1 00:00:00,120 --> 00:00:03,480 Speaker 1: Hi, This is new because of the coronavirus. I am 2 00:00:03,480 --> 00:00:06,960 Speaker 1: currently staying at home in Rome, where my wife serves 3 00:00:06,960 --> 00:00:09,800 Speaker 1: as the United States Ambassador of the Holy See. She's 4 00:00:09,920 --> 00:00:12,880 Speaker 1: leading the embassy in dealing with all the different changes 5 00:00:12,880 --> 00:00:16,440 Speaker 1: being brought about by the pandemic. To bring you this 6 00:00:16,520 --> 00:00:19,919 Speaker 1: episode this week, I'm recording from my home, so you 7 00:00:20,040 --> 00:00:26,200 Speaker 1: may notice a difference in audio quality on this episode 8 00:00:26,200 --> 00:00:29,280 Speaker 1: of Newsworld. This episode is the third in a series 9 00:00:29,320 --> 00:00:34,319 Speaker 1: of episodes we're presenting about COVID nineteen healthcare breakthroughs. We're 10 00:00:34,360 --> 00:00:37,360 Speaker 1: looking at innovations and healthcare that will help improve patient 11 00:00:37,400 --> 00:00:42,360 Speaker 1: outcomes with advancements in technology. At home recovery care provides 12 00:00:42,400 --> 00:00:46,720 Speaker 1: an alternative to acute care medicine by providing hospital level 13 00:00:46,760 --> 00:00:50,320 Speaker 1: care and patients homes through the use of telehealth in 14 00:00:50,479 --> 00:00:54,920 Speaker 1: home nursing visits and virtual visits by a physician. Based 15 00:00:54,920 --> 00:00:58,640 Speaker 1: on clinical studies, hospital equivalent care can be delivered in 16 00:00:58,720 --> 00:01:03,600 Speaker 1: home more effectively, both clinically and financially, and patients prefer 17 00:01:03,680 --> 00:01:07,119 Speaker 1: to be tweeter at home instead of the hospital. This 18 00:01:07,200 --> 00:01:11,360 Speaker 1: model of home hospitalization can improve patient outcomes, reduce the 19 00:01:11,440 --> 00:01:15,360 Speaker 1: cost of care, and support hospitals as they respond to 20 00:01:15,360 --> 00:01:20,360 Speaker 1: COVID nineteen. I'm pleased to welcome my guest, Travis Messina, 21 00:01:20,880 --> 00:01:33,720 Speaker 1: co founder and CEO of Contessa Home Recovery Care. Travis 22 00:01:33,760 --> 00:01:37,000 Speaker 1: Messina is the co founder and chief executive officer of 23 00:01:37,080 --> 00:01:40,759 Speaker 1: Contessa Home Recovery Care. I want to start, Travis by 24 00:01:40,760 --> 00:01:42,480 Speaker 1: asking you to talk a little bit about your own 25 00:01:42,560 --> 00:01:45,000 Speaker 1: journey and how you got to be the CEO for 26 00:01:45,120 --> 00:01:48,240 Speaker 1: Contessa Home Recovery Care. Have you always been interested in 27 00:01:48,280 --> 00:01:51,840 Speaker 1: healthcare or what's the background that got you here. I 28 00:01:52,000 --> 00:01:55,440 Speaker 1: came from a family of clinicians, had nurses, physicians, social 29 00:01:55,440 --> 00:01:59,040 Speaker 1: workers in my family. I pursued a career in investment banking. 30 00:01:59,480 --> 00:02:02,560 Speaker 1: At one point, I was actually coming back from a 31 00:02:02,600 --> 00:02:05,440 Speaker 1: meeting with a partner from the investment bank where I worked, 32 00:02:05,960 --> 00:02:09,920 Speaker 1: and we had pitched some operators of hospitals, and the 33 00:02:09,919 --> 00:02:12,120 Speaker 1: partner looked at me and said, you know, if you 34 00:02:12,160 --> 00:02:13,560 Speaker 1: were smart, you would go and work for one of 35 00:02:13,600 --> 00:02:15,880 Speaker 1: those teams so that you can actually help change the 36 00:02:15,880 --> 00:02:18,320 Speaker 1: healthcare industry. So I wasn't sure if it meant I 37 00:02:18,320 --> 00:02:20,280 Speaker 1: was either a bad banker. He was truly looking out 38 00:02:20,320 --> 00:02:22,560 Speaker 1: for my best interests. So at that point I then 39 00:02:22,639 --> 00:02:26,720 Speaker 1: went to a company called Vanguard Health, which operated twenty 40 00:02:26,760 --> 00:02:31,720 Speaker 1: eight hospitals in five states and started working on models 41 00:02:31,760 --> 00:02:35,600 Speaker 1: that helped change the traditional delivery form of healthcare. Why 42 00:02:35,600 --> 00:02:38,840 Speaker 1: did you think the time was right to begin changing 43 00:02:39,520 --> 00:02:43,320 Speaker 1: the model of healthcare? So while we were at Vanguard, 44 00:02:43,320 --> 00:02:45,200 Speaker 1: we were a bit unique and that we were an 45 00:02:45,280 --> 00:02:48,480 Speaker 1: integrated delivery system. By that, I mean we not only 46 00:02:48,520 --> 00:02:52,600 Speaker 1: owned and operated the hospitals and outpatient clinics and the 47 00:02:52,600 --> 00:02:55,320 Speaker 1: communities in which we operated, but we also owned the 48 00:02:55,360 --> 00:02:58,400 Speaker 1: insurance plans, and so we were responsible for financing the 49 00:02:58,480 --> 00:03:03,280 Speaker 1: cost of healthcare. By having that responsibility, we were trying 50 00:03:03,320 --> 00:03:05,680 Speaker 1: to find the most effective ways to render care at 51 00:03:05,680 --> 00:03:09,120 Speaker 1: the lowest possible cost while not jeopardizing the quality of 52 00:03:09,120 --> 00:03:12,560 Speaker 1: the patient satisfaction. You have to look to new models 53 00:03:12,560 --> 00:03:15,600 Speaker 1: of care so that you can improve the outcomes and 54 00:03:15,680 --> 00:03:18,880 Speaker 1: still do it in a sustainable cost model. If you 55 00:03:19,000 --> 00:03:21,560 Speaker 1: look at the healthcare system, three trillion dollars to spend 56 00:03:21,560 --> 00:03:23,520 Speaker 1: in the United States, A trillion of that is in 57 00:03:23,600 --> 00:03:26,919 Speaker 1: hospital care. A lot of focus was placed on how 58 00:03:26,919 --> 00:03:31,200 Speaker 1: do you prevent patients from presenting to the hospital and 59 00:03:31,240 --> 00:03:34,520 Speaker 1: how do you reduce that utilization of hospital services? And 60 00:03:34,560 --> 00:03:37,880 Speaker 1: I noticed this glaring gap that no one was focused on, 61 00:03:37,920 --> 00:03:39,520 Speaker 1: how do you come up with a different way to 62 00:03:39,560 --> 00:03:43,800 Speaker 1: render hospital level care. Historically everything has been focused upon 63 00:03:44,280 --> 00:03:46,920 Speaker 1: preventing that hospitalization. But I thought, if you could figure 64 00:03:46,960 --> 00:03:49,640 Speaker 1: out another way to render equivalent care that you could 65 00:03:49,640 --> 00:03:51,920 Speaker 1: receive in the hospital, and you could do so at 66 00:03:51,920 --> 00:03:55,840 Speaker 1: a lower cost, well, then you could greatly improve the system. 