Business Solutions: Putting Patients First with Technology and Holistic Healthcare
Download MP3Well, hi, everyone. I'm Daniel Williams, senior editor, of Industry Content and host of the MGMA Podcast Network, and I am here today with doctor Romy Chopra. We are gonna talk about a variety of topics today, but we're really looking at a theme here about putting the care back in health care. First of all, doctor Chopra, thanks for joining us.
Dr. Romy Chopra:Absolute pleasure. Thanks for having me.
Daniel Williams:Yeah. So I wanna go to that comment. We were speaking offline. You put that quote into my head, and, I wanna repeat it again. You said was you wanna put the care back in health care.
Daniel Williams:Share your thoughts on that statement.
Dr. Romy Chopra:Yeah. I've been doing this for a very long time. You know, I got into med school. I was 17 years old. My passion is taking care of people.
Dr. Romy Chopra:I tell myself I'm a humanist, and I believe in the human condition. And as I went through, I started in India all the way through Harvard Medical School, shared large departments, and health care become very transactional. And humans have three levels they live on, the body, the mind, and the spirit. Body is physical, mind is where you think, and feelings. And that's the thing that I found most was people were just treating other human beings like machines doing a procedure, not caring about it.
Dr. Romy Chopra:I'm an interventional radiologist. I used to see staff yelling at patients, don't move. I'm like, he's not deaf. Show some care. And so and to me, kindness is the core human value.
Dr. Romy Chopra:You cannot care if you're not kind, and those who don't care shouldn't be in health care. And we as humans are not capable of taking care of ourselves. We need prenatal care. We need postmortem care. And in the richest country in the world with the $4,000,000,000,000 economy, it was always about you know, if you go to big institutions, it's about the institution or the technology or something else.
Dr. Romy Chopra:But we as humans need care all the time. And it for us, you may be in the world, but, actually, the world is in you. I see the world as I see it. It's my paradigm, and we all wanna be cared for. And years ago, I said, you know what?
Dr. Romy Chopra:Why don't we put the care back in health care? That's how I got on this mission, and I've had this passion. And the only way to do that today is to really transform digitally and make life better with the patient as the center of our universe, which is everybody. So
Daniel Williams:Wow. That's a beautiful statement. Now if I heard you right, you you said you got in health care in at the age of 17. What got you interested in health care in the first place?
Dr. Romy Chopra:So, you know, I the youngest of seven kids back in India, and it was a different time, 07/19, '79. And, 17, I just felt like I gotta get the health care. I truly believe that there are no accidents in the universe. I thought I was first gonna be, you know, an engineer of some sort. As a young man, as a teenager, you get influenced by people.
Dr. Romy Chopra:But I had the opportunity to interact with a couple of physicians. I was ill. Not not ill that severely ill, but I remember just meeting this doc, and he put his hand on my belly. And the feeling I got, I said, woah. And, since then, I said, I'm going to medicine.
Dr. Romy Chopra:I had older siblings in medicine, cousins in medicine. And in India, if you were to be successful, they wanted you to be a doctor, an engineer, or very wealthy businessman. And I was just following my calling and landed up in med school.
Daniel Williams:You are currently, the chairman of Mehmet Health. Tell us about what is your what do you see as your role there, and what's the role and the objective of Mimit Health?
Dr. Romy Chopra:Yeah. So the first thing is my role at Mimit Health as the as the leader, the founder and leader, is I wanna put a dent in the universe in how we, you know, practice medicine. Done this at many different levels. And so we knew that we wanna do patient centered, evidence based care, do it better, faster, cheaper. And the other paradigm was center on the patient, connect with them, and collaborate for their success.
Dr. Romy Chopra:All of this is very true outside of health care, but health care is just once you come into health care, it's as if you are living in a different world. So I took Mimit Health to kinda do that. We're a multi specialty group. And, I I'm an interventional radiologist by training, but more like an endovascular surgeon. I do a lot of endovascular work, but we do a whole bunch of other minimally invasive surgeries.
Dr. Romy Chopra:But we have, anesthesiologist. We have primary care. We have a general surgery program. All of this centered around taking care of people. And one of the things that I was very passionate about was finding the ways to continually improve to provide that kinda in in that paradigm.
Dr. Romy Chopra:So my job today is, other than taking care of patients, is build an organization, provide the leadership, and develop the systems to make sure we meet that mission. What's our mission? To help people live their healthiest, best lives. You know, if you have mice at home, you're not looking for the fanciest mousetrap. You wanna get rid of mice.
