Latest / CareTalk: Healthcare. Unfiltered. / Improving Access to Care with a Clinic in a Box w/ Karthik Ganesh

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Improving Access to Care with a Clinic in a Box w/ Karthik Ganesh · CareTalk: Healthcare. Unfiltered.

• 0:07
  John: Welcome to Care Talk, America's home for incisive debate on healthcare, politics, and business.
• 0:13
  John: I'm John Driscoll, the chairman of Yukon, and this morning I have the good fortune to be exploring the great new company Oned with the CEO.
• 0:24
  John: Kartik.
• 0:25
  John: Ganesh Kartik.
• 0:26
  John: Welcome to Care Talk.
• 0:28
  John: Thank you, John.
• 0:29
  John: Glad to be here.
• 0:30
  John: So Carter, you know, uh, our listeners would love to know a little bit about your background and, you know, how you came to healthcare and what got you interested in, in solving the problems that, that, uh, your company solves.
• 0:43
  John: And, but maybe go a little bit, tell us a little bit about where, where you're from and how you got to
• 0:48
  Karthik: healthcare.
• 0:49
  Karthik: Of course, um, 25 plus years in healthcare.
• 0:52
  Karthik: And, um, I'd like to think I've touched this from all the angles.
• 0:55
  Karthik: It can be touched from.
• 0:57
  Karthik: I've done consulting, um, healthcare consulting with both EY and Deloitte.
• 1:02
  Karthik: I've done big payer with Aetna.
• 1:04
  Karthik: Um, I have, I have run a PBM, I've run a provider sponsored health plan.
• 1:11
  Karthik: Uh, helped build a value-based and, um, and.
• 1:17
  Karthik: A CO backbone if you will, ground up help signal launch care allies, which Cigna recently transacted, uh, ran a value-based PBM.
• 1:27
  Karthik: Then now, um, run running a, um, a healthcare access company.
• 1:31
  John: And how did you get into this, this, what drew you to healthcare in the first place?
• 1:37
  Karthik: The, um, I'm gonna probably say happenstance.
• 1:40
  Karthik: Uh, I was Ernst and young, this is when EY Consulting was the largest healthcare practice in the country.
• 1:47
  Karthik: And, uh, GE Healthcare was my first client.
• 1:50
  Karthik: Express.
• 1:51
  Karthik: Cris was a fast follower to that and, uh, and just never looked back.
• 1:55
  Karthik: I don't believe in coincidences.
• 1:57
  Karthik: I felt every step along the way.
• 2:00
  Karthik: I have felt a, um, I felt both a passion for the industry as well as a strong belief that in my own way I've been contributing to make one small little difference in the broader healthcare continuum.
• 2:12
  Karthik: But for all of that, I have never felt the perfect alignment of work and soul.
• 2:22
  Karthik: As I feel at On Med right now, I have been a, um, access has been incredibly important to me.
• 2:27
  Karthik: It has been those, those, you know, the folks who've known me for, you know, 10, 15, 20 years have known that.
• 2:34
  Karthik: Um, I've been a very, very vocal advocate of access I have over the years, you know, even as you think about health plans and the, the belief that.
• 2:44
  Karthik: You know, you've got to squeeze your network to be able to get the most out of it.
• 2:47
  Karthik: Always had a daily best rule.
• 2:48
  Karthik: I mean,
• 2:49
  John: just to kind of break that down for our, our listeners, you know, the, having been a healthcare executive, a health plan executive as, as well, the simplest way to reduce cost is reduce access in some ways, and I've always had a visual reaction
• 3:04
  Karthik: to that.
• 3:04
  John: And, and it's, and it's, it, you know, you will get greater discounts from providers if you can concentrate.
• 3:11
  John: But it also means a trade off, uh, as card's pointing out of access because there's, we live in a, in a system where some of the most vulnerable and.
• 3:22
  John: Most, most chronically ill patients, uh, have real challenges to getting the healthcare they need.
• 3:29
  John: Cartick, you've jumped around through a lot of different parts of healthcare.
• 3:33
  John: What drew that curiosity to take on a new challenge?
• 3:38
  John: Because certainly most people in healthcare will stay in consulting, stay in health plans.
