Lowering Cost While Addressing Baby Boomers and Millenials in the Same Business Model with Keith Figlioli, General Partner at LRVHealth

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.

: Welcome back once again to the outcomes or rocket podcast where we chat with the day’s most successful and inspiring health leaders. Today I have an outstanding guest for you today. His name is Keith Figlioli. He’s a partner at our LRVhealth ventures where they do a lot of venture investments in firms in the healthcare space. Most recently Keith was premiere’s incorporated senior vice president of Healthcare Informatics. In this role he oversaw the company’s enterprise healthcare technology business unit spanning strategy sales, marketing, clients, support, development, delivery and operations. Most notably he was able to as part of the leadership team helped this firm and its members raise 820 twenty million dollars in its IPO. It cochaired premiere’s member technology improvement committee. Before that he was able to be part of many different companies including one that was acquired by scripts where he provided many different leadership roles. Bottom line he is a shrewd entrepreneur. You’ll mind a leader at many organizations and we’re super excited to get his perspective here today on the capital side of healthcare so Keith it’s a pleasure to have you on.

: I appreciate it. Thank you very much.

: Absolutely. Now Keith, anything that I left out of your intro that you want to fill in the listeners on.

: No I think he did it. I think he did it nicely and had a lot of good detail so that’s appropriately. The only other thing I’ve I have done in the past is it has done a little bit of regulatory work with the federal government as part of the open NCAA standards committee which was important work back then and continues to be.

: Very cool very cool. You know health care is one of those industries that is just tough to navigate. So folks with the experience that he has I think you’re going to get some really great insights today. Keith tell us a little bit about why you decided to join the medical sector to begin with.

: Probably go way back which is I don’t tell the story much but I was a economics major at undergrad but ironically had a minor in neuroscience. And don’t tell me how I got there but I got there about how effective that college career and I quickly realize I’m like wait a minute maybe I just don’t want to do business. Maybe I want to get into more of a deeper science kind of healthcare background. So it actually started way back then. And you know I came out of school that your body came out of school. I came out of undergrad in 93 so I can what part of my background as I came up with kind of the Internet and it bounced around a bit with some consulting work in a variety of industries and quickly kind of found my way back into health care and that was always my focus and kind of married the best kind of business the growing of the Internet technology and healthcare and that’s sort of how I got my start. And more important for the last almost 20 years purely focused in the medical sector.

: That’s awesome and said it’s really been at the root of your interests. And fast forwarded. I mean the time fly doesn’t that’s crazy. It’s 20 years already.

: It is a little nuts. Yes. I just actually had my 25th year college ring. Oh yes. I’m dating myself here.

: Hey man that’s experience that’s experience for you. And it counts that health care for sure. Now talk to us Keith what do you think. A hot topic that needs to be on health care leaders minds today and how are you guys approaching it at LRV.

: Yes a little talk about maybe start with a little bit about LRVhealth and it plays right into that so and maybe even sort of my time at Premiere. So premiere which a lot of people don’t understand is actually almost like an association back in the day where it had a 180 a different health system owners as the actual equity owners of that and we took a lot of the concepts from there and LRV health has been investing with strategic investors meaning health care payers and providers for 17 years and we kind of put that on steroids with our latest fund. So at the core of our strategic investors meeting our limited partners as well as our partners are currently 10 health systems and payers that deliver care across 23 different states and deliver care about 45 million lives. So at the top of can tell you how many people we’ve talked to between my premier time and obviously my time and energy health you know were consulting with healthcare administrators and leaderships of payers and there’s sort of two major focus areas for focus right now if you break it down at a demographic level most people talk about the baby boomer generation and what’s happening as their age group ages and gets more chronically complex from a medical sort of use pattern. So there’s a lot of people within the system trying to figure out how to use service that group as they go from commercial plans down into lower reimbursement plans like Medicare and Medicaid and have a plans. How do you serve them as their utilization of the system goes up but at a lower cost rate. So the emphasis on cost right now and so we talk a lot about that with folks that thing that people don’t realize is the age group that actually just you clips the baby boomers is the millennial generation and that millennial generation now is bigger than the Baby Boomers and they want a completely different service offering from health care system they want self service they want all the different things they expect from their mobile phone and less access until that point so people talk about those independently. We actually talk about those together and I hope you find opportunities that while you can take down costs. But then you can deliver a new care experience to a different age group that’s coming into the system now and also start to utilize the system. So both of those intersections circles if you will are sort of what we call our north star and we think it’s top of mind for pretty much every leader across the health care sector.

: Very cool Keith and definitely a great point right I mean we’re dealing with two very different consumers and I think with the approach that you guys are taking given that it’s driven by investors that are the provider payer space it’s a really kind of frontline approach which is very differentiated. I would say I mean that’s a huge advantage that you guys have.

