Latest / CareTalk: Healthcare. Unfiltered. / Overriding America's Chronic Pain Crisis w/ Jennie Shulkin, Founder of Override Health

Transcript

Overriding America's Chronic Pain Crisis w/ Jennie Shulkin, Founder of Override Health · CareTalk: Healthcare. Unfiltered.

• 0:07
  John: Welcome to Care Talk.
• 0:08
  John: America's home for incisive debate on business and politics.
• 0:12
  John: And today we have another great founder and CEO Jennie Shulkin.
• 0:16
  John: Welcome, Jennie.
• 0:18
  Jennie: Hi, John.
• 0:18
  Jennie: Thanks for having me.
• 0:20
  John: Um, we have, we have a, we've had a number of great, uh, entrepreneurs on the show, but we've rarely had a, a father daughter separate issue.
• 0:29
  John: You know, we, we, we have, uh, we have a, we did a wonderful interview with your dad, uh, veteran Secretary David Shulkin, and had a intriguing conversation about where things are, where they're going, and we are delighted to have another member of the family who's building a great company.
• 0:45
  John: I. On the show.
• 0:46
  John: So, uh, if, if you are interested in, in, in that, the prior interview, uh, with Secretary Sheen, uh, that will be embedded in the, in the, in the show notes.
• 0:55
  John: But this episode is about your company override and the journey you have taken to kind of start this company that's working on really a persistent chronic problem that's not well addressed by the healthcare system.
• 1:11
  John: Chronic pain for those who aren't.
• 1:13
  John: Haven't touched it.
• 1:14
  John: It is, it is, it, it feels irrelevant, but it is a, it is a, it is a, it is a really mesmerizing, difficult issue for patients and families that have to deal with it.
• 1:24
  John: So, welcome, Jennie.
• 1:27
  Jennie: Thanks so much.
• 1:27
  Jennie: John.
• 1:28
  Jennie: You know, it's funny because I was the only member of my family who didn't go into healthcare.
• 1:33
  Jennie: I became a criminal lawyer, but, uh, soon enough I entered healthcare myself.
• 1:39
  Jennie: So here I am.
• 1:40
  John: Well, there's, there's, uh, I could go down an ironic route about law and healthcare, but let's stick to your, so tell, tell us a little bit about how did you, what, what, what gets you interested in, in this, in this issue?
• 1:52
  John: Because it's a, um, again, if you're, if it doesn't touch you, it doesn't, it, people don't realize how big an issue is and how hard it is to address, uh, because conventional healthcare has really struggled with folks with all kinds of different points for forms of chronic pain.
• 2:10
  Jennie: Absolutely.
• 2:11
  Jennie: So first of all, estimates say that about one in four Americans are suffering with some form of chronic pain.
• 2:19
  Jennie: When I started the company, when I started Override Health about four years ago, it was one in five Americans.
• 2:25
  Jennie: So the numbers just keep going up.
• 2:28
  Jennie: Unfortunately, I am one of those one in four Americans.
• 2:31
  Jennie: I have had a very complex chronic pain syndrome for the past 11 years that has taken me.
• 2:37
  Jennie: All over the country looking for relief pages and pages of medications, devices, interventions, physicians tried and failed.
• 2:46
  Jennie: And so I've learned a lot about the traditional chronic pain system and the gaps in care that exist for patients like me.
• 2:56
  Jennie: There are a lot of them.
• 2:58
  Jennie: And so about four years ago I came together with my father, Dr. David Shulkin, who is a physician by training and has spent most of his career leading major health systems, including the Department of Veterans Affairs, where he specifically saw.
• 3:14
  Jennie: A significant number of veterans suffering with chronic pain.
• 3:18
  Jennie: And we married our two experiences to form override health, which we saw as an opportunity to fill the gaps in traditional pain management and create a much better treatment program for people with chronic pain like myself and like the veterans that he was looking after.
• 3:35
  John: And, and, and.
