Why do patients have to wait months, or even years, for dementia care while their condition worsens? The current system is failing families, but our guests today have developed a new dementia care model to fix it. This episode of HealthTech Remedy dives deep into Isaac Health, a company using a technology-enabled services platform to deliver scalable, specialist-level brain health and dementia care directly to patients in their homes. We're joined by co-founders Dr. Julius Bruch, a former McKinsey consultant and dementia researcher, and Dr. Joel Salinas, a leading neurologist from NYU, to unpack how they are tackling one of healthcare's biggest challenges.
In this conversation, we explore the revolutionary approach Isaac Health is taking to solve the crisis of access in brain healthcare. You'll learn how their innovative, virtual dementia care platform is designed to eliminate the long wait times to see a neurologist - which can stretch over a year - and provide immediate support. We break down the new Medicare GUIDE model, a landmark payment initiative from CMS that is creating new pathways for comprehensive dementia services, and how Isaac Health’s model was perfectly positioned to lead the way. Co-founders Julius Bruch and Dr. Joel Salinas share the personal stories that drove them to leave successful careers in consulting and academic medicine to build a solution from the ground up.
This discussion is a masterclass in building a technology-enabled clinical services company. We cover how Isaac Health provides scalable specialist dementia care by using smart workflows and technology to empower a wider range of clinicians and extend the reach of top neurologists. The conversation also highlights the immense burden placed on families and the critical importance of dementia caregiver support, a core component of their comprehensive model. We also touch on the development of new value-based care models, the challenges of integrating medical and social care, and the incredible early results Isaac Health has achieved, including a 38% reduction in ER visits for their patients. From personal stories of patient impact to a high-level discussion of their business strategy and partnerships with Medicare Advantage plans, this episode is essential listening for anyone affected by dementia or interested in the future of healthcare innovation.
Introduction
Dr. Trevor Royce: Hey guys, good to see you.
Dr. Tim Showalter: Hey, good afternoon.
Dr. Paul Gerrard: Good afternoon.
Dr. Trevor Royce: Back in Chapel Hill, I've been traveling a lot for work lately. I came back and my wife bought a fish while I was gone. Every time I leave town, we have a new dependent.
Dr. Tim Showalter: Is it a complicated tank or a simple goldfish situation?
Dr. Trevor Royce: It's in a bowl. No salt water, fresh water. A little beta fish. I give it 48 hours life expectancy.
Dr. Tim Showalter: The first time you try to change the water, it's going to escape.
Dr. Trevor Royce: See if I can keep them away from my three-year-old.
Dr. Tim Showalter: You better get a little shovel because I'm sensing a backyard burial.
Dr. Paul Gerrard: That reminds me of the time I had a long day at work and I got home and we owned a cat.
Dr. Trevor Royce: Should we dive in?
Dr. Tim Showalter: Yeah, let's do it.
Dr. Paul Gerrard: Let's do it.
Dr. Tim Showalter: Paul, what's the other catchphrase today?
Dr. Paul Gerrard: I didn't.
Dr. Tim Showalter: All right, let's swallow the fish.
Dr. Trevor Royce: Welcome to HealthTech Remedy, the show where three physician leaders in health technology tell the stories of new and established companies and interview leaders from the industry. I'm Trevor Royce, radiation oncologist and researcher with experience in real-world evidence, informatics, and AI diagnostics.
Dr. Paul Gerrard: And I'm Paul Gerrard. I started off as a physical medicine rehabilitation physician before focusing on reimbursement policy, molecular diagnostics, and market access for AI products.
Dr. Tim Showalter: And I'm Tim Showalter, a radiation oncologist and prior med device entrepreneur who is now focused on bringing AI advances to cancer patients.
Introducing Isaac Health: A New Approach to Dementia Care
Dr. Trevor Royce: This week, we're diving into Isaac Health, a company rethinking how we detect and manage dementia and brain health. And we'll be joined by two guests, the co-founders, Julius Bruch and Joel Salinas.
Dr. Paul Gerrard: Isaac Health is building virtual-first interdisciplinary care to tackle Alzheimer's disease and related dementias, a massive and growing challenge for patients, family, and the healthcare system.