: Yeah I think I mean for us this is as much about being good investors and providing a solid return for investors. But it’s really about operational intent can we partner with our healthcare systems and our health care payer leaders to really drive different operational changes for them. And then also obviously get some kind of return back from them given that it’s a venture capital platform but you know all of us myself and our other partners at LRV health you know collectively we have about 70 plus years of operating experience in the healthcare space.

: Nice.

: To bring a whole different lens to this problem if you will rather than just a pure financing lens.

: Now it’s really. Now there’s a lot of companies in your portfolio. Keith maybe you could walk us through one and sort of a success story something that you guys have done differently that yielded results.

: So I guess I talk about one which is called intelycare.. It’s an investment we made in our last Farnes when I first came into LRV health about two years ago and had a pretty big service line. When I was a premier around healthcare labor we did a ton of rounds labor productivity as well as labor benchmarking. And the thing that was interesting there is that I don’t know how much you guys follow the trends but you know health care labor has outpaced every other labor class in any other industry through the recession. So there’s a tremendous amount of opportunity that sits around labor. So we spent some time in that market and found a company called intelycare which is all around basically oversimplifying it Oubre 5 million higher per Diệm or the by our.

: Interesting.

: Workforce in post. Q So in skilled nursing, in assisted living type facilities there’s an average 50 to 75 percent turnover. Most of these facilities there’s about 2300 regional staffing firms around this country and the largest staffing firm has about a 7 percent market share. So this is a industry ripe for disruption it’s all phone calls emails analog takes forever for people to sort of find people and these guys have actually built a technology enabled with a lot of predictive capabilities to understand what the temporary market looks like and each one of the geographic regions that they plan to they plan for states are going to about 6 in the next couple of months and they have a you know a national footprint goal to sort of really think through a different way to deliver high quality and safe care givers meaning nurses and caregivers to these facilities that really have a hard time finding the right type of people in the market so almost think of it as a matching principle and each one of these markets where there’s a ton of people that have flex resources and have flex needs but they don’t know how to match up with the ideal type of facilities. These guys enable that all through technology.

: I think that’s brilliant. And in this post to keep space with such high turnover I mean it is definitely a great platform. What are some of the things that they’ve been able to achieve as far numbers and not necessarily revenue but just kind of outcomes and stuff like that.

: Yes. So the average is just a couple ones. So the average time it takes to have somebody find the caregiver at some of these facilities is typically a week to two weeks. So if somebody has a shift that goes unfilled they need to go out to the market. They typically use five to six different what is called staffing agencies today. And it takes them about at least a week to two weeks to do that. These guys are doing it in 30 minutes with a push of a button. A ping goes out to 3000 nurse network. You know each one of the geographic markets and you can quickly sort of find the right type of resource. And it sits right there next to the actual scheduler and the person that actually runs these facilities. So that’s a big deal. Secondly most of these folks get about a 60 percent efficacy of being able to fill a shift and intelycare is doing it at 90 percent rate. So it just changes the dynamic. It’s classic use of you know technology disrupts and where it’s still a tech enabled services business but it’s using technology in a smart way to disrupt what is a very big business. I mean this is a 4 billion dollar market that people don’t really even know about. So we’ve had some great success and it’s still very early but great success.

: That’s great. And now folks if you’re a provider, a leader at a provider institution take a look at an telecare this is a fantastic solution for your post acute areas. Intelycare so it’s intelycare.com. Take a look at that really great resource shared by Keiht today. Now Keith, talk to us about a time when things didn’t go so well a setback that you had or one of your companies had what lessons did you guys learn from that.

: Yeah I think it’s an early lesson more from my operating days and I think when I first got into healthcare I came from a general technology background where we had helped build a company that worked with most of the Fortune 50 businesses around this country and world with places like Philip Morris places like Procter Gamble. And I think my use pattern or my thought pattern coming into healthcare like I think a lot of people when they first come in and I think a lot of people are experiencing this now because they have a lot of newcomers in the space. You don’t fundamentally understand the social system and how things really work. And I can remember building technologies early on during my days at eclipses which is now part of all scripts where we thought was like the cat’s meow or use the latest technology rebuilt like a clinical documentation module and literally people threw up all over it. And what’s the other use pattern. We spent years you know probably a year and a half doing that work. And so I think he learned very quickly that’s a very specific example where I learned very quickly that if you don’t fundamentally understand the workflow the social system what actually goes on day in day out. And I think that’s what we have in a lot of areas of healthcare technology today where we have a lot of great technologists building a lot of great infrastructure but they haven’t thought through the use case and the social demographic side of the equation as best they can frankly and you know you can look at that even in the broader H.R. space today there’s a reason why there’s so much angst in that space today is because you know those systems were basically built for billing they were built for their workflow and things to that degree.

