Advance Care Planning: How COVID-19 Has Changed How We Think About End-of-Life Care with Ryan Van Wert, Co-founder and CEO at Vynca: Audio automatically transcribed by Sonix
Advance Care Planning: How COVID-19 Has Changed How We Think About End-of-Life Care with Ryan Van Wert, Co-founder and CEO at Vynca: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Saul Marquez:
Welcome back to the Outcomes Rocket everyone, Saul Marquez here. Today, I have the privilege of hosting Dr. Ryan Van Wert. He’s the Co-Founder and CEO of Vynca. In addition to his role at Vynca, Dr. Van Wert is a part-time Clinical Assistant Professor at Stanford University, where he maintains a small clinical practice. Prior to Vynca, Dr. Van Wert co-founded AWAIR Inc., a medical device company focused on reducing complications for critically ill patients, which was acquired by Cooke Medical Technologies in 2015. He is frequently invited to speak about his passion for improving care delivery at the end of life and the process of value-driven health care innovation. He is named the inventor on multiple issued and pending health technology patents, so he’s very busy. Dr. Van Wert graduated with the University Medal in Chemical Engineering from Queen’s University, Canada. He completed medical school Internal Medicine residency from the University of Toronto, and his post-doctoral training at Stanford and Pulmonary Disease, Critical Care, Medicine and Biodesign. Just an outstanding individual and leader in the medical space, and I’m truly privileged to have him here on the podcast. Ryan, thank you so much for joining us today.
Dr. Ryan Van Wert:
Thank you for having me.
Saul Marquez:
Absolutely. So you guys are really honed in on the end-of-life process and doing it in a way that’s scalable and that keeps the patient at the center. We’re going to dive into what makes you guys special, different. But before we do that, I’d love to learn more about you. And why do you choose health care?
Dr. Ryan Van Wert:
Well, it’s a great question. And I’ve always found the work in health care to have a certain fulfillment that really has been meaningful to me in terms of being able to contribute to the lives of others and to society as a whole. And I think where I see the particular opportunity of impact in moving from a traditional clinical practice where you’re seeing one patient at a time, certainly that’s very powerful and important work. And you can think about, how do you scale your impact? And you can do that in a variety of ways. You can do that by building a practice, building out nurse practitioners mid-levels to have a broader impact in that way. But I think what’s really interesting about technology innovation is that you have an opportunity to have an impact on patients at a far larger scale than in seeing patients on one to one basis. So for me personally, what I do today is having a small practice, but still have the opportunity to have an impact on a larger scale is a really nice balance for me to seeing patients one-on-one, but also to have the opportunity for impact beyond that interaction.
Saul Marquez:
And that’s really great, Ryan. And since you still practice, that speaks for your love of what you do. And then as a CEO of Vynca, you get a good balance out of it, right. You’re helping more broadly give those results that you want at an enterprise level while helping at the bedside. What would you say is the main way that Vynca is adding value to the health care ecosystem?
Dr. Ryan Van Wert:
Well, to answer that question I’ll take you back to some of the insights that we had and the needs that we recognize in terms of starting Vynca and it was seeing individuals coming through the doors of the ICU, often on ventilators already from the emergency room who had existing serious illnesses, whether it was advanced cancer, dementia or otherwise. And we knew seeing these individuals come through and end up on life support in the ICU that in many cases their goals and preferences would have been better addressed with more comfort-focused care and spending their last time, not in a hospital, not with lines and tubes everywhere, not unable to speak and communicate with their family, but instead in a much more comfortable environment where the needs of the whole person could be met.