• 3:43
  John: Yeah.
• 3:43
  John: You know, we, our, our tribes tend to be very siloed in healthcare.
• 3:47
  John: Yeah, no, you're, is there any through, is there any through line there?
• 3:51
  Karthik: I would say the through line for me is, um, I grew up in India.
• 3:57
  Karthik: As a military kid, I'm very comfortable with change.
• 4:02
  Karthik: Any level of continuity.
• 4:03
  Karthik: Continuity quite frankly, makes me more uncomfortable than comfortable and, uh, which is a little counterintuitive.
• 4:10
  Karthik: Um.
• 4:11
  Karthik: But I will also say, John, the fact that I have moved around healthcare as much as I have is something that I would arguably look at as my secret sauce.
• 4:22
  Karthik: One of the things that I feel it's,
• 4:23
  John: it's a perspective advantage for sure.
• 4:25
  John: Huge people per a, people live in those silos of A PBM or pharmacy or health plans.
• 4:30
  John: Exactly right.
• 4:31
  John: Health plan or a CO or the people in provider sponsored health plans.
• 4:34
  John: Those are the ones that.
• 4:35
  John: You know, hospitals and Doctor Zone typically stay there.
• 4:39
  John: You know, healthcare is a career where often, you know, it's, it's a pie eating contest where you, you know, as you rise, you, it, it's a bigger pie and you've got a little bit less time to eat it.
• 4:48
  John: That's right.
• 4:48
  John: Um, so, so maybe talk a little bit about Ahmed's, really, I, I think a, a, a breakthrough idea, at least in my, the way I think about it.
• 4:57
  John: But maybe how did, how did you come to the idea and maybe tell, tell, tell a little bit the origin story of Oned.
• 5:02
  John: It's not just about access, it's finding a
• 5:04
  Karthik: solution.
• 5:06
  Karthik: It's finding a solution, and Oned has been around for, um, about eight years.
• 5:09
  Karthik: I joined Oned about, um, 17 months ago, 16 months ago.
• 5:14
  Karthik: The, the idea was a brilliant one.
• 5:16
  Karthik: When we look at.
• 5:18
  Karthik: When we look at the two modalities of care that exist today, the only two that we have, um, that we are comfortable with or are aware of are one, the traditional brick and mortar clinic-based, um, setting.
• 5:29
  Karthik: Or at the other end of the spectrum, as we went through COVID, we got very comfortable with telemedicine and that was the other end of the spectrum.
• 5:36
  Karthik: Both have hit a very natural ceiling and, um, I would say more, more unfortunate than fortunate.
• 5:44
  Karthik: Brick and mortar we're running out of clinicians as a country.
• 5:48
  Karthik: It do, it's incredibly expensive to stand up 2 million plus, plus about seven 50 KA year to administer, but to, to, to operate.
• 5:55
  Karthik: But even if we, if money wasn't the, uh, wasn't a barrier, we're running out of clinicians as a country.
• 6:01
  Karthik: We don't create enough doctors.
• 6:03
  Karthik: We don't create, we needed 200,000 more four years ago.
• 6:06
  Karthik: We're producing 17,000 a year, and there's a huge chunk of who, of the folks who are in practice today who are either retiree, pre-retirees, or just burnt out coming out of COVID.
• 6:17
  Karthik: So then we go through COVID and then, uh, we think telemedicine is the silver bullet, but it's been around for 18 years and the warts that existed still continue to permeate telemedicine when you've got a clinical conversation that lacks vitals, scans, diagnostics.
• 6:36
  Karthik: It doesn't feel like a clinical experience.
• 6:38
  Karthik: And as a result of that, we have continued to see the adoption of telemedicine drop year over year.
• 6:44
  Karthik: And it now has settled into a place that is fairly consistent with digital health tools at large, which is in the five to 7% adoption range, which given the, the, given the fact that the demand for access continues to grow as we get, you know, I I, to almost be provocative, I've always.
• 7:06
  Karthik: My, the, the why in my mind in terms of the demand for access growing is the fact that one 11 K, 11,000 people aging into Medicare every single day according to the WHO, right?
