Speaker 1: 0:00

With all the conversations that we have around problems and challenges in the industry, one of the biggest challenges is the shortest of physicians and we haven't talked about it a lot on the podcast. How do you solve that problem? We'll find out on this episode of Shift Shapers.

Speaker 2: 0:16

Change either energizes or paralyzes. The choice is yours. This is the Shift Shapers podcast, bringing the employee benefits industry interviews with individuals and companies who are shaping the industry shifts. And now here's your host, david Saltzman.

Speaker 1: 0:37

And to help us answer that question, we are joined here at the Ascend Conference in beautiful Salt Lake City, utah, by Lorenzo Amaya. Lorenzo is the Vice President of Business Development at Integrated Source One. Welcome, lorenzo. Thanks for being here. Thank you for having me. So let's talk a little bit about as I mentioned in the open, but before we get to that, let's talk about how you got to be doing what you're doing today, because everybody's story in this business is a little bit interesting, sure, how'd that happen? How'd you end up where?

Speaker 3: 1:05

you are, I'm going to give you the Reader's Digest version. So, I've been in banking for 20 years and actually started out because I went to church with a good friend of mine who was in the telemedicine space and helped that company build, went from 54 employees to over $4 million in annual revenue and oversaw the reseller, broker and white label channel and just found a love for the healthcare space.

Speaker 1: 1:29

Interesting, so that's a great place to come to. So let's talk a little bit. Let's set the table. We talked in the open about the shortage of physicians. I don't think it's a problem that gets talked about a lot because everybody thinks, well, there are doctors on every street corner and you can go find somebody whenever you want. What's the scope of that problem? How big a problem is it actually?

Speaker 3: 1:48

in practicality. Well, I mean, from a practical standpoint, people are experiencing it just, and I'm sure we've all experienced it on some level. But you know something as simple as my daughter waiting to see her OBGYN for five months, and there's been stats a growing stat of shortage of physicians for over the last five months, and there's been stats a growing stat of shortage of physicians for over the last five years, and they're saying it's becoming more and more of an issue. So accessing quality of care, accessing affordable care and in a timely fashion.

Speaker 1: 2:16

You know we'll discuss all those things, so I think those are very important aspects also. But to what do you attribute the lack of physicians? I mean, when I was growing up, every mom and dad wanted their kid to be a doctor, right? And now all of a sudden, we're not graduating enough doctors for the population that we have. What's happened?

Speaker 3: 2:33

Look, I believe what we're seeing in. We live in a litigious society number one, right, and so you see all these lawsuits that take place and lawsuits on malpractice and all these ridiculous things taking place, but aside from that, you're seeing a lot of the red tape, you know, with the insurance space. Doctors having to which is a good thing having to comply and all the paperwork that is necessary right In order to just have or deal with a Medicaid or Medicare patient is a good example.

Speaker 1: 3:03

You know, I I wonder, if you know. You go into medical school because you really have this desire to take care of human beings and then you get bogged down in all the malarkey that our industry you know serves to you, and so you're not helping patients. You've got to see somebody every seven minutes. You're $300,000 in debt. I mean, are people just opting out and saying you know what? It's just not worth it.

Speaker 3: 3:27

It's a great point because I think the reality is doctors are getting bogged down more with the administrative stuff, which is the stuff they love doing, which is the stuff they don't like doing, because they went to school to deal with, to help people right.

Speaker 1: 3:41

One of the things that you touched on in our first question is not only the shortage of doctors, but quality. Now, we've danced around quality in this industry for a long time. I've been at this since dinosaurs roamed the earth, and I've heard about quality back since the early 80s, but it seems like it's one of those things that a lot of people talk about, but not anybody has done a whole heck of a lot. What's happening about quality and marrying quality with availability and accessibility?

Speaker 3: 4:06

The industry is experiencing when we talk about quality of care, is that now, with limitations on the care that you're given, doctors are giving X amount of dollars. If you can't deal with that with the patient, then you need to figure out and it comes out of the physician's pocket, right? So here now we're saying, okay, I run lab work, I run an MRI, and when that's not sufficient, what else is needed to do in order to make sure that patient's going to come back with a healthy profile. When I say that, it's like have I taken all the necessary steps to make sure I can diagnose this patient and treat them properly?

