Why Firefly’s Employer Model Is Gaining Traction

Published Mar 7, 2023, 8:05 AM

Guest host Mitch Holdwick joins Jared to profile Firefly Health and evaluate their disruptive potential in the employer space. 

All that, plus the Flava of the Week about Dispatch Health’s ED-to-Home program. Can their transition program ease hospital overcrowding, and how can we encourage more partnerships between traditional and nontraditional healthcare? 

This show is produced by Shift Forward Health, the channel for change makers. Subscribe to Shift Forward Health on your favorite podcast app, and you’ll be subscribed to our entire library of shows. See our full lineup at ShiftForwardHealth.com. One subscription, all the podcasts you need, all for free. (#256) 

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New choices, new platforms, new care models and the health care of tomorrow, consumers win. But who will design it? What will it look like and how long will it take? We are here to answer those questions with some provocative thinking about how to create the health care that people actually want. Ready to roll up your sleeves, Look at the world a little differently and explore the frontiers of consumer health together. Join us. This is the health care wrap. Welcome back. I'm your host, Jared Johnson. And here's what's going to go down today. We have the flavor of the week of our Dispatch Health's ed to home program. Can their transition program ease hospital overcrowding? And can we encourage more partnerships between traditional and non-traditional health care? I'll talk about that then. Mitch Hardwick joins me again for another disruptor profile. Mitch and I evaluate Firefly Health's disruptive potential in the employer space. Their approach to personalized employer based care includes health guides and behavioral health specialists on care teams. It's time to dive right in. Are you ready? Let's go. Flavor of the Week. Dispatch Health is looking to improve the experience of transitioning from the emergency room to the home. Along the way, they hope to address hospital overcrowding and make a dent in the cost of treating bounce back patients. Dispatch Health offers an Ed to home partnership with hospitals and health systems that serves patients who are stable enough to discharge from the Ed but need follow up evaluation and care from a provider soon after discharge. According to their website, the goal is to reduce post-discharge bounce backs. Primary indications for Ed to home transitional care include congestive heart failure, urinary tract infections, dehydration, asthma, COPD, cellulitis, Covid 19 and pneumonia. They point to some interesting data to back up the need for this type of service. The American Hospital Association says that more than 33 million patients transition from US hospitals each year. Of those, 20% of elderly patients return to the hospital within 30 days, according to CMS. These patients can cost Medicare up to $26 billion a year, and Medicare could save more than 17 billion of those dollars if patients received the right kind of transitional care. So how does it work? The dispatch health provider conducts a full history and physical exam in the home and provides any medical or symptom management that the patient may need. This includes things like conducting medication reconciliation, arranging to fill the patient's prescription and evaluating their health literacy or their ability to understand their condition and treatment plan. They also evaluate social factors in the home that may affect the patient's health outcomes. If they come across issues that need input from their primary care provider, they can call the provider from the patient's home. A couple of the numbers speak for themselves. Only 22% of patients in the program revisited the Ed within 30 days, and they have a net promoter score of 98. You heard that right, 98. There's a lot to like here. And top of the list for me is the partnership aspect. When traditional and nontraditional health care can work together, consumers win. Let's spend more time evaluating partnerships as opportunities to innovate on their behalf. That's another way that we'll build the health care of tomorrow, and that's the flavor of the week.

The flow. The flow. The flow.

All right, everyone, let's get into the flow. Give it up for Mitch. Mitch is back. We're going to talk about some disruptors here. Mitch is here for this set of episodes. But Mitch, welcome back to the health care wrap.

Thanks for having me, Jared. Always a pleasure.

So we're right in the middle of spring training now. And last time we had you on, we were just talking about some things. We look forward to the beginning of the baseball season. You refer to it as just that, that first crack of the bat. Yeah, the sights and sounds. And, you know, I was curious if there was anything that's just kind of standing out to you in terms of what you're going to be looking forward to this season.