Dr. Romy Chopra:Same way people wanna live healthy. The word disease comes from when you're not at ease. And, you know, at the spiritual level, I always find it fascinating. We as humans, especially in this country, we're always hunting for diagnosis Worse is what people want us to feel well. And then when they feel well, they want the best option for them.
Dr. Romy Chopra:And that may not just be a surgery. It's it's all the things combined. So I say holistic means from meditation to AI. We have AI tools. We have lasers.
Dr. Romy Chopra:We have fancy equipment. But at the basic human level, you gotta touch that person's soul and connect with them at the spiritual level. It may just be holding their hands and say, please don't worry. Take I teach them breathing, teach them some meditation. That's the kind of paradigm.
Dr. Romy Chopra:That's what I mean by putting the care back in health care.
Daniel Williams:Yeah. Thank you for sharing that. You and I were talking offline earlier today, and you were talking about the quadruple aim. You were talking about how that is integral to your philosophy in your practice. Tell us about that.
Dr. Romy Chopra:Yeah. It's now actually become the quintuple AMGFI. Okay. Institute for Healthcare Improvement, Don Burwick. Years ago, I was a young fellow at, the Brigham and Women's part of Howard Medical School.
Dr. Romy Chopra:I was given a project that nobody wanted to touch. It was on quality management thing, quality assurance. Everybody hated that word. I loved it because it was like, well, there's something and I learned process engineering. I learned a lot about, you know, quality management.
Dr. Romy Chopra:There's Don Burwick, who was leading that. He talked about how you can spend a spacecraft to Mars, but why can't we figure out health care processes, etcetera? So from then on, I started looking at this, but the Institute of Health Care had first the triple aim. It became quadruple, and now it's quintuple. So what are those?
Dr. Romy Chopra:First is excellent quality of care. Second is an excellent patient experience. Third is cost effective care. Fourth is avoid provider burnout, the team's burning out. And fifth is equitable care.
Dr. Romy Chopra:And equity is not just about money. Equitable is about the social determinants of health. You may live in a ZIP code that you won't get help. Transportation issues, education level, poverty, not you know, food issues. So you kind of balance that to take care of the population.
Dr. Romy Chopra:Now outside of health care, I'm sure you buy from Amazon, don't you? Mhmm. Give me an excellent product, excellent care. You get a great experience. If you have any problems, you'll get excellent customer service.
Dr. Romy Chopra:Third, they they make money. You make money. Amazon cost will always give you a better deal than anywhere else. Well, you'll never meet a stressed out, Amazon employee at least customer facing. And fifth, they don't discriminate.
Dr. Romy Chopra:They'll get it to you. They don't care. It's equitable. Why can't health care be like that? And that's the question I always post to myself.
Dr. Romy Chopra:Why can't health care be like that? And then I start taking technologies. Our patients can text us, email us. We've taken the best of practice in other industries and have started bringing it on using technology. I learned a long time ago, technology is here to stay.
Dr. Romy Chopra:I mean, all the conversations about AI, it's not changing humans at all. You know, AI is just machine learning based on large language models. And having said that, the basic human need has not changed since man was walking the earth for the first time. Live, love, learn, leave a legacy. You want physical survival.
Dr. Romy Chopra:You wanna be loved and cared for. You're an intellectual, survival, love. And then we wanna live immortal, but we can't physically, so we leave our names behind. That comes from Steven doctor Steven Covey, the seven habits of highly effective people. But those are the core human values.
Dr. Romy Chopra:So when you keep the quintuple aim in mind and you anything we do must fit those four five criteria, guess what? It works. Wow.
Daniel Williams:Alright. Let's shift gears a little bit, and let's look at clinical burnout. We know that it is, it's an epidemic. You know? There is a lot of issues with burnout taking place.
Daniel Williams:Are there ways to solve this? If there are
Dr. Romy Chopra:Oh, we have to start a large degree. You know, I've recently hired over six to eight, nurse practitioners In the new paradigm, we we we built a a digital platform to the best of technologies elsewhere tied with EMR. So the two sources of truth, the EHR, and then you have a patient engagement platform or practice management platform. And we use scribes. We use all kinds of technology, which is obviously safe, secure, HIPAA compliant, etcetera.
Dr. Romy Chopra:The biggest complaint I get from my providers is and this was a huge compliment to me, they said, you know, we can't work anywhere else because after five, they don't do any charting. You know? All the information is managed. Health care, other than physically what you do with the human being, is a data information knowledge game. Why did I say data information knowledge?