: Now that’s a great share. Keith and one that that listeners go back rewind relisten to it. The purpose of the podcast model for you to be able to access these notes when you need them. Keith, what would you say at one of your proudest leadership moments in healthcare has been today?

: You know so it’s interesting when we were at Premier early on this was 09 in 2010. You know the ACL movement the value based care movement took place under Obama and what was so interesting for me was working with 70 different markets and 70 different health care leaders to sort of figure out what an ACL was and what value based care was. Nobody even knew what this was so we used to get all these people in a room in DC and things like that and get hundreds of people huddled around at the health care provider landscape and the first question was always like what is this. I think that was a pretty proud moment to be part of that leadership team to try to drive to an understanding of what value based care is and that’s still obviously morphing today but being really on the front lines on something that was completely unknown had been tried historically including a state that I live in Massachusetts many many years but at a scale level of what they were thinking about and specifically what CMM Ohio was thinking about at the time. You know we had partnered with Dr. Rick Gillfillan we now heads of Trinity out of Michigan. And it was a fascinating time. It’s a proud time because you know we didn’t have all the answers. We didn’t figure everything out. But being able to work in what has stuck with me forever and big part of why I love what we’ve done at LR health is this idea of working hip to hip with health care leaders the people who are delivering the actual care day in day out on these complex problems because you know the shock waves that happen in the healthcare industry literally every couple of years and most people don’t really understand what the shockwave is you know MIPS is a perfect example right now where you know people don’t even understand what that really is but they’re having to deal with it more openly the reimbursement is tied to it.

: Now that’s a really great call out and it’s tough to navigate these waters and maybe we could dive a little bit deeper into that experience. Keith what is it that helped you guys navigate this definition and trying to figure out and land on on an idea. Because oftentimes I feel like as a group you could land on an decision what something means but it really doesn’t mean that. How did you guys vet that out and how did you land where you landed?

: Yeah I think that the vetting for us. And the nice part about the premier platform at the time is just access. I mean I think yeah we by design have a tagline at LRB health which is called Inside healthcare. And the reason why we use inside healthcare it’s very deliberate. Meaning you need to be inside the game and really understand the game and have the right type of people around your platform to truly understand and solve these problems. Because these are not simple high level issues. These are very complex. You know there’s reimbursement issues there’s regulatory issues there’s all these issues in healthcare that people in my opinion a lot of times I’m going to gloss over. But the effort get into it for a while though like oh wow this is a lot more complex than I thought. I mean even take a Trump quote from about a year ago he’s like oh I never knew health care was as complex as soon as you get into it. You quickly realize that. So I think for us what would solve that a lot of our issues during the ACA and the baby’s care ramp up back in those days was having people like doctor Rick your phone which when you know was a consultant for us. But then he went let’s see my under cims you know having those type of people front and center with you is second to none. So to do that you know we take a same approach we help when we invest and when we think about problems you know we’re getting the best minds of the people that have lived this for decades. We have advisers that have been in the health care space for almost 50 years. And so you know their entire careers have been spent on this stuff. In my opinion the key to these problems.

: Love that. That’s a great way to approach it. And so now you’re here today. Keith you’re working on so many great things a great portfolio companies. What’s an exciting project that we had to point to one thing that you and your team are working on today that you want to tell us a bit more about.

: Yeah I mean it’s talked about a lot of Oliver Wyman a lot of credit for this terminology I’m about to use but we’re spending a lot of time around sort of what we call in a call and I’ve used as well which is the digital front door to healthcare into you know when you start thinking about what’s really happening back to this idea of delivering sort of the front end of access. And when you think about healthcare access and how hard it is when you think about navigation when you think about sort of even Rev’s cycle from a patient standpoint it’s all very opaque. And so we spent a lot of time over the last six months or so and will continue to spend a lot of time and then ultimately invest in a few of these type of companies that are helping people think through a different way to navigate sort of the front door to healthcare. And they run the gamut. They can be things that look like health savings account type applications they can be the front door of physician practice and how that actually extends out to a mobile application and then connects back into the system. It could be scheduling. There’s all different things that this could shaped on you know during our annual meeting this past April. We had brought in you know one executive from an employer to executives from health systems and executive from a payer. And then we brought in the woman that leads this area for all the women in purposely sort of had this open discussion which was a very kind of interesting discussion with all those type of characters and a very hot topic around this like who’s going to own the patient and who’s just navigating principle so like typically when a payer calls you on anything that they see that you’ve accessed the system most people don’t call the payer back. You always called doctor bag you always call you know your practice back but you know who’s going to own nettled somebody as the employer don’t know that given what obviously the tools reach an appointment and what JPM is doing and Amazon Berkshire and you know health care transformation alliance young employee to ramp up now because the problem is so big in terms of their cost infrastructure. So this is really a huge problem right now and it’s not something as simple. This again goes back to the depth of really understanding the problem and finding the use cases that actually are going to matter and more importantly deliver real jobs.

