Adding value in healthcare through virtual medicine programs and ensuring patient satisfaction
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robbie_allen@mac.com
Agility in the New Era of Specialist Care with Robbie Allen, CEO at SpineCenterAtlanta was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best audio automated transcription service in 2020. Our automated transcription algorithms works with many of the popular audio file formats.
Saul Marquez:
Welcome back to the podcast. Saul Marquez here. And today, I have the privilege of hosting Robbie Allen. He’s the CEO of Envision Orthopedics and Spine. Robbie got to start studying aerospace and chemical engineering at both Rensselaer and Georgia Techs. He proceeded to study clinical neuroscience and pursued board certification and neurophysiology while founding a company that focused on outsourcing neuroscience needs of hospitals around the world. After growing in excess of 20 percent per year organically for over 15 years, in 2012, he sold his company called Neuro Matrix to Specialty Care Corp., a billion dollar multi-specialty conglomerate providing a range of clinical services related to the O.R. around US and Europe. He spent four years running the southern U.S. operations for specialty care and continued to the board on M&A and business strategy before leaving to pursue a directorship in a telling medical space. Before it was cool. Following several years of private consulting and the world in telemedicine delivery and optimization of care models, he joined the Centers for Orthopedic and Spine Care, formerly Spine Center Atlanta collection of surgery centers and clinics throughout the Southeast that’s actively expanding through domestic international medical tourism, as well as creatively delivering care to surgical patients via telemedical and on site methods. As a CEO and a member of board directors, both jobs he holds currently, he’s charged with thinking about the health system of the future, which with the things that we have going on today, the future is today. And having a gentleman like Robbie at the helm focused on where things are going and how we could best serve patients and people. There’s some exciting times ahead, so I’m excited to dive into these topics with him. Robbie also speaks French, Spanish and English and is actively learning Mandarin and Arabic. Super interesting guy, Robbie, without further ado, just want to welcome you to the podcast.
Robbie Allen:
Thank you Saul. Well, I’m glad to be here.
Saul Marquez:
So, man, you have such a cool background, you know, neurophysiology. Then you founded a very successful business, got out of it, got an a telemedicine. You seem to be ahead of the curve on a lot of stuff that you do. What is it that made you choose health care and what inspires your work in the space?
Robbie Allen:
Well, when I was in school studying originally, I wanted to build a next moon rocket. I wanted to design the next space shuttle and the Cold War had just ended. And at that point in time, they were that was gonna be the end of that sector. So medicine was kind of the next thing to grab my interest. And I had the fortune and the misfortune and the luck to get involved in the early days of neurophysiology as it was being delivered and operating rooms, which was one of the first areas of broad use of telehealth. And I think it grabbed my engineering mindset and problems to be solved or significant.You know, we use banks of haze ninety six hundred baud modems to try to connect to operating room screens and transmit individual pixel changes to try to economize data. And it was it was an engineering problem that was a medical problem that was on the cutting edge of what we could do. It was it just happened to be during the phase of computerization of things and learning that we could automate. And it captured my attention and it managed to hold it through all of my adult career. So it’s been it’s been a really interesting ride.
Saul Marquez:
That’s really interesting. And I never made the connection, you know, but it’s there. But you did appreciate you mentioning this neurophysiology as sort of one of the first steps toward broad based telemedicine. There has been for a very long time the adoption of a remote neurophysiologist interpreting what’s going on in an O.R. I’m glad you mentioned that. I hadn’t connected those dots.
Robbie Allen:
Well, yeah, let’s. That was my introduction to telehealth,.
Saul Marquez:
Huh? And so I guess now that transition from that to telehealth seems a little more natural now that you kind of dough into that.
Robbie Allen:
I think that’s exactly how it worked out for me, in seeing the advantages of using experts delivered remotely and seeing that that can be done effectively, saying that that could be done in a way that materially added value and also was from a cost standpoint, efficient. It’s entirely motivated the second half of my career.