Dr. Romy Chopra:You need data at the core. Those are like the bricks. You process data a little bit. It becomes information. It's internalized, and it's organized a little bit.
Dr. Romy Chopra:Knowledge is now internalized. You know it. But where we really need to live is the wisdom level. Why do we do this? So we've taken that so and the burnout dis dissipated fast.
Dr. Romy Chopra:A physician who's highly trained and other providers highly trained, why would you want them do scheduling? Why do you want them to type sitting in front of a computer when your job is to be with a human being, find out what the problem is, meet the goal, which is to discover what's the cause of those problems and then eliminate them, that's your care plan. So we have built a paradigm where the providers do what they are best. I use the paradigm of flights. See, each patient care episode journey is a flight.
Dr. Romy Chopra:No flight in the world takes off without a flight plan or without control tower knowing. For human beings, if you go to another human being if you have a problem. So pain in my legs. Problem. First goal is discover why there's a problem.
Dr. Romy Chopra:Eliminate the problem if you're pain, which is a problem, maybe painkillers, but discover what's causing the problem. Now you have a problem. You have a goal. Now you got a care plan. That's like your flight plan.
Dr. Romy Chopra:Based on that, you have action items. Patient care is a journey, and we just like flights, I use the paradigm of flights. So any episode of care is like a flight taking off and land. Patient journeys are more complex than flight plans. No flight in the world takes off without a flight plan or without control tower knowing.
Dr. Romy Chopra:The same way with patient care journeys. Patients come to us with a problem, then you have a goal. And first goal is to find out what the problem is, discover the cause, and then put in some plan to get rid of the problem. That becomes a care plan. And those care plans now have to be managed by a care coordinator.
Dr. Romy Chopra:And the provider is like the pilot. So you don't see the pilot getting off the plane to go de ice the plane. The control tower does it and tells somebody else to do it. The same way we have built the platform now that allows us to create a care plan that other people are running it. In the past, I've done this for forty years or thirty years.
Dr. Romy Chopra:I've been entering stuff into EMRs. Nothing comes back. You you don't get insights out of it. So the real thing is actionable insights. And at the wisdom level, why do we do this?
Dr. Romy Chopra:How do we do this? We've also made it where with technology now, we are connected with the patients. They can text us, email us, call us, live chat, whatever that may be. But, you know, I we've developed what's called omnichannel health care delivery. What does that mean?
Dr. Romy Chopra:Patients live at home, so we do home visits. If they can't come to us, we see them in clinic. See them in the hospital. See them in nursing homes, and we do televisits. Yeah.
Dr. Romy Chopra:I don't know where else they would be. Right? So we provide care to them in all these environments. We then do omnichannel communication. Text us, email us, do face to face, whatever that may be.
Dr. Romy Chopra:For those who are marketers, you do omnichannel marketing because some people like Facebook, some like Instagram, some like email, whatever that may be. In that paradigm, it's about being connected with the patient and providing them care when they need it, including ePrescriptions. The biggest challenge today is actually dealing with payers
Daniel Williams:Mhmm.
Dr. Romy Chopra:And preauthorization. So we build systems around that. We do what's called a patient three sixty. So when a patient comes to us, we know what we need to know about them, including medical information, but how to reach them, email, mobile messages. We text them.
Dr. Romy Chopra:We have marketing journeys that we'll do, where we, you know, educate them. But beyond that, we also know the household, who's their caregiver at home, whether it's a nurse, a parent, a loved one. We have we connect with them via messaging, email, and then also the payer. The payers are probably the biggest gatekeepers right now. And you may have, you know, their payers, United is worth $492,000,000,000.
Dr. Romy Chopra:Mhmm. And each plan has a different, you know, criteria based on their stop loss ratio, so however they manage their business. And the same company with different plans will have different criteria, and preauthorization will be a nightmare. But we figured all of that out for the patient's case, for the provider's case. That's how we use technology in in providing them.
Dr. Romy Chopra:I'll try to touch upon all the points for you a little bit there so you can lead on to the next thing.
Daniel Williams:Sure. So let's talk about some tools then. You had mentioned earlier, electronic prior authorization. I'm curious what tools you're utilizing for that as well as reconciling any prescription costs you come across with.
Dr. Romy Chopra:Yes. So the first thing, you know, I've been doing this a long time. I work with every EHR that's out there. And, also realized that EHRs are the source of truth for medical information. They are not the source of truth for engagement.