• 7:19
  Karthik: We know three out of four Americans are either overweight or obese.
• 7:24
  Karthik: Medicaid enrollment has grown by 33% over the last five years, so to put it very bluntly, getting older, heavier.
• 7:33
  Karthik: And poorer as a country and, and close to 31% of all US adults have multiple chronic conditions, so we're also getting sicker as a part of that.
• 7:45
  Karthik: The risk pool continues to get, get.
• 7:48
  Karthik: Just more and more tainted in terms of debts deeper and broader, and it's growing demand for access even more.
• 7:55
  Karthik: And the only two ways we have historically looked at access have both hit a natural ceiling as they called out.
• 8:01
  Karthik: You can't throw the baby out with a bath water, and that's where unmet comes in.
• 8:06
  Karthik: Think of it as a clinic in a box.
• 8:07
  Karthik: It's an eight by 10 care station that brings the best of your traditional, the comprehensiveness, the comfort, the confidence that you get with a clinic.
• 8:19
  Karthik: Married with the rapid scalability of telemedicine.
• 8:23
  Karthik: You've got an eight by 11 let's care station.
• 8:26
  Karthik: Call it a kiosk.
• 8:27
  Karthik: You walk into it, roll into it based on what your situation is.
• 8:31
  Karthik: The bulk of the floor is your weighing scale, which if you're a wheelchair, it handles that comfortably as well.
• 8:37
  Karthik: 65 inch screen in front of you.
• 8:40
  Karthik: The tell the, the technology is not overwhelming.
• 8:43
  Karthik: We're rolling this out in West Alabama, west Texas, parts of the country where technology is not a friend.
• 8:50
  Karthik: The person walks in, they press start and they go.
• 8:52
  Karthik: Yeah.
• 8:52
  Karthik: Just describe that
• 8:54
  John: experience.
• 8:54
  John: It's a, it's effectively you're taking a lot of what the techs or the machines in a doctor's office would do.
• 9:05
  John: Upgrading them to modern technology and rolling that out so that effectively you're getting the data and the content that off That is really what the doctors and clinicians, PAs, nurse practitioners, are using to then diagnose and treat, uh, and making it pretty accessible.
• 9:26
  John: I mean, that isn't a big footprint.
• 9:28
  John: That is not a big footprint.
• 9:31
  John: And, and, and, and, and, and so you're, you're sort of substituting the need for a clinician in a brick and mortar, um, or even an urgent center with the center.
• 9:44
  John: And then, then what happens to that?
• 9:46
  John: The how does, how does, how does.
• 9:49
  John: First from a patient perspective, how would I find out about this?
• 9:53
  John: Is this like a part of an urgent center or is it part of a clinical practice or a doctor's practice?
• 9:59
  John: Like we have, uh, now that, now that we've describe this sort of, um, star Wars equivalent of access to evaluation, how do people come to come?
• 10:11
  John: How do people come to get roll
• 10:13
  Karthik: in?
• 10:14
  Karthik: We have, um, we, we clearly need to do more from a B2C marketing standpoint, John, but what, what, what differentiates the care station as compared to anyone else who has tried kiosks in the past is the fact that this is a B2B play.
• 10:34
  Karthik: And, um, you know, we talked about.
• 10:37
  Karthik: My secret sauce, if you will, being the fact that I've, I've touched healthcare from so many different angles.
• 10:42
  Karthik: There are a, there are a number of truths that I firmly believe hold, hold true, irrespective of where we are in the healthcare spectrum.
• 10:51
  Karthik: One B, two C as a pure play has never worked.
• 10:55
  Karthik: And, um, it doesn't matter if you are the Uniteds of the world with all of the money that they have to have in their, in their treasure, trust, everything
• 11:03
  John: that would be well united, all the, all the money in the world clearly is not focused on the consumer.
• 11:09
  John: But I'm just saying, I think just to break it down, most other digital businesses have succeeded by going direct to consumer.
• 11:16
  John: Um, there have been a lot of attempts both in service, uh, offerings or products.
• 11:22
  John: The only thing that's really.
• 11:23
  John: Done well is, uh, telemedicine for drugs, which turned into a, a, a scam, you know, during COVID, you know, where that, and, and I think there, it's now adapting to online pharmacies.