Well, as I mentioned in previous episodes and I'm afraid your listeners are starting to pick up on my obsession with the Detroit Tigers because they are not doing well, as predicted. Looks like it's going to be a long season, but I'm a glass half full kind of guy and a glass half full kind of fan. So I do see a lot of promise from some of the young players developing that I've seen in spring training. So that's always encouraging. And you know, we do have March Madness coming up for our basketball fans out there. So that's keeping me going, too. So it's a combination of baseball and March Madness sports related things that are getting me excited.

Yeah, lots to pay attention to right now and I'm excited to for this season. I wanted to make a prediction of who might be facing each other in the World Series, but back in the day when I would do that with Peter, I feel like it cursed those teams because spoiler alert, I would always say it's probably going to be the Astros and he'd be like, probably going to be the Brewers.

And that's right, He was the Brewers.

It didn't work out for a few years. We were able to claim some victory with the Astros this last season. So hey but enough about enough about that. Enough about that. I've rehashed that enough. And what we're going to do today is dive right back into this theme of profiling some of the disruptors in the space that especially don't get talked about as much, I feel like, but are doing some really interesting work and they are showing a consumer first mindset. And I think that's the glue here, the connective tissue, if you will, between a lot of these organizations that we're speaking about and a lot of them are venture backed, primary care or digital first primary care disruptive organizations. So with that, today, we're going to focus on Firefly Health, which is an interesting group. It's one of those that sometimes they hear a lot about. And then sometimes I'm like, okay, they're not on my radar for whatever reason. And I feel like after this, they are always going to be on my radar because there's a lot of interest in my mind here. First and foremost, is there anything that you'd like to share to help us introduce ourselves to Firefly Health? And I can cover some facts and figures, but is there anything you'd like to share just right off the bat?

I, you know, looking into Firefly, same as you. They were new to me, not on my radar, but I am definitely a super intrigued. They very much kind of fit in that realm of a disruptive partner in the space. And the way I kind of look at Firefly is they're one of those organizations that's really thinking outside of the box and outside of the box. For us in health care really means the patient portal because we know that, as you know, marketers and other professionals and health care with a focus on consumer first, the that's one of the more rigid areas. You take the concept of a patient portal coupled with some of the, you know, operational, disjointed ness within hospitals and health systems. It makes it really hard to create a true consumer first experience, like opening up an app and ordering a coffee at Starbucks and pulling up and having it waiting for you when you get there. And all the the things that we've become kind of conditioned to as consumers that health care just has not figured out, nor have they really figured out a pathway to get there. But you see companies like Firefly and having just quickly downloaded the app and I'm like, I could be a patient within minutes, that's saying something, whether that it truly works and we can kind of discuss that today is another story. But I'm really inspired and intrigued by companies at at least on the surface, are creating that more consumer focused experience through a mobile app. And that in itself is a big feat.

So I agree. And I think the interesting part is, you know, let's take a look at the broader view here, right? When we're talking about so many primary care startups that have cropped up in the last 8 to 10 years, you know, what's the main difference? Did we all of a sudden get better clinically at providing primary care? There's definitely been some improvements. There have been things that have incrementally improved, but it's not necessarily like a big trend. Of a huge leap forward in clinical quality that has led to these new companies. I feel like it absolutely is. The tech like you were saying, it's the digital first mentality because the tech had to get to a certain point to enable the model. But then if there wasn't a vision for for a new type of model, the tech wouldn't matter. So what it's done is allow companies like this. So Firefly Health focuses on employer groups, right? So it's a health plan benefit for employers. And that's, you know, that's one of the interesting parts here. So they it's funny an article in 2021 that I read in fierce health Care talked about that with this full health plan benefit that they want to build. They wanted to build a they refer to it as a digital Kaiser. So lower health care costs better quality for patients vertically, integrating the health insurer and the services provider, which in their mind was similar to Kaiser Permanente as who they were referring to. That was at the time when they had gotten another $40 million round in financing and they were seeing the opportunity here to go after the employer market. Now, I know and I'm curious to see if you felt the same way when I spent some time in the provider side of the industry at provider organizations, we sure didn't talk a whole lot about employer groups. There was a little bit of it there, but it was definitely not the focus, at least from a marketing and digital standpoint. And I was always curious about it. But the market is huge. The point of it being where does your health care come from, Where do your benefits come from? And it's one of those pieces that, you know, I had to take a step back from the hospital centric viewpoint that I had been trained on, quite frankly, to even really have the employer group side of health care come into view for me. So I don't know if you experienced the same thing.

