Latest / CareTalk: Healthcare. Unfiltered. / Healing Through Human Connection w/ Darin Buxbaum, CEO, Wider Circle

Transcript

Healing Through Human Connection w/ Darin Buxbaum, CEO, Wider Circle · CareTalk: Healthcare. Unfiltered.

• 0:00
  David: Medicaid covers nearly 90 million Americans, but coverage doesn't always equal health.
• 0:05
  David: What if the real driver of outcomes isn't the doctor's office or even an app, but the community itself?
• 0:19
  David: Welcome to Care Talk Executive features a series where we spotlight innovative companies and leaders working to advance the healthcare field.
• 0:26
  David: I'm David Williams, president of Health Business Group, and my guest today is Darin Buxbaum.
• 0:30
  David: He's co-founder and CEO of Wider Circle, a nationwide community powered platform that partners with health plans to engage hard to reach members through peer led circles and technology tools.
• 0:41
  David: Darin, welcome to Care Talk.
• 0:44
  David: Thanks so
• 0:45
  Darin: much for having me on, David.
• 0:46
  Darin: It's truly an honor.
• 0:47
  David: You know, wider circle is such an interesting, uh, organization just as I, as I look at the, at the website, and I'm wondering, you know, was what kind of inspired you, uh, with maybe through your own experience to, to start something like this.
• 1:02
  Darin: No thanks.
• 1:03
  Darin: Thanks for asking.
• 1:04
  Darin: And I, you know, I've been in healthcare for decades now.
• 1:07
  Darin: Uh, this is my third company and what really inspired this one was, uh, a family experience.
• 1:13
  Darin: Um, unfortunately, uh.
• 1:16
  Darin: After my grandfather's passing, my grandmother, who made the best chicken cutlets in the world, um, she just lost her connection with this world and nothing we did as a family.
• 1:27
  Darin: We, we moved her closer, essentially, into a great assisted living facility.
• 1:31
  Darin: Um, she never reconnected and her health just spiraled precipitously.
• 1:36
  Darin: I, I just wish I knew.
• 1:37
  Darin: Back then, what I understand now, which is how critical connection is our, for our health, for happiness.
• 1:45
  Darin: Uh, and that's what's really inspired, uh, wider circle.
• 1:49
  David: You know, it sounds right, and even it sounds like even if you didn't know exactly what was going on, you could see that there was like an impetus for it, right?
• 1:56
  David: She was okay cooking, doing everything, and then all of a sudden something changed and she wasn't, and she's not the only one like that.
• 2:05
  David: Clearly, I.
• 2:07
  Darin: Clearly now, uh, you know, loneliness is, uh, is an epidemic in this country and, uh, the surgeon General has recognized that.
• 2:15
  Darin: But I'll tell you what we've kind of understood is that loneliness is that scourge really eradicates hope.
• 2:22
  Darin: Uh, and that's what, if I look at both in healthcare and just society at large, you know, hope is that key ingredient that's, that's missing from too many of our lives right now.
• 2:32
  David: So when you were, when you were starting up this company, did you identify the gap like that?
• 2:37
  David: Like, we're gonna close the hope gap or what, what usually, you know, you identify some sort of an opportunity, something to differentiate on what, what was that at the time of the founding?
• 2:46
  Darin: At the time of the founding, it really was around loneliness.
• 2:49
  Darin: Like we saw that people were just lacking that pur that social connection and purpose in their lives, and that evolved to trust.
• 2:58
  Darin: Uh, when you create, have these groups, what we found was that wow.
• 3:02
  Darin: And these are peer led groups.
• 3:04
  Darin: These are like in real life.
• 3:05
  Darin: And what we found is people trust neighbors.
• 3:08
  Darin: They don't always trust their health plans, but they do trust their neighbors.
• 3:12
  Darin: And so we saw this massive trust chasm in, in healthcare, uh, that was being bridged by these peer led support groups.
• 3:22
  David: I mean, how do you spark up something like that?
• 3:25
  David: I mean, on the one hand I can understand that.
• 3:26
  David: Yeah.
• 3:26
  David: I trust my peer.