Speaker 1: 4:43

How do you? I mean, are there objective metrics by which you can, you can judge quality? You know, one provider to the next, to the next, it varies, right.

Speaker 3: 4:51

If you're going to a cardiologist versus a urologist, or whether you're going to a diabetic specialist, a urologist, then it all. All those things come into play.

Speaker 1: 5:02

So this, this shortage of physicians, is that kind of what you you know, you mentioned that you were involved in telehealth early on Is that kind of? What gave rise to the need for telehealth Was both the lack of physicians in general and accessibility.

Speaker 3: 5:15

I believe it did because it realized that we could do more, virtually, than we ever anticipated. And, shockingly enough, even though telemedicine has been around for 20 years, it really didn't blow up until after COVID. And then, after COVID, we saw the great response to virtual primary care. So to help flatten the curve of the COVID virus, they were saying, okay, keep people going into the hospital where there's other sick people. And so what they allowed people to do to flatten the curve is, they said, okay, so long as I'm having this continuity of care with the same physician, you mean to tell me that I can go and get my chronic care medication refilled that I've been getting for the last five years virtually for 10 minutes, instead of taking two hours off of work sitting in the doctor's office? Have my high blood pressure go up because?

Speaker 1: 6:07

my appointment was at 12, and it's 1 o'clock and I haven't still seen my doctor, and we've certainly all been there For sure, and you know it's not a fun place to be, For sure, Is it?

Speaker 1: 6:15

do you think that some of the pickup on telemedicine was generational? I mean, we're now. We've now got adults who are the first generation born with smartphones in their hands. Sure, We've now got adults who are the first generation born with smartphones in their hands. I remember years ago we had flip phones and T9 dialing. Anybody who's old enough to remember T9? Dialing should probably be thinking about retirement about now, but was that part of it? Are they more amenable? Is the younger generation more amenable to doing things via the phone?

Speaker 3: 6:37

Absolutely. You know, technology is constantly evolving, right, and the idea of you know picking up the phone and speaking with the doctor is great, but, to your point, we live in what we call I think they call this generation, you know the slide generation, where they slide left, and so the ability of not speaking to someone and being interacting, whether that be via text or whether scheduling that appointment on a, on your, through an app or through a web browser, it makes it. I mean, this is the generation we live in.

Speaker 1: 7:10

In best practices. If I'm having a telemedicine visit and it's clear that I actually need to see a doc, how do I do that? How do I do I then again run into the roadblock of lack of accessibility, lack of availability?

Speaker 3: 7:27

Look, great question. The idea is, one of the things that we see in the space that becomes a hurdle is that the typical method of scheduling a consultation is calling in, you're going into a call center, the call center then hopefully it's a, you know, a medical advisor of some sort that's familiar with the terminology. But what they do is they'll schedule that consultation with the doctor and then that consultation begins To answer the question that you were asking is it makes it easier when you can mimic that of a brick and mortar and when I say that walk into a hospital, walk into a physician practice, you know the receptionist checks you in but the nurse is the one going in, taking all the triage information, prepping you for the doctor. When the doctor come in, he just literally confirms what the nurse says and the rest is over.

Speaker 1: 8:17

Now I know one of the ways that some employers have tried to solve this problem, to unravel this, is by doing on-site and near-site and even bringing in mobile clinics. Talk a little bit about that. I mean, what kind of an employer decides that they want to do something like that?

Speaker 3: 8:34

Look, it's not a one-size-fits-all. And when we look at adding or putting, let me just, when you're looking to putting in an on-site, near-site, let me just when you're looking to putting in an on-site, near-site or mobile clinic, it really depends on the pain points that employer is experiencing at that time. So we would assess or I'm trying to say I know you won't Every client is assessed differently. So we build the box, as opposed to putting that client into a box and having them say this is what we have, this is what we have to offer and moving forward and now a word from our sponsor.

Speaker 1: 9:14

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Speaker 3: 11:01

Not necessarily. Again, is there space that this employer has? You know we're talking, we have currently. There's currently a university that had the space and essentially we just facilitated that space and we equipped it accordingly, based on how many people would be Is it just going to be the student or is it just the employer group? So we facilitate and equip it depending on how many people were going to be utilizing that clinic.

