Closing the Gap in Care Transition

Episode 319

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Closing the Gap in Care Transition with Brian Holzer, CEO at Lacuna 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 healthcare leaders and influencers. And now your host, Saul Marquez.

Saul Marquez: Welcome back to the podcast. It is a pleasure to have you tune in again. Did I have an outstanding guest. His name is Brian Holzer. Dr. Brian Holzer. He is the CEO at Lacuna Health. It’s a wholly owned subsidiary of Kindred Healthcare. Brian is a frequent speaker in the area of post acute care and population health, a topic that’s on the minds of a lot of you listening. In 2018, Brian was recognized by Health Data Management as one of the top 30 Chief Innovation Officers at Healthcare Organizations as well as being selected to the Council of 33 by the Healthcare Innovators Professional Society. It’s a big honored to be bestowed on anybody and it takes a lot to earn it. Brian joined Kindred from Highmark Health, the third largest integrated health delivery and financing network in the nation. Most recently Brian led the formation of HM Home and Community Services and served as President of the organization. Brian’s also held positions in healthcare consulting and various strategy operations and sales marketing roles in the biotech industry. So obviously his width and breadth of of experience in healthcare is going to be a very interesting part of our conversation today so Dr. Brian Holzer thank you for being with us.

Dr. Brian Holzer: Thanks Saul. It’s a pleasure to be here. Appreciate it.

Saul Marquez: Absolutely. Now let’s dive into it, Brian what is it that got you into healthcare to begin with?

Dr. Brian Holzer: You know I actually started in medical school so I was you know long as I can remember growing up some of my family’s closest friends were physicians and you know sort of set me on a straight path with science type schoolwork throughout high school and ultimately into college. And I ended up applying and being accepted to medical school Medical College Pennsylvania which now is called the Texas School of Medicine. So it’s been quite a journey. I graduated medical school within a year residency in the health system in Philadelphia and we ultimately made the decision to leave clinical medicine for reasons I still have a hard time articulating. But on the business side ever since I got an MBA in healthcare management from one school business ultimately then have been very fortunate that a number of very interesting experiences that sort of collectively have shaped all of you healthcare and how I go about trying to create innovations.

Saul Marquez: I think that’s brilliant. And you know I definitely believe that we need more physicians in leadership roles within the business sector and especially companies that are trying to to build products, services, technologies, to help serve practitioners and so I love to hear from you Brian what you think needs to be on healthcare leaders agendas today going into the new year and how you guys are working with that at Lacuna?

Dr. Brian Holzer: Yeah it’s a complicated question. It has different answers depending on the specific area that one focused on. But I think in general one of the commonalities across any sector in healthcare is we simply got to do better or deliver a better experience for patients and even further their extended care teams. There’s just a number of crises that all sort of interwoven right now. But one of the commonalities is as folks love one’s age there simply is just an enormous stress both financially and just practically on how families are trying to navigate what has become an increasingly confusing healthcare system. And so you know whether you work for an insurance company or a health system or your individual physician practice or practitioner, there are many many ways that we can do better collectively the healthcare system deliver a better experience to patients and their loved ones.

Saul Marquez: That’s really fascinating and so I think it’s you guys are filling in a very important gap in the healthcare continuum just for the benefit of the listeners that maybe aren’t as familiar about Lacuna, from what I know you guys are a white labeled patient engagement care management solution for really hospitals, ACO’s, anybody that needs it. I’d love to hear from you what it is that you guys do so that the listeners could level set.

Dr. Brian Holzer: A couple of things one you know I’ve been in Kindred now a year and a half. I wasn’t actually hired to do what I’m doing today I was brought on to forge more of a broader innovation platform for Kindred which has been a storied and broad deliver of post acute care services over the years from being one of the largest skilled nursing facility providers to owning only one today to be one of the largest remaining providers of long term acute care tax. We’ve got a enormous rehab division that manages inpatient rehab facilities both freestanding and for all the hospitals for their joint venture partners. The story post acute care provider that has been like a lot of providers trying to forge towards delivering solutions and services in addition to being a cure operator of the actual lines of service. And so you know here’s what happened I mean I got here Kindred had set up a nurse call center about four years ago called the Kindred Contact Center which was largely speaking nothing more than nurses. And I say that not to dismiss the value but when you look at our healthcare system today, one of the things that’s sorely lacking is having patients and their caregivers have ready access to trained clinical resources to help them with their questions and provide education. So in a very brief period of time I had perceived Kindred Contact Center and its concept of how to apply nurse labor force which is highly trained two in three decades of clinical experience 24/7 and so on and so forth. And that was the evolution of Lacuna. We made the decision to essentially spin the cost center into a wholly owned subsidiary that today is a C Corporation. Give it a new name called Lacuna which I named off the Latin root lacuna which means gap or missing piece and begin to offer…