• 3:27
  David: I don't trust my health plan, but like with a health plan, at least they, you know, they can hire a bunch of people, put 'em in a call center, you know, connect 'em and just like, oh yeah, I'm gonna have peers.
• 3:34
  David: Well, they, they may be doing something else.
• 3:36
  David: And you know, if you start off being lonely, I mean, what do you find these peers in, in the first place?
• 3:40
  Darin: Yeah, well we started the company inside of a senior center.
• 3:44
  Darin: Actually it was a, it was a living lab.
• 3:47
  Darin: And we saw how does this work?
• 3:49
  Darin: And I'll tell you, lot of senior centers, it, it's very much like, uh, like high school, being in a cafeteria.
• 3:54
  Darin: You know, people have their places.
• 3:56
  Darin: Can you be part of the clique, the group, the knot, uh, and what we, it, we spent a lot of time researching the psychology of belonging.
• 4:05
  Darin: Uh, and so we started in Medicare and then we've really branched into Medicaid in a, in a massive way because we were able to say what enables people to feel like they belong.
• 4:16
  Darin: And we have incredible community engagement leads that we have on the ground in these communities.
• 4:22
  Darin: We use a lot of data to kind of parse through and understand who should be in these groups.
• 4:27
  Darin: Think about it like an eHarmony matching algorithm for these groups.
• 4:31
  Darin: Uh, but then you have the spark.
• 4:33
  Darin: That's the incredible part of being human.
• 4:35
  Darin: Once you get people together, they can't help themselves but connect.
• 4:40
  Darin: And we have incredible stories about groups that you would never imagine connecting.
• 4:46
  Darin: Finding belonging, you know, in these groups.
• 4:49
  David: Nice.
• 4:49
  David: So I love the idea of how it started off in the, in the senior center and I can imagine like, you know, managing one high school group and all that and it's kind of, it's kind of exciting.
• 4:58
  David: But now you mentioned Medicare and then Medicaid and so I think when you talk about sort of scaling up and going beyond like a club model or something, but to actually making it.
• 5:07
  David: You know, sustainable and as a, as a business, you've gotta find the payer somewhere.
• 5:11
  David: So how does Medicare and maybe more importantly Medicaid, uh, come into it?
• 5:17
  Darin: Absolutely.
• 5:17
  Darin: When we got started, a lot of my, my co-founder, I, we've raised a quarter billion dollars in the past and people who have backed us said exactly what you're saying, David.
• 5:27
  Darin: They're like, how, how does this model scale?
• 5:30
  Darin: We're, we're talking humans, not, not tech, just pure tech.
• 5:34
  Darin: How does that work?
• 5:35
  Darin: And we're doing this now across, you know, 15 states.
• 5:39
  Darin: Uh, and the way that the, that it really scales, I'd say, is.
• 5:45
  Darin: What we do is we ignite the community, but people are just wanna, there are people who can't help themselves, but help other people in this world.
• 5:54
  Darin: And we call them ambassadors and those people in the group become the connective tissue that keeps that group together and then allows us to keep scaling more and more and more groups in the community.
• 6:06
  Darin: Um.
• 6:07
  Darin: Our transition into Medicaid, I'll tell you, was not an easy one because we, we actually rolled out in Detroit, Michigan, uh, at just pretty much one of the peaks of COVID and said, Hey, come on out, trust us.
• 6:22
  Darin: Like, and we, we, you know what I've learned about health plans, I thought about renaming us to St.
• 6:26
  Darin: Jude.
• 6:27
  Darin: They never give us the, the easy cases.
• 6:29
  Darin: They want us to reach the hardest to engage members.
• 6:32
  Darin: Uh, and so there we were knocking on doors, meeting people.
• 6:36
  Darin: That's the spark.
• 6:38
  Darin: But once it ignites the, the community takes on a life of its own.
• 6:42
  David: Nice.
• 6:43
  David: Well, I think that it would be typical, right to say, you know, when when you're starting something up, people, even though if you've had a track record before, people are like, nah, I don't know.
• 6:51
  David: But it's like, here's this group that they've totally written off, and it's like, give that one a try and see how it goes.