Dr. Tim Showalter: And we'll explore how their guide model, standing for goal-oriented, unified, interdisciplinary, digital, and evidence-based care, is transforming access and outcomes in dementia care.
Dr. Trevor Royce: We'll hear from the founders themselves about how their backgrounds in neurology, public health, and healthcare consulting came together to address this urgent problem. It'll be interesting to hear about how they met each other and got connected. I think they both have clinical backgrounds, but one of the founders particularly with a consulting background and how they took off from there.
Dr. Tim Showalter: Isaac Health is a good example of a technology-enabled clinical services model. I think we can talk a little bit about that overall business model and then focus on their specific clinical area and how they've responded to some of the available Medicare programs. They were founded in 2022, so a pretty young company. Found online that they had an oversubscribed seed round of $5.7 million. Lead investors were Meridian Street Capital and B Capital. Other participating firms were Primetime Partners, [Could not verify with context], VU Venture Partners, and AirAngels.
The founding area they're focused on is improving the function of patients with dementia and to make expert dementia care accessible to everyone. It's a virtual first clinic, but they integrate with brick and mortar's health systems. Looking at their information, I think that their really main initiatives are this guide dementia care model, and they partner with Medicare Advantage plans. And then they've got some interesting resources for caregivers as well, and make sure that they're offering all the social and behavioral health services that are important as patients experience cognitive decline. The idea is really connecting patients and their families where they are to make sure they've got all the right resources.
The Personal Toll of Dementia and the Need for Better Caregiver Support
Dr. Trevor Royce: A critical component here is the problem that they're addressing. A common catchphrase in early stage investing is to eliminate weak founders and small ideas. Well, these guys are tackling one of the biggest ideas or problems in healthcare, and they're strong founders with pretty impressive backgrounds.
Think of the problem in terms of dementia or Alzheimer's and all the associated diagnoses that come along with that. It's like cancer in that it literally impacts basically everybody with a family. And so when you're tackling a problem that touches everyone, it tends to be very bipartisan. Everyone's pulling for you and you hope that you come up with a solution that can make it better.
In my own personal experience, this was before I was in healthcare, but my grandmother had vascular dementia and it was just so taxing and stressful on the family, maybe more than any other diagnosis, even more so than cancer. Maybe psychiatric issues would be a close second or tied. But the burden on those caregivers when you have dementia and struggling how to fit that in and the financial repercussions of the time, there's just a lot packed in there. And if they can solve that, it's an amazing win for humanity.
Dr. Tim Showalter: A lot of the services people need are not traditional medicine. And everything that you access is hard. You've got a loved one with dementia. And so every trip to the neurologist, to get them out of the house and all dressed and ready to go must be a huge lift. And so if they can bring some of that into the home and make it easier to access and then make those connections that might otherwise be impossible to make if you're the caregiver. You've got family and your other jobs. I haven't had to deal with dementia in our family, but certainly have friends whose parents have had that. And just watching the amount of effort that goes into finding these services and accessing them is a pretty heavy lift.
Dr. Trevor Royce: For patients too. As oncologists, that's bad enough, but then you have a patient that has a cancer diagnosis and then you lay your dementia on top of that. Wow, what a challenging clinical problem to deal with. And a cool thing about what they're doing is they have services not only to treat the condition, but also to support those family members.
The Medicare GUIDE Model: A New Payment Pathway for Dementia Care
Dr. Paul Gerrard: They offer virtual care clinics for Alzheimer's disease and dementia, with the focus being on getting specialized expert care to the patient. For older adults, things like distance, getting to the clinics, geography can be a barrier. So by having these virtual care clinics, they can bring it to the patient.
It looks like they started before this CMS guide model, but in 2024, CMS put into place this guide model that they were really well positioned to start to take advantage of. The idea behind the guide model is that dementia care clinics can enroll in it and provide specialized care and support services for dementia patients and their families. Isaac Health, having already started up, having already thought about ways to implement this, was really in the right place at the right time to take advantage of the new CMS program that enables a fresh payment pathway for this kind of thing.