Dr. Ryan Van Wert:
And seeing that happen time and again made us recognize that the individual’s voice, particularly when faced with a serious illness, is not being heard in our health care system today. And there are multiple reasons for it that have to do with the fact that this is a very complicated process to actually implement, to make sure that every individual’s voice about care preferences are heard, particularly at the end of life, but that it is extremely important not only from this being the right thing to do. And I think when we look at, unfortunately, when we talk to people across the country, many people have a personal story about this where things maybe didn’t go well for a loved one at the end of life, or similar stories of when things did go according to that person’s wishes, which presented a far more dignified passing for that individual and a far more dignified last weeks, months, of life. So that’s where the individual facing the family, the clinician, the caregiver, knew that we were addressing. But when we look at the health care system as a whole, what we see is that most individuals toward the end of life do prefer to have less aggressive, more comfort-focused care along the lines of palliative services, hospice services. And yet, unless there is an off-ramp from this medical conveyor belt that we’re on, that that care is not accessible. And the result is that many people have seen this statistic of a third of the Medicare budget being spent in the last year of life. And you could say, well, a lot of that’s important spend because we’re attempting to offer curative treatments. We’re supporting these individuals at the beginning of their diagnosis. But toward the end of life, in the last two months of life, we’re still spending 60 billion dollars in health care interventions, many of them things like hospitalizations.
Dr. Ryan Van Wert:
What that means is that we’re spending an inordinate amount of health care dollars for care that is doing a disservice to patients. And that’s really where the disconnect is. So both from the individual level, from the health care system level, the problems that we solve allow for individuals to not only get the best possible care at the end of life but to avoid these unwanted health care utilization leads to an ROI that supports the broader health care system in the value-based world that we live in today.
Saul Marquez:
Very well, said, Ryan. And one of the things you said really stuck out was the off-ramp. And oftentimes that off-ramp isn’t accessible. And you painted a picture of that treadmill, right? You’re on it. How do you get off of it? And oftentimes you can’t, you know. And so that’s where I assume Vynca comes in and you guys are able to offer us as health care consumers, but also providers looking to offer more to these patients that are at that stage of care that is different than what’s available today. Tell us a little bit more about that.
Dr. Ryan Van Wert:
Well, I started by saying that acknowledging that, clarifying an individual’s preferences, and making sure that they are honored when faced with a serious illness is an inherently complex process. These are conversations that are difficult to have. They’re difficult both for the individual, for their families, caregivers, and, frankly, for the clinicians. And we recognize that this is due to its complexity. Many organizations, although they realize that this is an enormous problem, are going to have to struggle with implementing a solution to that problem. So at Vynca, our approach is to partner with a health care organization. And this is health systems, respiring organizations like Acos and health plans to support individuals, whether their patients or members of the case may be and clinicians within the health care system or within the network to implement and scale an organizational change around ensuring that an individual voice is heard or individual voices are heard. And this involves components of analytics. It involves components of technology solutions that support both patient and clinician workflows and services support where we offer best practices for these organizations to support the workflow redesign for the adoption of advanced care planning services and the broader aspects of really driving an organizational cultural change around advanced care planning. We also have the ability to offer trained facilitators that can support these dialogues, understanding that one of the many gaps that exist today is that many clinicians just don’t have the time to have these important conversations with their patients or otherwise. So we view ourselves as a partner to our organization and have a variety of tools that we leverage to support their success.
Dr. Ryan Van Wert:
One of the big things that we align with is not only the priority around patient experience and that patient voice that is so important today, but we also see that more and more the presence of an advanced care plan and in fact how serious illness populations are managed is becoming more and more important within value-based arrangements. And whether this is a quality measure that’s directly tied to the presence of an advanced care plan or whether it’s just broader metrics around supporting high-quality care for individuals with serious illness, more and more this is becoming a very critical piece of the value-based arrangements, and we can support the organization in their success with these arrangements.
Saul Marquez:
That’s really interesting. The tie to value-based care and making sure that even at the end of the road we’re treating people with. And respect and listening. So as your view of how implementations have gone, Ryan, how does that view compared to the regular way things are done? How are you guys improving outcomes?