Saul Marquez: Love that.

Dr. Brian Holzer: Patient engagement services using a trained nurse workforce in parts of post acute care that I felt were sorely lacking that clinical expertise from the perspective of a patient and their care team.

Saul Marquez: Love that. You know that’s fascinating. Love the root word lacuna the gap and really because that’s what you guys are doing. Interesting how you guys spun it out and so how long has it been and and maybe you could even do some examples of how you guys have created results by doing things differently.

Dr. Brian Holzer: Yes we set this up in January of this last year. This will be the first full year that Lacuna has been offering and operating underneath the Lacuna Health brands. And it’s been… thank you, I guess coming up. It’s been amazing an amazing journey. And quite honestly I struggle as I’m sure we’ll get into this early on because when you look at the healthcare system and where you can apply a highly trained nurse workforce albeit telephonically which is most of our interactions, you end up having this unlimited list of places that you could apply the concept and I struggled to narrow where we could actually from a true business model perspective position the business for the most amount of success and impact. And you know I went back to my roots I’ve spent five plus years in the post acute care arena. I worked for a health plan and health system. I’ve seen how post acute is both sorely, poorly understood and poorly applied. It’s a series of siloed businesses that unfortunately the patient get discharged from the hospital, they’re at the mercy of many many different kinds of businesses that have to come together to coordinate care and too often it isn’t. So we’ve positioned Lacuna towards the post acute care space in particular and more specifically towards the point of transitions. And so as folks are discharged from hospitals about 40% of them will go to some form of a facility or home care plus acute care setting. And about 60% of them will go home with no services at all and there are a number of products that we have produced to help health systems, to give you an example, in particular manage the patients as they’re discharged. One client is the University of Louisville Comprehensive Stroke Center. There’s been some news on our partnership under their brand, its white labels. We engage every stroke patient who was discharged from the University of Louisville Stroke Center for 45 days over a series of intermittent cadences where we’re assessing patients and helping them think through the medications they’re on providing any age education we’re helping them understand if they’re receiving home healthcare and durable medical equipment in many cases the nurses simply aren’t showing up or they’ve gotten an oxygen tank and they don’t know how to turn it on. We help them get a line back to their PC primary care physician. Too often folks are discharged with the discharge order a follow up their PCP. But people don’t realize that they don’t have a PCP or they don’t know how to follow up or they forget. So that’s one example in the hospital transition and I’ll just briefly provide a couple more and can take any of your follow up questions. If you get further away from the hospital you get even less resources available to patients. And so folks are discharged from the hospital about a quarter of them will end up in a skilled nursing facility for a period of time because they’re not well enough to go home or an inpatient rehab facility because they needed intensive therapy after say a stroke. That’s another transition. And then they get to something in many cases home healthcare which is skilled nursing delivered in the home. That’s another transition. So that the common complex patient may actually have two or three transitions of care from a hospital to a facility to home care to home with no services. And in each of those transitions there’ll be different complexities, challenges, medication regimens, bulb appointments we as well could have inserted ourselves into those transitions and offer our clients which are commonly hospitals, ACO’s, and physician groups, clinical support to assist them to deliver a better patient experience for the folks they’re caring for.

Saul Marquez: I think that’s it’s brilliant. And you know you call that Briony, a lot of people in the business are really great at what they do. The challenge is that it’s so siloed that when patients leave the hospital the acute facility it could get complicated. Your team has done such a great job of simplifying because you understand that post acute space so well and now you’re able to help them empower their care strategy afterwards. So I think that’s really brilliant when you guys have put together there.