67 00:03:56,240 --> 00:03:58,160 Speaker 1: And so I started doing tremendous amount of research in 68 00:03:58,240 --> 00:04:00,880 Speaker 1: that area and found this model called hospital at home 69 00:04:01,360 --> 00:04:04,800 Speaker 1: that had largely been operated in single payer countries, had 70 00:04:04,840 --> 00:04:08,280 Speaker 1: great clinical outcomes, and there had been some limited pilots 71 00:04:08,440 --> 00:04:10,680 Speaker 1: or research studies in the United States, but it always 72 00:04:10,720 --> 00:04:13,760 Speaker 1: failed to scale because there was never this reimbursement mechanism. 73 00:04:13,840 --> 00:04:16,880 Speaker 1: So trying to find that opportunity where you could reduce 74 00:04:16,920 --> 00:04:20,400 Speaker 1: the cost of something that now equates to roughly twenty 75 00:04:20,400 --> 00:04:23,240 Speaker 1: percent of our GDP, but still give patients a great 76 00:04:23,279 --> 00:04:26,200 Speaker 1: outcome was highly appealing to me because it presented a 77 00:04:26,200 --> 00:04:28,840 Speaker 1: great challenge and could obviously do great for the community. 78 00:04:29,440 --> 00:04:31,919 Speaker 1: You experiment with this, you learned about it at Vanguard, 79 00:04:32,520 --> 00:04:35,520 Speaker 1: but then you want to contessa. Now how to contesta 80 00:04:35,600 --> 00:04:38,800 Speaker 1: grow up? So while we were at Vanguard, we were 81 00:04:38,839 --> 00:04:42,520 Speaker 1: in the process of trying to launch a model that's 82 00:04:42,520 --> 00:04:45,760 Speaker 1: similar to what Contessa operates today. We call at home 83 00:04:45,760 --> 00:04:49,200 Speaker 1: recovery care. It's best known as hospital at Home. Johns 84 00:04:49,200 --> 00:04:52,359 Speaker 1: Tompkins is credited with, for lack of a better description, 85 00:04:52,400 --> 00:04:54,840 Speaker 1: inventing the model in the United States about twenty five 86 00:04:54,920 --> 00:04:57,560 Speaker 1: years ago. So we had done research and we were 87 00:04:57,600 --> 00:05:00,560 Speaker 1: trying to come up with new ways to deliver high 88 00:05:00,640 --> 00:05:03,880 Speaker 1: quality care. At that time, a group of the team 89 00:05:03,880 --> 00:05:06,719 Speaker 1: members from Vanguard and myself decided, let's go off and 90 00:05:06,760 --> 00:05:09,280 Speaker 1: start a company with the explicit purpose of trying to 91 00:05:09,320 --> 00:05:11,680 Speaker 1: make this hospital at home or home recovery care model 92 00:05:12,040 --> 00:05:15,480 Speaker 1: a standalone business. At that point, I did the proverbial 93 00:05:15,640 --> 00:05:17,960 Speaker 1: entrepreneurial track where I quit my job and went into 94 00:05:17,960 --> 00:05:20,440 Speaker 1: an office by myself and started writing the business plan, 95 00:05:20,960 --> 00:05:25,280 Speaker 1: and then ultimately in January of twenty fifteen, founded Contestant. 96 00:05:25,680 --> 00:05:28,320 Speaker 1: As you're thinking through this model, what's the source of 97 00:05:28,320 --> 00:05:31,719 Speaker 1: how you designed it? I looked at a combination of 98 00:05:32,080 --> 00:05:36,880 Speaker 1: outcomes from various sources, primarily the research from Johns Hopkins 99 00:05:36,920 --> 00:05:40,200 Speaker 1: in Mount Sinai, and then I combine that with the 100 00:05:40,320 --> 00:05:44,000 Speaker 1: scalable impact I would say of Australia. So Australia probably 101 00:05:44,040 --> 00:05:49,200 Speaker 1: has the greatest amount of patients treated in a similar model. 102 00:05:49,400 --> 00:05:53,680 Speaker 1: Roughly seven to ten percent of the patients in Australia 103 00:05:53,720 --> 00:05:56,479 Speaker 1: that need hospital level care receive that care in a 104 00:05:56,560 --> 00:05:59,800 Speaker 1: hospital at home equivalent model. I was looking to how 105 00:05:59,800 --> 00:06:02,159 Speaker 1: do you achieve a scalable state, because if you want 106 00:06:02,160 --> 00:06:05,839 Speaker 1: to be successful in changing clinical practice patterns, you have 107 00:06:05,960 --> 00:06:08,240 Speaker 1: to be able to apply that model to a significant 108 00:06:08,320 --> 00:06:12,039 Speaker 1: number of patients. It's hard to ask a clinician or 109 00:06:12,040 --> 00:06:15,160 Speaker 1: a health system to change its workflows if they can 110 00:06:15,240 --> 00:06:18,400 Speaker 1: only apply that model to a subset of the population. 111 00:06:19,240 --> 00:06:22,520 Speaker 1: So Australia was sort of the bellweather if you will. Then, 112 00:06:22,560 --> 00:06:26,320 Speaker 1: in looking at the most important outcomes was related to 113 00:06:26,320 --> 00:06:29,280 Speaker 1: the quality outcomes. Johns, Hopkins and mount senn I had 114 00:06:29,279 --> 00:06:32,640 Speaker 1: exceptional research related to their efforts. So I took the 115 00:06:32,720 --> 00:06:36,840 Speaker 1: combination of those three sources to state, how do you 116 00:06:36,880 --> 00:06:40,280 Speaker 1: create a clinical model that produces an equivalent outcome from 117 00:06:40,279 --> 00:06:43,640 Speaker 1: a quality perspective, and now use that as the foundation 118 00:06:43,680 --> 00:06:45,560 Speaker 1: to create a business model such that it could be 119 00:06:45,600 --> 00:06:50,719 Speaker 1: sustainable and the United States reimbursement or healthcare system, is 120 00:06:50,720 --> 00:06:56,440 Speaker 1: there any cultural difference between Australians and