Meeting Patients Where They Are

Episode 291

Recommended Book:

The Culture Code by Clotaire Rapaille

The Best Way to Contact Tim:

tim@ampersand-health.com

Company Website:

Ampersand Health

Meeting Patients Where They Are with Tim Petrikin, CEO at Ampersand Health (transcribed by Sonix)

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.

Saul Marquez: And welcome back to the podcast. Saul Marquez here and I’ve got Tim Petrikin on the podcasts. He is the CEO and co-founder of Ampersand health. He served as the Executive Vice President of Ambulatory Care Services previously Chief Transformation Officer of Vanguard Health Systems. He also co-founded e+CancerCare formerly known as e+Healthcare, served as its CEO as well. He has served as Vice President of Development at Ambulatory Resources Center which he also helped be part of the startup team since 97 and they grew 38 centers. He’s no doubt an innovator and an entrepreneur in health care that’s making a difference and it’s a true pleasure to have Tim on the podcast. So Tim, welcome to the Outcomes Rocket.

Tim Petrikin: Well thank you for having me Saul, I’m excited to spend this time with you.

Saul Marquez: Absolutely a pleasure to have you here so anything that I miss in that intro that maybe you want to cover with the listeners?

Tim Petrikin: You know people always miss the most important part of my bio is that you know 25 years ago before getting in this health care thing I was a retailer and a talk about dated industries people refer to the buggy whip a lot. Well I sold saddles and still a frustrated retailer I love that business but I’ve been around a long time but it is a big step to go from selling saddles to the health care industry. So I’m still learning but people always forget that I’m a saddle salesman before.

Saul Marquez: I love it. So that’s very interesting. So how long were you in the saddle business for?

Tim Petrikin: Well I grew up around horses and riding so I consider it as kind of a passion. And it was a hobby that I thought I was going to be the J. Peterman of the equestrian I did that for about five years and so I realized that it was a really really bad job.

Saul Marquez: Oh hey you know the important thing is that you changed direction and and so now you’re here it’s the bulk of what you’ve done, you’ve started several companies you’ve added value to the healthcare system. What would you say is a hot topic that needs to be on health care leaders agenda today and how are you guys addressing it at Ampersand.

Tim Petrikin: Well you know some of it’s born out of frustration and the frustration is I really don’t think we’ve done enough in healthcare and we’ve created enough value and that value really be improved well. I mean we all ought to be embarrassed as an industry with our health outcomes and the investments we’ve made the work we do in this incredible country with the incredible talent we have and resources at our disposal. We just haven’t done enough. And that’s really kind of a driver and was somewhat crusade that I’m on is the impact I want to make this not just economic value I think that healthcare is a great industry as you can do well while doing good. But we have to put that at the forefront of everything we do is are we improving health outcomes. And that’s just the critical factor. And so I don’t feel like in 25 years candidly we’ve done enough. And that’s what’s going to drive me hopefully for the next 20, 25 years.

Saul Marquez: Well it’s good to have…

Tim Petrikin: I’m home by the way. And then you know I hope so. I hope it doesn’t either. So I love to hear you talk about Ampersand level set with the listeners where you guys do. How are you adding value by doing things differently?