: I think that’s a really interesting project that you’re working on and I love how you tagged it. The digital front door to healthcare. And if you’re listening to this today and you’re working on a solution that is the digital front door to healthcare Keith and his team are obviously looking at this seriously. So at the bottom of the show notes you’ll find a way to reach our LRV and potentially even collaborate with them with your idea. Keith, This has been fun man we’re getting close to the end here. Let’s pretend you and I are building a medical leadership course on the Capitol side on what it takes to be successful. The 101 of Keith and so we’re going to write out a syllabus. I’ve got four questions for you lightning round style followed by a book that you recommend to the listeners. You ready?

: Sure

: What’s the best way to improve health care outcomes getting capital?

: Got to show our wife if you can show proven or awide typically the old 10 x factor. It’s very hard to get capital these days.

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

: Think the technology is going to solve it.

: Love it. How do you stay relevant despite all the change?

: I think you have to be a ferocious reader and if you’re not a ferocious reader and healthcare you’re pretty dead in the water.

: Do you do all your reading books stirred you do audio.

: I do pretty much everything from podcasts of videos to books to not from Kindle to the hard copy book.

: Love it man. You know one of the things that so we do a five day week podcast on health leaders are always recommending their best reads I found an app called Blinkist. I don’t know if you’ve heard of Blinkx just know this they basically give you synopses of the book in audio and in written form. So I’ve got out my books through Blinkist and it just saves me so much time.

: Very cool.

: Yeah and there are like 80 bucks a month. But really cool resource. Listeners if you haven’t checked out blink. Check them out. They’re a fantastic app and I’ll put a link on about bottom on the podcast as well so you could check that out. But last question here. What’s one area of focus that should drive everything in a health care organization?

: Understand the social system more than anything else.

: Dive a little bit deeper into that what do you mean?

: So I just mean the end of the day the social system and health care drives every decision and drives every workflow. So what I mean by that is you know we’re constantly painted that we’re slow costly painted that we adopt technologies five to 10 years later. If you don’t understand the pace of adoption and the pace of usage so give you a perfect example of giving all the details. I built the technology stack during my career days that was fairly expensive thought it was absolutely right in the middle of a sweet spot and the social system refused to adopt it. And it’s a no brainer. The whole reason why Amazon is coming in the space right now and it’s no different than what Amazon house. So it just you really got to understand how people adopt certain new ways of doing things.

: Got it. Very clear very clear. Thanks for clarifying there for us. Keith and very helpful. Well what would you say a book you recommend to the listeners is in this space?

: Yeah a lot of people are talking about this book right now and I hesitate to say but I’m going to say because it is that good. And I would say it’s not. It’s not one book. It’s actually two books. So if you look at all know as books sapiens in Homo deus. OK. Read them both and they’re big books but they’re quick reads but they are fascinating. Saipan’s is all about the history of mankind and then homo Deus is really about his predictions of where mankind is going in the future of our planet and it opens up your eyes to the reality of what the human race has actually done to society let alone the planet. And it’s really good stuff.

: Wow. Very cool listeners check those out. You could find all of the resources links to the books book’s links to Keith’s company go to outcomesrocket.health/LRV. You’ll find everything there. Keith, this has been a blast. Before we conclude I’d love if you could just share a closing thought with the listeners and then the best place where they could get a hold of you or follow you.

: Yeah so I think I’m kind of to the title of your podcast outcomes just everybody you know there’s a lot of I just wrote an article this past week about maybe there’s too many people in health care now trying to solve these problems. But I think everybody that’s focused has to continually focus on this is not about making money. I talk a lot about health care being sort of capitalism running amok which is this is about delivering care and bringing society up it’s the reason why I do what I do. I could easily do technology type things and it complicate things and many other industries. But I decided long long time ago that this is what I want to do because every day I wake up and I feel good about trying to drive a societal benefit. And I think people cannot lose sight of that. And I think a lot of people do when they get into space because they’re sort of chasing what is the latest greatest trend. You know I’ve been doing this so long that you know digital health wasn’t even a word ten years ago. No one no one at the venture capital community would even invest in a company. Our firm has been doing it for 17 years. We did our first patient gauge investment in 2003. So it’s just a different pattern. And to get a hold of me you know the best way is you know either my Twitter account @KeithFiglioli or you know ping me on LinkedIn by all means I typically respond to that pretty well.

: Outstanding. Keith thank you so much for spending time with us. It’s been really insightful diving through some of your thoughts on on the capital markets but also on the social aspects of medicine and things that today’s healthcare leaders needs to spend on so really, really appreciate the time you carved out for us today.

: No problem I enjoyed it. Thanks for the opportunity.

Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.

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