• 11:35
  John: I think starting to break through a little latik, but that's the only, I'm gonna
• 11:38
  Karthik: one, but I'm gonna, I'm gonna challenge that a little bit, John, and say that even as you look at digital solutions from a B2C standpoint, over 95% of them are not profitable.
• 11:49
  Karthik: And at the end of the day, if you're running a business, I mean, I've always believed this, if you don't have a clear line of sight to profitability, you're an experiment.
• 11:58
  Karthik: You're not a business.
• 12:00
  Karthik: You have to know what it takes to get profitable.
• 12:01
  Karthik: That's the entire idea of running a for-profit business.
• 12:04
  Karthik: B2C has been challenging in healthcare.
• 12:06
  Karthik: That's one.
• 12:07
  Karthik: Two, tech for tech's sake, has been a challenge in healthcare.
• 12:11
  Karthik: It's certainly the American consumer and the American patient.
• 12:15
  Karthik: See, see things very differently and we may be the exact same person we are not comfortable.
• 12:20
  Karthik: We may be comfortable with tech in every other aspect of our lives, but we like the human interaction as it pertains to healthcare.
• 12:25
  Karthik: And we have been.
• 12:27
  Karthik: Ahead and
• 12:27
  John: so and so, and so as you think about that, you know, you've solved the, the solution of building a a massive hospital or clinic, how do you bring in that human interaction to, that's right.
• 12:39
  John: The sort of the, this little care station, all, all of the diagnostics that are, you're making
• 12:44
  Karthik: available.
• 12:45
  Karthik: It's been very important to us, John.
• 12:47
  Karthik: So we have made sure that the technology inside of the care station is not overt.
• 12:51
  Karthik: It is.
• 12:51
  Karthik: Um.
• 12:52
  Karthik: You walk in the 65 inch screen you press, you don't have to do anything more than press start.
• 12:58
  Karthik: The clinician shows up and takes you on the journey.
• 13:00
  Karthik: This is a live clinician.
• 13:02
  Karthik: This is not an avatar.
• 13:03
  Karthik: This is not a bot.
• 13:04
  Karthik: This is none of that.
• 13:05
  John: It's not the metaverse.
• 13:07
  Karthik: It's not the metaverse with
• 13:08
  John: no legs.
• 13:11
  Karthik: This is a 65 inch person on the screen.
• 13:13
  Karthik: So you're, you basically feel the person's in the room with you at that point in time and she's taking you on this journey and, um, you know, you've, um, even she gathers your information, even your consent forms.
• 13:24
  Karthik: She takes you through all of it and you've got a sign at the end of it.
• 13:29
  Karthik: And it's been fascinating as a journey for us even, you know, really humanizing the tech.
• 13:33
  Karthik: We had fourth grade level consent forms.
• 13:35
  Karthik: We took them into West Alabama, portions of West Alabama where um, they couldn't handle the fourth grade level consent forms.
• 13:42
  Karthik: So we had to make them third grade level consent forms.
• 13:44
  Karthik: Yeah.
• 13:44
  Karthik: And
• 13:44
  John: it's not, again, this isn't a, a day gone, um, any part of the part of the state, but when I, no, it's not.
• 13:50
  John: But when I, when, when I, when I was building materials for Oxford Health Plans in the nineties, we brought in.
• 13:56
  John: Elementary school teachers to rewrite all of our literature because most of the literature is written for lawyers, accountants, and actuaries.
• 14:04
  John: That's right.
• 14:05
  John: Not for actual consumers who come to healthcare, vulnerable and scared, let alone forget their academic level.
• 14:12
  John: You want to make simple so that you don't create a barrier,
• 14:16
  Karthik: and that's health equity in a, what you just called out, John, in my mind, is health equity.
• 14:20
  Karthik: In a nutshell, how do you make healthcare?
• 14:24
  Karthik: More intuitive and more accessible for the underserved, where things that we take for granted.
• 14:32
  Karthik: Like technology, it's not a friend.
• 14:35
  Karthik: And you know, this is the part of the country that doesn't live in our world of wearables and AI and bots and things to that effect.
