Improving Outcomes in Orthopedic Care with David Brown, CEO at VOX Telehealth (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: And welcome back to the podcast, super excited that you tune in again. Today have an awesome guest. His name is David Brown. He’s the CEO at Vox Telehealth. David leads their mission with a clear vision of what patients need and what physicians and healthcare providers want in order to drive compliance and improve outcomes. You guys are listening to this because you want to improve outcomes. You want to drive compliance. He brings more than 20 years of entrepreneurial experience spanning several industries including behavioral healthcare, technology, banking, and retail. Prior to founding Vox Health, David spent 10 years overseeing patient engagement for a multi-state behavioral health practice and understands the importance of connectivity and programs that engage patients in a meaningful and effective way. Through David’s leadership, Vox has become an emerging leader in the growing field of patient centered care programs and it’s such a pleasure to have David here to share his thoughts of the healthcare industry and the awesome things they have gone on at Vox, so David, what a pleasure to have you on.

David Brown: Thanks a lot Saul. I’m looking forward to it.

Saul Marquez: Me too, me too and so you know before we get kicked off on the meat and potatoes or veggie and potatoes whatever you want of the interview today…

David Brown: I’m from Texas.

Saul Marquez: So meat and potatoes. What is it that got you into the healthcare sector?

David Brown: Well Saul it’s ultimately about a for beverage of your choice story but we give you the half beverage of your choice version. You know what was I had come out of business and finance and what was supposed to be about two years spent in behavioral health you know partly from a business perspective partly as a service perspective, ultimately turned into about twelve you know is really one of those situations where once I’d gotten a peek behind the curtain of all that was going on in that industry, I on one hand could not pretend like I had not seen what I had seen. So I decided to take a couple of years to prove out a couple of hypotheses on the on the clinical side. And as I said that led to a number of additional years of being engaged on the clinical side. So in year 7, then we became a last ditch effort for patients to avoid a 90 day treatment for addiction or intense behavioral health issues. And that seems like a strange thing to want to do. Help people that are obviously in need, avoid potentially something that they need in terms of the inpatient care but when you realize the long term success rates are often times 20 to 25% and the average patient that goes one, can go to three, to three to four times in the three to four different treatment centers. You begin to see the layers of inefficiency upon the layers of inefficiency and so to Vox actually began and to be behavioral health space in 0 9 to help patients is sort of a light technology back in scheduled calls, point of contact, early intervention to help patients avoid. And very successful in what we were doing. I mean not not because there was any real rocket science behind it but simply because it was just commonsense support and accountability that needed to be there if you were going to have a chance to avoid. So ultimately with that success began to consider a more scalable platform began to consider a more expansive business model which would include helping patients who had gone to 90-day treatment, improve that long term success rate. And I would say that’s when some of the naïve scales began to be pulled back from my eyes when I began to realize that you know in this country at least at that time you know most arenas in which you have a recovery and reintegration model there are a number of inefficiencies as well as some conflicts of interest that exist. So you know not to say that that was true of all treatment centers but you could begin to realize that there wasn’t a ton of motivation to see that relapse rate change within the fee for service model. So is as you know October 2012 when the first fines went out for high rates readmissions for hospitals. And we made a full pivot in 2013 just recognizing that as long as there is an economic driver there that is aligned with getting patients home and keeping patients home that’s where we needed to be. So that’s again a really long story made only long but how we ultimately entered into the medical field.

Saul Marquez: Now makes a lot of sense. And you know very smart of you to align you know one of the mistakes that happens often is you know entrepreneurs, companies see the writing on the wall but refused to figure out a way and so kudos to you and your team for seeing that and and reacting in such a way that you changed your model to make it work. Give us an example of what you guys are doing David to make things better, improve outcomes by doing things differently.