• 6:56
  David: And then of course if you can do it, then you know, because then they don't have any expectations and you can actually exceed that.
• 7:03
  David: And they say, wow.
• 7:04
  David: And then you can go from there.
• 7:07
  Darin: Yeah, absolutely.
• 7:08
  Darin: And, and that's kind of where we've gone think about it.
• 7:10
  Darin: What we realized is we've created this community engine and we've built that.
• 7:14
  Darin: We've closed that trust chasm.
• 7:16
  Darin: So now whatever a person needs to do to take better care of themselves, they can, and they're getting the support of their community through that.
• 7:26
  Darin: So whether it's.
• 7:28
  Darin: What's, what's the popular things?
• 7:29
  Darin: It's closing gaps in care.
• 7:31
  Darin: It's making sure that people can get through redetermination processes that they can si get, you know, sign up for important programs like SSI and get all of the benefits that, that truly that are coming to them and they deserve.
• 7:44
  Darin: Um.
• 7:45
  Darin: These are things that are just, quite frankly, creating that safety net so that they can have a healthy life.
• 7:52
  Darin: And then honestly, they're really seeking financial independence.
• 7:56
  Darin: That's what we're seeing in our groups right now.
• 7:58
  Darin: The hope that they ha want to aspire to the hope that they have is.
• 8:03
  Darin: I can get to a financially stable place in life and not even need to be on Medicaid anymore.
• 8:07
  David: Got it.
• 8:08
  David: And so, so you are dealing with a Medicaid population and some are probably dual elig eligible with Medicaid and Medicare.
• 8:15
  David: Is Medicaid itself a source of revenue, uh, for your activities?
• 8:21
  Darin: Yeah, so the model that we have works with Medicaid managed care organizations, and through those organizations, they sponsor our, uh, community groups.
• 8:33
  Darin: Um, and look, this is where Kumbaya meets calculators.
• 8:36
  Darin: You, you come to the group, you get a hug, you feel great.
• 8:39
  Darin: And let's be real, like health plans have a fiduciary responsibility.
• 8:43
  Darin: Claims are the source of truth.
• 8:45
  Darin: And so what we've done over time, we've brought in the top actuary, uh, actuarial firm in the country.
• 8:51
  Darin: You know, we've done, we've done multiple peer review published studies.
• 8:55
  Darin: We have shown that these communities lower, lower hospitalizations, they close the care gaps.
• 9:01
  Darin: They, you know, retain members and have a, a positive impact on the bottom line.
• 9:07
  David: Nice.
• 9:07
  David: So they could say, yeah.
• 9:08
  David: Is that hug worth 50 bucks?
• 9:10
  David: Okay.
• 9:10
  David: Yeah.
• 9:11
  David: 58 72. We'll sign up for another one.
• 9:13
  David: We,
• 9:14
  Darin: we are still working with the actu.
• 9:15
  Darin: I like what you're saying.
• 9:16
  Darin: We're, we're, we're working with the actuaries on the, you know, value of a hug.
• 9:20
  Darin: Yeah.
• 9:21
  Darin: But, uh, they, they, they leave the hugs to us and then we just share the numbers with them.
• 9:25
  David: So let's move out of the financial and the actuarial realm for a second and a little bit more.
• 9:29
  David: I'd like to hear about.
• 9:30
  David: Uh, how a pure LED circle actually works.
• 9:32
  David: I get it.
• 9:33
  David: You've got certain individuals, they want to be helpful.
• 9:36
  David: It's kind of the nature of people to get together.
• 9:38
  David: But gimme a sense of what, like what would a pure LED circle be like if I were enrolled in one?
• 9:43
  Darin: Yeah.
• 9:44
  Darin: A absolutely.
• 9:45
  Darin: So first we're inviting you to out into your community.
• 9:49
  Darin: Sometimes there'll be a community center, a park, a local business.
• 9:52
  Darin: We love to support local businesses, uh, and you know.
• 9:56
  Darin: Honestly, at the first time, we may just break bread together and you're coming and understanding like things that you can learn to get ahead in life.
• 10:03
  Darin: Um, so especially for our Medicaid population, there are a lot of folks that they just had their electricity turned off or like they're going through these different crises and they can come together and kind of get support in that group setting and, and learn from tips and tricks and when they figured it out.