Oh, for sure. There was never really an emphasis on that, you know, during my time in that space. But you see companies like Firefly really start to strategically penetrate those industries or those areas, and it makes a lot of sense because you're effectively empowering them to provide better services and ultimately care for their employees. And I think that's what Firefly and other groups are doing, you know, through their go to market positioning. And their narrative is really focused on, you know, how their services can create happier employees. And I think that's a super unique approach. But just like you, it's not something I'm trained on or I've been exposed to a lot professionally, but I sure am interested in. And I think it makes a lot of sense for companies like this.

Yeah, I think one of the the backbones or one of the the main pieces of their offering, if you will, has to do with a care team approach. So they emphasize that by being a virtual primary care provider, they are able to focus on a care team. And that care team typically includes the primary care doctor. It also includes a nurse practitioner, a behavioral health specialist, and a health guide. Yeah, So, you know, if we talk about the people parts about this for a second health guide, so that person who we probably always think about the in between parts of an individual's health journey right who's going to help me connect my wellness and preventive sides of my care to the things that I'm having to be treated for? Who's going to help me with questions? I might have? That health guide on the care team here is meant to help you do everything from eating healthier to managing stress and be really a coach. It's just another word for a coach. But having that not be just independent of somebody who doesn't talk to your doctor, that integrated approach is I know it's not unique to them, but it's it's a piece that, again, I feel like when we're looking at what are the disruptive qualities or the disruptive pieces of what they offer here, that's absolutely one. To me, that's just one of those things that when we're talking about how can you make anything easier in the health care experience? Yeah, have somebody help coach me. That's also integrated in the care team with my primary care doc.

Yeah, it's huge. And it's like kind of back to my point of thinking outside of the box or being kind of stuck within the parameters of a patient portal or patient portals that exist today that have all the best intentions and are continuing to evolve and become more sophisticated. But I think at this point, specifically around virtual care, it's a very transactional, it's a very, very specific episodic need. And in those cases it serves an amazing purpose. But I think where Firefly and other organizations are going is creating, to your point, is kind of more holistic approach on demand. So you may start with a chat, you know, with your nurse practitioner to discuss a. But that may lead to a primary care visit, and that can all be done seamlessly within one experience. And to truly be integrated not only within provider and services and resources provided by a company like Firefly, but also your preferred specialist or your preferred provider is is truly unique and truly a differentiator that I just don't see a lot of people doing right now.

Yeah, likewise. I don't either. I don't either. At least we don't hear it talked about as much as other things. And maybe that's a result of this trend of moving slowly from talking about digital transformation to consumer transformation. That's the thing that we've built on the foundation of digital transformation. And now here, here's a perfect example of it. When you can point to individual things like, Hey, you know, we've kept a pretty simple care team model, but that does include a couple of parts that aren't traditionally there. If you're focusing on the sick care system, if you're talking about specialty care, acute care, urgent care, that's not necessarily part of it. And I think what I what's really encouraging here is the evolution of the primary care model. So, again, it's not the fact that there's a virtual version of primary care available. It's the fact of what it can enable, like is the end or the means to an end. It's a means to an end in my mind. And some of the numbers on their website at least speak to that. Let me share with you some of these figures. They say on Firefly's website that 25% of their members engage with them on a weekly basis. So even right there, you know, just thinking about the communication and how often that that is, those of us, again, who have been in the provider space, the health system space and can look at those things, that man, wouldn't that be cool? How much more could we help people stay Well by doing that. There you have an example of yeah, one out of four of their members are engaging on a weekly basis. Another one is 80% of their patients follow their guidance for specialist or in-person care. I find that fascinating. I've never seen that type of stat anywhere else, like how many people actually listen to what we say.

