Hello and welcome to another episode of SurgiSnacks.

My name is Al Norweb, and I

am the Chief Growth Officer of Surgimate.

And if you like to nerd out about the business

of surgery, you have definitely come to the right place.

SurgiSnacks:

our idea is to provide you with brief 10, 12

13 minutes sessions that you can hopefully listen to

in your car, in the shower, whatever you’re doing,

and get a few insights that will help you

with your running of your surgical practice.

My fearless co-host Justin Rockman is not here with us

today, but I am extremely excited to be joined by the

one and only Ozzie Delgado, the COO of HOPCo.

Ozzie, welcome to the show. How are you doing?

Great, Al.

Really excited to be a part of SurgiSnacks

and getting to enjoy our chat today on it.

Thank you. Likewise.

We’ve talked many times and it’s great to be able

to have you on the show for your unique perspective.

For those that don’t know you or HOPCo,

Ozzie, maybe we could start,

you can give us a quick

bio about yourself and your organization.

Sure.

So I am the Chief Operating Officer at

HOPCo, which stands for Healthcare Outcomes Performance Company.

HOPCo is a company that was founded 20 years ago

by David Jacofsky, who had a thesis on establishing the

model of care for musculoskeletal care way before its time,

when he had a thesis on driving this and delivering

healthcare or musculoskeletal care in a different format.

This thesis that he had, he brought it to

fruition and it started within Phoenix, Arizona, and I

think 20 years later, we’ve seen it expand across

multiple states throughout the entire country.

So really excited about that.

Well, that’s a fantastic story and I really think you

guys have been doing this so long now you’ve taken

your lumps and learned what works and doesn’t work.

So, as our guests may have ascertained, our topic for

today is sort of the intersection between value-based care

and the business of surgery and surgical care.

Ozzie, you may not know this, but we have

a little bit of a gimmick on this show.

We always introduce a snack that’s sort of

representative of our theme for the day.

So I’m excited to introduce our snack for the

day is dark chocolate, which is not too bitter,

not too sweet, just finding that sweet spot.

And we also picked Trader Joe’s

brand because we’re very value-centric.

But VBC, value-based care can mean a

lot of things to a lot of people.

How do you define it at HOPCo?

So, you know, Al, it really comes

down to seeing a patient who presents

themselves with some sort of musculoskeletal issue,

you know, knee pain, joint pain, a

fracture, if you will, and really understanding

how we take that patient, assess that patient,

and really driving towards delivering the

right care at the right location at the

right time and accomplishing the best possible outcome

we can for that patient.

And that’s really kind of in a nutshell as

saying there’s no long way of accomplishing this, but

how do we make this very efficient and accomplish

that outcome at the end of the day?

Okay.

And I imagine your payer model has to reflect that.

So how does that work for you,

at least in some of your markets?

Yeah, it’s a good follow-up.

So for us, obviously, how much is

that really working and putting into play?

So we take full global capitated risk

on musculoskeletal spend overall in these markets.

And basically, the best way to pressure test your model

is whether you are doing a good job of taking

costs out of the system and being fully at risk

to ensure you could deliver that care and accomplish those

outcomes you want to obtain in caring for the number

of lives you are responsible for.

Because that model that I mentioned, that is ultimately

the test of whether we have the ability to

drive that spend down, but not necessarily compromise in

any way, shape, or form the quality and the

outcome that the patients end up receiving.

Okay, so you teed right up into the first

question I really wanted to ask you about this.

I hear generally, not just in the musculoskeletal world, but in

all specialties, one of the concerns around value-based care

is that it can lead to the rationalization of care

in an effort to cut those costs.

So how is it that HOPCo as an organization

strikes the balance between wanting to execute appropriate surgeries,

but knowing that’s one of the most expensive parts

of the care delivery process itself?

Yeah.

So again, it starts with understanding a patient who

presents themselves with a problem, a situation, and an understanding

how do we get with that problem to as

quick of the determination of what the root cause

of that problem is that they’re having.

That in and of itself could undergo many machinations of

how you end up figuring out what they have.

But how do we really use predictive analytics, evidence

based care guidelines to drive towards coming to that

decision as quickly as we possibly can, which, by

the way you are eliminating waste when you do

that, which ultimately translates to reducing overall cost.

Once you’ve determined what the root cause is, then

really what becomes the most cost-effective way to

be able to drive the outcome you need.

And a great example of that al would be

somebody who ends up having an X-ray.

You could determine an algorithm.

You know they’re going to need surgery.

There’s no need to waste time or treatments or

alternative treatments to try to get to that end

result that we’re heading on that path anyway.

That’s how you drive effective value-based care.

Obviously, this involves patient

participation and patient engagement.

Some patients may fear the need or the want to

be able to go and proceed with surgery, as you

mentioned, the potential biggest costs overall in the care.

But if you eliminate that other excess waste overall and get

that to that outcome, if it is a surgical outcome, then

we could kind of cut some costs along the way.

Furthermore, we could get into the conversation of what’s

the right location and what’s the right therapy and

how do they receive that to be able to

drive towards their full recovery and back to normal,

healthy living lifestyle that they were.

I’m hearing what you’re saying.

I think the suggestion is that in some delivery models,

there might be a delay of certain surgical care in

an effort to explore other alternatives, maybe because that’s what

the patient wants, or maybe that’s because of the incentives

of the payer models that exist.