• 3:37
  John: Jennie, if you could talk a little bit about how conventionally this is both dealt with and not dealt with Well, just so folks have a, a sense of, you know, there's, there's, there's a, obviously we are suffer in the midst of an opioid crisis that is, you know, partially driven by, uh, you know, addiction and heroin.
• 3:55
  John: But a lot of, a lot of opioid addiction has come through over medication, around pain for very conventional.
• 4:03
  John: You know, and, and more commonly occurring sources of, uh, of, of, of pain.
• 4:09
  John: Um, but this, it's, it's a broad based problem.
• 4:12
  John: Maybe you could talk a little bit about how people conventionally try to treat it and where the gaps are.
• 4:20
  Jennie: It's such a good question and it's such a complicated answer because pain is so many different things to so many different people.
• 4:28
  Jennie: So first of all, a lot of people do think opioids in the opioid epidemic when they think about chronic pain, and for sure, I. Um, trying to control chronic pain is the number one reason why Americans misuse opioids.
• 4:44
  Jennie: But there are also certainly people with chronic pain who are not on opioids or who are not misusing opioids.
• 4:51
  Jennie: And then there are all different types of pain.
• 4:53
  Jennie: So.
• 4:53
  Jennie: When a lot of people think of pain, they think of acute pain, which is someone hurts themselves, it's hurting a lot, and then they get it under control in a few weeks or a few months, and they're back to normal.
• 5:04
  Jennie: Acute pain is defined as pain that lasts less than three months.
• 5:09
  Jennie: Now, for other people, even if the pain was initially caused by an injury or some sudden onset of illness, after three months, they continue to be in pain.
• 5:21
  Jennie: And what the pain science tells us is that for those people, it actually shifts from a body part problem to a nervous system problem.
• 5:33
  Jennie: And so what happens essentially is that the brain learns how to keep pain going.
• 5:38
  Jennie: It gets used to being in pain, and it continues a pain cycle in the nervous system and in the brain that's difficult to break.
• 5:46
  Jennie: It's kind of like a broken record error loop.
• 5:50
  Jennie: And once you get into chronic pain, it needs to be treated in a different way.
• 5:55
  Jennie: So the things that might have worked for acute pain, like a cast or rest, or an injection or an opioid pill.
• 6:05
  Jennie: Those things aren't necessarily going to help with chronic pain, and we need to start treating it a different way.
• 6:12
  Jennie: Now, in the eighties and the nineties, there used to be comprehensive pain rehab programs where they had a team of specialists, a physical therapist, a physician, a psychologist, maybe an acupuncturist, and all these providers were working together to deliver comprehensive.
• 6:29
  Jennie: Long lasting relief to patients who could then take those tools home with them after they left these programs that were sometimes inpatient or sometimes outpatient, but far away.
• 6:40
  Jennie: Then most of these centers closed once doctors started prescribing opioids because opioids were quicker, they were faster, they were cheaper.
• 6:50
  Jennie: Now that we've recognized the evils of opioids, now suddenly we have millions of Americans who don't have comprehensive pain rehab programs to go to because they're closed and they're not able to get opioids from their doctors because their doctors either don't wanna prescribe them because they think that they're bad for patients or they don't wanna go to jail, um, which a lot of doctors are afraid of.
• 7:12
  Jennie: And so where are these patients supposed to go?
• 7:15
  Jennie: And that's largely why we formed Override Health, which is a virtual comprehensive pain rehab program that doesn't use opioids, but uses a lot of the other modalities and specialists That research has shown since the eighties to be most effective for people with chronic pain.
• 7:31
  John: H how did you come up with the name override?
• 7:35
  Jennie: That's a great question.
• 7:37
  Jennie: So we started the company as Global Pain Center.
• 7:42
  Jennie: Um, and when we raised our initial financing round with venture capitalists, they said one thing, the name's gotta go.
• 7:50
  Jennie: And so our lead investor said to us, here's a naming consultant.
• 7:56
  Jennie: He's $11,000.