• 10:19
  Darin: Here's the thing that people don't.
• 10:20
  Darin: Understand about healthcare and about life in general, but healthcare, it's emotional.
• 10:25
  Darin: So once they figure it out, now they're coming to the group and sharing that knowledge.
• 10:30
  Darin: So you come now, the first time you come, it feels like perfect strangers, but by the time you come a few weeks in a row, you're like, wait a second, like.
• 10:40
  Darin: These are now my, my, my friends, uh, you, you start building this bond of belonging and I, we do these mat in maternity support groups.
• 10:49
  Darin: We do, we, we do this across all ages, and that's the, what we see in common is once you have co-design and coex experience, that has a, a critical part of being human is just having that sense of belonging.
• 11:01
  David: And how does some of the kind of, you know, local, uh, communities differ from one another?
• 11:06
  David: I understand that it's the commonalities.
• 11:07
  David: You mentioned, I think you're in 15 states.
• 11:09
  David: I saw, you know, Baltimore and Baton Rouge.
• 11:11
  David: You know, both are places that you've been.
• 11:13
  David: Can you share a little bit of local flavor from?
• 11:15
  David: Those are two different places, both starting with ba, but.
• 11:20
  Darin: Yeah, that, and then the, uh, the similarities end about there.
• 11:23
  Darin: Uh, you know, just massive differences in digital literacy, uh, ma massive differences.
• 11:29
  Darin: Uh, uh, uh, in many ways what I would say, like what we see in Baltimore, for example, you know, we run these great maternity support circles.
• 11:39
  Darin: Uh, and you know, in those groups, and this is a sad thing, but people do not, this is a. Amazing, amazing life journey people are on and they're not getting the support at home, uh, to as they're going through their pregnancy.
• 11:57
  Darin: Uh, and they really, they, they don't even know which prenatal care visits they should be doing.
• 12:02
  Darin: They have lots of, you know, beliefs.
• 12:06
  Darin: Even like they deliver the baby.
• 12:08
  Darin: Like what's the best, what's the right way?
• 12:10
  Darin: Sleep on the front, on the back.
• 12:11
  Darin: I mean, there are some really.
• 12:14
  Darin: Critical needs that, that they're able to share with each other.
• 12:18
  Darin: Um, so we kind of see communities there in Baton Rouge.
• 12:22
  Darin: I'll, I'll tell you like a incredible event that we just did was an expungement fair.
• 12:26
  Darin: Have you ever been to an expungement fair, David?
• 12:29
  Darin: Like I had never been to an expungement.
• 12:31
  Darin: No.
• 12:31
  Darin: Okay, so we, we won't talk about maybe your record or things you've done in the past, but these individuals, like in Baton Ridge there, you can't even get a job in fast food, in some fast food chase chains if you have something on your criminal record.
• 12:47
  Darin: And this was a mistake that they may have made decades ago.
• 12:50
  Darin: You know, and they're like teams and so they're coming out and they're getting some support and help and figuring out how do you clear that, wipe that record clean so that you can actually move, move ahead and you know, get yourself ahead.
• 13:03
  Darin: So each community, different need being solved.
• 13:07
  Darin: Uh, but I, I'd say all being united 'cause like.
• 13:10
  Darin: Back to Baltimore.
• 13:12
  Darin: You know, in one of the groups, the, we have the moms like, write a letter to their unborn child and saying, what do they want?
• 13:19
  Darin: And so many of the moms say, you know, I wanna provide for them and give them a stable life that I never had.
• 13:26
  Darin: I want to make sure that, you know, they can get ahead, maybe they can go to college.
• 13:30
  Darin: That's a dream we all have.
• 13:31
  Darin: That's a, that's a shared Amer, like a shared experience of wanting it to be better for our kids.
• 13:38
  David: So a lot of this has been focused on the very, you know, human experience and with a little detour into the actuarial side of things, but what role does technology play?
• 13:48
  David: Because there's gotta be some role, I, I assume it has to do with, you know, amplifying the human connection.
• 13:54
  David: But where does, you know, you're not Luddites, I assume.