Dr. Tim Showalter: So this was a new entity created by CMS and my understanding is that it's pretty all-encompassing. So it's focused on improving outcomes for patients with dementia, but does it also include the caregiver support as well? It's the full package of this?
Dr. Paul Gerrard: Yes. And so this is a model done under the Centers for Medicare and Medicaid Innovation. And it's a little different than a lot of the models we see in that the model is not for whole cost of care, but rather there is an expectation that there will be a package, a suite of services delivered, this all-encompassing, holistic suite of services delivered. And in exchange for doing that, the provider gets a fixed payment amount.
Dr. Trevor Royce: So this sounds a lot like an alternative payment model, basically. Is it fair to categorize it as such?
Dr. Paul Gerrard: I don't know if it fits the technical definition, but it certainly is alternative to the typical fee-for-service payment model.
Addressing Neurologist Wait Times and the Specialist Shortage
Dr. Tim Showalter: What I think's interesting is I do think this scalability of a tech-enabled model like this, where especially Joel, I know is a big thought leader in the dementia space, to be able to make best practices available, potentially in the home or at least at a local clinic that they've partnered with, I think it's really powerful. As I mentioned, I haven't had a loved one need these services, but I have heard from people that when you even want to get initial intake and testing done for dementia, expect to wait several months to get in to see a neurologist. I think there's a shortage both of neurologists and neuropsychiatrics who would perform the testing. So I think they're really addressing some important needs.
And then to have it all in one shot, I think is a huge help for your family members. So I think that's to me what's the most exciting is bridging that gap and using technology to do it. We've talked a lot about how partnering, whether it's basic technology or artificial intelligence with actual care providers and the clinical expertise is a great business model. And I think this typifies one that is poised to have a big impact.
I did see there's a couple of competitors in this space. So other names I saw are Harmonic Health and Bold, but it seems like they're also pretty early stage, like Isaac Health, pretty recently founded companies. I think it's a good indicator that there's some opportunity to really improve patient care here.
Dr. Paul Gerrard: One of the big takeaways is they are designed to be able to take advantage of the Medicare guide model. So it'd be interesting to learn how they are scaling with this and how they are making specialty neurology and psychiatry or other dementia specialty care available to patients.
Dr. Trevor Royce: What I look forward to hearing more about is they have deep clinical expertise. They're taking this tech solution to enable specialty care for this massive problem in healthcare. And it'll be interesting to hear about that implementation piece to a lot of what Paul was talking about earlier. Also, how you navigate changing regulatory landscape post-COVID with telehealth regulations coming on, coming off, and so forth. So I suspect they'll talk a little bit about that as well.
Meet the Founders: The Personal Journeys Behind Isaac Health
Dr. Tim Showalter: Stay with us for our interview with Isaac Health's co-founders, Dr. Julius Bruch and Dr. Joel Salinas. We're thrilled to welcome Dr. Julius Bruch and Dr. Joel Salinas, co-founders of Isaac Health. Joel, Julius, welcome to HealthTech Remedy.
Dr. Julius Bruch: Thank you.
Dr. Joel Salinas: Yeah, thank you. Happy to be here.
Dr. Tim Showalter: Happy to learn more about you guys both and also Isaac Health as well. Paul, you want to kick us off?
Dr. Paul Gerrard: Yeah, I guess we'd love to know just about you as people and your personal journey. What led you to found Isaac Health.
Dr. Julius Bruch: Hi, I'm Julius, CEO, co-founder of Isaac Health. My journey involves a couple of steps. It started really with having a grandmother who had dementia, and I think that's an experience that I share with lots of people because ultimately, dementia does affect one in three people. I saw firsthand just how my family was going through this journey and process and how we had to make many adjustments. First of all, it was really hard to get to a diagnosis in the first place. I think that just reflects of the general lack of specialists here and how complex it can be to get to the right diagnosis, especially if it's not a standard form of dementia. And so really going through the grandmother moving into the home, moving into a nursing home, etc. So that really inspired me to go into medicine first, ultimately to also start training in neurology and doing my PhD in dementia. So my wish and dream was always to help people with dementia better and improve that journey. And initially, my approach was to do this through pharmaceutical innovation.
