wanna follow-up on something. What do
• 13:38
  - you find most exciting about,
• 13:42
  - how
• 13:44
  - physicians are now able to measure
• 13:46
  - brain health and help their patients moving forward?
• 13:50
  - Yeah. You know, a a statistic that really
• 13:52
  - hit me about
• 13:54
  - six months ago
• 13:56
  - was when I heard and and read the
• 13:59
  - Lancet study that about forty five percent
• 14:02
  - of all
• 14:03
  - dementia can be prevented
• 14:05
  - or or essentially
• 14:07
  - mitigated.
• 14:09
  - And what... And that that struck me because
• 14:10
  - I was always taught historically that Alzheimer's disease
• 14:14
  - and the other dementia is, you know, once
• 14:16
  - you have it, it's gonna progress. There's nothing
• 14:17
  - you can do about it. Here's a couple
• 14:19
  - meds that may or may not work.
• 14:21
  - But when you actually look at it... And
• 14:23
  - we're we're now actually looking at
• 14:27
  - what
• 14:28
  - really is the instigator of this. You know?
• 14:30
  - Is is it brain inflammation that
• 14:32
  - causes
• 14:33
  - the neurofibrillary
• 14:35
  - tangles
• 14:36
  - and the amyloid and the tau tangles to
• 14:38
  - form.
• 14:39
  - You know, there's a lot of information coming
• 14:41
  - out now that if we start looking at
• 14:42
  - early cognitive screening,
• 14:45
  - you know, for example, the the MOCA test,
• 14:48
  - and start hitting
• 14:50
  - in drastically reducing someone's
• 14:52
  - lifestyle,
• 14:53
  - improving their lifestyle,
• 14:55
  - decreasing the...
• 14:57
  - Their lipid,
• 14:59
  - having them to exercise more,
• 15:02
  - making sure that their hearing, their eyesight,
• 15:05
  - are being addressed.
• 15:07
  - Those are things that, in the long term,
• 15:09
  - can
• 15:11
  - mitigate
• 15:12
  - their thinking so that, you know, in their
• 15:14
  - seventies and eighties, they may... We may not
• 15:17
  - completely eliminate dementia, but we can certainly mitigate
• 15:20
  - those symptoms.
• 15:21
  - And with some of the new treatment options
• 15:24
  - now
• 15:25
  - that
• 15:26
  - in ten to twenty years, we may even
• 15:28
  - have better treatments to even nearly cure this
• 15:31
  - disease. So
• 15:33
  - screening these things early,
• 15:34
  - today when I screen patients,
• 15:37
  - neither one of the patients that I screened
• 15:39
  - today had any cognition problems,
• 15:41
  - and it was nice to get a good
• 15:43
  - baseline on them in their early life. And,
• 15:46
  - and, again, I don't think that's being done
• 15:48
  - in a lot of offices, and we hope
• 15:49
  - to change that.
• 15:51
  - Makes sense. And it's fascinating how all those,
• 15:54
  - factors you say,
• 15:57
  - work themselves into this equation and how exciting
• 15:59
  - it is that, like you said, twenty, thirty
• 16:01
  - years, maybe there's
• 16:03
  - a
• 16:04
  - grand,
• 16:06
  - comprehensive
• 16:07
  - group of treatments that can really prevent all
• 16:09
  - this. That's really encouraging, I think.
• 16:12
  - Yeah. And just a little follow-up statement on
• 16:15
  - that. Again, I've heard an immunologist the other
• 16:17
  - day say this, that if you could
• 16:19
  - actually live another ten years, if you can
• 16:22
  - keep from dying for the next ten years,
• 16:25
  - the artificial intelligence is in medicine now
• 16:28
  - that will be able to develop drugs at
• 16:31
  - a much faster rate.
• 16:33
  - And to have your
• 16:35
  - identical
• 16:36
  - twin, for example, that they can put your
• 16:39
  - genetic information, how you respond to drugs, your
• 16:42
  - allergies, your family history, etcetera,
• 16:45
  - that
• 16:46
  - they may able...
• 16:47
  - Be be able to, in ten years,
• 16:51
  - to essentially
• 16:52
  - cure most of the diseases that we know
• 16:54
  - now.
• 16:56
  - And he thinks that,
• 16:58
  - you know, this is going to be... AI
• 17:00
  - is going to really revolutionize
• 17:02
  - medicine
• 17:03
  - in... To the point that we can't even
• 17:06
  - see that now. So, yeah, there's a lot
• 17:08
  - of new stuff that's coming out, and I
• 17:10
  - I think the pharmaceutical industry is going to,
• 17:13
  - exponentially
• 17:15
  - come out with new drugs.
