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Addressing The Wound Care Gap in US Healthcare with Joseph Ebberwein, Co-founder at Corstrata was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text. Our automated transcription algorithms works with many of the popular audio file formats.
Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez. Welcome back to the podcast.
Saul Marquez:
Saul Marquez here today had the privilege of hosting Joe Ebberwein. He’s the co-founder and chief revenue officer at Corstrata, a tele-health company that’s re-imagining the way the wound care is delivered to the 7 million people in the U.S. suffering from chronic wounds after working at PWC early in his career. Joe moved into a corporate health care area and spent 30 years in various leadership roles in the post-acute industry, working at innovative home based care models such as skilled home health, hospice and private home care. Joe was fortunate to work with a team that successfully integrated tele-health and remote patient monitoring in the home health, when remote patient monitoring first emerged in the early 2000s, Joe has published and presented it nationally and topic specific to tele-health and wound care, chronic care, costs management strategies and transformation of care delivery models from volume to value. So it’s going to be a very interesting conversation around this topic, and I’m excited to have Joe, who spent so much time, speak to us about it. Joe, thanks so much for being with us today.
Joe Ebberwein:
It’s great to be with this call. I really am a big fan of your podcast. And so it’s an honor to be with you today.
Saul Marquez:
Thank you. Joe, I appreciate that. What would you say inspires your work in health care?
Joe Ebberwein:
So really, I’ve drawn a number of amazing inspirations, but one that I thought of that your health care audience might find it interesting is that although my undergraduate degree is in accounting, I almost minored in cultural anthropology because of one particular awesome professor that I had never bang. Little did I know that while I was studying anthropology with him, Irwin Press was working on a model of validated patient satisfaction data collection with a fellow professor and colleague Rob Kenley, which would become press case. When I was first starting Corstrata, I had the pleasure of reconnecting with Dr. Irwin Press for a launch in Chicago, and he shared the nitty gritty details of launching Press Ganey from his kitchen table. So that was inspiring, to say the least. You know, I’m also inspired by fellow entrepreneurs who are passionate about developing their models of care to really improve health care for people that don’t have access to optimal care. And I’ve had the privilege of a sense swarming course right, meaning these other startup founders who are still passionate about improving care and lowering the cost to the system. And then I’m constantly inspired by our wind and ostomy certified nurses course stratus team who really do put the patient at the center of everything we do and remind us constantly that it’s all about improving quality of life for our patients.
Saul Marquez:
Love it. What a great story, Joe. And that you are you in school at the Press Ganey, folks. And it really kind of the one thing that I always think about is that that quote that you’re the average of your five closest peers,.
Joe Ebberwein:
Right..
Saul Marquez:
And when you you know, and then these folks a year are your peers, you’re like, all right, you know what? I guess I got to build something too.
Joe Ebberwein:
Exactly. It was an amazing experience in the early days of Press Ganey and actually being able to study about medical anthropology from our own press. This really was a life changer for me.
Saul Marquez:
I love anthropology is actually one of my favorite. I took two classes in college as well. So interesting.
Joe Ebberwein:
It really is.
Saul Marquez:
It really is. So explains why you’re an interesting guy. So how are you and your business adding value to the health care ecosystem?
Joe Ebberwein:
Yeah, well, you know, I’ll reiterate, I work with a great team at corstrata and my co-founder Kathy Piette and I have actually worked together for 15 years now. And I would say we’re a bit obsessed with creating a better way to deliver care for our customers. But it’s really our clinical team boarded certified wounds and asked me nurses who are doing the real work of improving outcomes for our customers and the patients that they serve with chronic wounds and ostomy. And, you have saw wound care is really a bit off the radar in many ways because wounds are often secondary to other major chronic diseases that we hear so much about. But 30 percent of all post-acute patients have a wound, whether it’s a pressure ulcer, a diabetic foot ulcer, a lower extremity vascular wounds. And there really are real despot’s of care because only 10 percent of all board certified wound nurses, which is not a huge number to begin with, work in post-acute, while the other 90 percent work in hospitals and outpatient care centers. So Corstrata is really solving this problem by using technology to create access to these winker experts and access to Evidence-Based care to improve clinical outcomes, but at a lower cost.
Saul Marquez:
Well, it’s interesting. Right. and you and I had a chance to connect the four hour chat here and you really kind of gave me the basics of the problem, but I never realized that it was such a problem that so much of the care that was needed is happening outside of the hospital and the majority of the caregivers are in the hospital and a lot of it has to do with reimbursement. Right Joe?