But that's obviously a long process and complicated process. So after completing my PhD in that area, I actually moved to McKinsey where I saw much more the health system side of this. I primarily worked with payers, so health insurance companies, and again saw the same dementia problem from their perspective as a vastly underdiagnosed and undermanaged condition. And that's when what sparked the idea to start something like Isaac Health, to really create a platform that can scale specialist care in this space. And that's how I reached out to Joel.
Dr. Joel Salinas: I'm Joel Salinas. And so I'm the chief medical officer co-founder for Isaac, as was mentioned before. The way that I came to this, my family is originally from Nicaragua, first generation in the U.S. They came under political asylum, grew up in a very low-income household. And so I'm no stranger to having limited access to health care. Did all of my clinical training at Mass General and Brigham and Women's Hospital. Was faculty at Mass General for a while. Helped to found their Center for Brain Health. Was as clinical director and then in 2020 made the move to New York where I became faculty at NYU Langone.
I continued seeing patients at the Memory Center and on the inpatient consult services and all throughout, I've done a lot of research with the Framingham Heart Study to really understand the epidemiology of Alzheimer's disease and related disorders from a population health data science lens, as well as to understand psychosocial determinants of brain health. And at the national level, I worked very closely with the American Academy of Neurology National Brain Health Initiative. And three years ago, I got a cold email from Julius asking, would you be interested in starting an online memory center? I kind of took it as a sign from the universe. I'd been really staying up late at night, years leading up to that, just really concerned about our health system's ability to handle the huge influx of patients with cognitive disorders that are on the horizon. We often talk about the silver tsunami.
And being in behavioral neurology, really working with individuals at the earliest stages with these conditions and all throughout, it was just very clear that there just aren't enough specialists in this area to manage the high patient load and the level of complexity. So whenever I would see new patients, the first thing that they would say to me is, you have no idea how long it took for us to see you. It started out being six months, eight months, and then it became very clear it was about a year. Now, I still see patients one day a week at NYU, and I'm booking out to 2027.
And that is pretty consistent nationally across all the memory centers. The average wait time is about a year and it continues to grow. And there have been really quantitative forecasts done by groups out of UCLA and the RAND Corporation really showing that in the next couple of years, we're going to be looking at four, five, and sometimes eight year delays for people in particularly geographically isolated areas. And some are keeping showing that people who are dual eligible, who really need this kind of care, are going to have even longer waits, de facto. To me, that's a huge public health crisis. To start to develop a disease process that is impacting your identity.
Your ability to function in the world, how you are able to even care for yourself and make decisions for yourself, and then be told that you have to wait a year or more to be able to find out what's going on and manage it is a real problem. And even more urgent because we have these amazing historic breakthroughs, where we have these disease-modifying therapies, these amyloid-targeting monoclonal antibodies that help to clear amyloid plaque from the brain in the setting of Alzheimer's disease. But at the earliest stages, they're in a very specific window, and people will be likely to miss that window if they have to just wait to be seen. This would be inexcusable in oncology, that you start to develop a mass or tumor or you get something identified and then you have to wait a year or more to get treatment because we know what happens. Within a couple of months to a year, you start to lose your ability to have an impact. This was really what drove my decision to make the big scary leap out of the security of academic medicine and a research career that was really doing quite well and to start Isaac Health with Julius and really proud of the work we're doing. I know we'll go into a lot more detail, but meeting people where they're at by bringing comprehensive, collaborative models of care that have a really great evidence behind them with just basically what is good clinical practice and really shoehorning it within the healthcare system has been part of the innovation here.
Dr. Trevor Royce: Yeah, that makes a lot of sense. In retrospect, it seems so clear and obvious that this need exists, these incredible wait times, the sheer number of people that are impacted by dementia from loved ones to colleagues and coworkers and everyone in between. Question for Julius, was there a moment that really pushed you to act on this and leave your consulting job that sounds like you've been doing for a while and had great success with, to say, the timing is right to do this. It's now or never. Was that regulatory tailwinds? Was it a national tenor towards more virtual care? Can you tell us a little bit about that?