Americans that makes 121 00:06:56,440 --> 00:06:59,559 Speaker 1: it different to design the system or are they actually 122 00:06:59,600 --> 00:07:04,680 Speaker 1: pretty transferable? I think probably the biggest cultural difference is 123 00:07:04,720 --> 00:07:08,200 Speaker 1: just the reimbursement model as a whole. By and large, 124 00:07:08,400 --> 00:07:13,280 Speaker 1: a significant number of hospital operators today still function under 125 00:07:13,320 --> 00:07:17,480 Speaker 1: a fee for service reimbursement model. If you're reimbursed for 126 00:07:17,600 --> 00:07:20,600 Speaker 1: treating a patient, how do you willingly take a patient 127 00:07:20,680 --> 00:07:22,960 Speaker 1: that you could admit to your hospital and send them 128 00:07:22,960 --> 00:07:25,360 Speaker 1: home and render care outside of that setting? I think 129 00:07:25,360 --> 00:07:30,120 Speaker 1: that that's probably the biggest cultural difference. Ultimately, will it 130 00:07:30,200 --> 00:07:33,800 Speaker 1: make sense for every hospital to have a home recovery 131 00:07:33,840 --> 00:07:38,040 Speaker 1: care relationship? To be completely honest, I do not think 132 00:07:38,040 --> 00:07:41,520 Speaker 1: that that's the case, because we think of home recovery 133 00:07:41,520 --> 00:07:44,960 Speaker 1: care much like a service line initiative of a health 134 00:07:44,960 --> 00:07:48,520 Speaker 1: system or a hospital. So certain hospitals are very good 135 00:07:48,560 --> 00:07:52,360 Speaker 1: at specific service lines. But I think, much like health 136 00:07:52,360 --> 00:07:56,520 Speaker 1: systems have areas of expertise, certain health systems and hospitals 137 00:07:56,560 --> 00:07:58,880 Speaker 1: will have home recovery care as an area of expertise, 138 00:07:58,880 --> 00:08:01,680 Speaker 1: but not all hospitals will find it necessary to do so. 139 00:08:02,000 --> 00:08:05,800 Speaker 1: Are there particular disease states that are better adapted to 140 00:08:06,360 --> 00:08:09,920 Speaker 1: home recovery care and other disease states that are much 141 00:08:10,000 --> 00:08:14,880 Speaker 1: less desirable for home recoveris care. Absolutely. If you think 142 00:08:14,920 --> 00:08:20,440 Speaker 1: about complications associated with general medical conditions, those are the 143 00:08:20,440 --> 00:08:23,480 Speaker 1: types of patients that we're targeting for home recovery care treatment. 144 00:08:24,320 --> 00:08:27,520 Speaker 1: If you think of a hospital, you have the intensive 145 00:08:27,560 --> 00:08:30,120 Speaker 1: care unit, a step down unit, and then you have 146 00:08:30,160 --> 00:08:33,000 Speaker 1: what's referred to as the med search unit. We are 147 00:08:33,080 --> 00:08:35,880 Speaker 1: targeting those patients that would be going to a general 148 00:08:35,920 --> 00:08:39,960 Speaker 1: medical bed on the med search unit. So complications associated 149 00:08:39,960 --> 00:08:49,280 Speaker 1: with congestive heart failure, COPD, pneumonia, cellulitis, diverticulitis, dehydration, asthma, 150 00:08:49,440 --> 00:08:52,560 Speaker 1: conditions like that are best suited to be treated in 151 00:08:52,600 --> 00:08:55,440 Speaker 1: home recovery care. And when you look at what that 152 00:08:55,520 --> 00:08:58,360 Speaker 1: represents as a percentage of admissions to a hospital, those 153 00:08:58,400 --> 00:09:01,440 Speaker 1: conditions and all then we treat in home recovery care 154 00:09:02,080 --> 00:09:05,480 Speaker 1: typically account for about thirty five to forty percent of 155 00:09:05,480 --> 00:09:09,320 Speaker 1: all admissions for hospitals. When you set up a home 156 00:09:09,400 --> 00:09:13,160 Speaker 1: recovery care system, what has to happen at my home 157 00:09:13,840 --> 00:09:16,959 Speaker 1: for a home recovery care system to work. So we 158 00:09:17,080 --> 00:09:20,120 Speaker 1: have a number of partners across the country. I'll just 159 00:09:20,240 --> 00:09:23,400 Speaker 1: use Mount Sinai as an example in Manhattan. So we 160 00:09:23,520 --> 00:09:27,560 Speaker 1: have our ends that are affiliated with Mount Sinai, So 161 00:09:27,640 --> 00:09:30,240 Speaker 1: they are wearing name badges and lab coats of Mount Sinai, 162 00:09:30,280 --> 00:09:32,720 Speaker 1: and they are in the emergency rooms of our partner 163 00:09:32,760 --> 00:09:36,480 Speaker 1: health systems. They are screening patients as they come through 164 00:09:36,559 --> 00:09:39,760 Speaker 1: the emergency room, and they're trying to identify those patients 165 00:09:39,760 --> 00:09:42,800 Speaker 1: that are most suitable for home recovery care. When they 166 00:09:42,840 --> 00:09:45,679 Speaker 1: identify those patients based on the chief complaints that are 167 00:09:45,720 --> 00:09:49,080 Speaker 1: registered in the er system, they do three quick screens. 168 00:09:49,720 --> 00:09:51,480 Speaker 1: One are they a member of a health plan with 169 00:09:51,520 --> 00:09:54,160 Speaker 1: which we have a contract? Two do they meet the 170 00:09:54,160 --> 00:09:57,880 Speaker 1: clinical criteria to be admitted to a hospital? And three 171 00:09:58,320 --> 00:10:01,200 Speaker 1: is there clinical presentations such that they could be safely 172 00:10:01,200 --> 00:10:04,679 Speaker 1: treated at home? If they quickly pass those three screeners, 173 00:10:05,120 --> 00:10:08,559 Speaker 1: we then engage a local hospitalist that's employed by Mount Sinai. 