• 13:58
  Darin: We are, we are not Luddites like I, I live in Silicon Valley.
• 14:01
  Darin: Uh, you know, AI it has, is going to, you know, forever change our society.
• 14:07
  Darin: Uh, we use technology kind of in two places, but it's really to scale and give time for people to have, build these relationships.
• 14:17
  Darin: So on the front end, you know, we do data science and analytics like any value-based care provider.
• 14:24
  Darin: Understand what are the modifiable utilization patterns?
• 14:28
  Darin: Like what are members, by the way, what are matching algorithms?
• 14:32
  Darin: So that's, you know, David, you, you may be the, the paragon of health, the archetype, the thing that everyone wants to follow.
• 14:38
  Darin: Well, who are other people you could connect with and you can kind of help them find the path that you did.
• 14:46
  Darin: We also are using technology to just.
• 14:49
  Darin: Facilitate getting stuff done.
• 14:51
  Darin: So we have, uh, an ai, like we use an LLM in order to help people locate and solve their social determinants of health needs, but at a very community based level so that that's not something that you necessarily like, need someone holding your hand through entirely.
• 15:09
  Darin: If you're like, no, I, I need a place where, where can I get food today?
• 15:13
  Darin: Like, where can I get some help with housing assistance?
• 15:16
  Darin: Great that that's a great thing to have a personal assistant in your pocket.
• 15:20
  Darin: And so we're finding technology really is able to scale solving the social determinants of health.
• 15:27
  David: So in terms of measuring the results, you were talking before, we'll go back to the actuarial side, uh, for a moment and understanding kind of like sure.
• 15:34
  David: The net impact, but what are the sort of the drivers of it?
• 15:37
  David: Uh, you know, we could talk about, uh, I can just hear from some of the things you were saying, like with the maternity group.
• 15:42
  David: Like if you don't know what prenatal visits you're supposed to have, then assuming the prenatal visits are actually, you know, useful.
• 15:48
  David: If you can go to more of those, that's better.
• 15:50
  David: The baby's supposed to sleep on his back instead of the front then.
• 15:54
  David: That is good for reasons you're reasons you're, David, we're gonna have you in.
• 15:57
  David: Yeah, yeah.
• 15:57
  David: Well I have, I have four, four kids, so let we know about that one.
• 16:01
  David: But Congrat, but are there, are there specific things that you kind of look at beyond just to say, Hey, this should work.
• 16:06
  David: People, people get together, it's nice, they'll share views and then it'll be successful.
• 16:10
  David: Or are there like particular areas like the, do you keep somebody in the managed care plan longer?
• 16:16
  David: Do you prevent them from going to the er?
• 16:18
  David: Like are there certain things like that?
• 16:21
  Darin: Yeah.
• 16:21
  Darin: And that, that's exactly it.
• 16:22
  Darin: David, you know.
• 16:24
  Darin: The hardest part, you know, there's the dreaded a word in healthcare and that's attribution.
• 16:29
  Darin: Like how do you connect a hug to someone not going to the er?
• 16:35
  Darin: And what we found is we get people on these journeys, uh, and we're able to first build trust.
• 16:43
  Darin: Like the first couple of months we're just building trust in that relationship and then we realize there are critical things for them to do for their health.
• 16:51
  Darin: Um, so.
• 16:52
  Darin: Our popula, when you sum it all up, I'll say what you see in our populations is a, a concomitant rise in, you know, preventative care.
• 17:00
  Darin: People are going to see their PCPs more.
• 17:02
  Darin: So PCP visits per thousand increase, like the preventative care gap closure increases.
• 17:08
  Darin: So you're seeing all the things like if you.
• 17:10
  Darin: Like population health, they're supposed to happen.
• 17:13
  Darin: You're supposed to do.
• 17:14
  Darin: And then you see a reduction in, uh, urgent care, like ER utilization.
• 17:20
  Darin: And by the way, our groups talk about urgent care.
• 17:23
  Darin: And this is the funny thing 'cause every plan sent out the, Hey, go to urgent care postcard, it's gonna be a better, it's gonna be better.