• 14:43
  Karthik: This is the part of the country that some cases don't, cms
• 14:44
  John: they're betting long on, on, on the whoops and the, and the, and the wearables.
• 14:49
  John: And there may, and there is something there
• 14:51
  Karthik: and there's a place for that.
• 14:51
  Karthik: Absolutely.
• 14:52
  Karthik: There's a place for that for
• 14:53
  John: sure.
• 14:53
  John: And I'm excited about that.
• 14:54
  John: But I think what you're trying, what you're solving for.
• 14:57
  John: Is the access to diagnostics for the vulnerable, which I think is super interesting.
• 15:02
  John: How do you maybe, maybe talk through how who buys this and how does a, how does a consumer in the, in parts of the country get access to it?
• 15:12
  John: Is it, is it their employer that would, that would buy it?
• 15:16
  Karthik: It's a combination, John.
• 15:17
  Karthik: So we have payers.
• 15:19
  Karthik: Who are doing this.
• 15:20
  Karthik: So we've, we've got, uh, we've got national contracts with United Molina, et cetera.
• 15:24
  Karthik: They're doing this for a bunch of different reasons.
• 15:26
  Karthik: One, it is a more appropriate site of care from an ER standpoint.
• 15:32
  Karthik: Um, so that's one, but it's
• 15:33
  John: effectively, it's effectively giving for a lot of people who a access emergency room care for basic primary and alternative primary care.
• 15:42
  John: And when they access that emergency room care, it's actually very expensive because it, it, it's, it's a terrible consumer experience if you're not, you know, if you're not, if you're not su, if you're not triaged as as super urgent.
• 15:54
  John: Exactly.
• 15:55
  John: It it, but it is where it a, a absent, the endless, uh, wait on the phone call and the, and the, and the, and the regular doctor's hours, the where, where a lot of America will access primary care.
• 16:07
  John: So it's, that's an economic win.
• 16:09
  John: It's an economic win for the
• 16:10
  Karthik: payer and for the provider as one of that as well.
• 16:13
  Karthik: And,
• 16:13
  John: and it creates access.
• 16:15
  John: Probably safer access
• 16:17
  Karthik: for a lot of patients.
• 16:18
  Karthik: 75% of the people who acce, who go to the ER are for non-emergent reasons, right?
• 16:23
  Karthik: So this provides an, this provides an alternate venue for them.
• 16:27
  Karthik: It also creates additional access for payers in the communities they're getting into.
• 16:31
  Karthik: So we ha we're the, our clients are payers, we've.
• 16:35
  Karthik: A bunch of health systems in the mix as well as a part of this.
• 16:38
  Karthik: It's the same win for them, including getting their brand out into their catchment areas so folks can access it in rural communities, et cetera.
• 16:46
  Karthik: Um.
• 16:48
  Karthik: We are, we've got universities as clients, so we, South Carolina State, Tuskegee, uh, but it's
• 16:54
  John: all about expanding access to, it's about expanding access to pri primary and chronic care for non-emergent situations, I would say
• 17:03
  Karthik: primary, urgent, and some post-acute.
• 17:06
  Karthik: What we also continue to find, John, is that, um, underserved is not a rural America challenge.
• 17:14
  Karthik: Underserved, quite frankly, doesn't differentiate based on your net worth you could have, you know, John, I live in, I, I tell people this, um, all the time.
• 17:22
  Karthik: It's, um, I live in Greenwich, um, the hedge fund capital of the country.
• 17:29
  Karthik: 80% of the community can't, it doesn't matter what their net worth is.
• 17:32
  Karthik: They 80, 90% can't access A primary care physician, can't get a doctor's office for four or five months.
• 17:38
  Karthik: A doctor's appointment for four or five months.
• 17:41
  Karthik: Irrespective of what they were willing to pay for it.
• 17:43
  Karthik: So as a result, the bulk of the community has gone.
• 17:45
  Karthik: Concierge, the concierge is a, is an abnormality.
• 17:51
  Karthik: But the fact
• 17:51
  John: that even if you've but 70%, 70% of the pop, 70% of the population in Greenwich is middle, middle class, or below.