David Brown: Yeah. You know again what what has really helped us Saul is the fact that we didn’t come out of a technology background. You know we have an absolutely remarkable technology team but I’m one of these I’ve certainly appreciate that convenience as I appreciate technology. But I carry a leather calendar and I will always probably carry a leather calendar. It’s coming out of behavioral we understood something about folks that maybe someone coming from a technology background does not. And so from the beginning we took all of our successes, all of our failures, all that we had learned from behavioral, applied it towards our platform and at the end of the day from it being a closed loop environment to it being a universal platform we really built the thing to ultimately drive accountability. So if you were to see our platform you think man that is a deeply very deeply educates and empowers the patient and the caregiver it very much drives them towards ownership and all of those things. But at the end of the day Saul the real means by which we create the impact that we do is the back end and it’s the accountability that we drive through our alert escalation notification system. So we educate them and empower them deeply so that we can hold them accountable deeply. And it seems a little oppressive but what we’ve felt we’ve known from the beginning and have proven that it’s really the most concierge thing that you can do otherwise you know what we’ve what we’ve been competing against and what we’re now actually replacing in the marketplace are open ended apps and apps that assume that the common consumer, the common patient is going to be so excited about having access to this information that they’re not only going to use it but they’re going to persist in the use of it until any impact is made. So we instead came at it understanding that’s just not true that at the end of the day if you’re if a platform for managing patients is open ended and is therefore best characterized as a free resource available to them that the only folks that are going to really persist in the use of it are the same 7% of folks that are going to laminate their discharge plans and probably have outstanding outcomes with or without you. At the end of the day, Saul we’ve really just been really trying to drive that ownership, drive appropriate responsibility back to the patient in the caregiver feeling that we could really move the needle there’s the needle needs to be moved in certain areas. We knew we could move it at least in that.

Saul Marquez: I think that’s I think that’s really interesting David. And so just just for clarification sake, what patient populations are you focused on?

David Brown: Yeah we really have originated in episodes of care and have ultimately stayed there. We’ve found some very exciting partners like vilify health that whose core competency is around risk stratified population health. But we have really stayed focused towards defined episodes and want to drive our leadership in preoperative medicine. So you see this evolution now even happening and preoperative where you know it’s all about pre op patient optimization. So we were one of the early organizations that just said look yes because again in 2013 and 2014 right all the print all the focus was on those 30 day readmissions. So you had a number of organizations that were grabbing hold of the hand of the patient at the time of discharge. It was all hands on deck and we’re going to keep them out of the hospital for 30 days well ahead. Now that’s a little upsetting in terms of is it really impact because do you really care what happens on day 31? But from our perspective it was you know you’ve just missed the biggest opportunity for truly impacting that patients experience for impacting their their outcomes. And that is you’ve got to grab hold of them beforehand. You’ve got to you’re going to manage the expectations, you’re going to make them very responsible, and have ownership in that episode of care. And we just felt like that was where if we were ever forced to choose a 30-day period in which to engage patients to most impact 30-day plus discharge you know post discharge readmissions and other outcomes, it’d be 30 days pre up every time. And so we’ve had a lot of exciting alignment with with Dr. Sol Aronson and some of the leadership at Duke who’ve been real leaders in pushing the enhanced recovery after surgery protocols as well as this pre up patient optimization and that’s that’s really where we’re going to continue to hang our hat as in that peri operative medicine space.

Saul Marquez: Well I think it’s really cool and you know one of the things that I believe turns heads and creates attention is an approach that is different. You know an outstanding approach and in what you’ve done is said “hey you know what, why don’t we turn this upside down people and rather than look at the last 30 let’s look at the first 30.” Now you’re talking. And I think that’s really cool you’ve done. A nice a nice way to sort of approach it but also a way that really makes a lot of sense. Prime the people are going through the procedures to to really the expectations educate empower them as you call it deeply to do to make this impact. I’d love to hear as as you were on the road to developing this maybe a setback that you had and what you learned from it.

David Brown: Well we would need it. We should probably set up a whole ‘nother chunk of time to talk about all of that.

Saul Marquez: Look its for the like why this is tag but…

David Brown: exactly you know solve it on one hand the nice thing is that you know this is all quite still quite fluid right. I mean I probably don’t even know. My biggest. Mistake yet. You know because it’s all sort of still playing itself out on the other hand you know I’d say our biggest decisions that have certainly at times seemed like mistakes in some ways are playing themselves out to have really saved the day for us and to have really helped to set us apart. You know I mean so for example you know coming from behavioral and coming from one sort of mission or orientation to the next mission orientation which isn’t always real healthy for your sleep or for your bank account or anything else. We were still utterly committed to making sure that we did not enter the market until our platform could really do what we said it could do. So we certainly wanted to have it a lot of integrity in that. But along the way you pay the price and wonder if you’ve made the right decision behind by saying going into the market ultimately that really has saved us a one because our platform does do the things that we say it will do and it has had the integrity once it was deployed and as I mentioned we’ve now begun to actually unseat existing platforms and in hospitals. The other thing that helped us do is was that some of those some of the competing organizations that had some early successes selling directly into the hospital and and maybe got some premature funding and then premature staffed and and stayed focused on that direct the hospital sales model that’s where the real struggle became right because the procurement still wasn’t there the industry has still not been fully birth. So that premature funding ultimately. You know. Can can be the death of an organization at least as much as it can bring life to it. So you know that’s one one of those decisions we also had a decision to you know to partner fairly on we had built out the program and and had done the pilot had gotten some outstanding outcomes and so as every entrepreneur hopes to do then you look to do that strategic partnership and you find and scale and go and maybe we did not listen to our intuition quite enough as we were getting into this partnership and I would say that the folks that make up the organization today are fantastic folks the folks that were part of it at that time not necessarily as outstanding and so I would just say there’s a good deal of scar tissue Having navigated this industry and and watched it finally be born and I would say we’re we’ve never been more excited about where we are today and where the industry is than we are today.