Saul Marquez:
Well, and today, where it’s such an interesting time with what’s going on with the Coronavirus, and even before this became a big thing with COVID-19, we are on the cusp of digital adoption. And as we were discussing before our recording time here, we believe this is kind of going to accelerate it. So give me give me a little bit of your thoughts on on how Envision Orthopedics and Spine is is adding value to the health care ecosystem. How is it different?
Robbie Allen:
You know, the thing that that we’ve been able to do at Envision for a variety of reasons that are structural that we make can go on to later, is we’ve been able to change the way that people think about seeing an orthopedist or surgery center, for example. You obviously have to do surgery in an operating room for a host of reasons. We connect with patients. We’re able to work with the diagnose, interact with update and follow up with patients remotely. And we’re able to do that across six centers that are scattered geographically and across the country and really even the globe for patients and their homes. And we’re able to do that with all the levels of providers, both the M.D., the mid-levels and even the interactive nursing and medical assistant care. And it’s as simple as interaction on the iPhone. It can be the computer or it can be many other things. Patients, once they adopt this, it tends to give them much more stickiness to their care plan. We’ve even adopted that for physical therapy as well as some things that you don’t often think about. And when you consider surgical patients, the post-op care or the post-op mobility, training and interaction is one of the biggest predictors of success, post or orthopedic surgery.
Saul Marquez:
Fascinating and so engaging patients remotely orthopedic spine rehabilitation, improved adherence is, is certainly something that I think a lot of providers strive for. How is it that you guys are doing it? I mean, how are you doing it? Number one. And then number two, what has enabled the success because others have tried and not really been successful at it?
Robbie Allen:
So two things have enabled us structurally. A huge portion of our patient mix is, curiously enough cash or domestic medical tourism, which is as a payer source, looks a lot like cash, a personal injury, which looks a lot like cash. And so because those buckets of patients don’t have some of the regulatory hurdles that would ordinarily prevent us from being more creative or depending on your tack, more aggressive with the use of direct patient contact methods like telemedicine and we use both our EMR. Most EMRs now integrate telemedicine directly. There are also third party platforms like ExamMed. One is one that we use quite frequently that make it incredibly easy to interact on a video basis with a patient over a secured and sort of hip approved channel. Those things combined have allowed this to be an interesting lab to see where the boundaries of what we can do exist. There are certainly some patients that are not well suited to doing at home physical therapy via their iPhone. There are plenty of them that are. And we’ve learned, for example, that the iPhone is probably not the ideal format for physical therapy, whereas a computer screen or something somewhat larger is. You’re seeing this carry out even into the consumer market. One of the most popular exercise devices is now what amounts to a large telephonic delivery system of an exercise class in the form of a mirror. This is in no questionable way coming. So those things structurally have allowed us to push this out. The corporate structure of our physician and mid-level provider arrangements also facilitates that heavily. It’s much more corporate than it is typical medical practice, which means that everybody’s kind of aligned on the same incentive plans from top to bottom, pay, bonuses, care. All of that tends to be done the same way, whether it’s at the MBA level or the physician level, because everybody’s paid on the same reward systems and that is how well we take care of the patients as opposed to production RV used for the physicians volume the patients scenes for mid-levels, things like that that tend to unwittingly, I think in health care pit people’s incentive systems against each other.
Saul Marquez:
Yeah. That’s super interesting. The model sounds very agile.
Robbie Allen:
Yes, that’s the word.
Saul Marquez:
And it’s something that..
Robbie Allen:
We struggle with in our current system, you know, and you call it corporate versus medical plan provider system bureaucracy, largely due to the cash type of business that you guys run.
Saul Marquez:
Very insightful. Was this customer type of structured into the model or is that how it started? And then because of it, you guys were able to evolve?