• 17:30
  Darin: But here, here's how peers talk about it.
• 17:32
  Darin: They're like, ah, you know, my, uh, my son, you know, played baseball, got got this injury.
• 17:38
  Darin: And I, like, I always go to the ER or like, I even go see my PCP, I go to the er.
• 17:43
  Darin: But you know what, it's not fun to go to the er.
• 17:45
  Darin: The wait times were long, all these things.
• 17:47
  Darin: And another person in the group will be like, I went to this urgent care clinic.
• 17:50
  Darin: They saw me in five minutes.
• 17:51
  Darin: It was great.
• 17:52
  Darin: And the person's like, what really?
• 17:55
  Darin: And that's actually how we get people to modify site of care, change their behavior.
• 18:01
  Darin: They, they hear it from a peer.
• 18:03
  Darin: And then the end result, you lower er, guess what?
• 18:05
  Darin: You lower inpatient too.
• 18:07
  Darin: It, it just is like dominoes that, that fall.
• 18:10
  David: That's good.
• 18:10
  David: So I think a lot of those factors are well understood by the plan.
• 18:13
  David: So if you said, you said if we could have an impact on, on these topics, on these drivers.
• 18:19
  David: Then they could see where it's gonna go.
• 18:21
  David: So that makes sense.
• 18:22
  David: Now what about, um, so in addition to caring about, you know, costs, the plans also care about things that give them a reputation and some cases also additional payments.
• 18:31
  David: And I'm talking about things like star ratings, HDA scores.
• 18:35
  David: Do you also look at that impact or is it more just from kinda like the individual level of claims?
• 18:42
  Darin: No, we, we really look at this as a, uh, on a population basis.
• 18:46
  Darin: So you, you kind of mentioned duals, Medicare.
• 18:50
  Darin: I would say the trends we saw last year was everyone wanted to get annual wellness visits.
• 18:56
  Darin: They wanted to make sure that, you know, there was accurate coding and, and all those things.
• 19:01
  Darin: We're seeing a very different tone and temperament this year.
• 19:04
  Darin: Uh, now everyone is playing the Stars game.
• 19:07
  Darin: They're realizing we really need to boost quality.
• 19:10
  Darin: Uh, and so we are on a blitz right now where we're building these communities and closing colorectal cancer screening and making sure people get their blood pressure checked and PA past that.
• 19:21
  Darin: So we're closing tremendous numbers of he DDI gaps to ensure that plans can get those star ratings up.
• 19:29
  Darin: Got
• 19:29
  David: it.
• 19:29
  David: Okay.
• 19:30
  David: 'cause I know they care, you know about that.
• 19:32
  David: There's different angles to go at.
• 19:33
  David: And then it's interesting to hear like, what's the flavor of the year?
• 19:35
  David: You know?
• 19:35
  David: I didn't know it was, uh, you know, co colon cancer season, uh, prevention season.
• 19:40
  David: Yeah, that's right.
• 19:42
  David: Yeah.
• 19:42
  David: That's good.
• 19:43
  David: That's a good season.
• 19:43
  David: That's a healthy season.
• 19:45
  David: Now you've said something interesting out.
• 19:47
  David: It is there, there's an interesting thing.
• 19:49
  David: I was attributed to you or to the, to the company and, and it's a thought I hadn't had before, so I wanna see if I'm right and if you could explain it so.
• 19:57
  David: You talk about looking at Medicaid, Medicaid plans, looking at community as critical infrastructure.
• 20:04
  David: What, first of all, is that something that wider Circle talks about and what if so what, what does that mean?
• 20:11
  Darin: Uh, David, let's, let's take a step back.
• 20:14
  Darin: You know, we live in the democracy.
• 20:16
  Darin: Community is critical infrastructure for society to work.
• 20:20
  Darin: Uh, and I. I think we're gonna see that more and more, uh, writ large.
• 20:26
  Darin: Uh, and in healthcare it, it's, it's even more critical because to your point, people are just trying to say, oh, let's rely on some call centers and other things.
• 20:36
  Darin: You know, it's one thing to send it's message sent, but is message received?
• 20:41
  Darin: Is message heard.