Dr. Julius Bruch: I think all of these played a role, but ultimately it was that I was during the pandemic was doing one project for one of the national health insurance companies to roll out their digital health strategy. And as part of that, we were looking for solutions in a bit of a hurry just to roll them out and get access to the population. And specifically, I was actually looking for a dementia care solution there and there just wasn't any. That was the impetus to say this is something that needs to exist.
At the end of the day, then we tested a few landing pages and saw that there was quite a bit of traction, that people were looking for this kind of care, not just payers, but also people directly, then we started. And then actually, it was quite funny that people started reaching out. For example, we had the chief medical officer from one of the national health insurance companies reach out through a Slack message on the Health Technology Nerds channel to say, hey, I heard what you're doing. I'd love to talk. And so that's how these things really emerged. It's funny that actually, quite a number of our first payer clients we got through proactive outreach, just how people heard from us.
The Isaac Health Business Model: Clinical Expertise Meets Payer Savvy
Dr. Tim Showalter: You guys seem like you bring complementary backgrounds and yet you're both physicians, but have a different lens on this. What is it about your backgrounds that you think really complement each other? Maybe Joel will propose that to you.
Dr. Joel Salinas: We're a good match. We've been working together for it feels like years and years and years and years and years, because it's every waking moment. We finally got into a place where we basically have an extension on our own cerebral hemispheres. I think we kind of know what the other person's thinking.
It is nice that we're both physicians, so we have at least a foundational level of understanding of health and healthcare. The way our Venn diagram works in our co-leadership model is anything that's much more very specific, clinically oriented. Clinical questions, clinical model, where things are moving within the field, those are more clearly my area. And then because of my research background, things that relate to understanding epidemiology, population health, data science, that also falls within my realm.
Whereas with Julius, his background is a really nice complement because his background at McKinsey and another experience that he had, he's able to really think about what is it that payers want and need. He really understands the ins and outs of how the health system works and how it doesn't work and where the value proposition really is. And he's also able to do the things that you don't learn in residency, which is doing really great modeling and forecasting of what to expect over time and really put together really nice McKinsey level presentations that really articulate the main point that you're looking to present and beyond the clinical piece. Because I think if you work within a hospital system, you can think about any kind of quality improvement effort. But if you're not able to articulate it in a way that makes sense within the context of the business, it's going to fall on deaf ears. It's just going to seem like a theory project, to kind of put it crudely.
`[Could not verify with context]` and I work really well. We have this really healthy tension where I'll lean more toward just let's get the clinical care to people's hands. And Julius is like, okay, but let's make this a really workable business model that's compelling.
Bridging the Gaps in Conventional Dementia Care
Dr. Paul Gerrard: You've talked at a high level about the goal that you're trying to achieve and the benefit you're trying to bring to people. And then you touched on that idea of, hey, it's tough to shoehorn best medical practice into the existing healthcare system. And so that implies to me that the conventional healthcare system lends itself to gaps. Do you have a sense on what specific gaps are there in the difference between what the conventional healthcare system allows and what best medical care is? It sounds like you guys are trying to bring best medical care, but what are those gaps that you're filling and what have been the innovations in payment models, both under Medicare and private payers that you think have enabled you to fill those gaps and make a solid business case to do it?
Dr. Julius Bruch: One of the fundamental challenges with dementia is that it really spans the medical aspect and the social care aspect. And that really historically have always been two very different funding sources. Medicare or commercial insurance pays for the treatments and the diagnosis. Then it falls really flat when it comes to the long-term care and support. Medicaid or private payers have always, or people themselves, have usually picked up the bill on the ongoing care, like getting home care, getting additional supports. And that's obviously just as important and critically important, especially to keep these patients in their home, well supported and out of hospitals and emergency departments, because that's usually the worst place for a patient with dementia to be. That is the fundamental problem.
And Medicare's put forward a great new model recently with the guide model that actually merges some. I would say it's an early attempt at merging some of these funding sources and aligning the incentives here. And so it's a single payment model that covers both aspects. But obviously, there's a far way to go in terms of designing more value-based models here in terms of actually measuring outcomes in cognitive health and quality outcomes. I think there's a lot still that needs to be developed and standardized. Here at Isaac Health, we are really at the tip of the spear of innovation here and working with Medicare Advantage plans and Medicaid plans to actually devise some of these quality metrics and outcomes and value-based care models. But obviously, it's a work in progress.