Speaker 1: 11:29

It's interesting. I mean, I think most people kind of conceptually understand on-site clinics. I think everybody understands mobile, right yeah, for people who don't know what is a near-site clinic and where is that applicable, where does that fit, where is that a good solution?

Speaker 3: 11:42

A near-site would be something along the line of let's think of a trucking industry. A guy driving a tractor trailer cannot pull an 18-wheeler into a Baylor Scott and White. So we would then put a near-site clinic either in route for that tractor trailer or for that trucking company that they're familiar or they're running, and it would be a near-site clinic versus a mobile clinic at times. So it literally would be something within route.

Speaker 1: 12:11

Are near-sites, a solution that's also used by perhaps a group of employers who are, you know, not co-located but within a reasonable distance of each other. It's almost like creating a little center.

Speaker 3: 12:21

Absolutely. So let's take something like Maine right, where you don't have a bunch of physician practices. Maybe that would require us going in and looking for a physician practice near that employer group and then us working with that physician practice, saying, hey, we have an employer group with about 150 employees. What would that look like if we started steering them towards you?

Speaker 1: 12:44

In your experience, and I'm sure it varies, but do a lot of employers include employees only or do they include family? Is it just dependent on how the employer sees their population?

Speaker 3: 12:54

It does, and typically you see it just for the employee. And this is when the virtual piece would come in handy, because, to your point, if it's just the employees, well what are you going to do if a family member or if that employee gets sick and they're away from work? So this gives the ability of having that virtual access as well.

Speaker 1: 13:14

Is. You know? People who've been on the podcast a number of times have heard me say that, unfortunately, as an industry, for a long time we've spent of necessity, we didn't have the tools. We spent a lot of time looking out the rear view mirror and not out the windshield. Does this help companies and people who pay claims be more proactive rather than being reactive, and if so, how, and can you give me an example?

Speaker 3: 13:35

Great question. So typically, yes, we would like to say that we think proactively. Right, we want to do something before something episodic happens. Right? The idea of knowing that you have someone or having they said well, let me back up a little bit. There's a stat that says half of the American population are walking diabetics and don't even know it until something episodic happens. Right? So the idea that you realizing you're a diabetic because you passed out, you're in the hospital and you just racked up a $100,000 bill. So if there were ways that you could actually build continuity of care with a physician and explain how you're feeling, have blood work done? Now you take the guessing game out of your health. They could look at your blood work and say okay, you know what, your insulin levels are high. Well, these are out of range and now you can do something proactively about your health before something episodic happens. Absolutely.

Speaker 1: 14:31

So I'm a benefit advisor. How do I start having this conversation with the groups that I serve?

Speaker 3: 14:38

I think it's we fit in and the good thing is we're not insurance right. We could be added at any given time. So there's no open enrollment or any special time. We're not, you know, can be bolted on in any you know, onto any plan. These conversations are great because everyone talks about reducing costs and mitigating risk, but that only really happens if you can keep the employee out of the ER. What are you going to do when that face-to-face is required? So the ability of having that urgent care accessibility is great. The ability of having that virtual primary care accessibility is great. But when that face-to-face is needed, because x-rays you cannot do virtually, sutures aren't going to be done virtually. So we can now steer that individual towards a doctor network to make sure that they get the proper care they need at an affordable rate.

Speaker 1: 15:30

And as the advisor for this firm do, I have to do a lot of employee education. Is that changing? Is it becoming a more normal part of what employers offer, or how do I have to get to employees to get them to utilize these services?

Speaker 3: 15:44

That's a great question and it really boils down to look. We always talk about utilization in this industry, right, and utilization is only going to be good as awareness and education. So it's making the employer as well as the employee know not only how the plan works, but when and how to use it.

Speaker 1: 16:05

Do they do this with an app, or do they do this over the phone, or do you try to meet them wherever they?

Speaker 3: 16:10

are. We meet them on site. So many times we go on site educating and that would be anywhere from going in person. Anytime a new group is coming on, we make an effort to be there during that open enrollment to make sure they're educated properly. But then we have Zooms that we can educate not only the HR but we can educate the employees as well.

