Tista Ghosh, Senior Director of Impact Evaluation/Medical Director at Grand Rounds

Top 3 Biggest Issues in Healthcare Today and What Our Employers Can Do to Help with Tista Ghosh, Senior Director of Impact Evaluation/Medical Director at Grand Rounds transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
Welcome back to the Outcomes Rocket. Today, I have the privilege of hosting Dr. Tista Ghosh. As the senior medical director, an epidemiologist for grand rounds, Dr. Ghosh acts as Virtual Chief Medical Officer for numerous companies. She’s trained both in internal and preventative medicine. She previously served as the Chief Medical Officer for Colorado and was a member of the CDC’s Preventive Services Task Force. Today, we’re going to be diving into some fascinating work that they’re up to. And I’m privileged to really welcome to the podcast today to share her insights in health care space, but also what grand rounds is up to within the health care sphere. So, Dr. Ghosh, such a privilege to have you here with us today. Thanks for joining us.

Dr. Tista Ghosh:
Thanks for having me.

Saul Marquez:
So it’s an absolute pleasure. And we’re dealing with a lot of new normals and different things changing with the epidemic. But even before then, there’s been an opportunity to do things differently. And what you guys are doing at grand rounds is an example of that. Before we dive into that specifically, I’d love to learn a little bit more about what inspires your work and health care.

Dr. Tista Ghosh:
Sure. I guess going back to being a little I was told that there are people who make a difference in the world and those who just live. And I wanted to be a difference maker and I felt that health care was a space where you could really make a difference in a person’s life. You could really help someone. And then later I went into public health, which meant that I could help potentially thousands or millions of people by focusing on the health of populations.

Saul Marquez:
It makes a big difference. And I love the way you said that you could help people or you could just live. And certainly the folks listening to this podcast are all in the people that want to help people. And so I’m so glad that we could hone in that. Tell us a little bit about Grand Rounds and what you guys are doing to help people have better health care and access to to caregivers.

Dr. Tista Ghosh:
Sure. So Grand Rounds is really unique in that its mission is to really democratize health care so that if you’re living in a rural place with little access to academic medical centers and you have a condition that is concerning or life threatening, you have access to specialists at Stanford or Harvard or Mayo as you would have the same access that anyone else would in an urban center. Some grand rounds does is try to make this type of access virtual so you don’t have to travel. You can have access to experts around the country and get second opinions and the best medical advice possible to help with your treatment. But another thing that has really done, especially in response to COVID, is expand access to clinicians, sometimes twenty four, seven. So they’re there virtually to answer your questions. And by clinicians, I don’t mean just our end. I mean physicians. We have PAs, advanced nurse practitioners who are there to answer your questions. No matter where you live, you can get access to almost like a doctor in your family so that any questions you have there available either by phone or through our app. So it’s really amazing to see how well Grand Rounds is able to expand access to clinical advice across the country.

Saul Marquez:
That’s great. And you think about an employee’s typical benefits plan and you go and they have clunky guide that is usually there to help them find it. I mean, I’ve been through it looking through different providers, and it’s not always the easiest way to find the best in network providers.You’re saying you guys do it differently and I love to better understand how that process looks and feels and really what the core difference is in the in the Grand Rounds method to finding health care professionals.

Dr. Tista Ghosh:
Yeah, so we have a product called Provider Match, which actually is almost like a joke about this Match.com for doctors and patients. So we look at over a billion different data points on individual level providers. So not just people at the facility level, but each individual provider and put them in quality sort of scoring deciles. And based on that, we match a person to the highest quality clinician in their area. And also based on that individual’s needs, are they a diabetic versus do they have kidney disease? They might need a slightly different type of specialist. So we really create a match between providers and patients that are unique, that are within their insurer network and are hopefully within a reasonable driving distance for them. And then. That’s one part of our goal, to democratize high quality health care. And I think it’s very different from other other businesses in that it looks at the individual provider. It does not focus on one practice because a lot of times practices are bought by academics, Center A and that doesn’t mean that the doctors, they’re changed. It just means they have a different sign on their door. So just because you’re part of a certain academic institution or a certain brand name doesn’t mean every provider in that practice is a good one. So this has been really helpful to people and we’ve seen better outcomes. We’ve seen lower E.R. visits. We’ve seen lower unnecessary surgeries. We’ve seen lower unnecessary hospitalizations. So lots of great outcomes as a result of this type of match.

Saul Marquez:
Now, that’s very interesting at the individual provider level. And you mentioned quality is one of the aspects of it. And one thing that’s kind of tough to measure. How are you guys doing it?