Joe Ebberwein:
Yeah, it does. And you know, reimbursement is changing in the post-acute space as we see kind of a shift from volume to value. Home health was really one of the first models of care that moved from a per visit to an episodic payment model back in 2000. And so it’s been interesting to see how technology has evolved within that model of care. And there’s still a lot of room for opportunities within that space. But yes, it is definitely shifting. And CMS has got a real focus on tele-health and remote patient monitoring now, which did not exist before.
Saul Marquez:
Let’s zoom into this a little bit more and tell us what corstrata does different and better than what’s available today.
Joe Ebberwein:
Yeah, I think the best way to answer that is to give you an example of how we changed the course of care for one of our nursing home customers patients. We started working with the SNEATH who was caring for a patient who had a leg ulcer for 18 months and maybe even longer. And really, this was a 5 star facility that was doing the best they knew to do to care for this gentleman. But it included painful daily dressing changes that were really not healing the wound. Our corstrata nurse reviewed the case, implemented in evidence based care plan that included the proper use of compression therapy, which had not been used before. Also, introduce some advanced dressings that require changing only twice a week. And we got that wound closed in 11 and we so you can see the return on investment is pretty clear, you know, related to the cost of care and the labor component. But even more important is really the dramatic improvement in the quality of life for this gentleman who was a deacon in his church and was able to return to church after two years of really being very isolated. So that’s one example that we’re really proud of.
Saul Marquez:
And there’s so many stories like that. You know, I mean, it’s so many people are living in pain and outside almost ostracized.
Joe Ebberwein:
Right.
Saul Marquez:
Because of these wounds. And it just doesn’t make sense for that, just for the money that we pay for health care in this country. We need more. And I’m glad that you and your team, Joe, are are stepping up to the plate to tackle this this issue.
Joe Ebberwein:
Well, thank you. We’re we are dedicated and committed to it. Thanks.
Saul Marquez:
So, yeah, I know for sure. And so that’s an extraordinary example of improving outcomes, improving business models. Any other examples that maybe you want to share around outcomes improvement?
Joe Ebberwein:
Yeah. You know, one thing that I hear over and over is the theme to your podcast, obviously relaxed outcomes. So in addition to some of these patients success stories, that corstrata, we’ve been able to collect real objective data on wound healing. We partner with some mobile wound imaging technology solutions. We’ve got customers and multiple provider segments now, home health, hospice, a skilled nursing, rehab hospitals. And we’re really proud that most recently we have partnered with a Medicare Advantage Pay Vidar that needs additional support around wound care patients. So we’re producing a measurable or for our customers by reducing the labor and addressing costs components. But also we’re really improving quality metrics such as reduced private provider acquired wounds, a big CMS metric, reduced wound and ostomy hospital readmissions and reduced wound related litigation. And you see that if you turn on the TV, you’re going to see about a loved one with a bed sore. So one extremely rewarding outcome of our work is that our customers staff, the hands of clinicians who are not usually certified and wound care, feel much more empowered to care for when patients really see the results of the collaboration with core strata and healing their patients chronic weight. So photographs tell a great story appeal.
Saul Marquez:
That’s for sure. That’s for sure. And tell me about the name that’s thinking what is Corstrata mean, we’re…
Joe Ebberwein:
Yeah. So we initially came up with tele-wound solutions and our trademark attorney said, good luck with that. You’re never going to get that. So basically told us to go create a word. So we took two Latin words, core or heart and strata or either the epidermis of the skin, which we’re working to heal or the stratosphere because we’re cloud based. So let me put those two together. And it’s worked well for us.
Saul Marquez:
I love it. Corstrata. They have it, folks. Corstrata. Well, super interesting. Joe, the work that you guys are doing, the impact. I’m sure, you know, we’ve talked. I mean, you guys are working with many health systems now and partners on this topic with bringing on new business and the revenue going up and the numbers going up. What would you say is one of the biggest step actually experienced and most of you learned?