Dr. Romy Chopra:They are easy enough to engage. You can't get I I remember I needed just one field. It took five years, and I still didn't get it. Mhmm. Finally, I've, come upon AdvanceMD, that SaaS based, and I can create a field.
Dr. Romy Chopra:We understand it. It's on FHIR standards. But in it and they have open APIs. The other thing is everybody lives on their mobile devices as you know. So we have invested heavily in platform for practice management and patient engagement.
Dr. Romy Chopra:So took the EHR, AdvancedMD, for example, has a medical record, has stuff in the front for about scheduling, etcetera, and then has revenue cycle processes at the back. We took that. We took things like Salesforce, Box, Amazon Web Services, Vonage, different technologies that we've wrapped and built up a platform. We've actually spun it off into a management service organization. If you get a chance, look at it.
Dr. Romy Chopra:It is cimss.com, Sims. And what we did there was try to provide a comprehensive integrated management system that provides all these solutions. That's the acronym for SIMS. And with that platform now, every democratization of data, my front desk person, my marketer, my billing person, the provider, the nurse, everybody can see this on their handheld. So we've used technology that some of the top tech companies use to kind of bring this in.
Dr. Romy Chopra:So we do pay a $3.60. It means I every plan, we know what criteria they meet. People are talking about AI, this, that. Well, we've been using it long time now. We took Salesforce.
Dr. Romy Chopra:We took the when they tell us a certain plan and has these criteria, we have taken those criteria, made that into an internal knowledge base that is available to the provider at the time of service or to the care coordinator or to the person doing the pre auth. Some and and there are different tools out there, but the one two two, we use AdvancedMDs for medication, you know, getting pre authorization because we do e prescriptions. Earlier, it was a nightmare. We used to have to write all these things, print it, fax it, keep it here, keep it there, including the, controlled substances. And now it's all we don't write a single piece of paper, rarely.
Dr. Romy Chopra:We've got some that we keep on the lock and key. We've even had somebody stole some of mine and kind of fake signatures, etcetera. All that all that is gone. But even once you send the escript, you have the patient's mobile number, advancing this platform will and the pharmacy, they talk to each other through Shure scripts. And next you know, they are actually getting text messages, hey.
Dr. Romy Chopra:Your med medication's ready. We use a pharmacy that, actually does home delivery for patients. So that's for talk about equity of care. Older people can go to the pharmacy having problems, etcetera. But, also, we do the reconciliation of meds as well.
Dr. Romy Chopra:And pain also, chronic conditions, eighty percent of Medicare's budget. And in that, one of the things we know that, as patients go here, they go there, they're all over the place. They even go to a pharmacy. So being part of SureScripts and in advance, I mean, we have clinical information exchange. That works with care equality and basically almost every large systems out there, PCC, Cerner, Epic, all the pharmacy, etcetera.
Dr. Romy Chopra:So we see in our EHR a summary that shows up and say, this is the location summary for the patient. This is where he's been. These are the docs. Here is a a CDA document that says, here's a clinical summary. These were the meds.
Dr. Romy Chopra:We can see their problems, their meds, and we have a team of care coordinators that look at all of this and say, hey. Patient a, b, c, you know, you forgot. You got twenty minutes, but do you take these? Oh, yeah. I forgot.
Dr. Romy Chopra:So that helps us.
Daniel Williams:Right.
Dr. Romy Chopra:Similarly, through that technology, we are able to send information, clinical information exchange, to another provider. It's actually Medicaid mandates that is direct messaging. So we can look up in our EHR the particular number, name of the doc. We know we have it. Send the clinical summary over and vice versa.
Dr. Romy Chopra:Yeah.
Daniel Williams:So, doctor Chopra, before we conclude this conversation, I really wanted to talk to you about a topic that, we had talked about offline, and that's about payer clearance. I wanted you to elaborate on that and how it solves for prior authorization.
Dr. Romy Chopra:So, you know, I joke about this that, connecting with the payers like praying to God. Nobody's met God. God never talks to you back. If you do, then people think you're schizophrenic and you're on some meds or smoking something. It's the same with the payer.
Dr. Romy Chopra:You send the claim. They pay you if you have if you're lucky. If you don't, you send an appeal. Try calling them. It'll take you two hours on the phone.
Dr. Romy Chopra:And, you know, if you ask them the name, they only give you the first name. You can text them. You can email them. They'll do some stuff in there. And so and every payer, it's it's very opaque to say the least.