Dr. Brian Holzer: Thank you.

Saul Marquez: Yeah. Yeah. Give us give us an example of while you were organizing this you know you mentioned wow there’s so many applications right to use this, you narrowed it down. Give us an example of maybe something that that a setback that you had and what you learned from it as you guys were putting this together?

Dr. Brian Holzer: Look I’m not a huge quote person. Every once in a while when I look for inspiration, I will do a google search and come up with something that’s just so true with what I’ve been going through and there’s a quote that I love by Thomas Edison that says “I have not failed. I’ve just found 10,000 ways that won’t work.” And I think that most describes the last five years of my career. If you are playing on the side of new care models and trying to push the envelope on innovations and thinking differently, life just becomes a series of missteps and failures and Italy and wrong ways of thinking about stuff. And I’ve just become incredibly comfortable and I’ve embraced a process where you know failure is a prelude to success and not understanding something just forces you to focus on what why you don’t understand it or why it’s not working so you can course correct or pivot. And I wasn’t I didn’t get I wasn’t born good at it. I’m still a work of progress at it but it becomes the true north. How I’ve been able to think and guide through some very complex new business models that don’t have a clear path on how they would get paid for it. Who’s going to pay you for it and what price point. And so the answer your question is it’s a daily, hourly events where I come across something that isn’t working doesn’t make sense the customer doesn’t quite understand what we’re trying to do. And I simply you know all I can say is that I’ve embraced that as part of the process and it keeps us moving forward as you constantly have to pivot along the way.

Saul Marquez: Love that Brian and so you’re probably listening to this folks and you’re 100% going through something that’s not working. And so take this inspiration from Brian Holzer, Dr. Brian Holzer. Edison found 10,000 ways that it didn’t work. And we kind of do that. That’s the true North as Brian says and it happens daily, hourly so sustain the game. Great things do happen if you stay with it. Brian I’d love to hear the other side of that coin. You know a time when you’ve been most proud of what you’ve been doing.

Dr. Brian Holzer: I think there’s a there’s a sort of newness bias. I love what we’re doing at Lacuna Health. You know this is an opportunity to create something from an idea. Ben Breier, the CEO of Kindred Healthcare gave a lot of credit for us, stayed true to the concept of funding a contact center on his dime, Kindred’s dime. Had to do great work when it wasn’t always clear if there was a financial or why did that work. But it was the right thing to do for Kindred’s patients. And you know to be able to take that and name it and get started and develop the business model from inception on how we would actually do great work, helped patients their caregivers and be financially sustainable when none of that was clear. And many days still isn’t. It’s been a lot of fun. And I work with nurses predominantly on our workforce. We’ve got well over 40 to 45 highly trained registered nurses, many of which are two and three decades of bedside experience have chosen this because they believe they can apply their life learnings at bedside to helping the patients we engage. It’s been an enormous amount of fun and I’ve had a lot of fun in other roles building other types of companies. But there’s something wonderful about what we’re doing and as a result I come to work most days really excited to kind of push the ball forward.

Saul Marquez: That’s wonderful Brian congrats. Kudos to you. Kudos to the vision of the CEO as well to be able to say “you know what I’m going to move forth with this with you Brian.” And bottom line folks, good care is good business. And we’re seeing that with the progress here of Lacuna with Brian and his team’s efforts. You know and on the topic of sort of you know nurses being able to help patients as they transition, the call center, is any of this… are you able to do any of this like remote working? You know I know that’s a new trend in today’s workforce and I know it would be a huge benefit for a lot of nurse talent.