Robbie Allen:
So I did not inherit that or I did inherit the patient mix by and large, although I will say that the use of wide spread domestic and international medical tourism is a growing phenomenon related to increasing deductibles and total cost of care. Underneath that umbrella amount. So that’s relatively new and that I’ve watched and over my tenure. But those things sort of predated me. I think the early experimentation, based on what I’ve learned about the company’s history and it’s old, it’s been around for almost 30 years, is that it was a decision consciously to try to serve certain segments of the market that were more cash oriented, even to the level of something like a membership program. OK, we’ll pay $100 dollars a month. And that kind of gives you certain levels of access to care significantly pre-dating the concierge medicine effect. And again, much like tablets and things like that. I think the practice was probably a little too far ahead of that curve. And so the patient mix we have today, though, is a conscious choice of avoiding the bureaucracy that goes with and the high just the high churn and volumes associated with a pure or 70 percent Medicare practice that, you know, it’s it’s forty five patients a day per provider. And it’s it’s entirely down to the tenth of an RV management. We’ve structured it a little bit differently.
Saul Marquez:
It definitely sounds like it, Robbie. And so walk us through how you guys are improving outcomes and business success with the model that you have going on here.
Robbie Allen:
Certainly the things we know about health, the typical surgical practice is entirely.. Volume. It’s you know, we know that we operate on 5 percent of the patients come through the door. Therefore, we need its funnel management you to use corporate language. And in our world, we kind of turn that around. And so if we looked at our patient population, which is fairly stable, the new number of monthly patients and we thought about them as acute care and the orthopedic setting, which generally speaking our patients are, we don’t do a lot of the chronic long term management of knee arthritic conditions and things like that. It tends to be acute injury, which was a specifically designed sector we decided to enter into. If we looked at those and decided what’s the best care plan for them? And we look at treating them across a 90 day arc. And so plenty of patients deviate from that arc, if we kind of bucketed their treatment into bringing them in and assessing and getting the right things that they needed at that point and moving them through the arc in a very conscious way, the use of telemedicine and the use of sort of nontraditional interaction allows that to move fairly quickly through this hour. Now, obviously, somebody is going to have a significant spine procedure scheduled that day. Eighty nine is not done with care in 90 days. That’s, but we’ve moved in them through this diagnostic and treatment plan arc that lets us fairly, cognitively look at what we want to do with these patients and what we want their ultimate outcome to be, which is always we want the better or at least to the best level they can be when we’re done treating them. And so that focus, that kind of relentless focus on moving patients through is what’s driven internally our adoption of these non-traditional sort of interaction methods. And it’s turned out to work really, really well. The patient satisfaction has gone through the roof. Patients love being able to reach out and interact directly, almost on demand with providers when they’re in that care arc. Each patient is assigned sort of an internal medical manager that sort of manages their care through the system. And liaison is what we will call them, it sort of manages the patient’s care delivery through their arc checks in with the providers. We haven’t heard from Mr. Allen in 60 days. And he just had an epidural injection and nobody’s responding. You know, we should we should try to check back in with them. Who’s reached out, you know, what’s the care plan if they’re that kind of thing?
Saul Marquez:
Mm hmm. So. So tell me that it’s very it’s very interesting. And I appreciate the approach. How does your coverage work as far as like geographic coverage? Right. Because, you know, we’ve got, you know, health leaders, business leaders listening to this. You guys are based in Georgia. But tell me a little bit about coverage and how this remote capability potentially enables your coverage beyond the geography that you’re based in or can you go further? I’d love to hear your thoughts.
Robbie Allen:
Ok. We’re certainly based in the what I would call the traditional southeast. Atlanta is the headquarters of the operation, certainly the largest physical facility, South Carolina, Florida, Tennessee and Alabama tends to be the nucleus of the catchment area for a variety of reasons, both clinical locations and those areas, but also easy proximity to physical access. I will say that about 10 percent of our patients come from widely outside that area internationally has grown from about 1 percent two years ago, for two reasons. One is certainly the employer-directed care in a large companies like Google and Amazon that offer incentives for employers, employees to go to single points of care. The other is just simply direct marketing, kind of in a way that other large centers like formerly LSI used to do, although much more targeted. One sector of what we do is failed back syndrome and we do it. One of the orthopedic surgeons particularly loves doing that. And it’s not a sector that I would say a lot of people enjoy. And so we bring in people from all over the world for that and their word of mouth then trickles out to friends, family and things like that. So the geographic catchment area is theoretically unlimited. The remote capability, though. I’m glad you asked. Is it regulated state-to-state with with very little national oversight, much like medical licensing, which is the driver behind what does this. So you need technically dual licensure except in certain states that offer reciprocity to physicians need to be licensed both in Georgia or South Carolina and the state that a patient is sitting in. And so that can be cumbersome and that limits the scope and scale of national footprint rollout on a rapid basis. Something I learned early on with nerve physiology in the operating rooms. Physician licensure. It took us on average three years to license us. Remote reading physician in all 50 states.