Joe Ebberwein:
Well, I think for us, every setback is a real opportunity for a course correction on being an early stage company. So. But, you know, one theme that I’ve seen throughout my career in health care is really problems related to misaligned incentives. And that’s something I’ve heard over and over again from your podcast sponsors. So, you know, really, as we shift from fee for service to value based models of care, there are a lot of new technologies and innovations that can improve clinical and financial outcomes, but really only if clinicians on the frontline see a real value in adopting and engaging with these new technologies. Then I’ll give you an example of a planned incentive that really resulted in low engagement with our solution. We on board at a new home health customer. We came up with a great formulary for them. We recommended Evidence-Based Care Plans with advanced wound dressings, which would allow for longer where time and therefore fewer nursing visits per week. And you know, our our Lab with home health is if we can reduce the number of nursing visits and still produce clinical outcomes, that goes right to the bottom line. But a plan of care would have produced clinical outcomes and lower costs. But we weren’t seeing the business decreasing in line with our recommendations. And when we dug into the root cause, we found that our customers, the nurses, were still being paid per visit Right. and they were self scheduling. So they saw our recommendations as reducing their pay rather than seeing that our recommendations actually produced better healing outcomes and gave them capacity for additional patients Right? Productivity, So we worked with our customer and we came up with some innovative ways to align the incentives and overcame that hurdle. But misaligned incentives were at the root of a lot of problems in health care.
Saul Marquez:
Yeah, wow! That in particular it’s terrible. Right? mean that you are able to find a way to make it work.
Joe Ebberwein:
Yes, we were pretty excited by the way we were able to turn it around and really get the buy-in from our customers clinical staff. And you know, it’s really we hear anecdotally all the time for the first time, I feel good about caring for my patients. And that’s that’s a very rewarding for our staff.
Saul Marquez:
Yeah, I mean, if I may ask. I mean, what was the how did you do it? Because that’s hard that a lot of people that’s where they stop. And I don’t know, maybe it’s your CFO mind that figured out a way, but I’m just curious so…
Joe Ebberwein:
Well, so we came up with some metrics that we could implement both around feelings and metrics, but also we worked with our customers marketing and sales staff to go out and actively market with their referral sources how they were improving wound outcomes with tangible, objective data. So they increased their number of patients served, which then filled in some of the gaps for the clinical staff with new patients. So it didn’t affect it. Yeah, it’s pretty cool.
Saul Marquez:
That is cool and also very creative. So I want to give you kudos for finding a way. Yeah, it’s it’s it’s not easy to always find a way. It’s difficult.
Joe Ebberwein:
Yeah. Especially when the reimbursement is not aligned. So part of what we committed to when we formed Corstrata is that we really we’re going to focus on on value. And so we are not set up to Bill CPT cause we have a nursing model that really, really works with existing providers to produce or so or what. Sometimes we feel like we’re on the bleeding edge. But it’s worth it. It’s where things are going.
Saul Marquez:
No. That’s fantastic. And as you think about the landscape today, what would you say you’re most excited about?
Joe Ebberwein:
Gosh, so many things. You know, our team has really been heads down since we formed Core Strata working with early customers to both develop and test our wound care treatment algorithms. And we’ve had some great successes, really, in providing value to our customers in caring for these wound care patients as we continue to collect that wound outcomes data. We see a really great potential in creating predictive analytics and prescriptive protocols for patients who are at highest risk for wound formation. So imagine a home health, admits a patient that got certain comorbidities, a certain risk factors, and we could actually predict the propensity to heal based on on all of these data points. So I’m excited about that. The data that we’re gonna be able to. To produce, we’ve got some pretty aggressive plans in 2020 to scale our operations, increasing our customer base to reach more patients. We’re working with some of the most innovative home health agencies in the country to deploy our solution. But we’re also working. And this is was an interesting kind of revelation to us. But we’re working with wound care manufacturers and distributors also who are looking to add outcomes based solution to their product offerings as they and we all enter into risk bearing contracts. That’s exciting. And then to begin work with payers when both win prevention using some pretty amazing technologies as well as wind and ostomy management. So it’s really going to be an exciting year for us at corstrata.
Saul Marquez:
That’s very exciting. And thinking about that and through it, it’s probably a good stage where maybe you want to partner up with some strategic partners.
Joe Ebberwein:
We would love to do that. We’ve had some great early discussions with some strategic partners that we welcome the opportunity to have those discussions. We’re working with some health systems around management of ostomy patients in particular. It’s hard to believe, but ostomy remission rates, 30 day readmission rates are upwards of 30 percent. And that’s just kind of ridiculous in this day and age. So we’re working at some sophisticated health systems about really reducing that rate and giving better quality of life. Talk about social isolation. When you talk about Assamese, it’s really a that’s a big problem. So we’re working hard to solve that one as well.