Dr. Ryan Van Wert:
Well, I think our approach, as I mentioned, is one of true partnership for the organization. And I think as a clinician myself, very quickly realize that simply dropping a technology, dropping any kind of solution into the health care ecosystem is not going to drive any kind of success. And when we partner with an organization, we’re not only implementing our solutions with them at the beginning, but we are supporting them to make sure that they are seeing the adoption and utilization of our solutions that we expect and where we know that we can drive their success in these organizations. So what we do is support the implementation process. And what we’ll typically see as a KPI is looking at widespread adoption of the solution, which is really a testament to saying that more advanced care planning dialogues are happening across the organization and that more quality advanced care planning dialogues are happening across the organization. And that in turn, by having these dialogues within a serious illness population, more individuals have the opportunity to express their preferences and to make sure that they are honored when their serious illness and as their serious illness progresses.
Dr. Ryan Van Wert:
What we’ll typically see in partnering with these organizations after those process-related metrics is seeing reductions in unwanted health care utilization as a metric of goal concordant care and as a metric of avoiding these events like hospitalizations and otherwise that we know are doing a disservice to patients toward the end of life. We’ll typically see very important reductions in the last 30 days of life and hospitalizations, a reduction in-hospital death, which is a very important metric that health systems track today and attempt to reduce, increase in hospice utilization, and ultimately a reduction in intensive care utilization. So whether our partner is a health care system that’s perhaps in a value-based arrangement, perhaps concerned about their in-hospital mortality rate, perhaps concerned about opportunity to see the benefits of things like the Advanced Care Planning CPT codes, which are available to clinicians to be recognized for the work that they do in advanced care planning, but are simply not being leveraged as a revenue source, or whether you’re a risk-bearing entity that is concerned about the overall quality of care their populations are receiving and wanting to make sure that there is not excessive utilization that is beyond what an individual patient or member wants, that’s where we really drive the value for these organizations.
Saul Marquez:
And that’s fantastic, Ryan. And actually, I didn’t know there was advance care planning.
Dr. Ryan Van Wert:
Yes, they’ve been around now, and it was a real testament to CMS leadership in promoting high-quality, serious illness care to include these codes. They’ve been around for a few years now, and there are some really nice opportunities within somebody’s routine process of care to implement them. For example, during an annual wellness visit, you can add these codes and get recognition for that. And that’s often one of the things that we support our partners to implement, looking for these natural points in the care delivery process to embed and normalize is these dialogues. And that’s a great opportunity to do so. And again, to make sure that these organizations are seeing the recognition for the work in the time that’s going into having these dialogues.
Saul Marquez:
That’s great to know, Ryan. And everybody listening to our conversation today knows very well that ideas don’t just stand alone by themselves, especially in our health care system. They have to be backed by the system. They’ve got to have reimbursement. And it’s great to hear about this from you and kind of how it all comes together. So I really appreciate you sharing that. What would you say is one of the biggest setbacks you’ve experienced in putting the business together, implementing, you name it. You know, what’s one of the biggest setbacks you’ve seen, and what’s a key learning that came out of that?
Dr. Ryan Van Wert:
I think for any entrepreneur who is developing a solution for what I’ll call enterprise health care, i.e. a B2B solution, that the enterprise sales cycle and the enterprise sales process in health care is an exceptionally complex one. And I think exceptionally difficult for early-stage companies to navigate. And largely that comes appropriately from a seed of wanting to make sure that health care organizations are accountable to their patients, to their members.
Dr. Ryan Van Wert:
And to make sure that if they’re partnering with an organization that is going to be a solution that will add value and will be secure and all of those other things that perhaps partnering with a very large and established organization isn’t there to the same extent. So in the early days, I think one of our biggest challenges was going along a pathway in which we took quite a bit of time to earn that trust within the market and to move from our first partners who are still wonderful partners to have today to that second and third and fourth partner really took a lot of effort in building that relationship of trust, of showing the value of what we were doing, showing the adoption of what we were doing at other sites.
Dr. Ryan Van Wert:
But that process takes time and the early-stage company time is always something that you got your eye on. And you’re in some ways, you’re always fighting a clock. And I think, fortunately, our early partners were great and continue to be great, as I said, and we were able to get some of these large national health care systems on board and from there that drove further adoption across the country. And now we have we serve patients in every single state. We serve more than eight hundred thousand individual patients. But those early days, we’re building that relationship of trust, and proving one’s value takes longer than one expects.