Tim Petrikin: You know we’re taking a very common sense approach in how we integrate solutions and we kind of consider ourselves as a solutions platform for Medicaid beneficiaries so we spend 100 percent of our time in Medicaid and power we bring in solutions to the communities we serve and in trying to take a very common sense number based approach to that versus a provider forward approach which I think is historically the way healthcare does approach things and we take what we learn. I mean I can’t tell you that we know every answer on what works. We keep discovering we’re an organization that wants to fail quickly and inexpensively and not repeat it. And rather than design these perfect beautiful elegant solutions and then discover they don’t work and we spend all of our time protecting the process that we went through and supporting a bad decision we think we can do that much easier. And the other thing that makes us unique also I’ll kind of our solutions platform but is our belief in segmentation of customers understanding our customers better than anything. I think that it’s constantly learning about them and bringing solutions that are designed specifically for them and by specific point is it that you can not simply apply Medicare or commercial solutions to Medicaid population. And I think vice versa. I think that each of those customer segments requires different solutions and that’s one of the approaches we’re taking. And secondly I think our platform by being an integrator of technology versus developer of technologies is the thing we’ve decided. There’s no great solutions out there for anything you want to do. There’s a half a dozen really good solutions and I applaud the industry for having those. They tend to be point solutions and in and of themselves less effective if we put it together and apply those solutions we can do it. Both cost effectively and enhance the effectiveness of any one point solution on its own. So that’s kind of our belief around technology. And finally I think what we really look at in our population particularly sense of 75 million people about 26 percent the population that’s that would be represented by Medicaid. You have to scale and you have to know a lot about people so data becomes critical in multiple forms and with a largely unbanked population. Some of the behavioral data is the toughest data to get clinical and then claims data is not very hard to. So we’re really focused on those areas of integrating technology applying and analyzing data to know more and better customers and developing solutions that are specifically targeted to the needs of people that candidly are impoverished and tend to be vulnerable.

Saul Marquez: Tim I love the focus. And very insightful. You definitely laid down some major major nuggets of wisdom here. If you build it they won’t come and there’s so much stuff out there that implementation is the real innovation in health care and so I love that you’ve taken this no nonsense approach and are tackling the issues head on by integrating. Give us an example of what you’ve done, how it’s been different and how it’s created results?

Tim Petrikin: Well let me give you the first example about what we’ve done is we’ve abandoned the idea of a medical or clinic of being the hub of everything that happens.

Saul Marquez: Okay

Tim Petrikin: So think about this. Think about the fact that what we’ve tried to do historically is what we’ve been there for people to reactively select and decide they needed care. I mean that’s how it happens. I’m too sick to handle it myself or through over-the-counter drugs or I didn’t heal so I seek care at a facility that’s located conveniently for a provider of that care that has some training, education, and certification or licensure to deliver that we’ll just abandon that whole idea and. Okay, how do I how do I get to you where you are proactively, allow you to react when you need help not be done. You know there was so much a part of your life your annoying but how do I become part of that. And so so our first approach is going to how we we simply approach members and we call them members because we don’t want to wait until they’re a patient. Candidly that that’s failure to us that will happen but that’s failure. How do we get to members early. So we’ve adopted the idea we want to own their phone and we want to be in the community aggregation point for them that they normally we say live, work, play, and worship. And so that’s around churches, grocery stores, right mail schools and daycares is really kind of where where we’d like to put ourselves with resources. And so that’s the first step is how do we change the mindset of our approach instead of sitting back waiting for someone to self diagnose themselves to check to heal themselves? That’s kind of the first critical factor when you fully adopt that and we have not and when we fight this cultural battle every day because of the gravitational force and pull of the clinic and the facility around health care. But that’s kind of where we push that forward. And so if you think about that length the world gets different we don’t go into homes and we don’t go into work so there’s different reasons for that, probably a longer conversation but we go to aggregation points where people are congregating and live because we think there’s power to that. So every tool we look at has to be through those lenses not interested in apps, portals, or anything. Someone has to we watch people how do they communicate with one another. And we want to be in whatever app or whatever way they normally do it. And that’s generally the SMS function on their phone or it is voice. Increasingly some of it has video but still rare. People want to do things the asymmetry of communication. The text seems to really have grabbed people. So that’s where we want to live, on the phone and be a part of their lives in a way they can outreach that they don’t have to have. One time I’d say when they do need care is they need it in a time frame that they want it which generally means have the ability for someone to walk in and seek care. Also you have to design your business to be able to allow for that and work within the payment mechanisms to do that. But no one wants an appointment three weeks from Tuesday.

Saul Marquez: Right.

Tim Petrikin: At 2:00 in the afternoon when their at work. For a lot of our folks that are that are part of the knowledge on board of course they don’t know what their schedule is in three weeks. So they need to be able to walk in now and receive care. So you have to design the whole system around the population you’re seeking to serve not around the provider that’s delivering the care.