Dr. Tim Showalter: What have you found the overlap to be between the structure of that model and really what you set out to do or what you think the ideal blueprint looks like for Isaac Health? I'm just curious if there are additional services that you think are really important that are not included, or if that shape of that legislation really kind of checked all the boxes.
Dr. Julius Bruch: The guide model is a payment model. I think that we've always got to be clear about that. It pays, I think, for the full set of services that we offer. And in that sense, it's a really good fit. We were obviously doing this kind of care model, comprehensive dementia care model, long before the guide model was even discussed or published or was a thing. And so I think it was a convenient fit. But what Isaac Health does in addition is really to take that payment model and turn it into a clinical model that's really effective. And specifically, the Isaac specific special source really is in scaling that specialist care and also as of really then supporting the members to stay independent. We've developed, for example, a whole compensatory skills training program and similar strategies that really help add the value and really help support this patient population in a way that the guide model stays more and more vague and loose on.
Dr. Joel Salinas: I think the guide model is a really important and historic start to addressing these gaps that we have in the health system. I think the elements that are missing from it, just at a practical level, just thinking about the health system as a whole, is there's a whole other patient population that's being missed from the guide model. There's people who have mild cognitive impairment who are likely to convert to dementia who would benefit from having some additional supports and services and a comprehensive approach earlier on to be able to have a really strong impact on long-term trajectory of the individual. And right now, the guide model is very focused on mild, moderate, and severe dementia.
The other piece of that for other health systems is the feasibility of implementing it. I think it's something that I hear more and more from people who have tried to develop the guide model. That's basically academic medical centers. I've heard many of them had applied, came into the established track and then decided to just forego doing it because they just couldn't make it work.
Because it is quite involved and the payment model starts to align incentives, but the actual reality of it is that the compensation from it for systems, the revenue doesn't necessarily support how they typically deliver care. And I think that's part of what Julius and I have built here at Isaac with our whole team is creating a system that is able to provide that very comprehensive collaborative model that can scale and is able to make use of these types of funds. But we're also able to replicate that within a lot of our partnerships and saying this is the ideal kind of care. And this is how we want to work with you to make it accessible to more people.
Scaling Specialist Care Through Technology and Scalable Workflows
Dr. Paul Gerrard: In your explanation, Julius, you talked about part of your secret sauce being the access to specialist care and at scale. And I'll say anecdotally from my days in practice that that could be really tough to do. How are you guys doing that? Is that just through, you've got training programs, you've got good networks. Is it a technology solution or is it something completely unrelated?
Dr. Julius Bruch: The key here is in the technology. There is really a lot of smart workflow management guidance and really I would say hand-holding the clinician if they are non-specialist to be able to provide specialist care and extending the reach of the limited pool of specialists that we do have that I think is where technology plays a huge role and where I think we've got a great model at Isaac Health now that works really well to scale specialist care in a highly effective way and that can really scale infinitely to cater to the full population.
Dr. Tim Showalter: Am I hearing you right? Is it an interface between primary care providers and specialists primarily? Or where does that scale point happen?
Dr. Julius Bruch: We have different care models. I would say the default care model is really that Isaac Health provides the full set of services and we provide everything through our platform.
Dr. Tim Showalter: And then I've heard stories about wait for initial intake. In terms of the neuropsychiatric testing and the sorts of rigorous cognitive measurements that need to happen in the beginning phase, do you guys have a solution for scaling that as well? It may be hard if you live in a rural area to find a specialist who's ready to administer a battery of tests.
Dr. Joel Salinas: For the neuropsychological testing, our system is pretty standardized. And so what will happen in a lot of health systems is that if somebody refers for neuropsychological testing, they'll see a neuropsychologist, a licensed individual, and then they'll usually have the same backlog that the behavior neurologists will have. So you're looking at many months before you get evaluated. We have a pretty good system where we have psychometrists who are able to administer the battery of tests. So this is a lesser skilled, non-licensed, but certified group of staff. We also have an algorithm that helps to guide which assessments to conduct and when to help to minimize burden for the individual. So that way we're getting only what we need for the clinical evaluation.