Saul Marquez:
That’s a it’s a long and drawn out process.
Robbie Allen:
Definitely.
Saul Marquez:
You’re seeing more companies now, though, right? I mean, you’re seeing larger companies that are more corporate. Start to really do this, right? I mean, some that come to mind, you know, ninety eight point six more on the primary care side. One medical right there start to do something interesting. I mean, they’ve been at it, but, you know. Well, have you thought about potentially partnering with some of these existing footprints to offer them and their patient-base an orthopedic specialty?
Robbie Allen:
That’s exactly what’s currently going on. Some of that I can’t really talk about.
Saul Marquez:
Sure.
Robbie Allen:
Just because of the players involved. But that is I think that’s absolutely some of where I see the next steps in health care evolving. I mean, you have very large players.
Saul Marquez:
It’s really cool.
Robbie Allen:
TeleDoc, like play an example. I mean, you have huge public companies that are invested in health to massively get involved in this..
Saul Marquez:
American.. Right, I mean, there’s just a bunch of.. That’s cool. Robbie and you know, it’s neat that you guys are thinking of it. And as we think about partnerships in the new era of health care, this is what it’s going to be. It’s the conglomeration of people that are already there, like you guys with other companies to offer both primary care and specialty.
Robbie Allen:
I think that’s accurate. I think once you start getting some of the arcane regulatory issues that have prevented health care from enjoying what let’s just frankly call it what it is, just best business practices. Right. that other industries enjoy. Once you kind of move those out of the way and look at making them more meaningful to the care and health of people. These types of partnerships, I think definitely spell the, the forward looking answers for a whole host of issues that face health care from provider shortages in rural areas or all over. Mean, there’s just there’s plenty of real issues that are real because of geography, but not real because of numbers.
Saul Marquez:
Fascinating, Robbie. You know, one of the things that, you know, it would be a good discussion. I mean, you’re you’re a thought leader in this space. I mean, what what are your thoughts on that and those regulatory hurdles, cross state lines to provide telemedicine? I’ve heard on the one hand it’s, you know, states wanting to collect license fees. I’ve heard just uncertainty about how the policy would work. What are your thoughts there?
Robbie Allen:
We’ve managed to solve this for overland trucking, for airline industries, for basically every business except education and health care, and education is massively being disrupted right now. And I think health care somewhat by force and health care is next. But in terms of sort of national medical databasing, practitioner licensing, distributed licensing fees based on practice locations, it’s not hard to see that the physician of the future in many specialties will be entirely distributed. It’s not hard to see a neurologist routinely looking at patients in 20 states. So the licensure aspects of that are going to have to change around fee distribution, which is one aspect. Control is another. But the existing systems have the capability to look at quality of care delivered the basic metrics of whether or not we want to license somebody. But it’s as simple as looking at physician mobility. If you look at Merritt Hawkins, they’re talking about 12 to 18 percent physician job changing. That’s 20 years ago. That would have been frankly, a staggering number. It was 2 to 3 percent. And I think you’re just seeing medicine begin to evolve into a system by which we as the public engage for our health and wellness as opposed to a system that kind of served itself in many ways.
Saul Marquez:
Yeah, now that’s that’s an interesting perspective, Robbie. Back to your point of increasing deductibles and and now the actual consumer of health care having to take ownership more hands on ownership and start to make decisions rather than just giving the decisions to the employer. A lot of that has to do with it, too. And it’s a great opportunity, certainly exciting. And, you know, you’re you’re one of the first. I mean, maybe even the first orthopedic specialty group that I know of that’s doing this.