Saul Marquez: Yeah I think that’s a really great call out. So Tim what’s a typical value point that you guys offer so you meet people where they are. You want live in their phones. What are you doing for them?

Tim Petrikin: Yeah that’s great. So what we’re generally finding areas I would say in the Medicaid population which we work with lots of moms and kids. So you’re looking proactively to take the measures that from a policy standpoint and from an evidence based medicine standpoint you want to do. So you are we are proactive about well people interacting with us to get back seems to get different screenings and testing in the Northeast where we are led testing is big. So part of that is just proactive. Secondly it’s how do we address care earlier. There’s a lot of delayed care within the community. And then it’s a higher acuity those it’s more severe, it’s more expensive, and more disruptive to people’s lives. So the first thing we use and we talk about where we are we want to just start a conversation. We don’t know if that’s a deep trusting relationship but we want to have a conversation. And so that’s really what we’re trying to do and we want to be a part of that conversation around health. That’s we really focus on things where there are challenges criminally aware chronic disease. We have it’s really a pandemic of diabetes, hypertension, and asthma in these inner city zip codes that we work in and we need to help people with the resources to self manage and care. Those are all diseases that can be managed. If I manage, they get really expensive and they will get really sick but they can be self managed. We want to help them self manage their disease and provide them the tools and the confidence and the knowledge because we are dealing with low health literacy often times in these communities. They haven’t had the access and exposure that other communities have had. So how do we provide that knowledge. And then finally how are we there when they need us? And so were we really delivering primary care that’s accessible in a ways they want to access care and providing the capacity to take the time when it’s needed. So we’re trying to avoid primary care delivered in the emergency room. We have nothing against emergency rooms with love. We just want him to handle emergencies that I think most of our joint joy the same. And how do we provide for that. And there really is much of that in the inner cities today from a primary care standpoint. So we do have to deliver traditional care as part of this. But ultimately I think it’s those things we’re proactively reaching out with the conversation we are heavy into self care management. And finally were there when you need us when you’re sick in a way that is approachable and affordable.

Saul Marquez: And I think a very valuable discussion here folks and addressing this the need for more responsive and meet you where you are primary care models is definitely crucial Tim, Ampersand, and the company that he and his team run are really doing just that. I’ll tell you what Tim I’m tired of e-mails and when somebody does reach out to me via text I’m more likely to respond. And so I definitely get what you’re saying with that and as a consumer that resonates with me now you know I think it’s truly valuable to have more people that we’re selling saddles to join us in healthcare because it is the basics of consumerism that we’re missing. So Tim thanks for bringing that common sense that it really is kind of uncommon. And I appreciate you doing that.

Tim Petrikin: Well so I’ll tell you one funny thing that I spend most of my time doing is energy text conversations.

Saul Marquez: Okay.

Tim Petrikin: And what I’m going to have to end up doing is retraining A.I because we are using A.I in the conversations back and forth. They’re interesting but for some reason we want to train the army to speak in some way and so know Queen’s English that no one actually speaks and that there’s something to a very colloquial approach to the population. And I spent I argued for a week with a PhD behavioral sciences about why we should just say hey instead of hello with a comma and starting a text and in that text campaign we had fewer opt outs and a higher percentage of responses than they’d ever seen and we simply were weren’t speaking the way any of us would look at our texts and our phones.

Saul Marquez: Love it.

Tim Petrikin: And you have to communicate with people the way they want to be communicated with and the way they communicate naturally because that’s how you build trust.

Saul Marquez: I love that I’m going to give that an amen my friend because it is truly impactful and yeah. Doesn’t surprise me that you got better uptake and something that we need to be thinking about more right. So if you’re an executive thinking about how you’re going to more effectively influence and lead your team something to keep in mind to right meet them where they are if you’re a physician looking to more productively influence your patients meet them where they are. Hey versus Hello comma, super super insightful. It’s the small things Tim but you guys are doing them, what would you say is is an example of a set that you guys had and what you learned from it?