174 00:10:08,679 --> 00:10:12,480 Speaker 1: The hospitalist is typically responsible for admitting patients to the floor, 175 00:10:12,520 --> 00:10:15,040 Speaker 1: so we wanted to keep that workflow in tank. He 176 00:10:15,160 --> 00:10:17,880 Speaker 1: or she would come down and review the chart because 177 00:10:17,920 --> 00:10:20,440 Speaker 1: it is a physician driven model. Ultimately, he or she 178 00:10:20,520 --> 00:10:23,439 Speaker 1: has the decision to admit the patient to recomb recovery 179 00:10:23,480 --> 00:10:27,240 Speaker 1: care if they agree. There's a conversation with the patient 180 00:10:27,559 --> 00:10:30,439 Speaker 1: at the bedside in the emergency room that says, as 181 00:10:30,440 --> 00:10:33,720 Speaker 1: a Mount Sinai patient, you're eligible to receive the SCARE 182 00:10:33,760 --> 00:10:35,840 Speaker 1: at home through our Home Recovery Care program. We're going 183 00:10:35,880 --> 00:10:38,480 Speaker 1: to send nurses to your home. You're going to receive 184 00:10:38,559 --> 00:10:41,640 Speaker 1: a telehealth visit by a physician. Would you like to 185 00:10:41,760 --> 00:10:45,040 Speaker 1: enroll in our program? Because of IMPALA, you can't force 186 00:10:45,080 --> 00:10:46,800 Speaker 1: the patient into the program. You have to give them 187 00:10:46,800 --> 00:10:51,040 Speaker 1: the option if they agree, we do a fourth screener, 188 00:10:51,040 --> 00:10:52,920 Speaker 1: which is a health and Home assessment, which is a 189 00:10:53,000 --> 00:10:56,040 Speaker 1: verbal survey to make sure that that environment is suitable 190 00:10:56,440 --> 00:10:58,400 Speaker 1: not only for the patient to receive care, but also 191 00:10:58,480 --> 00:11:01,400 Speaker 1: for the caregivers that are going into the home at 192 00:11:01,440 --> 00:11:03,840 Speaker 1: that point. If they need any treatments, they would receive 193 00:11:03,840 --> 00:11:07,320 Speaker 1: it in the emergency room, and then we transport the 194 00:11:07,360 --> 00:11:10,760 Speaker 1: patient to the home, typically via ambulance or a non 195 00:11:10,800 --> 00:11:15,480 Speaker 1: emergency transport service. Once the patient is in their home, 196 00:11:15,760 --> 00:11:18,600 Speaker 1: we send our ends registered nurses to the home at 197 00:11:18,720 --> 00:11:22,320 Speaker 1: least twice a day. If they need more visits, we'll 198 00:11:22,320 --> 00:11:24,920 Speaker 1: send a nurse out as many times as necessary, and 199 00:11:25,080 --> 00:11:28,040 Speaker 1: once a day. While the nurse is at the bedside 200 00:11:28,040 --> 00:11:31,160 Speaker 1: of the patient in the home, a hospitalist will round 201 00:11:31,200 --> 00:11:34,040 Speaker 1: on that patient virtually using a telehealth kit that we 202 00:11:34,120 --> 00:11:37,560 Speaker 1: sent home with a patient. So this enables the physician 203 00:11:37,679 --> 00:11:40,439 Speaker 1: to see all the vital signs of a patient and 204 00:11:40,640 --> 00:11:43,720 Speaker 1: enables them to have an audio and visual communication with them. 205 00:11:44,280 --> 00:11:48,040 Speaker 1: There's a virtual stethoscope that allows the nurse to move 206 00:11:48,240 --> 00:11:50,880 Speaker 1: in accordance where the physician needs to hear, for instance, 207 00:11:50,920 --> 00:11:55,400 Speaker 1: oscultations of heart and lungs. The nurse will carry out 208 00:11:56,200 --> 00:12:00,280 Speaker 1: lab draw services, they'll do plain film imaging, I'll do 209 00:12:00,280 --> 00:12:04,120 Speaker 1: infusion services, and they'll help administer any durable medical equipment 210 00:12:04,160 --> 00:12:07,600 Speaker 1: such as oxygen. And when that physician deems the patient 211 00:12:07,640 --> 00:12:09,599 Speaker 1: ready for discharge and I'll put that quote because the 212 00:12:09,640 --> 00:12:12,280 Speaker 1: patient is already in a home, they then move into 213 00:12:12,400 --> 00:12:15,760 Speaker 1: what we call a monitoring phase, whereby we follow up 214 00:12:15,760 --> 00:12:18,679 Speaker 1: with that patient until the thirtieth day from when they 215 00:12:18,679 --> 00:12:20,640 Speaker 1: were admitted to the program to make sure that they're 216 00:12:20,640 --> 00:12:23,839 Speaker 1: getting on that path to recovery, making sure that they're 217 00:12:23,880 --> 00:12:26,360 Speaker 1: getting in to see their primary care physician. If they 218 00:12:26,440 --> 00:12:28,439 Speaker 1: need to see a specialist, we can arrange for them 219 00:12:28,480 --> 00:12:30,840 Speaker 1: to get those visits and we help them get the 220 00:12:30,880 --> 00:12:35,600 Speaker 1: transportation as necessary. So we create a comprehensive, holistic approach 221 00:12:36,080 --> 00:12:39,160 Speaker 1: to care as opposed to the traditional episodic care that 222 00:12:39,240 --> 00:12:55,360 Speaker 1: has been rendered in the traditional hospital setting, and what 223 00:12:55,559 --> 00:12:59,079 Speaker 1: is the advantage of accepting your home recovery care option 224 00:12:59,240 --> 00:13:02,680 Speaker 1: rather than just going into the hospital bed. So, I 225 00:13:02,679 --> 00:13:05,800 Speaker 1: think first and foremost, and especially given what we're experiencing 226 00:13:05,800 --> 00:13:10,239 Speaker 1: with COVID nineteen, you're not susceptible to other potential infections. 227 00:13:10,559 --> 00:13:13,719 Speaker 1: When you're in a hospital, nurses and doctors are going 228 00:13:13,760 --> 00:13:16,600 Speaker 1: from patient to patient, there is a higher propensity for 229 00:13:17,400 --> 00:13:21,160 Speaker 1: viruses or infections to be transferred to another patient. Secondly, 230 00:13:21,200 --> 00:13:23,959 Speaker 1: you're in an unfamiliar environment. The majority of our patients 231 00:13:24,080 --> 00:13:26,760 Speaker 1: or geriatric patients, and so when they wake up in 232 00:13:26,800 --> 00:13:28,240 Speaker 1: the middle of the night and they need to use 233 00:13:28,240 --> 00:13:31,280 Speaker 1: the restroom, they're not familiar with that setting. When you're 234 00:13:31,280 --> 00:13:35,000 Speaker 1: in your home environment, you're around your own germs for 235 00:13:35,080 --> 00:13:38,560 Speaker 1: lack of a better description, you don't have the chance 236 00:13:38,600 --> 00:13:40,520 Speaker 1: to get a hospital acquired infection. When you're in your 237 00:13:40,559 --> 00:13:42,800 Speaker 1: home and you know the layout, you know where your 238 00:13:42,880 --> 00:13:45,200 Speaker 1: nightstand is, you know where the corner of your bed is, 239 00:13:45,760 --> 00:13:48,360 Speaker 1: and you don't have those falls and those accidents that 240 00:13:48,520 --> 00:13:51,160 Speaker 1: happen in unfamiliar environments. And the studies released by Mount 241 00:13:51,200 --> 00:13:54,400 Speaker 1: Sinai and Johns Hopkins support that evidence that you do 242 00:13:54,520 --> 00:13:59,160 Speaker 1: a higher quality outcome because you're in that familiar, safe environment. 