Robbie Allen:
I think we are there certainly, depending on who you ask, I think. I think orthopedics consider themselves as a role fairly progressive. I think I would argue that from a medical care delivery standpoint, it’s, it’s not overly progressive. But this is the part of this that I have been excited about from day one, and that is that every specialty can alter structurally how we do this and ultimately drive down to a direct consumer market that even if it’s mitigated by third party insurance or governmental insurance, that really doesn’t matter what the choice and the interaction really and the value creation can begin to share between the ultimate consumer and the provider without so much of the middle. In the middle is made up of lots of things insurance, regulations, facilities, structure, you name it.
Saul Marquez:
That it’s exciting times. That’s for sure. So what would you say has been one of the biggest setbacks you’ve experienced, then, what it was a key learning that came from that?
Robbie Allen:
I’ve had lots and I think I think anybody who hasn’t had them has not been in business long. We’ve run up against huge problems with patient compliance early on, particularly in the, from a standpoint of telemedicine. You know, you think it should work one way and we have this problem. The thing that we interact with is a human being that has its own they have their own life and they have their own things going on. And just because it’s what we think doesn’t mean it’s what they think. And that’s fairly humbling when you start to look at that from a business standpoint and try to model out what’s going to happen. It doesn’t behave that way. So we have to build in the accounting for that. And that’s that’s proven. Probably the single biggest con down over the history of my career and virtual medicine. The patient is one of the biggest confounds in the system. And instead of throwing your hands up in the air and running away from that, what I’ve learned to do is try to embrace that. And let’s look at how and I think we look at successful tell the medical companies that’s exactly what they’re doing. They’re saying this is it’s not a thing to be changed, it is, so let’s work with it. Let’s see how we use it.
And it it’s been at times incredibly humbling. But I think I will say also you asked about orthopedics. I wouldn’t say orthopedics is a terribly flexible by nature profession. And so learning to adjust and this will vary way with patients. That has also been a significant hurdle. You know, this is a group of providers who are incredibly competitive, incredibly bright, used to being busy and making decisions and. You know, when you suddenly flip the paradigm and say we need to be responsive to our customer.
And ask what they want. It doesn’t always go the way that you would hope.
And, you know, I can imagine that’s definitely an issue. And and I appreciate you being honest.
You know, just kind of putting it out there because it’s true. And in order for us to make those leaps forward, we have to embrace those challenges. And so that flexibility. And I go back to that darling quote, Right. Robbie. You know, it’s not the strongest or the smartest. It’s the most adaptable that survives. And it goes right back to that.
And so kudos to you and the work that your leadership team and and the group is doing to be forward thinking and adaptable, because it’s certainly something that we all need. And we appreciate your leadership and the leadership of your group.
Well, you know, I enjoyed I enjoy learning from everybody from both your show, others and reading. I think it’s a it is just an exciting time.
So on that excitement, no. What do you think is the most exciting thing today?
You know, I think the exciting thing today is in a very unfortunate way, you’ve got an event that’s causing people to rethink everything. And when that happens, I think it draws attention to what works and what doesn’t. And the risk is that we don’t learn from it. I think that probably is going to not be the outcome. So I think it’s just going to continue on long enough that we’re going to have to learn from it. So that creates a lot of opportunity for us to fix so much of what. Isn’t really working well and there’ll be a lot of smart people who will want this to be fixed in a way that meaningfully changes things going forward. And look, let’s be let’s be absolutely direct.
Health care is nearly four trillion dollar aspect of our economy that is woefully complex. But there are pieces of this if we can keep attention focused that we can really do things about quickly that make good sense.
Know post-Depression, people started making really good common sense judgment calls. And that’s largely, in my opinion, some of what medicine needs is some good common sense calls that can move things forward for all of us.