Saul Marquez:
That’s awesome, Ryan! Congratulations. That’s a huge impact. And you’re right. It’s an uphill battle. And you guys have done a good job of it. And thus you’re helping so many people now. So just want to give you guys huge kudos for what you’ve done there.
Dr. Ryan Van Wert:
Appreciate that. Thank you. Lots more work to do, but definitely a lot to be proud of in the years that we’ve been growing.
Saul Marquez:
That’s so awesome. And so as you reflect on the successes and the challenges and also look forward, what would you say you’re most excited about today?
Dr. Ryan Van Wert:
I’m also excited about the… Little characterizes it as multiple tailwinds around providing high-quality care for individuals with serious illness. And as I alluded to earlier, there’s is a complex process. And as you mentioned, there always needs to be the alignment within the health care ecosystem to say that this is a critically important problem to go after and the changes that we’re seeing on the value-based on CMS increasingly highlighting the importance of high quality, serious illness care, highlighting the importance specifically of disaster planning, we’re seeing advanced planning as a metric come up close and see in my mind models that as well as in several mandatory models that health care providers are being held accountable to.
Dr. Ryan Van Wert:
And what I see in this change over the years that we’ve been building the company and our partnerships with health care associations is that the momentum around the importance of providing high-quality, serious, almost care, making sure that the individual’s voice is heard has never been greater. And that’s not only aligning with the concept that I think we’ve all known and recognized for a very long time that this is a critical part of what we do as physicians, as health care providers, as insurers, as research organizations. But now the ecosystem and the payment structure are all aligning to make sure that care is provided in the highest quality way possible. And on the company side, we’re building out our solutions to support serious illness populations and an even greater and more powerful way, largely through advanced care planning. But I alluded to some of the service offerings that are being rolled out now, which offer a more holistic and comprehensive solution to our health care organization partners, and really excited to see the impact that those solutions can have and these broader tailwinds that support the quality of care for individuals at the end of life.
Saul Marquez:
Wow, that’s great. And it is exciting to hear that there’s an openness to this and not just openness, but as you mentioned, you know, they’re putting the incentives in place to make these types of advance care planning a priority. And I’m just thrilled to hear that from you. And I’m sure the audience is, too. And for those of you that are leaders at a health care organization, whether it be an acute hospital or an L-Tech or whatever, and you’re looking for options, answers, hospice, reach out to Ryan and his team. It’s VyncaHealth.com. We’ll leave the different ways to get in touch in the show notes. Go to OutcomesRocket.Health, type in Vynca in the search bar, that’s V as in violin, Y M C A. You’ll see the entire Discussion pop-up there with Show notes. But let’s give the mike back to Ryan here. Ryan, leave us with the closing Thought and leave us those places where we can get in touch with you to learn more.
Dr. Ryan Van Wert:
Well, first of all, thank you for the opportunity to join today and to share our story. Really. I really appreciate that opportunity. I can be found on LinkedIn and you’ve given the website for the company. VyncaHealth. com. Please feel free to reach out to me personally or to us on the company website. And I would just say that I think we’ve had the opportunity and I think what we’re seeing out of the COVID pandemic is this opportunity to really drive innovation in many different ways within our health care ecosystem. I think as much as this pandemic has been absolutely terrible and so many different dimensions with so many different ways that there is the silver lining of driving change in our health care system that is perhaps in many ways overdue. And I do think that one of those things at least, is we’re seeing it from our side is that there is more about and acceptance of the importance of looking at new ways to solve problems in health care and that the serious illness population is an exceptionally important population to ensure that voices are heard and that care is provided in the best possible way for these individuals.
Saul Marquez:
That’s great closing, thought Ryan, and couldn’t agree with you more. Thanks to you and your team. There’s a scalable way to do that for the people listening. Certainly, I’m sure they’ll consider what you guys have to offer. So, Ryan, just want to say thanks again for joining us. This has been a true treat and privilege and really hope that you guys can help many, many more people at that stage of their care. Thank you so much.
Dr. Ryan Van Wert:
Thank you very much.
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