Saul Marquez: And so really appreciate the candor there. David And what would you say the most say proud moment you’ve had to date?

David Brown: Well again almost it’s it’s it’s it’s that first decision do have delayed going into market you know and then secondarily the second one would almost be what we did to navigate out of that that situation with the partnership and. And what’s interesting is is the fallout of that partnership. You know it’s amazing saw because what would happen there were there was a period of time where we were potentially at risk of there less than altruistic motives. And so that’s part of what made us move entirely away from direct to hospital sales model because in my mind I thought well if they are successful in getting any of our stuff then as long as we’re just talking to hospitals and trying to get more contracts we will have just been working for them. So instead I’m going to focus on partnerships that they can’t take and that you know once we’ve navigated our way from them will allow us to scale more quickly catch up where we would have been and surpass where we would have been. It took that Saul to to then finally get the perspective of wow that direct hospital sales model is sadistic. I mean to be honest I mean it’s it’s not efficient. And so we ultimately have created some really remarkable partnerships and very scalable distribution models that that have put us into a completely different place and that ultimately have attracted other great partnerships and and friends in the market to further facilitate.

Saul Marquez: That’s pretty cool and like you said it’s a kind of a blessing in disguise right.

David Brown: Very exciting. Exactly.

Saul Marquez: That’s pretty cool and I love love that it’s worked out for you and it continues to work out. What would you say today is one of the most exciting things or projects you guys are working on at box today is?

David Brown: Yeah I would say like well two things. And again it is it is that finally this preamp patient optimization has has in some ways in the same with the value based was was slow to give to be birthed simply because you had an industry that wasn’t quick to jump to it in the same way that pre op patient optimization is finally having its day. You know again I referred to Sol Aaronson earlier that one of the great things he loves to say is there’s never been a trend in aviation where pilots landed planes before the wheels were down. But in healthcare that has represented a whole lot of procedures that have taken place and without the risk based mandates that are upon us today would would continue to do so. But now you have to be focused on the optimization of the patient. You’ve got to be focused on is that patient even an appropriate candidate. And if they are an appropriate candidate, are they in an optimal state to undergo that procedure on that date? Then if they’re not, are we as an organization, am I as a physician or we as you know a clinical body willing to postpone that for the greater good of that patient? And and now for the greater good of of the economics that are behind that. So we’re extremely excited about that piece of it. We’re also extremely excited because we know along with building out partnerships that to ultimately create kind of a universal platform that include vilify that include patient point, we also have been really focused on building out what we refer to as a risk sharing ecosystem. So from our perspective the next phase is to ultimately recognize that hey the impact that we’re making in these patient patient outcomes certainly we help the hospital, certainly we help the payer, you know who else we help, we help med mal. So for example what we’re doing in terms of tracking patient engagement obviously, standardizing all consents and all that they’re doing, we make a very significant impact on claims and exposure to claims. I mean again here’s this remarkable thing that’s come to into you until you do and that’s 41.7% of all med mal claims are not tied specifically to clinical negligence but are actually tied to information and communication. So there’s been a complication but stand out. Now if you’re going to have a patient say Hey well we were never informed or informed in a manner that we could understand of these risks. Had we been we possibly would have made a different decision which probably would not have. But there’s a complication now you’re upset and this is the basis of your claim. So we’re basically saying hey there’s lots of different things there’s lots of overlapping benefits to other pieces of this grand puzzle. Let’s bring them all together. So we’ve really tried to be a real convener and be one stop shopping so that we can sort of see to that practice to that hospital. You know you’ve got a med mountain carrier here who’s willing to partially sponsor the program. You’ve got a payer who’s willing to enhance your risk based contracts as a result of bringing us in and and then we’ve got this affiliation with Duke that will come and provide a pre outpatient optimization assessment of your capabilities and continue to engage with you as as needed. So it’s it’s just it’s been an exciting time to be a convener of all. As I said all these pieces that ultimately make up you know a pretty fine puzzle if we can connect all the dots and bring all the pieces together.