• 7:58
  Jennie: All he does is the name, no branding, no colors, nothing.
• 8:02
  Jennie: Just the name.
• 8:03
  Jennie: And honestly, he came up with nothing.
• 8:06
  Jennie: The name worked.
• 8:09
  Jennie: And so this was a big lesson for us.
• 8:11
  Jennie: He's got one move and he does, it
• 8:12
  John: doesn't work.
• 8:14
  Jennie: Right.
• 8:15
  Jennie: But, um, so eventually, you know, we racked our brains and we thought of different names, and I came up with override because it's this idea of overriding the pain pathways in the brain, the neural pathways that form in the nervous system in the brain when you exist in a sustained period of chronic pain.
• 8:32
  Jennie: We wanted something active, you know, not something like soothe or.
• 8:37
  Jennie: Relief.
• 8:37
  Jennie: We wanted something that said, this is hard work.
• 8:41
  Jennie: Getting outta chronic pain is the hardest thing that you'll ever do or learning to manage it.
• 8:46
  Jennie: And it takes work.
• 8:48
  John: And, and, and when you think about, like, as most people do, think of pain as acute pain, if you're not in the, you're in the you, you either chronic pain's, like a lot of things in healthcare, you either understand or you don't.
• 8:59
  John: So you're in that loop.
• 9:01
  John: The broken record that just keeps your brain is now feeding you signals that you have pain.
• 9:08
  John: What are the.
• 9:10
  John: Drug therapies that would, that you think are more, more novel, that are working for you for folks with chronic pain that, that perhaps folks who aren't in that, in that area wouldn't expect?
• 9:22
  John: Like what's, what's working in different ways perhaps maybe start there and what's working in different ways that people would find unexpected.
• 9:34
  Jennie: So novel really is the word, because the industry is still trying to figure this out.
• 9:39
  Jennie: There's a lot that we don't know.
• 9:40
  Jennie: There's a lot that we don't understand.
• 9:43
  Jennie: The big.
• 9:45
  Jennie: Buzzword and the big new philosophy that is making waves is called pain reprocessing therapy or PRT.
• 9:53
  Jennie: And it's this idea that we can use pain education and pain psychology techniques to rewire the brain and the nervous system and override pain, override chronic pain, and it's getting some really quick and successful results for some.
• 10:12
  Jennie: It's not helping others.
• 10:14
  Jennie: And so at Override Health, we believe that pain psychology has to be a component, and pain education has to be a component of the overall treatment protocol, but that that can't be the be all and end all because it doesn't work for everybody.
• 10:28
  Jennie: And when it fails, the patient feels like a failure and goes back into the spiral of hopelessness and despair and nothing will work.
• 10:36
  Jennie: Things that their doctors have told them over and over likely.
• 10:40
  Jennie: So what we do at Override Health is we combine the most necessary components of chronic pain recovery, which is a physician and medication management.
• 10:49
  Jennie: It's a physical therapist for movement, strength, mobility, range of motion.
• 10:55
  Jennie: It's a pain psychologist for these things that I just spoke about, you know, fear, rumination, catastrophizing.
• 11:01
  Jennie: All things that really affect the way that we're able to manage chronic pain.
• 11:06
  Jennie: And then it's a health and wellness coach, which, um, does group coaching.
• 11:10
  Jennie: So it leads the component of peer support, also helps patients through pain education does a lot of overlap with the pain psychologist.
• 11:18
  Jennie: So those are the key four.
• 11:20
  Jennie: Specialists at Override Health that work together and the importance of working together can't be understated.
• 11:27
  Jennie: Because what happens when a patient is working with so many different specialists and none of them are talking to each other, is they all have contradicting treatment plans and contradicting ideas as to why the patient is pain is in pain, and what solution they need to apply to get the patient out of pain.
• 11:45
  Jennie: And it ends up with the patient's.
• 11:47
  Jennie: Spinning their wheels and confused and not finding relief.
• 11:51
  Jennie: So we make sure that there's a team-based approach where all the providers are aligned and a patient feels like they really have a support team around them.