Tim Petrikin: We have them everyday but given the big ones I highlight that we like to have moments. It’s a problem is it it takes a long time for people in the organization to learn that it’s okay to make mistakes. We don’t want to make clinical mistakes and that’s an area where we do seek perfection and we don’t want to ever harm anyone but when it’s an approach like we’re taking it you know a lot of the mistakes are over design and we’ve done that we over designed we hired I won’t call out any any names but this year we had the good fortune at Vanguard as a fortune 500 company to have a wealth of resources and a great deal of support from a visionary CEO and a strategy officer. So we’ve hired these firms and they do all this great work in design work in the first scene and we design these care teams and people want to be healthy. What you realize very quickly and I’m glad we did it was our only survival is that no one wanted to care team no one knew what a care team was. No one actually wanted to. The other thing we had is a really cool advertising go to market campaign around health improving health. No one actually wanted to buy health. What they wanted you to do is just be there when they needed you. Just you could, could you just do that. So we over designed this idea and we got caught up in what I kind of called the TED speak of the world of all this beautiful design and we forgot what the member really wanted. We weren’t listening to what the member really wanted and they just wanted you to be there. And then when you were there then you could build upon that and the other funny thing I see and this is the industry thing is now we’re going to try to meet all of these value based metrics and alternative payment models. And the other funny mistake and an example of that is you know I shadowed one of our physicians and a member had a sore throat and we tried to deliver care telephonically for them and help him with some solutions but they just purged it the process they wanted to have an appointment they came into the appointment we did this really smart thing in the industry we match Paxil visit to close all the gaps in care and the member looked at me as said “I don’t know what kind of place you’re right in here but I came in with a sore throat and I’m leaving with a mammography and a colonoscopy. I don’t want any of this.” And so what we we also learned is meet them outside of that sick visit for the well care in the screening that we believe is valuable and the evidence shows as valuable. Separate the two. So here’s an industry idea of combining them. That’s a dissatisfier. So now I’m going to have a harder time bringing that member back in for something or them approaching us because they just want to get fixed for whatever is wrong with them today they just want to feel better and they don’t need all this stuff that the industry prescribes that we have to approach it differently with those two. Those are some of the kind of over design listening to the echo chamber of what people should need versus just watching people and listening to what they really want. And if you do that you learn to sequence your business. It doesn’t mean you don’t get to do all of those things and close the gaps in care. You learn sequence to be more effective.

Saul Marquez: What a great great example you’ve provided several examples and yeah it’s it’s it’s easy to over engineer it’s it’s easy to prescribe without listening and and so now you guys have some some great learnings to implement from that. And I love the word that you used, sequence. It doesn’t mean you’re not going to be able to help folks take care of themselves. It’s just a matter of how you do it when you do it. And that’s also very valuable. So what what would you say the other side of that coin is, Tim what’s one of the proudest experiences you’ve had something you guys did really right?

Tim Petrikin: They really are caught up in everyday stories impacting people’s lives and having the opportunity the amazing thing and those people the lives you’ve impacted now that we’ve been at this for for three years in Philadelphia and we’re expanding to New Jersey. But now there’s some people joining our team and I think having patients that want to join our team in roles is one of the things that just means the most to me when I hear that in the second song and that is humming and watching caregivers develop and that’s a hard thing to see happen because we’re very regimented we’re very factory oriented I mean there’s talorism built into the whole health care model and it’s supported by certifications and licensure and scope of practice model but to see caregivers develop and realize “I can do this” in this whole mess the top of my license which I’m really not trained corn is released profitable thing for most people to do. They make money at the bottom of their license generally is to see them really want to do that. And the joy they get. And so the development on both sides have been kind of the coolest thing we’re seeing and I think that’s what we want to see more of is how do we we develop people within the organization to have this mindset. I’ve also been told that a run to people that can no longer work anywhere else because it works and I think that’s why my favorite quotes that Oliver Wendell Holmes said the line that is stretch by no treatments can never go back to its old dimensions when I was in I went through that but if you think about it there’s a lot there to back. And I think that’s what we’re trying to create here in both areas for both the members that we’re caring for and with the caregivers that are part of the organization.