243 00:13:59,440 --> 00:14:02,640 Speaker 1: You're also ambulating much quicker because when you're in the hospital, 244 00:14:02,640 --> 00:14:05,199 Speaker 1: you're sitting in that bed for the significant majority of 245 00:14:05,240 --> 00:14:07,319 Speaker 1: the day, whereas when you're at home you have a 246 00:14:07,400 --> 00:14:09,840 Speaker 1: higher propensity to ambulate and move about your house, and 247 00:14:09,880 --> 00:14:12,160 Speaker 1: so you get back on that path to recovery much 248 00:14:12,240 --> 00:14:14,480 Speaker 1: quicker than you would in the hospital while you sit 249 00:14:14,520 --> 00:14:18,160 Speaker 1: in the bed. But what doesn't that increase the likelihood 250 00:14:18,160 --> 00:14:21,280 Speaker 1: of you're falling because again, you're in a familiar environment, 251 00:14:21,400 --> 00:14:24,800 Speaker 1: mean you typically have spousal support or family support. You 252 00:14:24,880 --> 00:14:27,920 Speaker 1: move in whatever equipment we're going to need. How does 253 00:14:27,920 --> 00:14:30,880 Speaker 1: that work? So when we transport that patient home from 254 00:14:30,880 --> 00:14:33,480 Speaker 1: the emergency room, we do send them home or we 255 00:14:33,600 --> 00:14:35,640 Speaker 1: arrange for the equipment to be delivered to the home. 256 00:14:35,680 --> 00:14:38,000 Speaker 1: The biggest misconception is that you do need a hospital bed. 257 00:14:38,120 --> 00:14:40,680 Speaker 1: We actually do not send hospital beds into the home. 258 00:14:41,160 --> 00:14:44,280 Speaker 1: It's perfectly acceptable to use their own bed, but it 259 00:14:44,440 --> 00:14:46,320 Speaker 1: is a part of that health and home assessment to 260 00:14:46,400 --> 00:14:49,840 Speaker 1: make sure that everything is suitable for them. But we 261 00:14:49,880 --> 00:14:52,160 Speaker 1: do send an equipment. The most typical equipment is our 262 00:14:52,240 --> 00:14:55,800 Speaker 1: oxygen tanks. Sometimes we need walkers to help them assist 263 00:14:55,880 --> 00:15:00,360 Speaker 1: with that ambulation I described, So you're really describing very 264 00:15:00,440 --> 00:15:03,760 Speaker 1: high percentage of the people who are getting home recovery 265 00:15:03,840 --> 00:15:09,520 Speaker 1: care are probably retired and probably on Medicare. Most of 266 00:15:09,560 --> 00:15:13,040 Speaker 1: our patients are enrolled in Medicare advantage health plans. I 267 00:15:13,080 --> 00:15:15,920 Speaker 1: think one of the bigger challenges of home recovery care 268 00:15:16,000 --> 00:15:18,960 Speaker 1: is the fact that Medicare does not reimburse for the model. 269 00:15:19,080 --> 00:15:22,440 Speaker 1: So if you're a straight Medicare fee for service beneficiary, 270 00:15:22,560 --> 00:15:25,600 Speaker 1: this program cannot be available to you because it's not 271 00:15:25,600 --> 00:15:28,680 Speaker 1: currently reimbursed by CMS. If you commit at a lower 272 00:15:28,720 --> 00:15:32,840 Speaker 1: cost than treating the same person in the hospital, why 273 00:15:32,880 --> 00:15:35,640 Speaker 1: wouldn't it be the Medicare's advantage to at a minimum, 274 00:15:35,640 --> 00:15:38,440 Speaker 1: on a break even basis, pay you as long as 275 00:15:38,480 --> 00:15:40,960 Speaker 1: you're not more expensive than the hospital. I think it 276 00:15:40,960 --> 00:15:43,400 Speaker 1: would be an exceptional idea for Medicare to reimburse for 277 00:15:43,640 --> 00:15:47,560 Speaker 1: the program. To the hospitals themselves. Oppose it or is 278 00:15:47,600 --> 00:15:51,360 Speaker 1: it just bureaucratic inertia? I think it's just the regulatory challenges. 279 00:15:51,520 --> 00:15:56,040 Speaker 1: The reimbursement mechanism for hospitals has always been a hospital 280 00:15:56,040 --> 00:16:00,080 Speaker 1: submits a DRG, which is a diagnosis related group for 281 00:16:00,560 --> 00:16:05,160 Speaker 1: reimbursement from metacare. Now you're talking about rendering hospital level care, 282 00:16:05,280 --> 00:16:08,640 Speaker 1: but it's in the home. So we've actually proposed to 283 00:16:08,720 --> 00:16:12,360 Speaker 1: CMS that they use the bundle payment reimbursement mechanism, which 284 00:16:12,400 --> 00:16:15,960 Speaker 1: we think that that's a great idea because it promotes 285 00:16:16,040 --> 00:16:19,840 Speaker 1: higher quality care at lower cost. Given the Trump administration's 286 00:16:21,120 --> 00:16:26,000 Speaker 1: bias in favor of innovation and desire to reduce cost, 287 00:16:26,080 --> 00:16:29,360 Speaker 1: I would think that this is a very very real 288 00:16:29,400 --> 00:16:35,800 Speaker 1: opportunity to create a better outcome at lower price. I agree, 289 00:16:35,840 --> 00:16:39,400 Speaker 1: And obviously with the virus, they have been very receptive 290 00:16:39,640 --> 00:16:43,440 Speaker 1: to new models. Given that we seem to believe that 291 00:16:44,360 --> 00:16:48,200 Speaker 1: COVID nineteen is particularly dangerous if you're over sixty five, 292 00:16:48,840 --> 00:16:54,520 Speaker 1: there's a pandemic related reason to encourage people going into 293 00:16:55,160 --> 00:16:59,640 Speaker 1: this kind of home care recovery system rather than staying 294 00:16:59,640 --> 00:17:03,680 Speaker 1: in a Hospitals have amazing care, but in certain instances 295 00:17:03,680 --> 00:17:06,160 Speaker 1: it's not the best environment for you to receive that care. 296 00:17:06,359 --> 00:17:09,959 Speaker 1: In addition to the clinical and quality components of the model, 297 00:17:10,480 --> 00:17:13,919 Speaker 1: you also have the financial