Dr. Brian Holzer: I think in business I’ve also folks that are successful I think a commonality that I’ve seen as you end up being more flexible in time match to some things that you don’t want to be flexible on and this is an example we when I first sort of thought through Lacuna we embraced the concept that all of our friends are in a single contact center environment in Louisville Kentucky. And when you look at a lot of the other contact centers that are up and running and are serving a healthcare space you’ll find offshore examples, you’ll find folks that have 100% remote model. And I was stubborn to the extent, I was like “No” you know we need to be that the culture and the training and the the concept of everyone being in one place looks great on paper or nurses if you walk our floors are constantly collaborating which is true to how our nurses are wired and I didn’t want to go towards a remote model but you know it turns out insurance there’s many many entities starting with insurance companies they’re using nurses in many different types of ways and to stay competitive we actually put a performance based work from home model in place where we’ve got about a dozen nurses that will spend a couple of days a week working from home. But it’s performance based. So they drive performance in our contact center, they earn the right to do some work from home. And so we became more flexible around that concept. And what I’ll tell you is what happened which is even more intriguing is they were then offered work from home and we found that they ended up only using it one or two days a week because they loved coming to work and having that collaboration with their fellow registered nurses. And so we’ve got basically a hybrid model will continue to stay flexible around the concept.

Saul Marquez: Love that Brian. Now thanks for sharing that your thoughts around that. You know the leaders tuning into this, you’re always thinking about ways to hire recruit and the flexibility that Brian just mentioned is key. But the even more important part is the importance of culture building. And Brian, I respect you for that being able to just say “hey look this is the model that we want, this is what we’re going to do” and it’s building a culture that’s creating results. So so kudos for that work. It’s it’s not easy to do.

Dr. Brian Holzer: Thank you. I do appreciate it.

Saul Marquez: So what would you say right now is an exciting project that you guys are working on at Lacuna?

Dr. Brian Holzer: We have partnered and look Lacuna’s business model has also evolved more towards finding other great companies. They are doing great things and figuring out how we complete each other so that we can collectively more provide customers more of a platform versus what I see too commonly are these siloed point solutions that may make money in the short term but aren’t really solving the broader healthcare problems. And so we’ve teamed up with a company called GAPS which is a physician led startup organization serving right now that skilled nursing facility space which is you know quite honestly a segment under pressure. Reimbursement challenges and regulatory issues have forced the space to really rethink how they’re going to do their work very efficiently in a really important segment. Because there are the folks that end up in commercial facilities for 15, 20, 25 days are very sick. And so we’ve put the two together and we’re currently marketing and having some early customer contracts in the area of delivering clinical pod models where it’s an M.D. pharmacist and PNRN as a replacement to the existing and the only medical director models that are common across the skilled nursing facility space connected to an RN led post discharge program. So we deliver a highly intensive clinical utilization model inside the four walls and a skilled nursing facility predominantly led by the MDN pharmacist and then the folks are discharged and enrolled in a Lacuna Health or an aftercare model where we continue to follow the patient for 30 days including medication, education, and regimens, primary care appointment, medical equipment, home healthcare, and so on and so forth. When you put the two together, I would say if we held this podcast in six months we’re going to have enormous uptake across the skilled nursing facility segment because we’ve put together two pieces into one. And basically what you have is a medical doctor led clinical utilization model to improve quality and service within the skilled facilities connected to a post discharge are in LED follow up program which we think is going to change the game in the skilled nursing facility vertical.

Saul Marquez: Very cool that very apparent that this will certainly increase the quality of care and very exciting work. We’ll be excited to see how this progresses here in the next six months to a year. But it definitely sounds promising Brian. Yeah absolutely. And bottom line is you guys continue to put things out there and collaborate and I mean it’s pretty impressive that you’ve been able to find this new niche.

Dr. Brian Holzer: Well it’s again it’s been an evolution and I’ve drawn on many different career stops to create that look in the health business model and you know I spent four years at a large insurance company in Pittsburgh and I had so many super exciting digital health and technology solutions presented to me. And what I know what I learned along the way is you so frequently found myself saying “Jesus if the three that I just saw last week work together and they were one company that would be the solution versus the three components that each are solving just a piece of the solution” and I develop the mindset around platforms versus point solutions as ways to create sustainable scalable change. And you know it can be you can be overambitious with this stuff and failed because of it. But Lacuna health is predicated on a goal of finding partners that are like minded that solve for you know a couple of things that we don’t adding ourselves to the equation and creating unique product, partnerships, that can for our customers and ultimately the end users that the patient drive sustainable change.