I think there's a lot of solutions out there that are AI based or use augmented reality or VR and games. And they've been developing these things for decades now. And I think there's a lot of promise behind them. To some degree, you don't need to do all that. And oftentimes what most health systems and payers really want is the reassurance that it's something that's really well validated and very practical. And on the patient side, you don't really meet them where they're at.
Then you might miss the mark. And for a lot of these patients, they might not have access to internet. That's the key thing or any technology. And so having an app that they can download doesn't really work for them because they have a hard time navigating an app. And it's not because they're cognitively impaired. It's because they just don't have access to those resources, just not part of their day to day. And so we've created our network of psychometrists, and we have our own AI based algorithm around the testing to make it much, much more scalable.
Measuring Success: Clinical and Financial Outcomes
Dr. Trevor Royce: What kind of outcomes or metrics are you optimizing for? What's your benchmarks for success? Or put another way, what outcomes are you proud of to date that you've achieved that kind of reflect the steps you're taking towards that?
Dr. Julius Bruch: There's definitely some clinical outcomes in terms of stabilizing cognitive decline and also helping patients with their neurocognitive goals. But then where we've invested more time is really to measure those slightly harder outcomes of, for example, ED admissions. We've seen a 38% reduction in ED admissions within four months of participating in our program. Also, a 28% reduction in hospital days. So those are where you really see why a payer would be interested in managing this population better because you can really see significant outcomes. But then beyond those metrics, there's a wide array of additional outcomes that we do monitor. Joel, I know if you want to go into deeper on those.
Dr. Joel Salinas: One that I am pretty proud of just speaks to how hard it is to actually scale this kind of care is our operating margin, making sure that we're able to function in a way where there is still some revenue left over to be able to continue to build and compensate people properly and scale the operation. I think that's one of the things that's made a lot of health systems really leery of this kind of care is if they operate on a negative margin, then they're just going to see it as another cost center. And then you go into this death spiral. For us to be able to have a pretty healthy operating margin really makes sure that we have a really compelling argument for building this out and continue to invest within what we're building here so we can reach more people.
From the Front Lines: Patient and Caregiver Stories
Dr. Tim Showalter: I know that since your focus is on patients and caregivers ultimately, and you're really bringing care to folks, curious just to hear the feedback and stories you've gotten from patients and caregivers. Is there anything that's particularly memorable for you, for the two of you, that's really propelled you forward?
Dr. Joel Salinas: Quite a few of these situations. I think just generally a lot of the time I hear patients and families, they'll bring up their care navigator a lot. The Care Navigator is really the heartbeat of the work that we're doing.
They're their main point of contact. They know all their Care Navigators by their first name, and it's very common that they'll get into tears just to feel that they have that kind of support and access to someone who can help to guide them through a really complex situation. People really love how prompt we are, how everything is under one roof a lot of the time.
There are stories that we have that I think really send out to me are the patients and family members where they hear about what we're doing and they'll say something like, we thought this was using an expletive. We thought this was all a bunch of hooey. But now that we're saying this, I can't believe that this is real. And we've had situations where just having a `[Could not verify with context]` come to the home to help facilitate the visit has identified people who are in really dire straits from both husband wife couples where both of them have dementia that's progressing and they don't have any support. And so that's a real recipe for disaster. To coming to the home and finding that someone was down at home, delirious because they had a big medical complication and be able to get a wellness check and get them to the emergency room and give life saving intervention. I think it's really, really powerful what you learn when you're actually going into communities, really coming to people's homes, which is something that, having been within hospital systems for all of my clinical career, you really don't see it because you only see the people that come to you.
Dr. Trevor Royce: Pretty powerful and compelling testimonials there. Julius, Joel, thanks so much for sharing your work with us. You guys are tackling one of healthcare's biggest problems. And I think it's safe to say everyone's rooting for you. And we'd love to see this scale. Best of luck with all your efforts. And that'll do it for today's episode of HealthTech Remedy. Don't forget to subscribe, rate, or share the show. Thanks again. Looking forward to seeing you guys next time.