• 20:43
  Darin: Where, where community comes in is when community sends that message.
• 20:48
  Darin: When it's your neighbor, when it's your friend.
• 20:50
  Darin: Let's be honest, we don't even all listen to our like.
• 20:53
  Darin: My, my wife is gonna watch this and I'm gonna, and make an admission.
• 20:56
  Darin: Do I, do, I always, always follow all of her very sage wisdom.
• 21:00
  Darin: I mean, it's painful.
• 21:01
  Darin: She's always right.
• 21:02
  Darin: Not always, but like, when my neighbor or my friend nudges me, I'm like, uh, okay.
• 21:07
  Darin: I'm like, I, I, I, I realize that I need to, you know.
• 21:12
  Darin: Actually take the next step, go to the gym, whate like what it might be, that's where community becomes critical infrastructure.
• 21:20
  Darin: It's where messages get heard.
• 21:23
  Darin: I, I'll, I'll give a great example.
• 21:25
  Darin: Um, we had a, a member who, in her own words, she was like, I was, you know, my costs were astronomical.
• 21:32
  Darin: I was visiting the er like, like I was punching a ticket like multiple times a month.
• 21:38
  Darin: Uh, and look, she suffered, she.
• 21:40
  Darin: She had diabetes, uh, and her doctor told her, look, it's time.
• 21:45
  Darin: Let's get you an insulin pump.
• 21:46
  Darin: You're gonna, you'll, you'll just do so much better.
• 21:49
  Darin: She didn't, she just didn't trust him.
• 21:51
  Darin: She came to one of the groups and lo and behold, someone in that group had an insulin pump, had a continuous glucose monitor, uh, and, and an insulin pump.
• 22:00
  Darin: And she got, she, she talked about it and the person's like, yeah, this has been great.
• 22:04
  Darin: She's like, all right, maybe this is gonna be half bad.
• 22:06
  Darin: She got the CGM.
• 22:08
  Darin: She has not been back to the ER in a year.
• 22:11
  Darin: Her time in range is over 80% and but commu, the reason why community is a critical infrastructure is because they're those members that you cannot engage.
• 22:22
  Darin: But just hearing it from a neighbor one time all of a sudden change their entire behavior and saved a year worth of ER visits.
• 22:31
  Darin: That's why community is critical.
• 22:32
  Darin: Infrastructure.
• 22:34
  David: So let's talk about accountability, which, if that's not the theme this year, probably be the theme next year.
• 22:38
  David: And in particular, I would like to get your view about who should be accountable for Medicaid outcomes.
• 22:44
  David: You know, you've got these managed care organizations, you've got the states, you've got the providers, you've got the individual.
• 22:51
  David: How about the communities?
• 22:52
  David: I mean, where's, where should the accountability lie?
• 22:56
  Darin: Yeah, David, when everyone talks about accountability, what they're really talking about is dollars.
• 23:01
  Darin: Okay.
• 23:02
  Darin: And, you know, I, I get, I, I hear it and I get it.
• 23:06
  Darin: Uh, and I think what we're missing when we say the word accountability is, uh, and what the healthcare really wants is.
• 23:14
  Darin: Healthcare wants individuals to be accountable for their health.
• 23:17
  Darin: Oh, I get that.
• 23:18
  Darin: Um, and, uh, you know, let's be, let's be real.
• 23:21
  Darin: A lot of healthcare would like them, the, the consumer, the patient to be accountable for the dollars too.
• 23:26
  Darin: But at the end of the day, if they can be.
• 23:31
  Darin: They could be accountable for their health if community and like really can.
• 23:36
  Darin: And I, I believe like lift up others, then let them be accountable and then let let these other entities be responsible for covering some of the bills.
• 23:45
  Darin: I think we'd see a much different outcome, to your point,'cause it is about outcomes.
• 23:50
  Darin: If the community really was accountable, uh.
• 23:55
  Darin: And for anybody, anybody who wants to just read something, absolutely mind blowing.
• 24:00
  Darin: Um, there's a book called Connected, uh, by Nicholas Christis.
• 24:05
  Darin: They've published six New England Journal Medicine papers on this.