Dr. Romy Chopra:And at the same token, one of the things is they have all these plans, and now they have Medicare Advantage. Medicare Advantage is not Medicare, and it's not Advantage. It's a glorified HMO. I might get in trouble for saying this for some people, but it's the truth. You know, the companies I know several people in the business.
Dr. Romy Chopra:It is a way to take the money. They have stop loss ratios. They gotta manage. They try to get more money by all the diagnosis codes, chronic codes, then they gotta tighten the purse strings. As soon as it comes to the end of the year, closer to the end of the year, they they do all the analytics for their stop losses.
Dr. Romy Chopra:If they're getting close, all of a sudden denials, then they start retrospective denials. So we have actually tracked every payer. Payer is just the company. Then every plan, we actually rate them. And I even know what and they all they are by law not allowed to make more than a certain amount of money depending on their size, 15 to 20%.
Dr. Romy Chopra:But they use intermediary companies. You'll have all these whatever name health company. They do peer reviews. They do all this stuff. They play all these games.
Dr. Romy Chopra:I got denied on a report of $20,000 surgery because of the word occlusion was somewhere in the report. The same company has with guidelines on a different plan, pay pay pay does no problem. Patient has done fantastically well. He's been my patient for twenty years. We saved his limb.
Dr. Romy Chopra:So the best first thing is we do something called p three RM, patient relationship management, so patient three sixty, provider relationship management, who are all the providers, what do we do. But third is payer relationship. So you do a payer three sixty. So sometimes when they come in and I see their payer, the plan, I know exactly what's gonna happen. And I tell them, the patient, this is what most likely will happen.
Dr. Romy Chopra:And that so in that spectrum, first is knowing the payer and the plans, then they all have care determinations. They have all these guidelines. Guidelines are not for care. It's about what to pay for and what not to pay for. And then it's a documentation game.
Dr. Romy Chopra:You know, one patient had symptoms, got rest pain, got all these problems, and the surgeon's arguing with me as to why he would approve it. And, like, finally, I had to tell him. I said, listen. I didn't tell the patient to choose your plan. I'm gonna tell the patient, you have this.
Dr. Romy Chopra:These are the findings. Another plan would pay for it. Medicare pay for it. They don't wanna pay for it. So your choice.
Dr. Romy Chopra:You wanna change, change, come back, but this is all I can do. Within a second, he goes approved. Think the phone done. So my point is what we've done is first know the payer well, know the plan well, know the criteria they're using well, and it's a documentation game. Now still, you know, most practices, you have a practice manager.
Dr. Romy Chopra:You don't have a system. You don't know. They are faxing. They're calling. Where else in the world do you use a fax?
Dr. Romy Chopra:So they faxes, then they they said we didn't get this. We go back. So we track every call, everything. There was one patient that they had pre authorized, predetermined. We did the procedure, and then they denied, denied, denied, went to this, that, that nine months later.
Dr. Romy Chopra:I wrote a letter to the commissioner. I got a payment next day because they met all the criteria. They for them, it's a money game. So it's a long way of telling you. You gotta know the payer well, know the plan well, and manage that information well in whatever system you use.
Dr. Romy Chopra:EHRs are not the best for that. EHR has the clinical data. So we have actually built a platform now that we have all this. We actually use what's called you know, in in Salesforce, we use service cloud where we've actually built a case with all this information, put it all together. Now there are payers who are willing to accept this electronically because it's as big a headache for them.
Daniel Williams:Mhmm.
Dr. Romy Chopra:Manage that. So we're trying to work on this. So we actually built our own. We tried other companies, and it's the same game. You pay them all these fees.
Dr. Romy Chopra:You're going back and forth. So there are several companies that have come out in the pre auth space, but there's nothing better than using one of your own systems where you know the payer and the plan well. For certain things like medications, imaging, we use AdvancedMD, it's easy. Then we use a couple of other platforms that we've tried out. But for managing it internally, that seems we built our own.
Daniel Williams:Okay. Well, doctor Romy Chopra, it's been great hearing your insights on putting the care back in health care. Thanks for joining us.
Dr. Romy Chopra:Bless you. Thank you. My pleasure. Thanks for having me.
Daniel Williams:You're welcome. That is gonna do it for this episode of MGMA's Business Solutions podcast. We've been, here talking with doctor Romy Chopra. He's founder and chairman of Mehmet Health. We will, add many resources and links in the episode show notes.
Daniel Williams:So the items that doctor Chopra was talking about, we can take you right to those. So thanks again for being a listener to the MGMA Podcast Network. If you like the work we're doing, please consider becoming an MGMA member. Learn more at mgma.com/membership.
