John Criswell Episode.mp3: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
John Shufeldt:
Hello, everybody, and welcome to another edition of Entrepreneur, where we help health care professionals own their future. Hey, everybody, and welcome back to the show today. I'm excited to have John Criswell back with us, to catch us up on all the new and cool things he's been doing. John's newest transformative healthcare solution is called Porter, and Porter transforms the care at home journey for payers in the most vulnerable members. It is powered by AI derived insights and a dedicated clinical team and a really cool, sleek member facing platform. Porter delivers a smarter, faster, more personalized way to navigate the complex at home health care journey. Before Porter, John was a founder, CEO and chairman of Pulsate, which is a healthcare analytics technology company that delivered complete visibility into the efficacy of risk adjustment and quality management programs. Pulsate revolutionized AI, machine learning and analytics covering Medicare Advantage and Medicaid patients, and was the leader in creating analytics for the Affordable Care Act, thus reducing unnecessary and wasteful interventions. Pulsate was acquired in 2019 by a publicly traded company. John, good to have you back on the show. It's good to see you again.
John Criswell:
John, A pleasure. Great to see you. Summer is.
John Shufeldt:
Over. Summer Well, not in Arizona, it's not. It's still like 100 and a zillion here, which is getting a little bit old, but there's a light at the end of the tunnel, knock on wood. So catch us up. What's going on with Porter? As you know, we participated in some of the financing and it's been pretty exciting to watch the growth.
John Criswell:
It's exciting to have you and your team on board. You guys are fantastic and given your track record, we're delighted. So thank you. Just having celebrated Labor Day, we had a moment to think about our care guides and the work that we're doing in the home, and it's fantastic work. So many calls motivated, purposeful stories of helping patients, whether it's transition of care from a setting into the home, supporting their home. And we're getting fantastic results both from the member patient side, individuals that have really provided wonderful testimonials to the work that we're doing and as you know, we're primarily focused on supporting the payer community. And in that area we're hitting on the four things that we do best, starting with one is driving outcomes, supporting the reduction of trend by helping patients with the services, resources and products they need on their care journeys. That's number one. Number two, stars quality. So we support the testing that supports number one, which is reduces outcomes and costs, which adds a lot of value to the member patient journey. The third part is somewhat nebulous, if you will, but what is called risk adjustment to the larger market. So that's the financial mechanism that mouse or payers are compensated in part on. And then the fourth is retention, and our retention numbers for their members are in the high 90s. So we feel really great about how we're supporting our payers, we feel great about how we're fighting for our patients, for our members, and we think we're doing really great work. And I'm delighted to lead an organization that has taken from analytics in my past life to actually delivering the services and the technology to support a more simpler, what I call speed to recovery to achieve your best self.
John Shufeldt:
Yeah. For patient outcomes. I think anybody listening to this who is either navigating the health care system or help family members navigate the health care system, it's a morass and it's a morass to people who are in the health care system. So I can't imagine if you are a patient in the middle of nowhere, so to speak, in like, Hey, I'm not used to this. It has to be nearly impossible to navigate the health care system these days.
John Criswell:
I couldn't agree more. And I have felt for a long time prior to founding Porter that I knew enough about health care to navigate the system. And what I've come to learn is that is not true and it's overly complicated. How do we simplify it? And that's really our goal. And whether you're caring for a child, a parent or yourself, it is hard to do. It is just very difficult.
John Shufeldt:
Yeah, it's crazy. I'm glad you guys are finding some success because God knows it's needed. As I recall, you started Porter right before Covid really hit. Do I have that correct?
John Criswell:
Right. Kind of in the middle of Covid, Right in the middle.
John Shufeldt:
Okay. So good time to start a company.
John Criswell:
Yeah.
John Criswell:
That's right.
John Criswell:
Yep, Yep.
John Shufeldt:
So what's the transition like? So you manage through Covid and a startup which had to be gray hair producing, although don't see much on your head. And now you transition to kind of post-COVID leadership. What's been the transition? What's been the Aha moments?
John Criswell:
The last organization that I founded and worked for was largely, if not 98% virtual. We ultimately became 100% virtual. We still had an office. The environment, pre-COVID was very different. We had a system, we had a routine, we had rules and. And we embrace those rules because we had the privilege of working from home, which was a much more intimate, sophisticated system where I would know kids names, pets, names. I would welcome people into my kitchen, they'd welcome me into theirs. And now pre and now post Covid. It's one that I've had to really learn and adjust the new dynamic not only for my team but for myself constantly being interrupted. There's no more uninterrupted time. Whether that time is being interrupted by a delivery to your front door by a family member. It is constant interruption and that interruption creates challenges around focus. The second part, and I don't agree with this move wholly to working within four walls and office space, but I see some of the benefits that I didn't initially understand. So for your younger the new entrance into the workforce, when they're working from home, they are lacking the mentorship and the connection that one gets from an office environment. And you now couple that with even if they are required to go to an office, there's no senior level executives in the office because they're working from home. And so there's a real deficit that I think is unknown for the new entrance into the workforce in terms of how they will develop, how they're learning and how they're growing and didn't arrive at that on my own, having talked to a number of our younger, newer work entrants, it's a real challenge.