• 17:17
  - Certainly, a lot of people, maybe everyone who
• 17:19
  - really hopes that he is right, Kevin. Yeah.
• 17:22
  - Yeah. That'd be extraordinary
• 17:24
  - indeed.
• 17:25
  - So, Kevin, so as we mentioned, you're a
• 17:28
  - former
• 17:30
  - hospital CMO and COO.
• 17:32
  - You've been in and out of hospital system
• 17:34
  - before you, started the the companies that you
• 17:36
  - started, including
• 17:38
  - Helix.
• 17:39
  - So
• 17:40
  - having looked back on your time in the
• 17:43
  - hospital and health system universe
• 17:46
  - as fondly as you've looked on that, what
• 17:48
  - do you think they may
• 17:50
  - misunderstand about primary care and prevention,
• 17:52
  - and what would you change if you were
• 17:54
  - back in the c suite?
• 17:57
  - Yeah.
• 17:58
  - You know, I I I think hospitals
• 18:00
  - in general,
• 18:02
  - some are different, but I think hospitals in
• 18:04
  - general treat primary care as a distribution channel
• 18:07
  - for the hospital.
• 18:08
  - And I can tell you after working for
• 18:09
  - larger hospital systems,
• 18:12
  - you you do feel like a commodity,
• 18:14
  - in the system.
• 18:17
  - And the... As they feel, the implicit job
• 18:19
  - of the internist or primary care is to
• 18:21
  - keep the imaging, the OR, and and their
• 18:23
  - beds busy.
• 18:25
  - Because we still live in a fee for
• 18:27
  - service world even though
• 18:29
  - we are, you know, looking at
• 18:32
  - ways to to
• 18:34
  - reward and and sometimes even punish,
• 18:38
  - people for their
• 18:39
  - lack of quality metrics,
• 18:43
  - and that whole value based care. But we
• 18:45
  - still live in that pay for service world.
• 18:47
  - And that prevention that actually keeps people out
• 18:49
  - of the building looks like a volume problem.
• 18:51
  - So
• 18:53
  - that prevention
• 18:54
  - arm of
• 18:56
  - primary care really becomes a brochure and a
• 18:58
  - wellness committee rather than something that actually happens.
• 19:01
  - And so
• 19:02
  - I I think they've confused access
• 19:05
  - with their primary care with slots that are
• 19:07
  - open. So opening more fifteen minute appointments, for
• 19:10
  - example, is not really truly access if the
• 19:13
  - physician
• 19:13
  - can't think and go through
• 19:15
  - this whole prevention problem.
• 19:17
  - And so that twelve minute visit
• 19:19
  - cannot do advanced lipids, cognitive screening,
• 19:23
  - medication reconciliations,
• 19:25
  - and a real conversation about sleep stress and
• 19:28
  - alcohol use.
• 19:30
  - Employ primary care with two to 3,000 patients,
• 19:33
  - which I've been a part of, is really
• 19:35
  - not a prevention strategy. It's a... It's an
• 19:37
  - access strategy that produces late diseases.
• 19:41
  - And I spent a lot of years on
• 19:42
  - that hospitalist side and in the post acute
• 19:45
  - care and,
• 19:46
  - you know, that patient who arrives at a
• 19:48
  - facility on 14 medications with no one owning
• 19:51
  - that list is really a systemic primary care
• 19:54
  - failure that started five years ago. So,
• 19:57
  - you know, unfortunately, I I do think that
• 19:59
  - hospitals look at that primary care mode as
• 20:03
  - a as a way to keep the the
• 20:05
  - rest of the services, those highly paid services,
• 20:08
  - busy and active.
• 20:10
  - That was interesting. Second part of that question,
• 20:12
  - if I were back in 6th Street, what
• 20:14
  - would I like to change?
• 20:17
  - That is a difficult question because I I
• 20:19
  - do also understand the complexity
• 20:21
  - of that environment.
• 20:23
  - But I I think if there is a
• 20:25
  - way, for example, to cap employed primary care
• 20:28
  - panels at a size
• 20:30
  - where they have that same week access and
• 20:32
  - the real annual exam
• 20:34
  - that
• 20:35
  - are operationally
• 20:37
  - possible, possible even if that means hiring more
• 20:39
  - providers, that would that would certainly be a
• 20:41
  - nice option.
• 20:42
  - I know when I go visit my own
• 20:44
  - primary care physician, it's it's a ten to
• 20:45
  - fifteen minute
• 20:47
  - exam
• 20:48
  - Mhmm.