Saul Marquez: So it’s really insightful and and so what would you say today Tim is an exciting project your focus that you’re working on?

Tim Petrikin: Well and most excited about these in community care teams that were deployed alongside where we have clinic resources and we’re leveraging technology. But I’m really excited that the median numbers and exploring ways to be more effective and our whole approach is that is where we’re going to integrate behavioral health and address the social determinants of health. So that’s kind of a neat thing where we’re working on. I think it’s not that everything we’re doing is news it’s that we’re bringing it across an entire solution that leverages technology, leverages human interaction in the community, and has resources for you in a clinic when you need that type of setting. And so that’s the piece that we’re most excited about and the connecting the fact that technology now allows us to be completely connected in every one of those each of those areas that I mentioned. So when you’re in the community you can be working in the same instance of a record as someone in a clinic or someone in an office somewhere and all working on the same goal from the same member and seeing that is really really valuable. So we’re excited about that but I’m most excited about the work we’re doing in the community.

Saul Marquez: That’s exciting super impactful. I’m definitely interested in seeing how that project unfolds, Tim. So maybe maybe we link up again and about a year or so to hear how that resulted. Let’s pretend you and I…

Tim Petrikin: I hope those outcomes rocket though. Sorry to interrupt you.

Saul Marquez: No Please.

Tim Petrikin: With Outcomes Rocket I hope you lead with tell me that health outcomes you’ve made, that’s the will we can be as passionate as we want and I’ll get back to my first statement. I want to make sure we’re improving the health status of these other populations we’re so lucky to serve.

Saul Marquez: And that’s absolutely what it boils down to. So you’re excited to hear about those results. Tam so we’ll definitely bring you back on if you’re up for it here in about a year or so. We’d love to hear how that goes. Right now we’re going to do a little one on one course. It’s a lightning round so we’re gonna build a course on what it takes to be successful in the business of healthcare. And so Tim, what’s the best way to improve healthcare outcomes?

Tim Petrikin: Proactively engage people. Yes I’m afraid of poor health.

Saul Marquez: Awesome. What’s the its mistake or pitfall to avoid?

Tim Petrikin: This a corner with a reactive stick here. Stop doing it.

Saul Marquez: How do you stay relevant as an organization despite constant change?

Tim Petrikin: Culture. You have to build a culture that attracts great people and allows them to do great work.

Saul Marquez: Love that. Yeah. One of my favorite quotes is I think by Drucker says “culture will eat strategy for lunch any day”. What’s one area of focus that drives everything in your organization Tim?

Tim Petrikin: No I think we are very purpose driven and that purpose is we talk about improving health but the reality is we really are driven by this idea of the opportunity disparity that exists in this country. And it’s really driven by multigenerational poverty. And that’s the core driver is opportunity disparity. And how do we change that. So we were constantly driven by that and I think without a purpose of being purpose like that then it’s really hard to do this work because it’s frustrated and you have to be persistent and there’s really a hit you are going to get a very strong ecosystem as I was saying the current health care eco system treats anything new like a virus and attacks it. And so you got to be resilient and you can’t be without a strong purpose and a strong culture to support that.

Saul Marquez: What book would you recommend to the listeners?

Tim Petrikin: My favorite book The Culture Code by Clotaire Rapaille.

Saul Marquez: Huh. Love that. Haven’t heard that one before. So folks the Culture Code, will provide a link to that one here. Tim thank you for that, will also give you this syllabus that we constructed with you along with the full transcript of the discussion. Just go to outcomesrocket.health/ampersand and you’ll find out all there. Tim, before we conclude I love if you could just share your closing thoughts and then the best place where the listeners could get in touch with or follow you.

Tim Petrikin: Sure. My best advice to people is stop talking about it and just start doing it. The more we we do things with the right intention the better results will get. You can find me at tim@ampersand-health.com is my email or look us up online.

Saul Marquez: Outstanding Tim. Hey this has been a pleasure. Truly appreciate you spending time with us.

Tim Petrikin: Right. Thank you Saul it’s been my pleasure.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

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