Saul Marquez: Yeah that’s that’s brilliant man. I think it’s great and the call out of platforms versus point solutions is is definitely important. Even even in the in the in the business side of things, healthcare is siloed. So you know Brian’s doing some cool things to really look at this from platform based way. You should think about that too. Let’s pretend we’re putting together a leadership course and what it takes to be successful in healthcare. It’s the one on one of Dr. Brian Holzer. So I’ve got five questions for you. Lightning round style followed by a book that you recommend to the listeners. You ready?

Dr. Brian Holzer: Yup yes.

Saul Marquez: All right. What’s the best way to improve healthcare outcomes?

Dr. Brian Holzer: Build it from the patient backwards to ask folks that have never really touch the patient are trying to design solutions for what is the end user and that’s just that’s a recipe for failure.

Saul Marquez: What’s the biggest mistake or pitfall to avoid?

Dr. Brian Holzer: I think I think arrogance. You’re never gonna be smarter than you are when you realize you don’t know everything.

Saul Marquez: And don’t believe your own press sometimes.

Dr. Brian Holzer: Absolutely yup.

Saul Marquez: Love that. How do you stay relevant despite constant change?

Dr. Brian Holzer: Thirst for knowledge and just a true desire to self educate. It’s a there’s just never enough hours in a day where I’m for me to simply learn and it’s just the constant evolution.

Saul Marquez: What’s one area of focus that drives everything in your organization?

Dr. Brian Holzer: The patient.

Saul Marquez: Love it. And what would you say your number one success habit is?

Dr. Brian Holzer: Intellectual curiosity. I just it’s sometimes manning the others around me but asking why instead of just accepting the way things are is a habit that served me well.

Saul Marquez: It’s great quality and what book would you recommend to the listeners Brian?

Dr. Brian Holzer: I loved Bad Blood which is the story of fairness. Too often in our… I’ve seen many examples I’m sure your listeners have, there’s a fine line between madness and failure and brilliance. Managed brilliance I guess. You know there was a lot of brilliance with I think Elizabeth Holmes and I think arrogance and madness sort of overcame it and it’s a true story about how ambition which is a good quality can work against you when you’re blinded to some very important things like your own arrogance.

Saul Marquez: Great one to recommend. Listeners great resources, tips, and tricks, pearls of wisdom shared by Dr. Brian Holzer, you could get a full transcript as well as links to all the things we’ve discussed,, a link to the book go to outcomesracket.health and in the search bar type in lacuna health and you’ll find all that there. Brian, this has been fun man I really enjoyed this.

Dr. Brian Holzer: Likewise. Thank you very much. Looking forward to following you.

Saul Marquez: Yeah. And listen if you can just leave us with a closing thought. And then the best place for the listeners could follow your work.

Dr. Brian Holzer: Look I just think the concept of stay curious and ask why in healthcare. There is we just all the beautiful thing about healthcare and why I love working so much is not only are we working in healthcare for those that we do. We are consumers of it and I just every day that goes by you run into someone else who’s been who works in healthcare, CEOs on down to line workers that have been adversely or negatively affected by our system for a loved one that they care about and you can just see sort of the intense focus on wanting to fix what’s what’s broken in our system even more profoundly in the so-called affected negatively by it personally. And if we don’t fix this we will be affected by it personally for ourselves and our loved ones, our children, our grandchildren, and that’s what drives me and hopefully will for many of your comfort that you’re this year’s as well.

Saul Marquez: Such a such a true message there Brian. Every day I hear something you know somebody talking at the gym or at the grocery store or at work. So definitely a great point to leave us with. And where would you say listeners could follow your work and the things that you do.

Dr. Brian Holzer: I maintain an active LinkedIn page both personally and for Lacuna. I would welcome anyone that wants to follow me on LinkedIn when we do what we do things to look into health or we don’t see things that I like from others. I do tend to get posted on LinkedIn and my Twitter feed and that would be a great way as well as our website lacunahealth.com.

Saul Marquez: Outstanding. So there you have it folks, follow Brian’s stuff. He’s always posting interesting things. He enjoyed today’s interview. You’re going to enjoy the things that he puts out there so Brian thanks again. This has been a pleasure. Really appreciate you spending time with us.

Dr. Brian Holzer: Thank you. Likewise. Take care.

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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