components, and that with the 298 00:17:13,920 --> 00:17:17,159 Speaker 1: aging of America, the baby boomers that are continuously growing, 299 00:17:17,359 --> 00:17:20,640 Speaker 1: it's creating capacity constraints on a number of health systems 300 00:17:20,640 --> 00:17:25,399 Speaker 1: across the country. The cost of creating a new bed 301 00:17:25,640 --> 00:17:28,399 Speaker 1: for a hospital is roughly two million dollars. If that 302 00:17:28,480 --> 00:17:32,000 Speaker 1: hospital operates in a state which requires the certificate of need, 303 00:17:32,440 --> 00:17:35,679 Speaker 1: it's probably upwards of three million dollars. We have a 304 00:17:35,760 --> 00:17:39,760 Speaker 1: virtual bed like you have with a home recovery care program, 305 00:17:39,840 --> 00:17:42,880 Speaker 1: it's roughly nineteen to twenty thousand dollars per bed. You're 306 00:17:42,920 --> 00:17:46,120 Speaker 1: an essence funding the staff that's needed to run the program. 307 00:17:46,560 --> 00:17:49,880 Speaker 1: So with those significant costs of creating a physical bed, 308 00:17:50,280 --> 00:17:53,480 Speaker 1: it's just going to further contribute to the increasing costs 309 00:17:53,480 --> 00:17:57,280 Speaker 1: of healthcare, which is one of the problems that we have, 310 00:17:57,400 --> 00:18:01,000 Speaker 1: and so creating a more cost of fish model, again 311 00:18:01,040 --> 00:18:04,600 Speaker 1: without jeopardizing quality, is something that our healthcare and industry 312 00:18:04,640 --> 00:18:07,400 Speaker 1: needs so that we can create a sustainable, more cost 313 00:18:07,400 --> 00:18:26,560 Speaker 1: efficient model. One of the things that the Trump administration 314 00:18:26,600 --> 00:18:30,240 Speaker 1: has really been pushing hard is the whole idea of telemedicine. 315 00:18:30,600 --> 00:18:34,040 Speaker 1: To what ecent does that also play into your home 316 00:18:34,119 --> 00:18:40,400 Speaker 1: recovery model. It's essential without the advent of telehealth or telemedicine, 317 00:18:40,640 --> 00:18:43,840 Speaker 1: home recovery care wouldn't be successful because it wouldn't be scalable. 318 00:18:43,880 --> 00:18:47,080 Speaker 1: If you go back to the original research papers, the 319 00:18:47,240 --> 00:18:52,000 Speaker 1: programs relied upon physicians or clinicians going into the home 320 00:18:52,040 --> 00:18:55,320 Speaker 1: for a visit, where you need an army of clinicians 321 00:18:55,440 --> 00:18:57,720 Speaker 1: to be able to treat a credible number of patients. 322 00:18:58,080 --> 00:19:01,440 Speaker 1: Now that you do have telemedicine capable abilities, a physician 323 00:19:01,480 --> 00:19:04,000 Speaker 1: can do a rounding on a patient virtually. He or 324 00:19:04,040 --> 00:19:07,560 Speaker 1: she can see the vital sign monitorings no differently than 325 00:19:07,640 --> 00:19:10,240 Speaker 1: they could see when they are on the hospital floor. 326 00:19:10,600 --> 00:19:13,080 Speaker 1: That is what makes hospital at home or home recovery 327 00:19:13,119 --> 00:19:16,639 Speaker 1: care a scalable model. So without telemedicine, we wouldn't be 328 00:19:16,680 --> 00:19:18,480 Speaker 1: able to scale to the number of health systems or 329 00:19:18,480 --> 00:19:20,719 Speaker 1: treat the number of patients that were capable of treating. 330 00:19:21,000 --> 00:19:24,760 Speaker 1: Do you bring in the home side portions of the 331 00:19:24,800 --> 00:19:29,480 Speaker 1: telehealth or telemedicine as part of the contract we do 332 00:19:29,520 --> 00:19:32,160 Speaker 1: when a patient leaves the emergency room and goes home. 333 00:19:32,160 --> 00:19:35,840 Speaker 1: In our program, they get, for lack of a better description, 334 00:19:35,880 --> 00:19:38,919 Speaker 1: a small briefcase which contains all the materials for the 335 00:19:38,960 --> 00:19:42,879 Speaker 1: telemedicine capabilities. It has a tablet, it has a blood 336 00:19:42,920 --> 00:19:45,520 Speaker 1: pressure cuff, it has a pulse ox monitor. It has 337 00:19:45,520 --> 00:19:48,560 Speaker 1: a virtual scale and a virtual stethoscope, and so by 338 00:19:48,560 --> 00:19:51,680 Speaker 1: having those materials in the home, the physician is able 339 00:19:51,680 --> 00:19:53,879 Speaker 1: to round on that patient while that nurses at the 340 00:19:53,920 --> 00:19:56,399 Speaker 1: bedside to see all the vital signs no differently than 341 00:19:56,440 --> 00:19:58,280 Speaker 1: he or she would see on the floor. Do you 342 00:19:58,320 --> 00:20:03,800 Speaker 1: see potentially the beginning kind of a baseline home health 343 00:20:03,880 --> 00:20:08,000 Speaker 1: kit that you can imagine would simply be in virtually 344 00:20:08,040 --> 00:20:14,000 Speaker 1: every home, so you could in many ways provide the 345 00:20:14,160 --> 00:20:17,600 Speaker 1: data online without having to go to the doctor's office. 346 00:20:17,840 --> 00:20:19,840 Speaker 1: I do think that that's highly probable. You have a 347 00:20:19,920 --> 00:20:23,120 Speaker 1: number of retail companies that are trying to do just that. 348 00:20:24,000 --> 00:20:27,439 Speaker 1: Are you able to provide this kind of service in 349 00:20:27,560 --> 00:20:31,159 Speaker 1: very rural areas we do. It was critical that we 350 00:20:31,280 --> 00:20:34,400 Speaker 1: demonstrate the ability to succeed in a rural area because obviously, 351 00:20:34,400 --> 00:20:37,080 Speaker 1: if we want to apply it to Medicare beneficiaries, you 352 00:20:37,160 --> 00:20:40,080 Speaker 1: have to have that capability. Our first partner was with 353 00:20:40,119 --> 00:20:44,680 Speaker 1: the Marshfield Clinic and Marshfield, Wisconsin, which is rural Wisconsin 354 00:20:44,760 --> 00:20:47,400 Speaker 1: is the town of about eighteen thousand people and their 355 00:20:47,560 --> 00:20:50,840 Speaker 1: service area is about thirty thousand square miles. You have 356 00:20:50,880 --> 00:20:54,800 Speaker 1: people driving hours into the Marshfield Clinic in doctor Turney, 357 00:20:54,840 --> 00:20:58,160 Speaker 1: the CEO, and doctor Moraley realize that they had to 358 00:20:58,160 --> 00:21:01,960 Speaker 1: create a better way to hospital level care to their community. 