John Shufeldt:
I can only imagine starting out, you graduate from college and you think you're going to be in this workforce and be interacting with your peers and learning from them as you go, and all of a sudden you're sitting in your kitchen on a laptop going, okay, this is what I signed up for. That has to be unnerving for them.
John Criswell:
It is. And I think the other component of that is, is this really life? Because they have watched now their parents for many years work from home, family members, friends, and as they are trying to integrate and learn and grow, I can imagine the challenges that they have. We haven't solved for that yet. At Porter. We are doing some things that we think will support it, such as more frequent on sites, trying to get together for more face to face interactions involving our team in conferences and other venues where they can learn to have more face to face interaction. But I think it's still very new and unknown.
John Shufeldt:
What advice can you give to new founders who are trying to balance this? Because you saw where Facebook kind of mandated people to go back to the office and just got a tremendous amount of pushback on it because now I think people are comfortable working from home. We've already gone through over that hump. What advice do you have for founders who are trying to balance this at home, virtual versus in office continuum?
John Criswell:
I think for many entrepreneurs and doing a startup, you crave command and control, and I think that exists for leaders and publicly traded company and midsized type companies as well. I think having a decision tree within yourself and some self-awareness in terms of why I'm mandating individuals to come back. And then if you can separate that decision tree into needs versus wants, then you can develop systems that support the need for people to work remote from home and balance perhaps your need to have face time with individuals. I do believe the balance can be struck, but really having a degree of self-awareness around the reasons why. I think from a talent perspective, we have seen an influx of resumes as a result of businesses that are requiring individuals to return back to work. And it's not just a state by state. We're also seeing this as a shift from those that have moved from their primary place of business that are now being required to return or terminate employment.
John Shufeldt:
I haven't noticed that yet, but that's kind of sweeping where companies are mandating return to work and people are saying, I'm tapping out for this. I want to stay working from home.
John Criswell:
I'm tapping out. And those that have required them to return back to their primary state or place of business face some sort of termination. They're staying put. They're staying put.
John Shufeldt:
Interesting. You know, I read an article recently, I think it was in The Wall Street Journal. It said the great resignation is over. Have you seen the more applicants come back into the workforce?
John Criswell:
We're seeing a lot more applicants and especially in the stressed area of health care, Right. We lack enough nurses and nurse practitioners. So we are seeing a great deal of candidates. Our candidate flow is very strong for those that are interested in working for us. Essentially, I think that's a big part of our benefits package. I have been surprised that it has not been more significant as a market standpoint, but I do not see the Great Recession. I still see a lot of tightening across other industries and trying to hire talented individuals that lack or that have certain talents.
John Shufeldt:
For my frame of reference of being in the hospital, often it seems like there been nearly a sea change of hospital dynamics, and I don't think for the better. You know, you would think that sometimes crisis builds resilience and improves processes and everything, and I haven't seen that yet. How has it been for your business, you know, now post-apocalyptic Covid crisis? What's changed and how have you seen the relation to government agencies and just doing business?
John Criswell:
Gosh, you've actually brought up something that I don't think is discussed enough. So we know in the hospital and acute settings that they are spending more money to bring in traveling nurses, if you will, and staff. What that creates is a lack of community in the hospital system. When I would go pre-COVID into a hospital, it felt busy. There were a lot of resources around you, whether they were administrative or clinical. And now when you go to a hospital, they feel lonely, They feel empty. The nurses, the support staff, the techs, they lack the community knowledge that exists. That creates a challenge around discharge processes. When you're given all the discharge instructions in the nurses from out of town and another state, he or she has no knowledge of where the best provider or provider is or the pharmacy that will be open at 10:00 at night to provide this. I think it's a real loss. I think it's a real challenge. And I'm not sure that the the system is quite prepared to handle that given the financials that occur in hospital systems. How that has affected Porter is it's making us more valuable in transition of care because we do know we have the technology that supports what patients and members need. We are contacting them as soon as they arrive a hospital, what we call the head in the bed, we're contacting them and then we're supporting them all the way through to their home and then sending clinicians in and then spending minimally 30 days with that member to support all of their transition of care needs, social needs, food, etcetera.