Dr. Tista Ghosh:
Well, like I said, there’s millions of data points that we use, but some of the things are more obvious types of data points like very easy. One, has the physician been sanctioned? But even beyond that, do people come back to them? If they’re a primary care physician, do they actually return to this doctor or do they just see them once and never come back? Does the primary care doctor, if we’re looking at primary care, have good rates of preventive screenings, recommended preventive screenings at the right times to their patients, get screened so that they have better outcomes in the future? We look at unavoidable or avoidable E.R. visits. Do their patients tend to have E.R. visits for things that they really didn’t need to go to the year for? Do their diabetics have good outcomes for surgeons? We look at their surgery outcomes. How often do they need revision surgeries? How often are they, if they’re an orthopedist, likely to just operate on anybody who comes through the door versus send them to physical therapy or other evidence based practices? We also look at their referral patterns. Are they are just referring to their buddy or are they referring to high quality specialists? So we’re looking at tons of data points and even prescribing patterns. Are they more likely to prescribe opiates or benzodiazepines that are not necessary? So these are just examples. But there is so many data points that actually go into grand rounds algorithm. And we’ve actually had independent third party validation of our methods through Harvard.

Saul Marquez:
Very cool. Thank you for that. I just and I think a lot of people also would press on that to say, all right, how exactly are you doing it? And that’s helpful to know the various data points that you guys are pulling from to understand. And as an employer, you’re wanting to really pressure test a lot of the options that are out there. If you’re able to best match your employees with providers that are both transparent in their quality metrics as well as the best match for what they actually need, it’s a win win. Absolutely. So share your story with us about how the business Grand Rounds has helped improve outcomes or maybe even made business better for the employers you serve.

Dr. Tista Ghosh:
Yeah, well, I think in terms of outcomes, having matched people to higher quality care from the studies that we’ve done, show improved rates of retention with primary care doctors, decreased rates of avoidable E.R. visits, decreased rates of unnecessary surgeries, decreased rates of opiate use, which arguably is a very important outcome for patients and for employers. So I think we’ve need we’ve had a lot of outcomes that show not only improved health care, but also reduced cost to the employer, because when your visit could be 12 or 14 hundred dollars versus a visit is far less so. Getting people to avoid the E.R. en masse is huge for an employer, especially if it’s unnecessary E.R. visits. Of course, there times you definitely need it. But so I think there’s been a lot of improved outcomes and value brought not just to the employer, but also to the employee, because they have better health outcomes and because we also offer claims advocacy so that sometimes we’ll notice that a patient is getting a bill that seems out of whack. It’s three times what you would normally get charged. And the patient doesn’t know that. The employee doesn’t know that. And we may contact them and say, this seems odd to us. Can we go ahead and help you and proactively reach out to this practice and see if they need a building here? And most of the time they did. And that not only saves the employer, but it saves the employee any out of pocket expenses. So. We really make a difference not only in their health care, but also their financial health as well.

Saul Marquez:
Totally. And you think about wellness. Financial wellness is a big piece, health, social, and with the big out of pocket deductibles nowadays, that right there seems like a great component of the offering. So you guys are doing this, and any time an outlier like that happens, you reach out automatically.

Dr. Tista Ghosh:
Yeah, we have a claims advocacy group that is constantly looking and finding if there is something unusual and either reaching out proactively or sometimes people call us saying they don’t understand their bill. Either way, grand rounds. Once we’ve established trust with someone about their financial claims, they’re more likely to use us for our clinical services, which is good because we want them to be healthier. So establishing that trust through financial help is actually really important and improving people’s engagement in their clinical health.

Saul Marquez:
Oh, yeah. I mean, just an incredible benefit there for anyone because it’s not easy to interpret medical bills. And also it’s not easy to really understand the quality of care that your physician might be aligned with. And so I think it’s both great, great services. If you had to identify maybe one setback that you guys have experience, what would you say that is? And what’s been a key learning that’s made you guys better from it?

Dr. Tista Ghosh:
Hmm. So I would say one of our setbacks when we when covid started was maybe and I wouldn’t necessarily call this a setback, but it was definitely a learning experience, was not realizing how important having access to clinician advice would become to employees and how scared and concerned they were and how scared and concerned employers were. And I think we didn’t understand right away quite the impact that COVID would have. What I do think we were able to do is once we realized it took a week or two, but once we realized we really rapidly expanded our offerings to existing clients. So we were able to expand virtual clinician access. Twenty four seven to some of our existing clients, which meant that their employees, if they were scared or worried, could call us any time. And this, we think, helped reduce the burden on the health care system. This was a time where the physical in-person health care system was completely overwhelmed. And so we were able to take that all those questions and keep those who are just worried or maybe had just mild illness home and reassured. And we could follow up with them and check on them. But we kept them out of the bars and out of doctors’ offices where more sick patients could be seen. So I think we were able to really make a difference there in the pandemic and for the health care system in general, I think the other thing we were able to offer quickly is virtual chief medical officer services to various companies, because what we realized is many of them had business continuity planning, but they didn’t have sort of a health component to it. They hadn’t anticipated a health crisis. They anticipated a wildfire or a flood, but not not this. And they needed medical experts to help guide them on how to keep their employees safe and when to close and how to reopen and all of that. And so I think we were able to pivot and offer some of that quickly to a lot of the employers. So we were not only able to help the employees, but also the employers. And I think we learned quickly, again, I wouldn’t call it a setback, but I would call it a learning experience that you have to pivot quickly in the marketplace and be able to fill needs that maybe you didn’t anticipate sometimes in a week.