What a great call-out. Robbie, well-said. I love it. And the risk everyone is, is that we don’t learn from this. And so we could think about this systemically. But the true difference comes about when you think about it in your own company, in your own practice. The risk is that we don’t learn from this. And so the call out here is let’s take these lessons and make some common sense changes that work to help us get that those results meaningfully in a lasting way. Robbie, this has been a ton of fun. Before we close it out. I’d love if you could just leave us with the just closing thought and in the best place that the listeners could continue the conversation with you guys.
You know, I think you opened it. One of my favorite words and it’s one of the things that I look at and executives that I hire. It’s one of the things that I try to instill in corporate boards I’m on. And that is agility. And I think what we’re all getting a powerful lesson and today is the system is so they can complex that we’ve lost agility, both of thought. Agility requires information that requires processing information. It requires humility, it requires responding and not reacting. But it requires doing that in a timely manner. And it’s one of my favorite words. It’s one of my favorite philosophies. And I think the more we’re able to drive everybody to thinking about caring for people in an agile way, the more it naturally can sort decision making for everybody. It’s going to it’s going to improve the system immensely if we can just build in 10, 15 percent agility and efficiency.
Saul Marquez:
Man. That’s awesome. I agree. I agree, and that’s it is a great word. I’m right there with you and in practice it’s even better. Right..
Robbie Allen:
That’s right,.
Saul Marquez:
Robbie, you know, I didn’t ask you and I always like to ask what book you would recommend to the listeners?
Robbie Allen:
In terms of a reading book?
Saul Marquez:
Yeah, book to read something you enjoy or that’s influenced you and you’re thinking.
Robbie Allen:
So recently, I’ve had almost all of my management team reading one of Brene Brown’s books, which is I had him all read Daring Greatly because. Empathy is the key inoculation to all of us communicating well. Part of the division that we have is born out of an inability to face to face empathize with the fact that you might disagree with me and where where would that come from? And she’s done a lot of research and sort of shame. You know, she’s made her name in terms of being famous for research around shame. Every business meeting I’ve been in is entirely personal and it’s everybody’s individual agenda as it’s everybody’s individual egos and her philosophies and that come out of let’s acknowledge those and let’s instead of saying this is business, not personal, let’s go ahead and at least acknowledge those those factors are in the room and in health care in particular. I think we expect that out of nurses on the floor. And I think we expected to be absent. And the physicians and executives, which is again, back to alignment and agility, whenever the alignment of incentives, both monetary and otherwise, are out of whack. It’s not going to go well. And so that’s kind of my that’s my current book with my management team.
Saul Marquez:
Love it. Great. Great recommendation. Appreciate you sharing that. And Brene Brown. It’s Dare to Lead?
Robbie Allen:
Dare to Lead Yeah, Oh no. Excuse me, Excuse me. Not Dare to Lead, Daring Greatly.
Saul Marquez:
You know what I’m thinking of her other one dare to lead.
Robbie Allen:
Her other one is. Yes.
Saul Marquez:
Okay. But yours is daring greatly. That’s what you have to pick up. Awesome. Awesome. And folks. You know where to go, outcomesrocket.health in the search bar type in Robbie Allen and you’ll see our entire show notes, transcript, links to to to their company and the practice that they lead and also links to the book that Robby just recommended. So check those out there. Robbie, this has been a a blast. I really appreciate it. And really kind of last, Last question is where can the folks reach out to you if they have further questions or or want to explore an opportunity to collaborate?
Robbie Allen:
Oh, I welcome it. My email is I’ll give my more public facing email. Sure is robbie_allen that’s robbie_allen@mac.com. Please feel free to reach out. I love collaboration. I love kind of talking through the tough problems because if we don’t talk about the tough problems, we’re not going to get anywhere.
Saul Marquez:
Love that. And I think, folks, you’ve seen that through our candid discussion with Robbie today. So take action. If you feel there’s an opportunity, don’t wait, because if you wait, you’re probably not going to do it. Robbie, appreciate you jumping on with us today. This has been truly a lot of fun and excited to see where you guys take this.
Robbie Allen:
Awesome. Well thank you, Saul. It’s been a pleasure. Truly enjoyed it. And big shout out to your podcast, your listeners and everybody.
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