• 17:58
  John: It's actually got a pretty substantial Medicaid population.
• 18:01
  Karthik: It does.
• 18:01
  Karthik: But John, what is fascinating is even if.
• 18:04
  Karthik: Even with the money, the folks who do have it, they can't get an appointment.
• 18:09
  Karthik: So you, we, we are now deployed in everywhere from rural America to employers like, um, the state, the state health plan of Georgia.
• 18:18
  Karthik: We have it in the state capital building.
• 18:20
  Karthik: We put it in a year ago.
• 18:21
  Karthik: They've just signed up for their second care station to be deployed across.
• 18:24
  Karthik: They want to have a network of care stations across Atlanta for their state employees.
• 18:29
  Karthik: We are deployed.
• 18:31
  Karthik: In partnership with United, we're deployed inside of everything from a prison to outside of Fiesta Mars, uh, in Texas.
• 18:37
  Karthik: We are in a homeless shelter.
• 18:39
  Karthik: So, so, so the,
• 18:41
  John: so I think we've, it's fascinating.
• 18:42
  John: We've touched, we've touched that a little bit be Before we wrap Karthik, I'd love to have you talk a little bit about why you think this particular part of your career, this particular company, ties together your, your capabilities, your ambition and soul.
• 18:58
  Karthik: There are too many people.
• 19:00
  Karthik: Millions and millions of people who are making fundamental decisions around fundamental choices.
• 19:06
  Karthik: Do I pay my rent this month?
• 19:08
  Karthik: Do I get healthcare?
• 19:09
  Karthik: Do I go see a doctor?
• 19:10
  Karthik: Do I buy my groceries this week or do I, do I refill my prescription?
• 19:17
  Karthik: A lot of these people need a break.
• 19:21
  Karthik: That one break could possibly change the rest of their, the, the quality of their life just on other fronts.
• 19:29
  Karthik: If we can be that break, we will have done our part.
• 19:35
  Karthik: For someone who has been passionate about access for the longest time, this is what we're doing is the perfect hybrid of the way we've traditionally looked at care and what telemedicine brings to the table.
• 19:49
  Karthik: And the last thing I would leave with that is we have.
• 19:55
  Karthik: Access infrastructure challenges the country.
• 19:58
  Karthik: So when I think about Oned and I think about the opportunity we have, and I think about, and I, I take a step back and I look at what is important to us as a country, I.
• 20:11
  Karthik: I would expect the care station to be part fundamental to our public health infrastructure as a country care station, as a node across millions of nodes in this country where every single node becomes your Either it, it, either it is your medical home or it's your primary point of care where you then get routed to wherever you need to get to next.
• 20:34
  Karthik: We need to rethink the way we think about our health infrastructure.
• 20:37
  Karthik: If Well, that, that,
• 20:39
  John: that's absolutely true.
• 20:41
  John: Kartik.
• 20:41
  John: We both, we both have suffered from that.
• 20:44
  Karthik: We have, and what I would leave you with, John, is, and I would leave your, your listeners with is I.
• 20:51
  Karthik: If 120 million Americans had lack, did not have access to water, we would be up in arms.
• 20:58
  Karthik: If 120 million Americans had suboptimal access to power or power, that was in and out, we would think our government is letting us down.
• 21:08
  Karthik: We have 120 million people who have sub suboptimal access to healthcare.
• 21:13
  Karthik: We should be kicking and screaming a whole lot louder than we are right now.
• 21:16
  Karthik: I
• 21:16
  John: think.
• 21:16
  John: I think we both agree on that and that government on its own, let alone the private sector, could be doing a lot, a lot, a lot better.
• 21:22
  John: A lot more.
• 21:23
  John: Well, well, that's it for Care Talk.
• 21:24
  John: If you like what you heard or you didn't, we'd love you to subscribe on your favorite service.
• 21:28
  John: And Kartik, you've laid out a really exciting vision.
• 21:30
  John: Thanks for sharing it with us.
• 21:32
  John: And also the congratulations on all your success across multiple fronts.
• 21:35
  John: Thank you.
• 21:36
  John: There's obviously a lot more demand than there is supply, so I, I expect, we'll, we'll have you back at some point to talk about that.