Saul Marquez: David I think it’s very exciting and gosh I mean like you said right. The planes never land or try to land with the wheels not down. We don’t begin a year at least you know businesses don’t begin a year without the planning process. Why would you do that in the operating room and just think hey come on people make sense right.

David Brown: Yeah.

Saul Marquez: But it’s like we’ve done we’ve done something for so long that we don’t actually think about it. And so it’s it’s it’s great that you guys are working to make things easier by applying these concepts and processes to help them succeed in the OR so super thrilling. As a patient I would like that and I know everybody I know would. So why not. David Love that kudos to you and your team. Getting close to the end here of the interview. Let’s pretend you and I are building a leadership course on what it takes to be successful in the business of medicine today. It’s the one on one of David Brown. And so I’ve got five questions for you. Lightning round style followed by a book that you recommend to the listeners. You ready?

David Brown: I think so.

Saul Marquez: All right. You’re gonna do great. What’s the best way to improve healthcare outcomes?

David Brown: First I would just say first you got to decide you know as you said healthcare is a business. You got to decide. There’s going to be better care better business or you’re going to really stick to a conviction that in fact better care is better business. So first go to a game that conviction. And then from there I would say it’s for us. It’s really about getting back to driving that patient responsibility and ownership in their care and in their health.

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

David Brown: I would say getting a head down you know I mean it’s particularly in this evolving landscape. Boy if you don’t keep your head up you’re going to miss something. And so I would say really you don’t want to get your head down and get it stuck in a trench or a particular model that you think worked yesterday or even works today. Because may not be where you find success tomorrow.

Saul Marquez: It’s a great metaphor. How do you stay relevant despite constant change?

David Brown: Well adding to the less answer I would say again just keeping your head up and continuing to look down the road right. I mean we tried this said earlier be focused on building that universal platform but in building the risk sharing ecosystem we were trying to go ahead and build out where we think things are going to head so that’s all holes. Wayne Gretzky metaphor of trying to really play the game where we’re considering where the puck is going to be not where it is right now.

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

David Brown: It probably sounds kind of trite but I would I mean I would genuinely say passion. You know I mean we’re a bunch of people who as I said plenty of scar tissue but it’s just a really you know you get around us and you kind of just pull the string a little and you know we all start talking too fast and we’re getting ahead of ourselves. We’re just excited about what we’re doing. And then really driven by the conviction of what we know we can accomplish if we’re if we’re allowed the opportunity.

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

David Brown: Gosh particularly in this space and I’ve never been faced or forced to engage in this as much as I have in the healthcare but it’s just perseverance. You know I was kind of think of Jason Witten the former tight end of the cowboys you know here’s a guy with over ten thousand yards in receiving yards and then yeah. For me you know I think for a lot of people right the defining 20 yards in this man’s career was the 20 yards he was running without a helmet on. And so it’s sort of if you’ve got that conviction you know you’re going to be faced with a lot of obstacles even some bad folks along the way and that’s what you’re going to do in that Jason Witten moment what you gonna do and when your helmet flies off, you’re going to run to the sidelines or keep on chugging.

Saul Marquez: I love that that and that perseverance is key. And David I definitely feel you there. It’s a it’s a long road ahead. But those that stick with it do succeed and so listeners take that bit of wisdom from David, do better care is better business and definitely a great syllabus we’ve compiled for you here go to outcomesrocket.health type in Vox in the search bar or type David Brown you’ll find it there, full transcript and in a summary. Dave, this has been a blast man. I’ve had a great time chatting with you about the things that you feel are important healthcare. I think it’s resonating with our listeners, can you share a closing thought and then the best place for the listeners can’t get in touch with their follow you and then we get to say goodbye.

David Brown: Yeah well I mean my really my closing thought is just one of appreciation to you and your own convictions and the time and effort you’ve spent to to really make a difference and in the same way that we’re trying to unify organizations that are like minded and be a convener of that. You are obviously doing that on an individual basis and so it’s a rich resource and a fantastic exercise to get to spend this time with you and obviously they can get a hold of us you know by way of Vox telehealth my email’s david@voxtelehealth and certainly our website is available to all. So I really appreciate it Saul.

Saul Marquez: Hey thanks again David. True pleasure. Keep up the awesome work and way to turn it around man. This is great opportunity for healthcare providers looking for a different way of doing things. Take David up, reach out to him and maybe today is the day that you do something new that really unlocks some value. So David again thanks again for your thoughts.

David Brown: Absolutely. Take care Saul.

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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