• 12:01
  John: Um, Jennie, that's a really I important point that Madison is, is, is is research developed and trained and then people have their careers in.
• 12:12
  John: Very specific silos, whether it's a, a doc, a neuro circle, people typically specialize what that can mean for a.
• 12:17
  John: Patient who doesn't have a very, a narrow specific condition is other things can be missed or the opportunity to work with other members can be missed.
• 12:28
  John: And yet it's interesting that two hospitals that really best practice team-based medicine, Mayo and Cleveland are the two that are regularly ranked one, two, or three for the last.
• 12:41
  John: 50 years as long as I have looked at it, and yet medicine doesn't move that way.
• 12:45
  John: So it's really impressive that it override you pulled that together.
• 12:49
  John: Um, so back up a second.
• 12:51
  John: How do, how does a patient access override and, and what's your business model?
• 12:56
  Jennie: We primarily target health plans, and then secondarily, we target provider groups and health systems.
• 13:03
  Jennie: So what we do if we launch a partnership with a health plan is we get the health plan to get the word out to its members.
• 13:12
  Jennie: So maybe they send a text message campaign or an email campaign to their members.
• 13:18
  Jennie: They give us the ability to do that directly to its members, only the eligible members.
• 13:23
  Jennie: Of course, we're not spamming everybody, but essentially what we do then is we say to the member, this is a covered benefit through your health plan and you can join us.
• 13:35
  Jennie: The way that you start is you start with a physician evaluation after they're evaluated by a physician who does diagnosis or re or confirms a diagnosis, maybe starts medication Me.
• 13:47
  Jennie: Management.
• 13:48
  Jennie: Then from there, the patient is assigned the rest of their care team, which could include a physical therapist, a psychologist, a health coach, and a peer support group.
• 13:57
  Jennie: And then from there, there's a frequency of appointments set per month.
• 14:03
  Jennie: And it's pretty much rinse and repeat.
• 14:05
  Jennie: From there, the patient is using our mobile app, which we designed in-house.
• 14:09
  Jennie: It has an entire pain, neuroscience education curriculum on it, a meditation library, goal setting tools, messaging capabilities with providers, um, scheduling and reed.
• 14:20
  Jennie: You've this tools.
• 14:21
  Jennie: You've done list more
• 14:21
  John: than once.
• 14:21
  John: Jennie, I can tell.
• 14:24
  John: Yes.
• 14:25
  Jennie: So they have all of this through their technology, through their mobile app, and then they also have their live video appointments with their provider care teams.
• 14:34
  Jennie: And they're doing that on a regular basis.
• 14:36
  Jennie: So they might have two or three appointments a week, and they might be looking at their app education two or three times a week.
• 14:44
  Jennie: The point is, we're trying to get them to form new habits.
• 14:48
  Jennie: So we are trying to give them a little bit of contact every day or every other day, or every third day.
• 14:55
  Jennie: And we generally stay with the patient for a period of three to six months because we're targeting the some more, the more severe end of chronic pain, which requires a little more care and lengthier care.
• 15:08
  Jennie: And we're also trying to get them to rinse and repeat and form habits that they need to sustain.
• 15:14
  John: And, and so you're just, I, I want to touch on first how you get paid.
• 15:18
  John: So the health plan would pay you because you're taking care of a problem that's not going away for members that are bouncing around the system and seeing a lot of different specialists.
• 15:28
  John: That makes sense to me.
• 15:29
  John: And, and I'm presuming you charge the health plan and would be pay based on fee for service plus outcomes.
• 15:35
  John: Is that correct?
• 15:37
  Jennie: Pretty much, um, you know, when we get in front of a health plan, they often say to us, well, we're not really sure how big of a problem chronic pain is.
• 15:46
  Jennie: Now, generally, if the statistics say that chronic pain costs the US more than cancer, heart disease, and diabetes combined, this is about 725.
• 15:56
  John: If you could just repeat that.