John Shufeldt:
Yeah, that transition of care time is incredibly difficult because we're discharging patients far earlier than we ever have because of bed shortages in the statistics. Somebody comes back into the emergency department after just being released 80% of time. I'm going to admit them because I don't know everything that's been done to you. I have some of your records, hopefully, but you're at risk and I'm not the one taking the fall. So I'm just going to admit you back in the hospital. And that's a huge hit to the.
John Criswell:
Hospital, 100% on the quality metrics, the readmission rates, It's a real challenge for sure.
John Shufeldt:
It was funny, I was back in Saint Joe's where I've worked for 23 years and I don't work there much anymore, But I was back seeing a friend of mine who I thought I needed to do a paracentesis tap his belly, and one of the charge nurses came up to me and said, Hey, everybody's wondering who you are. And I laughed because as I looked around, I didn't recognize I'd been there forever. I wasn't quite a fixture, but I was close and I'm like, Gosh, I don't recognize any of these nurses. And it's exactly what you said. Now I have a health care staffing company, so I get it and I kind of like it. However, if you're a patient or if you're a provider who's been there like me forever, it's like, I don't know these nurses anymore because, you know, the emergency department is you have this banter and camaraderie and it's a super team effort and it still feels that way. But you're right, people are coming in. They don't have the institutional knowledge that you'd hope they do. And next week somebody else is there. It's a much different environment.
John Criswell:
It really is. And probably from your time in medicine, think it's a joke in health care, but you never want to get admitted to the E.R. during Thanksgiving or. Christmas, right? Because it's all the low level, the newbies, if you will, from a hierarchy standpoint. And at that stage of their career, they lack the institutional knowledge. But now that seems much more pervasive, right? Because of the lack of community, local support and talent that can help you navigate.
John Shufeldt:
Yeah. How was post Covid now impacted The CMS and the OIG and governmental bodies that impact health care?
John Criswell:
There's a lot of changes going on within CMS and I think all for the good focusing on ACO reach models, changing the risk adjustment model with a primary emphasis on the member, and so focus on the member for quality or what a Medicare Advantage would be referred to as stars or star ratings, a much heavier emphasis. And so the two sides, if you will, of the health care system, you have insurance and you have health care delivery. The two roads shall not meet. Well, what is happening as a result of CMS, emphasis is putting more intensity and focus on the member for insurers. And so insurers are far more engaged today in doing way more for members, whether it's transportation, whether it's food insecurity, housing, all different sorts of benefit structures and engagement mechanisms to support the member and what they need to have a better outcome. And I think that's fantastic. On the other side, OIG has taken this broader lens around payment mechanisms for payers, and recently in March of this year, Inspector Grimm from OIG said, Hey, 90% of what is happening is occurring in the home, has no evidence of treatment. That's a shocking number, 90%. And she further went to share, if you will, not by name, but by size. You could figure it out. Companies that are performing these services that have no evidence of care. Now, one could argue that the model doesn't suggest that you need evidence of care, evidence of treatment, that you need documentation to support the existence of the condition. Having said that, you're getting paid a rate to provide treatment.
John Criswell:
And so with that backdrop in March, April, I think, and we are seeing some of this more investigations and audits from OIG and CMS on how we can address these payment models to deliver care. They made a number of other comments around network, and you're probably seeing some things in the news around elimination by large payers around prior authorization. So I suppose if I was to project into the future, risk adjustment will contain sdoh social determinants of health mechanisms for payment, I would project more emphasis on the member and that will continue to inspire payers to offer more. And they're offering all different types of valuable benefits to members and I think that will continue because at the same time we're seeing more senior members switching payers than we have in their history and I think they're becoming more savvy around the benefits that are being offered. So ultimately, I think we're going to have more scrutiny, I think at least under this administration, I think that's going to continue to push more value, drive the continuity of care, the care coordination aspects, much of which is what Porter does, right? So we set up at the beginning of the end of any intervention, a care guy that spends a minimum of 30 days to help you activate your treatment plan. Because after that visit, once you've completed that, you have a laundry list of things. And many of us, including myself, don't have the time to activate those things to make the scheduling policy. And we do that for you. That then solves for Zweig's evidence of treatment concern.
John Shufeldt:
I would think that's a great answer. I've been involved in kind of the male sphere as an expert and a little bit as an attorney for three decades. And a lot of bad stuff happens when people leave the hospital. And oftentimes it leads to complaints of medical malpractice, lack of communication. The patients are upset. The providers don't call them back. They don't know where to go. They get worse. They stay at home too long. They finally go back in and they're even sicker and all hell breaks loose. If I was a provider like a hospitalist, I would insist that the hospital uses Porter or a porter like company to help with this transition of care for a number of reasons. But one of those is to reduce my medical malpractice risk, because if you're there interacting with patients and you see something or hear something, the porter ears only get perked up and say, No, no, no, this isn't right. Let's get someone on the phone that can address this or we'll help you get back to the hospital because something ain't right here.