• 24:08
  Darin: And what they found, by the way, Zuri, like you wanna know if someone's gonna quit smoking or not.
• 24:13
  Darin: Think about like things that healthcare co like cares about.
• 24:16
  Darin: Are you gonna lose weight?
• 24:17
  Darin: Are you gonna start exercising?
• 24:18
  Darin: Are you gonna quit smoking?
• 24:19
  Darin: They wrote six New England Journals of medicine papers, and what they found is based on your neighbors.
• 24:25
  Darin: This was a retrospective analysis of the Framingham Heart study.
• 24:27
  Darin: 80 years based on who your friends were, they could tell you.
• 24:33
  Darin: Are you going to quit smoking?
• 24:34
  Darin: Are you going?
• 24:35
  Darin: It turns out we do not make these decisions ourself.
• 24:39
  Darin: That's why community can be accountable.
• 24:43
  Darin: Like, because communities actually help us make these decisions.
• 24:48
  David: So my final question I wanna ask you relates to, uh, CMS priorities in 2025.
• 24:54
  David: There's been an increased importance on, uh, aligning priorities with the executive branch of the federal government.
• 25:00
  David: And I wonder how, you know, where CMS is now, um, how their priorities are aligning with what you're trying to do.
• 25:10
  Darin: Yeah, look, uh.
• 25:12
  Darin: I, I was, you know, chatting with, uh, some folks at HHS and CMS recently, and we have there, there is just a tidal wave coming.
• 25:24
  Darin: Um, and that tidal wave is work requirements.
• 25:27
  Darin: Um, so as much as I wanna say SDOH and all these other are important, they are.
• 25:33
  Darin: But now is the time where we have to get ready for these work requirements because, you know, close to 10 million individuals will likely lose coverage.
• 25:43
  Darin: Uh, and, and the vast majority of them, it'll be administrative reasons.
• 25:47
  Darin: Like you look at the unwinding, uh, like.
• 25:50
  Darin: Of the last couple of years, you know, 70% of Disen enrollments were administrative.
• 25:55
  Darin: They were procedural disen enrollments.
• 25:58
  Darin: And so now is the time for us to actually build trust in the communities.
• 26:03
  Darin: 'cause you can look at states who have had work requirements in the past and they sent all the messages out.
• 26:09
  Darin: This is again, the message sent but not received.
• 26:12
  Darin: They sent all those messages out and people just.
• 26:15
  Darin: Didn't do it.
• 26:16
  Darin: And like there were states where the first month, 17,000 people lost coverage in a single state.
• 26:21
  Darin: So the critical piece now is building that trust over the next year, building up these communities.
• 26:28
  Darin: And believe me, these communities will help each other ensure that they can get through the work requirements, gauntlet help keep coverage, and we can't stop there.
• 26:40
  Darin: We have to do more.
• 26:42
  Darin: Coverage enables health stability, but that should build to financial stability.
• 26:48
  Darin: So that's where communities need to come together next.
• 26:51
  Darin: Uh, and I'd love to see CMS say, yep, look, we want people to graduate off of Medicaid.
• 26:57
  Darin: We want health to be the foundation.
• 26:59
  Darin: And then let's come together as communities to find better economic opportunities and help promote people off of Medicaid.
• 27:06
  David: It sounds like it's gonna be a whole new topic for a podcast in about 12 to 18 months.
• 27:10
  David: It's really pretty fundamental, what you're just describing there.
• 27:13
  David: It's a totally different way to look at it than what I've seen.
• 27:15
  Darin: Yeah.
• 27:15
  Darin: That, that's, uh, that is the power of community.
• 27:18
  Darin: It can actually take the, the problems that we all think are impossible.
• 27:21
  Darin: It could restore hope and, uh, improve outcomes, but improve life, improve life outcomes.
• 27:28
  David: Well, that's it for yet another episode of Care Talk Executive Features.
• 27:32
  David: My guest today has been Darin Buxbaum, he's co-founder and CEO of wider circle.
• 27:36
  David: I'm David Williams, president of Health Business Group.
• 27:39
  David: If you like what you heard, please subscribe on your favorite podcast platform.
• 27:43
  David: Thank you, Darin.