• 15:58
  John: 'cause I think that will give people a sense of, of how big it is Yeah.
• 16:02
  John: And how, how, and how far reaching it is.
• 16:04
  Jennie: Sure.
• 16:05
  Jennie: So chronic pain costs the US more than cancer, heart disease, and diabetes combined.
• 16:13
  Jennie: Now, the reason that people may not know that, or may not realize that it's such a big problem is because chronic pain generally doesn't kill people.
• 16:22
  Jennie: That cancer kills people, or heart disease kills people, and so it's not as.
• 16:28
  Jennie: Big of an issue or as high on people's radars, whether it's a normal person or whether it's a person who works at a health plan.
• 16:36
  Jennie: So what we say to health plans is let us give you a list of our ICD 10 codes and some criteria of how to run your data.
• 16:45
  Jennie: You run your data and come back to us.
• 16:47
  Jennie: I see
• 16:47
  John: them being the diagnosis codes that, that are on the billing for patients who are seeing doctors, specialists, non-specialists, and that are charges.
• 16:57
  John: So it's a, it's a way to index where the patients really are based on the bills the health plans already paid.
• 17:04
  Jennie: Exactly.
• 17:05
  Jennie: So we may say, you know, here's a list of chronic pain diagnoses.
• 17:09
  Jennie: Why don't you catalog people who have had.
• 17:13
  Jennie: Five or more claims in the last year, or ER visits related to it in the last year.
• 17:18
  Jennie: And without fail, the health plans come back to us and they say, oh my God, we had no idea how expensive chronic pain was.
• 17:26
  Jennie: And at that point, there's a value proposition and there's a reason for us for them to pay us.
• 17:32
  Jennie: So that's how we work with health plans.
• 17:34
  Jennie: We can either work with them, fee for service, we can work with them through a bundled approach.
• 17:39
  Jennie: Um, eventually we wanna be.
• 17:42
  Jennie: Doing value-based care and taking on risk, but we're not quite there yet.
• 17:47
  Jennie: The other way that we get patients is directly through providers.
• 17:52
  Jennie: So we have partnerships with health systems and provider groups where the doctors understand that they're not able to give chronic pain patients enough time, resources, and attention that these patients need to start making meaningful progress.
• 18:07
  Jennie: And so they think of us.
• 18:09
  Jennie: As supplemental support, you know, as, as wraparound support to the services that they're giving to their patients in person.
• 18:18
  Jennie: And so they're referring patients because it's the right thing to do for their patients.
• 18:23
  Jennie: And they also know that we're covered by most of the patients health plans.
• 18:27
  John: And, and I guess Jennie from, uh, um.
• 18:31
  John: From a patient perspective, that's, you've just given me a, a, a, an and and, and our listeners a real sense of how health plans should, should, should be using override and working directly with you.
• 18:45
  John: Um, maybe talk a little bit about the patient experience, how much of it's virtual, how much of it's in person, and how patients should be thinking about.
• 18:54
  John: Lessons, you've, you've, you've, so how, how they would access the system through override and interact with it.
• 18:59
  John: And then general advice for patients with this, this problem, but maybe start with how do they access and use override and how much of it's virtual either through a a, a computer or a mobile app, and how much of it's in person?
• 19:14
  Jennie: 100% of it is virtual.
• 19:17
  Jennie: So override currently has a medical practice launched in nine states, but they are completely virtual medical practices.
• 19:26
  Jennie: A patient is meeting with a physician just like you, or and I are talking right now through Zoom.
• 19:32
  Jennie: Um, same with physical therapy.
• 19:34
  Jennie: Physical therapists are setting up mats in their own home offices and they are showing patients how to do exercises in their living rooms and.
• 19:43
  Jennie: Everything is virtual, and that's intentional because when you need this level of comprehensive care that could be three appointments a week, you can't really do that in person while still continuing to live a life while still continuing to work a job and take care of your family and do what needs to be done in your community.
• 20:05
  Jennie: So this is entirely intentional.