359 00:21:02,000 --> 00:21:04,080 Speaker 1: Just as you described, it's a better experience. If we 360 00:21:04,119 --> 00:21:06,240 Speaker 1: can bring that to their home in a rural setting, 361 00:21:06,680 --> 00:21:09,000 Speaker 1: then we're highly capable of doing it in more urban 362 00:21:09,040 --> 00:21:12,960 Speaker 1: areas like New York and Phoenix. In Nashville, if you 363 00:21:13,040 --> 00:21:16,920 Speaker 1: have large high rise buildings and you can help particularly 364 00:21:16,920 --> 00:21:21,399 Speaker 1: senior citizens get to care they need without having to 365 00:21:21,440 --> 00:21:25,040 Speaker 1: expose themselves to all of the germs and the elevator 366 00:21:25,080 --> 00:21:28,280 Speaker 1: and all the germs and the subway, etc. There's some 367 00:21:28,400 --> 00:21:32,720 Speaker 1: huge advantages both to telemedicine and also to this home 368 00:21:32,760 --> 00:21:36,720 Speaker 1: recovery model in terms of protecting people. If you look 369 00:21:36,760 --> 00:21:39,320 Speaker 1: at the fact that everyone has been talking about flattening 370 00:21:39,400 --> 00:21:41,600 Speaker 1: the curve and sheltering in place and home recovery care 371 00:21:41,600 --> 00:21:44,359 Speaker 1: and enables patients to continue to shelter in place and 372 00:21:44,359 --> 00:21:48,800 Speaker 1: still receive that care. So as the crisis started, we're 373 00:21:48,800 --> 00:21:52,679 Speaker 1: partnered with Mount Sinai and we had that firsthand experience 374 00:21:52,840 --> 00:21:56,120 Speaker 1: in New York, and so we started by treating patients 375 00:21:56,160 --> 00:21:59,000 Speaker 1: that had tested negative for COVID nineteen and so we 376 00:21:59,000 --> 00:22:01,040 Speaker 1: were taking them when they into the health system and 377 00:22:01,080 --> 00:22:02,639 Speaker 1: make sure that they stayed at home so that they 378 00:22:02,640 --> 00:22:06,160 Speaker 1: wouldn't have that exposure to the virus. We then quickly 379 00:22:06,280 --> 00:22:10,879 Speaker 1: moved to treating patients that had tested positive for COVID 380 00:22:10,960 --> 00:22:13,400 Speaker 1: nineteen because of the fact that there were just so 381 00:22:13,440 --> 00:22:16,560 Speaker 1: many cases, they needed to free those beds at Mount 382 00:22:16,600 --> 00:22:20,639 Speaker 1: Sinai for higer acuity patients. But still, even though they 383 00:22:20,640 --> 00:22:22,919 Speaker 1: had tested positive, we were keeping that patient confined to 384 00:22:22,960 --> 00:22:25,400 Speaker 1: their home and they were able to prevent from being 385 00:22:25,440 --> 00:22:28,119 Speaker 1: out in the community and obviously further contribute to the spread. 386 00:22:28,119 --> 00:22:30,160 Speaker 1: So I think benefits can be seen on both sides 387 00:22:30,160 --> 00:22:33,439 Speaker 1: of the equation. With that capability of treating patients in 388 00:22:33,480 --> 00:22:39,600 Speaker 1: the home, you actually have a dramatically lower readmission rate 389 00:22:40,440 --> 00:22:43,720 Speaker 1: than people who stay in the hospital. Can you talk 390 00:22:43,760 --> 00:22:47,080 Speaker 1: about that. That's right. We track a number of quality metrics, 391 00:22:47,560 --> 00:22:49,840 Speaker 1: probably the one that we're most proud of achieving our 392 00:22:49,920 --> 00:22:51,960 Speaker 1: first and foremost, as you mentioned, the readmission rate or 393 00:22:52,359 --> 00:22:54,720 Speaker 1: specifically the reduction of reamission rate, but also the patient 394 00:22:54,800 --> 00:22:59,040 Speaker 1: satisfaction for the program, because those patients are in the 395 00:22:59,160 --> 00:23:02,280 Speaker 1: home and in that familiar environment and they are able 396 00:23:02,600 --> 00:23:04,639 Speaker 1: to be around their family and not be exposed to 397 00:23:04,680 --> 00:23:07,639 Speaker 1: those complications that can be generated in a hospital. We 398 00:23:07,720 --> 00:23:11,760 Speaker 1: have been able to reduce that readmission significantly forty four 399 00:23:11,800 --> 00:23:15,600 Speaker 1: percent reduction to the baseline readmission rate. The care team 400 00:23:15,680 --> 00:23:18,880 Speaker 1: is interacting with that patient numerous times throughout their home 401 00:23:18,880 --> 00:23:23,080 Speaker 1: recovery care experience, so through a hospital equivalent experience on 402 00:23:23,400 --> 00:23:26,160 Speaker 1: the telehealth side, they really do get on that path 403 00:23:26,160 --> 00:23:30,280 Speaker 1: to recovery much quicker. So you have a shorter land 404 00:23:30,320 --> 00:23:36,199 Speaker 1: to stay for a hospital level care, fewer readmissions, and 405 00:23:36,240 --> 00:23:40,320 Speaker 1: as I understand it, the significant and improvement in patient satisfaction. 406 00:23:40,600 --> 00:23:43,240 Speaker 1: That's exactly right. We have the equivalent of a ninety 407 00:23:43,240 --> 00:23:47,040 Speaker 1: percent satisfaction rate. I think ultimately one of the main 408 00:23:47,119 --> 00:23:50,560 Speaker 1: contributors is that patients historically have not had a choice 409 00:23:50,600 --> 00:23:53,120 Speaker 1: as it relates to hospital level care. When you need 410 00:23:53,200 --> 00:23:56,480 Speaker 1: hospital levels care, one of two things happens. You're either 411 00:23:56,520 --> 00:23:59,480 Speaker 1: admitted to the hospital or you leave against medical advice. 412 00:24:00,200 --> 00:24:02,840 Speaker 1: And now presenting patients with a third option, you're not 413 00:24:02,920 --> 00:24:05,280 Speaker 1: forcing anything upon them, but you give them that optionality. 