And one of the things you see is that jumping

some of that care and just getting straight to surgery

can actually be the right thing for the patient and

actually ends up saving costs for the overall system.

That’s correct, because when you look at the treatment,

it’s not about the episodic treatment of care.

It’s not about the cost of surgery, but it’s really

about the patient presented at this point with a problem.

What the surgical is just one

episode of that care continuum.

Even the post-surgical period, whether

it’s receiving therapy and recovering, it’s

an entire continuum of spend.

So where can we take the chunks out that are

unnecessary waste, if you will, and we end up cutting

our overall costs in that continuum of care.

This is putting you on the spot, but off the top

of your head, do you have a sense for kind of

the relative portion of the cost that you have in your system

related to surgical care versus non-surgical care?

Yeah, I don’t have that off the top of my head.

But I could tell you that when a patient

will not benefit from surgery because that’s maybe more

on the minority on the musculoskeletal side, but when

they will not benefit from surgery.

The options are still provided for the patient to be able

to feel better and kind of come away with at least

some solution that makes the most sense for them. Right.

Because again, we’re dealing with the humanistic component of

a patient who presents with a problem, a chief

complaint, and our ability is to be able to

kind of figure out what’s going to be the

best outcome for them overall.

And that might be something

related to non-musculoskeletal related.

It might be something neuropathic-related that requires

some neuromodulation or something to that effect.

So really kind of trying to understand and

uncover what that is, helps drive that outcome

we can for that patient, as long as

we’re able to rule out quickly and efficiently

that it’s not going to be solved through

some musculoskeletal intervention for that patient overall.

Okay.

For the benefit of the audience and certainly for

me, can you give me an example, like a

concrete example of a patient who presents where you

find that there’s a certain way that you guys

can optimize that care to deliver a better outcome

to them and lower costs, a specific procedure type?

Yeah, I think I’ll talk at a grander level and

certainly push on me and I could get into more

details, but I think we’re seeing a lot of care

in the United States shifting from the inpatient traditional type

of treatment model to more of an outpatient treatment model.

You’re seeing joint cases, joint outpatient joints being more and

more know where in the past it’s been only an

inpatient hospital type of surgery, if you will.

If you look at the CMS list of

inpatient-only surgical cases, that number has severely

been reduced over the last ten years overall.

So you’ve seen that number of cases go down.

So I think it’s really an example would be

understanding here are patients that were receiving care, surgical

interventions now are being done with same-day surgery.

Go home and spend the evening in the comfort

of your home and having zero impact on the

outcome of how they end up fully recovering overall.

So I think seeing that and that’s just one

small example of what’s out there right now.

Yeah, the push to ASC is enormous,

right, and I almost describe it as violent.

I’ve seen some charts where you see like,

in the last ten years, it’s a positive

violent, let’s just say, but even cardiovascular and

other conditions that you thought could only happen

in the hospital, that’s all going because of

technology enablement and the data that’s showing that

these things can be performed in those environments.

Another interesting angle to this, I was just speaking

with a practice recently that they had a very

long-standing relationship with their local hospital and things

kind of changed and the hospital began to kind

of undercut them and they didn’t have their own

independent ASC, which is now something we’re commonly seeing

with surgical practices.

And it know, obviously put them

in a lurch from an organizational standpoint.

But the thing that really struck me about

it, which ties back to, I think, our

discussion overall is they were very frustrated as

consumers in the local market, that they were

losing access to this sort of specialty care

outside of that hospital network, that they were

literally seeing the outcomes and knowing how the

hospital took care of some of the patients

in that market that their kids, their wives,

their friends and family would actually be getting

a lowering quality of care, which I think

that’s part of where you guys are at

as an organization is the ability to be

truly specialized in the delivery of this care

so you do it better and cheaper than what

the larger institutions might be able to do.

Yeah, I think that’s spot on when you

think of high-quality care outcomes and no

matter what specialty you’re talking about, it’s about

ensuring that you’re doing it highly repeatable functions

and highly reliable functions.

And you might lose a sense of that when

doing it in a multispecialty kind of conglomerate of

we do everything and we’re everything to everyone versus

really going to focus in this kind of wing

of specialty care, but everybody’s going to be completely

aligned and trained and competencies achieved,

and accomplished, where everybody knows this is what we

do and what we do every single day.

It’s highly repeatable and we expect

to highly reliably attain those outcomes.

Okay, well that definitely makes a lot of sense.

And I have a pure business background, really,

and not a clinical background, and minimizing variations

and doing things in a consistent way is

absolutely a principle of good operations.

So it makes a lot of sense.

So, Ozzie, we are up against our time

because we always promise our audience that we

will keep it short and sweet.

But this has been a great primer about

the organization, about HOPCo, about value-based care.

And what I want to turn to as we go

to our next session is how do you work with

your doctors on this and get your perspective on that

because I’m sure that would be very interesting to many

of the folks that might listen.

So let’s pause there.

But for those who are listening, we will be

introducing a second session of this down the road.

So be on the lookout.

Thank you for tuning in.

As always, we look forward to your feedback and

thoughts on the show, so be sure to leave

us notes and we will see you again soon.

Thanks so much, Ozzie, really appreciate your time.

Thank you Al. Thanks for having me.