John Criswell:
Yeah, it's actually.
John Criswell:
A very astute comment. It's something that we do not discuss during the sales process with our health systems or our payers. But I think you're spot on. When I worked in urgent care, every visit received a phone call the next day. And we forget if you're a parent and you have your child in and it's 10:00 at night and you receive your treatment plan instructions the next morning, you've probably forgotten what they said, right? And so it's there to to help support them. So there is an intrinsic value in doing that, but there's also a legal liability component as well.
John Shufeldt:
Totally mean. We do the same thing. We call people up the next day and in 36 hours and I always call it the shot over the bowel call. So if there is an issue, you'd get a shot over the bow and you'd say, Oh, we better fix this because we don't fix it. We're going to get patient complaints, we're going to get malpractice events, all sorts of things. And I can't tell you, but I know that we dodged a lot of bullets by calling people up and saying, Hey, anything else we can help you with? Did you get your prescriptions? Did you follow up with your orthopedic surgeon, what have you? And there was a lot of things we pulled out of the fire just by doing that alone. But I wondered if you went back to the hospital and say, look, if you contact your insurers, I will bet you the Porter patients are less likely to engage in medical malpractice. Probably don't have a long enough history yet, but I bet you're coming up close.
John Criswell:
I bet. And I will say that the value that we provide to those members, I think it's an unequivocal result of reduction in medical malpractice. But you're right, we're still early in that journey.
John Shufeldt:
Yeah. So we have a lot of folks who are listening and will hear this and say, wow, that is very cool. And I've got an idea that probably like Porter started out of a need you saw on the system these physicians or non physicians want to be involved in a health care startup because they have a problem worth solving. What advice would you give them because you've been there, done that a few times now.
John Criswell:
It's interesting, John, and you've done this several times as well. Your first time is different than your second time, and I feel like there should be a book written on the second and third and fourth time because it's just different. But for first time entrepreneurs, I think you need to have a discussion with yourself on just grit, persistence, and then that quickly is followed by a healthy dose of self-awareness, because at some point you will pivot, you will change as you're trying to figure and explore intellectually. And then in real life your market fit and product. And so number one is grit. That to me is the number one trait of any entrepreneur. As an investor myself, I look for and have been fortunate enough to have a couple of investments in entrepreneurs I'm just so impressed with and learn from. So grit is number one. Two is a healthy dose of self-awareness that you will change. Your idea will morph, It will grow even the best ideas. And by the way, you don't need to necessarily abandon your original thought, but you might have to put it on the shelf for a bit until you get your product fit and market, right?
John Shufeldt:
Yeah, just kind of laughing when you said this about the first, second and third. And I'm thinking intuitively, you would think the second and third are much easier than the first and it just should get better, easier every time. And I can say that it does because maybe I just now know more than I used to, because before I was fat, dumb and happy, and now I'm not quite as dumb. But now there's more. I realize I still don't know. And I can say it's been easier any time.
John Criswell:
I can attest the second time is not easier than the first for sure. And I will say that one of the challenges when you have had a successful company, many more people will pick up the phone and talk to you and as a result, you lack the real gritty thoughts and intelligence on your idea concept business. When you're new and nobody knows you and you have an idea, everybody will tell you that your idea is terrible. 99 out of 100 people will tell you it's terrible. And that is the best thing the second or third time around. Every. Listen and is afraid to tell you your idea is terrible.
John Criswell:
Yeah, that's really funny.
John Shufeldt:
That's absolutely true. The first time everybody has no problem telling you you're an idiot if they talk to you at all. By the third time they're going, huh? You know, maybe. Maybe he or she has something here when you actually don't have anything. But you think that's right?
John Criswell:
That's right.
John Criswell:
That's right.
John Criswell:
That is so.
John Shufeldt:
True. Well, John, it's been great catching up with you. I'm glad things are going so well. I expect great things from you and Porter.
John Criswell:
Well, great catching up with you. And look forward to catching up with you in Arizona soon.
John Criswell:
Thanks.
John Shufeldt:
I hope so. Well, everybody, thanks for another episode of Entrepreneurs. Thanks for listening, John. Always good. We'll have everything. The show notes for people who want to reach out and contact you. So thanks again.
John Criswell:
Thank you.
John Shufeldt:
Thanks for listening to another great edition of Entrepreneur to find out how to start a business and help secure your future. Go to John Shufelt Webmd.com. Thanks for listening.
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