• 20:48
  - Discussion. And I bring my agenda, and that
• 20:52
  - person has their agenda.
• 20:54
  - And
• 20:55
  - compressing that into that eight to fifteen minute
• 20:59
  - exam is difficult,
• 21:01
  - if not impossible.
• 21:03
  - So that... That's one thing I would do.
• 21:05
  - And certainly,
• 21:06
  - you know, maybe another is to give them
• 21:08
  - support for the complexity of their patients that
• 21:11
  - they're seeing.
• 21:12
  - Wouldn't shock you that, you know, patients come
• 21:14
  - in with
• 21:15
  - very complex lives. And so having social workers,
• 21:19
  - pharmacists,
• 21:20
  - and some back office support
• 21:23
  - for the myriad forms that come through that
• 21:25
  - office, which is absolutely unbelievable these days,
• 21:29
  - and put psychological pressure on the clinician. You
• 21:31
  - know, things like f o m I papers,
• 21:34
  - pre authorizations,
• 21:35
  - emails,
• 21:36
  - these are things that are...
• 21:38
  - And and and the EMR itself, these are
• 21:41
  - things that are taking time away from the
• 21:43
  - patient.
• 21:44
  - And so even if the providers in primary
• 21:47
  - care are not actually talking about this, they
• 21:50
  - will all complain about
• 21:52
  - the large number of interruptions that occur during
• 21:56
  - their days and inability to take care of
• 21:58
  - the complexity of their their patients.
• 22:01
  - And then maybe another thing is put prevention
• 22:03
  - metrics, you know, that per... Predict events on
• 22:06
  - the same dashboard as
• 22:08
  - the OR volume.
• 22:11
  - And so looking at things like, you know,
• 22:13
  - APOB levels
• 22:14
  - that are... That you need to get to
• 22:16
  - target and calcium scores that need to be
• 22:19
  - acted on.
• 22:20
  - Because if... As you know, if it's not
• 22:22
  - in the board packets, not being measured really
• 22:24
  - isn't a priority.
• 22:26
  - And then maybe stop building wellness centers that
• 22:29
  - are disconnected from the interns who holds the
• 22:31
  - chart.
• 22:33
  - Prevention that doesn't
• 22:35
  - live in the medical home is really marketing.
• 22:37
  - And so I'm I'm a strong believer that
• 22:40
  - primary care really should be owning this whole
• 22:44
  - avenue of wellness rather than making specialty wellness
• 22:47
  - centers.
• 22:49
  - And then this is the topic, you know,
• 22:51
  - maybe getting the board to understand that wellness
• 22:53
  - truly is a feeder into the system.
• 22:56
  - You know, primary care and executive and executive
• 22:59
  - physicals remain a low cost way
• 23:02
  - to originate high margin elective work.
• 23:07
  - Specialty referrals and hospital
• 23:09
  - can sell a healthier workforce to
• 23:13
  - employers.
• 23:15
  - So that I think direct contracting
• 23:17
  - there really looks nice.
• 23:19
  - And they're really really looking at where wellness
• 23:22
  - actually shows up on the p and l.
• 23:24
  - You know, is it in shared savings, cash
• 23:25
  - memberships, or downstream revenue?
• 23:28
  - Because if you don't match the economics to
• 23:30
  - the mission in the hospital, it'll get lost
• 23:32
  - in all this.
• 23:34
  - Then maybe one last comment on this, you
• 23:37
  - know,
• 23:38
  - because I don't wanna be negative to hospitals.
• 23:40
  - I still love them. Hospitals will always, always
• 23:44
  - be needed... Always will be needed there for
• 23:46
  - the crash, what, Peter Taylor calls the medicine
• 23:49
  - two point o. We have to be... And
• 23:51
  - and we're... And they're really, really good at
• 23:53
  - that.
• 23:54
  - But it shouldn't be the only place where
• 23:56
  - medicine
• 23:57
  - is allowed to be very thorough.
• 23:59
  - And so I... Big believer that, you know,
• 24:01
  - this primary care,
• 24:03
  - wellness,
• 24:04
  - keep people in all the hospitals
• 24:06
  - is where that belongs.
• 24:09
  - Well, Kevin, you've given our audience a ton
• 24:11
  - to think about today, so we very much
• 24:13
  - appreciate that from everything you're building at Helix
• 24:16
  - to all the experience that you've had, with
• 24:18
  - hospitals and health systems. Thank you so much
• 24:20
  - for being on the podcast today.
• 24:22
  - Well, thank you very much for having me.