Speaker 1: 16:33

Well, that's an interesting question. How does this sell to HR folks? Do they see it as one more thing they have to deal with, or do they see it as taking up, generally speaking, as taking a problem off their plate?

Speaker 3: 16:42

I would like to see it as an advantage is where we kind of work with the HR person, because they're juggling so many balls and they're trying to keep them from hitting the ground. Yes, we work with HR to make sure that this is seemingly integrated into their plans.

Speaker 1: 16:59

So put on your crystal ball and, you know, think a few years down the road. What are the inroads that these kinds of services have made and where do you see it going?

Speaker 3: 17:12

services have made and where do you see it going? I think having the ability to have quality of care, the accessibility of the care, affordable care. What I didn't know when I got in this industry over seven years ago, I didn't know that many of these urgent cares were owned by VCs. Was not aware of that until seven, seven, 10 years ago. When you have a practice that's ran by physicians and not VC, the love and the quality of care that an individual get is different from just a bottom line.

Speaker 1: 17:40

Tell me about that. How might that manifest itself if I'm a patient?

Speaker 3: 17:43

Well, look at it this way If we have an onsite clinic or we have mobile clinics, we have these in place. They're not owned by a venture capitalist. They're not looking for an ROI. I mean, they're looking for an ROI. I apologize For us being in this space. When we create these clinics, we're making care accessible right, Whether that be in a rural area, whether it be on-site, whether it be near-site, whether it be mobile, we're making it just care accessible.

Speaker 1: 18:18

We haven't talked about that a lot. I mean, do you see a lot of play in underserved areas?

Speaker 3: 18:23

Absolutely. I mean many of it. A lot of it has to do with, you know, just building a facility and the cost of erecting the facility and then the structure of having the infrastructure for having, you know, the internet, and so many people don't have that accessibility of, as we take for granted, just opening up your laptop and having a video consultation. Most people don't have that. So the idea of just going in and physically seeing a physician, it's still a good thing.

Speaker 1: 18:50

Why, in your opinion, why is this a better solution than urgent care? Is it that rearview mirror or windshield thing? Again, yes, absolutely right.

Speaker 3: 18:59

And, by the way, there's a stat right now that states more than 80% of urgent care visits can be handled virtually. So you're thinking of your low and common acute conditions, right? So we're talking about cold flu, fever, pink eye strep, throat, swimmer's ear, the list goes on and on. They say more than 80% of ER visits aren't of an emergency. So we have the ability of addressing those low and common acute issues. But then when that face-to-face is needed, we do provide that ability for someone to see a physician face-to-face.

Speaker 1: 19:33

Well, and that's kind of like a trifecta it's better care, it's better outcomes and it's way lower cost for the plan.

Speaker 3: 19:38

Absolutely, absolutely.

Speaker 1: 19:40

Have you had any self-funded employers chat with you about them seeing this as part of their fiduciary responsibility?

Speaker 3: 19:48

Just like you know, we're here at the conference and they talked about the conference. There's that line, right, that we're fed and so, yes, we fit well into a self-funded or a level-funded plan. Right, because the idea is we want to reduce costs and mitigate risk, and we talked about earlier. The only way that's going to happen is if you can keep the employee out of the ER. The only way that's going to happen is if you can keep the employee out of the ER, so we could say, okay, great, before you go into a hospital and rack up the bill, why don't you go to one of these doctors within our network? And there's no additional cost, there's no deductible, there's no copay. Therefore, it keeps the claims bucket clean.

Speaker 1: 20:29

Yeah, I mean, at the end of the day, the things that people are gravitating towards today, especially the younger generation, is places where there's no friction.

Speaker 3: 20:33

Absolutely.

Speaker 1: 20:33

And if you can provide good care without friction, it's easier to get buy-in. I would imagine Absolutely what a great place to end our conversation. Lorenzo Amaya, vice President of Business Development at Integrated Source One. Lorenzo, thanks for a great conversation. Thank you, sir. I want to give a quick shout out to our sponsor and our producer, hatcher Media. Hey, if you need podcast production or professional graphic design, josh Hatcher is the expert to contact. For more information, visit him at HatcherMedianet. That's H-A-T-C-H-E-R Media dot net.

Speaker 2: 21:16

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