Saul Marquez:
So, yeah, and that’s what it’s been. And that’s great. You guys changelings Right. you’re spending time and the benefits, employee wellness space. Then you shifted to operations as virtual Kimo’s. And I think that’s a really innovative approach. And it sounds like probably very helpful for a lot of companies that didn’t have that insight or know how.

Dr. Tista Ghosh:
Yeah, I think it’s been really helpful and I think we’re helping them with how to return to work safely, how to keep their employees and their customers safe. And what I’m really proud of is that some of these companies are critical infrastructure companies that help keep the American economy going. And so that we were able to play even a small role in keeping that critical infrastructure going means a lot. I mean, it makes me feel like a difference maker in a big way.

Saul Marquez:
So kudos to you and the team doctor. Gosh. And being able to listen to the market and add value where even unexpected. I love the quote on your site and folks, if you want to. And more about Grand rRounds, it’s grand rounds, dotcom, the quote here, says that securing amazing care isn’t rocket science is data science. And I think that’s awesome. Just match as well with your words around the different data points for quality. When you think about today and then the shifts you guys have made, what are you most excited about?

Dr. Tista Ghosh:
I’m excited that we’re pushing into a more telemedicine type space. We’re shifting from just providing clinical advice to actual telemedicine. And our goal is to not just be a teller, urgent provider like, hey, I have strep throat, can you write me some antibiotics? But really to offer more whole person care and more of a virtual patient center medical home? We’re not there yet, but that’s where we’re headed. And I think why that’s important is a lot of health care will be disrupted as a result of this pandemic. There will be small practices that go out of business. There will be disruptions in specialty care as well as primary care in parts of the country where there are primary care shortage areas. That’s just going to get worse. And so virtual access to whole person care is going to become extremely necessary, especially in certain parts of the country. And I’m excited that we’re heading in that direction and that hopefully very soon we’ll be able to offer that. And I think that’s going to be a game changer for a lot of people in parts of the country where their own health ecosystem is disrupted.

Saul Marquez:
Yeah, this is such an insightful comment. And for a long time it’s been happening Right. the change has been happening slowly. But to your point, the front door to health care will forever be changed. And it’s exciting to hear that you guys are also considering this virtual access to whole patient care. And it’s going to be a brighter future for consumers in health care right before this whole thing happened. We’re talking about how we’re getting closer to more consumer friendly health care. And this what you just mentioned is helping us lead to that in a much faster way.

What are your thoughts on that? Absolutely. I think this will be much more consumer friendly, and I think a lot of consumer needs will shift after this pandemic in the sense that a lot of people with high risk conditions might no longer want to sit in a waiting room and expose themselves to potential viral spread. And a lot of people will say, hey, this not having to make an appointment and just being able to quickly talk to a doctor in my own time, that’s huge. I don’t know why I would make an appointment and wait. So I think consumers will see what’s possible and that it is possible to reinvent that experience.

And I think there will be demand for that totally of the new possibilities. And they’re all opening up before us, thanks to the innovators in the space and the needs that are pushing us to get there as we use this time to transform our businesses and our practices. Do you have any books in mind, though, that you’d recommend for us to consider?

So fiction wise, I would say cutting for Stone is a good health care book.

Cutting for stone. What’s the nutshell on that one?

It’s by Abraham Verghese, and it’s about a surgeon who happens to have the same last name as me. So that might be why I’m partial to dinner. And then I think when we do harm, the doctor confronts medical error is an interesting read as well.

Some great recommendations there, folks.

You know where to go for the show notes the full transcript links to grand rounds go to outcomes rocket health and in the search bar type in grand rounds. And you’ll be able to find all of those notes and links with our interview today with Dr. Gauche over here. It’s been a very interesting conversation. I’d love if you could, Dr. Gauche, just leave us with the closing thought and then the best place where the listeners could continue the conversation with you or your team. Sure.

My closing thought is health care will change forever. I think as a result of this pandemic, I think there will be a shift towards virtual care. And I think employers should consider virtual care options that meet their employees needs as they go into the future. And I think we’re going to see this not only in the upcoming year when we see resurgences in viral spread, but also afterwards when I think we’ll see a major disruption in how health care is currently delivered and a lot of consumers shifting to a virtual model. So thinking about that in advance is only to your advantage.

That’s a great. Great. And where would you say is the best place for the listeners to reach out and continue the conversation, you can find me on LinkedIn.

I’m just under Stagecoach and feel free to reach out to me there. And I am happy to continue the conversation.

I love it. Well, there you have it, folks. Dr. T. Gauche at grand rounds.

The way that you provide care for your employees and receive care doesn’t have to be grounded in opaqueness. Right. there’s data science to back up the way you access health care professionals, but also question billing that doesn’t look right. And hey, even during these times, maybe a virtual CMO could be there to help. So I just want to say thank you so much stuff for the time you spent here with us and definitely looking forward to staying in touch. Great. Thank you.

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