• 20:09
  Jennie: Um.
• 20:10
  Jennie: And what the patient experience would look like is they're setting up appointments on their own time.
• 20:17
  Jennie: They're meeting with their providers when it's convenient to them.
• 20:19
  Jennie: It could be on their lunch break, it could be at six o'clock at night.
• 20:23
  Jennie: It could be on a Saturday morning, and then they're doing the app homework and education.
• 20:30
  Jennie: On their own time and they're doing whatever they need to do for their home exercises on their own time.
• 20:36
  Jennie: So it's both designed to be very supportive and comprehensive with a lot of provider support around the patient, but also flexible and independent.
• 20:47
  John: And how, and have you done, like, what are the out outcome?
• 20:50
  John: What, how, what are the outcomes on on in terms of cracking this really brutal problem?
• 20:54
  Jennie: Yeah.
• 20:55
  Jennie: Um, we've gotten really incredible outcomes.
• 20:59
  Jennie: I mean, we definitely have a bunch of miracle stories of patients who have been suicidal and completely given up hope with, you know, 10, 20, 30 years of chronic pain.
• 21:11
  Jennie: And this has made the difference for them.
• 21:13
  Jennie: Um, you know.
• 21:15
  Jennie: We also then have a lot of patients who haven't had access to the type of care that those patients maybe have had.
• 21:22
  Jennie: About 60% of our patients currently are on Medicaid.
• 21:25
  Jennie: Actually, our biggest health plan partnership to date is with the Blues Medicaid plan.
• 21:30
  Jennie: So, you know, those patients haven't had phenomenal access to care and different interventions, but they come with a ton of comorbidities.
• 21:39
  Jennie: They come with hypertension, diabetes, obesity and chronic pain, and PTSD, you know, all sorts of things.
• 21:46
  Jennie: And they've gotten phenomenal results from the type of comprehensive multi-specialty care that we offer.
• 21:52
  Jennie: Um, so you know, about, about 80% of our patients report improved pain management after working with override for about three months.
• 22:11
  John: That's amazing.
• 22:12
  John: And so maybe to, to, to wrap Jennie, what's your advice to a patient who's got chronic pain and doesn't know how to take that first step towards a a, a better solution as they bounce around a healthcare system that may not be solving their problem?
• 22:31
  Jennie: Well, my first piece of advice is to consider working with override if you live in one of the nine states where OVERRIDE exists, and that's on our website.
• 22:43
  Jennie: Um, you can participate in the full comprehensive pain program with the physician, physical therapist, pain psychologist, and health coach.
• 22:50
  Jennie: If you don't, and even if you live outside of the us.
• 22:54
  Jennie: You can participate in our pain management coaching program, which is individual and group coaching sessions with the health and wellness coaches and also full access to the app.
• 23:04
  Jennie: We get phenomenal results from that as well.
• 23:07
  Jennie: Um, you know, and also if, if override isn't for you or if you don't feel like you're ready for it, um, there's a lot of.
• 23:15
  Jennie: Resources out there on pain science, on pain education.
• 23:19
  Jennie: We have our whole resources page on override health that you could take a look at.
• 23:25
  Jennie: And I think finally just to have compassion for yourself because especially when chronic pain is not responding to treatment, it is one of the most, um.
• 23:40
  Jennie: Frustrating and depressing situations that there is, and I know that very personally.
• 23:46
  Jennie: Um, and there are often no easy answers and often no quick fixes.
• 23:52
  Jennie: So being patient and trying to stay the course is difficult, but
• 23:58
  John: very important.
• 23:59
  John: Well, I, I think you're a, a leader in, in, in that approach of compassion.
• 24:04
  John: So that's it for care talk.
• 24:05
  John: If you like what you heard or you didn't, we'd love you to subscribe on your favorite service.
• 24:11
  John: Jennie, thanks so much for sharing your journey, your success, the, the promise of override and the promise of of change in this, this, this, the horrible cloud of pain management.
• 24:22
  John: Thanks for joining.