Saul Marquez:
That’s great, Joe. So I’m wondering, you understand this population very well. What percentage of these patients are working and not going to work because of it vs. they don’t work anymore, They’re retired. What’s the percentage there?
Joe Ebberwein:
That’s a great question. And what’s really interesting is we have basically an epidemic of diabetes, 13 million diabetics, 70 million or some say closer to 80 million pre diabetics. This is a working or working population problem. Diabetic foot ulcers, about 6 percent of all persons living with diabetes are at highest risk for development of a diabetic. But also sometimes they show up at the E.R. They didn’t even know that they had it because of severe neuropathy. We’ve got some amazing technology available now that can predict formation of a diabetic ulcer 5 weeks prior to formation. And that’s a game changer because if you can prevent 1 diabetic foot ulcer, you’ve saved payers about 44,000, 1 average. So yet these are not just your typical Medicare age population. These are people who once are in the workforce and want to continue in the workforce and really need assistance with preventing these ulcers.
Saul Marquez:
Yeah. You know, my mind goes to the employers that.
Joe Ebberwein:
Right.
Saul Marquez:
Are self-funded and you know, for their insurance, they mean they pay for their own insurance. I mean, these dollars are leaving the company. I mean, I guess. What’s the shout out to the employers?
Joe Ebberwein:
Well, given that 50 percent of employees in the US are covered under a self-funded plan, there needs to be much more focus on this. I mean, we’ve focused a lot on wellness programs, some of which work, some of which didn’t. But there’s some amazing innovative models around managing the health of employer employee populations, direct primary care, a lot of different cool models out there that are really, really getting ahead of some of the chronic diseases. So I would shout out to them to really look for innovative models. And if if they’re third party administrators are bringing solutions to the table, they need to search for the one two who can’t.
Saul Marquez:
Great call out. What would you say is your favorite book?
Joe Ebberwein:
I have two. So one of them is, how will you measure your life? by Clay Christensen, which was obviously you’re given his recent passing, but his work is amazing. The Innovator’s Dilemma. I particularly like how you measure your life because it’s got both business and personal applications. Yeah, but the other one is being mortified to go on that. I have amazing respect for it. I’m very fortunate to be on the board of the Hospice and Palliative Nurses Association, which is an amazing association of 10, that over 10,000 hospice and palliative nurses throughout the US who are really changing the way that we approach advanced illness and end of life. And I think being more at all just encapsulates that spirit. There’s a better way and these people are doing it. So shout out to HP.
Saul Marquez:
That’s awesome. Now some great recommendations. Folks, you know where to go. Outcomesrocket.health in the search bar type in corstrata. Is that one t or two t’s, Joe?
Joe Ebberwein:
C O R S T R A T A,.
Saul Marquez:
A T A Okay, got it. Corstrata type that in and you’ll see Joe’s interview and all the show notes, summary and the links to the books that he recommended. Just check that out there before we conclude Joe. I’d love if you could just leave us with the closing thought and then the best place for the listeners to get in touch with you to continue the conversation.
Joe Ebberwein:
Sure. Well, I really thought about this, and I’d like to encourage all other early stage startup founders who are really passionate about approving health care for patients. It’s not an easy road, but I believe that the pursuit of some of the most valuable innovation really takes a dogged perseverance and a commitment to doing which I believe will improve care for the patient. So, yeah, it’s so important to me to encourage other other founders, stay in the fight,.
Saul Marquez:
Stay in the fight.
Joe Ebberwein:
And it’s easy to get in touch with me either through the corstrata Web site or linkedin, Twitter or certainly text me. I could give you my mobile number 9 1 2 3 4 4 1 4 1 9. I’d love to speak with anyone who believes that corstrata solution could provide to their patients. And we’re looking for customers and strategic investment partners to really expand our reach here in the US and globally.
Saul Marquez:
So they have it, folks. Great way to get in touch with Joe. We’ll include that number in the show notes or just hit rewind and write down. But this has just been a fascinating conversation around wound care, ostomy and improving outcomes there. I mean, 30 percent re-admit is it’s just not not acceptable. And Joe, kudos to you and your team for what you’re doing to bring that number down and to improve the quality of life. So I appreciate you jumping on with us.
Joe Ebberwein:
Thanks Saul. It was my real privilege and keep up the great work.
Thanks for listening to the Outcomes Rocket podcast.
Be sure to visit us on the web at W W W dot outcomes rocka dot com for the show notes, resourses, inspiration and so much more.
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