414 00:24:05,320 --> 00:24:07,000 Speaker 1: If you want to receive this care in the home, 415 00:24:07,359 --> 00:24:09,199 Speaker 1: then you have that right. If you want to go 416 00:24:09,240 --> 00:24:10,960 Speaker 1: to the hospital that ran as you wors as well. 417 00:24:11,440 --> 00:24:14,879 Speaker 1: When we offered the program to a patient of the 418 00:24:14,880 --> 00:24:18,119 Speaker 1: time they enroll. That's remarkable. Let me ask this, So 419 00:24:18,320 --> 00:24:21,240 Speaker 1: we're in the middle of a pandemic. If I became 420 00:24:21,359 --> 00:24:27,760 Speaker 1: a COVID nineteen patient, what would potentially be the home 421 00:24:27,800 --> 00:24:30,520 Speaker 1: recovery model that you would recommend and how it all 422 00:24:30,560 --> 00:24:33,760 Speaker 1: work in terms of getting care at home rather than 423 00:24:33,760 --> 00:24:37,720 Speaker 1: the hospital. But the outset, we were very cautious as 424 00:24:37,720 --> 00:24:41,160 Speaker 1: it related to treating COVID positive patients in a home 425 00:24:41,200 --> 00:24:43,960 Speaker 1: recovery care model. That was largely due to the fact 426 00:24:44,040 --> 00:24:47,280 Speaker 1: that this virus was so unknown and the complications that 427 00:24:47,280 --> 00:24:50,280 Speaker 1: could come about happen in a very quick timeframe, that 428 00:24:50,359 --> 00:24:54,280 Speaker 1: we were very cautious and actually did not target COVID 429 00:24:54,320 --> 00:24:58,159 Speaker 1: positive patients at the outset. That being said, after a 430 00:24:58,240 --> 00:25:01,639 Speaker 1: considerable amount of time working with these types of patients 431 00:25:01,640 --> 00:25:04,560 Speaker 1: in New York with Mount Sinai, we were able to 432 00:25:04,600 --> 00:25:07,399 Speaker 1: identify patients that had been stabilized they were not at 433 00:25:07,480 --> 00:25:10,200 Speaker 1: risk of respiratory failure to be treated in the home 434 00:25:10,680 --> 00:25:15,240 Speaker 1: with traditional respiratory treatment, so they would have oxygen continuous fluids. 435 00:25:15,480 --> 00:25:18,360 Speaker 1: We're making sure that they're not at risk of pneumonia, 436 00:25:18,440 --> 00:25:21,399 Speaker 1: respiratory failure. So much like you would treat a patient 437 00:25:21,480 --> 00:25:24,240 Speaker 1: for pneumonia complications in the hospital, we were doing the 438 00:25:24,280 --> 00:25:28,119 Speaker 1: same at home, again largely through oxygen treatments, monitoring their 439 00:25:28,200 --> 00:25:30,080 Speaker 1: vital signs to make sure that fluids not building up 440 00:25:30,119 --> 00:25:33,159 Speaker 1: in the lungs. All capable of being monitored remotely with 441 00:25:33,200 --> 00:25:37,440 Speaker 1: telehealth capabilities. We're working on a project right now beyond 442 00:25:37,480 --> 00:25:40,600 Speaker 1: the pandemic, what's the shape of the health So simnibate, 443 00:25:41,080 --> 00:25:43,359 Speaker 1: what you're doing is clearly an innerfit piece of it, 444 00:25:43,800 --> 00:25:45,159 Speaker 1: and there are a number of other things that you 445 00:25:45,160 --> 00:25:48,879 Speaker 1: can sort of begin to see as a more dynamic, 446 00:25:50,000 --> 00:25:56,080 Speaker 1: more decentralized, and more patient centric system. It really ultimately 447 00:25:56,080 --> 00:25:58,680 Speaker 1: comes down to the patient adherents in changing patient behaviors 448 00:25:58,720 --> 00:26:01,560 Speaker 1: such that they engage with that wearable or that device 449 00:26:01,600 --> 00:26:04,320 Speaker 1: in a consistent manner. When we are able to crack 450 00:26:04,400 --> 00:26:07,560 Speaker 1: that code, that's when you'll see monumental shifts. I believe 451 00:26:07,600 --> 00:26:09,879 Speaker 1: in the outcomes of health because you will have that 452 00:26:10,000 --> 00:26:13,280 Speaker 1: continuous engagement with the patient and their overall health. That's great. 453 00:26:13,720 --> 00:26:16,520 Speaker 1: You are a great pioneer, and I think you have 454 00:26:16,560 --> 00:26:19,119 Speaker 1: a piece of the puzzle that could be very helpful 455 00:26:19,160 --> 00:26:20,919 Speaker 1: for the whole country. Well, thank you so much for 456 00:26:20,960 --> 00:26:22,920 Speaker 1: the time and the opportunity. It's a pleasure to speak 457 00:26:22,960 --> 00:26:31,800 Speaker 1: with you. Thank you to my guest Travis Messina. You 458 00:26:31,800 --> 00:26:34,560 Speaker 1: can read more about at home recovery care as an 459 00:26:34,600 --> 00:26:38,280 Speaker 1: alternative to acute care medicine on our show page at 460 00:26:38,359 --> 00:26:42,040 Speaker 1: newtsworld dot com. Newtsworld is produced by Gingwish through the 461 00:26:42,160 --> 00:26:47,080 Speaker 1: sixty and iHeartMedia. Our executive producer is Debbie Myers and 462 00:26:47,160 --> 00:26:50,720 Speaker 1: our producer is Garnsey Slap. The artwork with the show 463 00:26:50,880 --> 00:26:54,359 Speaker 1: was created by Steve Penman. Special thanks to the team 464 00:26:54,359 --> 00:26:57,880 Speaker 1: of Gingwish three sixty. Please email me with your comments 465 00:26:58,240 --> 00:27:01,679 Speaker 1: at newt at neutsworld dot com. If you've been enjoying 466 00:27:01,720 --> 00:27:04,639 Speaker 1: its World, I hope you'll go to Apple Podcast. You 467 00:27:04,760 --> 00:27:07,359 Speaker 1: both rate us with five stars and give us a 468 00:27:07,440 --> 00:27:11,920 Speaker 1: review so others can learn what it's all about. On 469 00:27:12,080 --> 00:27:15,240 Speaker 1: the next episode of NETS World, as we defeat the 470 00:27:15,320 --> 00:27:20,200 Speaker 1: virus and start to reopen America, what happens next, I'm 471 00:27:20,280 --> 00:27:23,359 Speaker 1: joined by Larry Cutler, who serves as Assistant to the 472 00:27:23,400 --> 00:27:27,919 Speaker 1: President for Economic Policy and Director of the National Economic Council. 473 00:27:28,400 --> 00:27:32,240 Speaker 1: He leads the coordination of President Donald J. Trump's domestic 474 00:27:32,280 --> 00:27:37,000 Speaker 1: and global economic policy agenda. I'm new Gingrich. This is 475 00:27:37,080 --> 00:27:37,680 Speaker 1: NEWTS world.