Compliance. Yeah.

And I see why they're putting that on there. 80% if that's true like that, is that truly is something to to speak about. And then the the next one was 20 to 30% cost reduction per member per month for employers. So that pmpm per member per month, 20 to 30% cost reduction, which makes sense to me. I don't know if I've ever put a figure to it, but I feel like that's a realistic number for having an accessible primary care option that comes from your employer that's integrated with other benefits. I would just I'm like, That makes sense. That's pretty logical that you could expect. It's not going to solve everything and reduce all your costs, but 20 to 30%, who wouldn't want that?

That's right. Not that's not insignificant by any means. Right.

Right. And, you know, bigger employer groups, of course, they're going to think that they're going to multiply that out pretty quickly and say who else can even compete with that part? So, yeah, interesting. And anything else come to mind with those numbers? I don't know if.

It's it is I guess it is kind of related, but the one that came to mind, you talked about 1 in 4. Are you using it once, once a week, Right. Yeah. To me that like even though we talked about kind of our background professionally and being focused more, you know, on the, you know, patients, community members versus employer groups. But one thing I did learn is that inevitably, as you develop different strategies, whether you're a marketer or just somebody focused on consumer engagement, the more paths of least resistance you can create. You see this influx of even if it's not volume in terms of encounters, people just engaging with your hospital or your health system. And, and think about that concept and the fact that Firefly has, you know, if you go on their app or you read about their services like we've talked about, not only their approach to creating this integrated health care plan, but also so many different ways to interact. You can chat, you can book a visit, you can start a process for a referral, all with a tap on your phone. And I think that's what really creates that statistic. The fact that people are engaging once per week is because they've created multiple paths of least resistance. And people will just they'll find that, you know, as consumers, we are conditioned, I was going to say trained, but it's more kind of conditioned to being drawn to organizations or experiences that make it really easy to do simple things, even if it's not an episodic moment. If it's you just, you know, you're up late at night and you're having, you know, some mental health struggles, you can connect with somebody 24 over seven to have a conversation. And that means a lot, I think at the end of the day, for their for their members. Yeah.

Yeah, I think one thing it's easy to just lose sight of if we do stay within a hospital centric point of view is the fact that any employer based health benefits will not scale to everyone in society. They don't scale to every community. And that doesn't, in my mind, prevent it from having a huge effect potentially on our health and wellness. And I don't want that to get lost in the sense of everything we're talking about of like, Oh, well, it's an employer benefit, you know, that's limited in scope. Not really. Like there's, there's an opportunity by design, by intentionally referring to themselves as a virtual primary care first. Like that's the first way they refer to themselves. They then describe, hey, this is a focus on employer groups. That's who we're targeting. But the service itself, yeah, it's virtual. So by name at least, it is scalable, it is accessible and they have a potential trajectory from there.

And you can experience it as a like just like just like I did, just like you did. Even though they may have a focus on the employer realm, you know, from a business perspective. But anybody can download the app and get a feel for what it's something. It's tangible, You can touch it, you can feel it even if you're not experiencing it as a patient, it makes sense within minutes. And there's very few things like that, as you know and your listeners know, and health care that you can just go, Oh, I get it, I can download it. And this makes sense. I get how this works.

There's a place for that, an increasingly large place for it in different sides of the industry. And so again, it's one of the hallmarks, I think, of this podcast, but also just a lot of content that I consume that I latch on to is that theme of let's not discount something that on the surface might feel like it has less of a reach because actually not only does it have a much broader reach than we might think, but the potential to help those within that reach is big. I feel like the standard for what we're going to refer to as primary care, I don't know, three, five, ten years from now, this isn't even going to feel like an exception or something that's going to be like, of course, that's how primary care is offered. Of course, it's virtual first. Of course, it's offered through an employer. Group, of course, includes a health specialist and a behavioral health specialist. Of course, it includes those things. And I think that's one of the broader points here is that the potential to change the narrative around what primary care looks like, at least on the surface. And again, having virtual primary care, there's a lot of them. But overall, what does that do for us? Well, it changes our expectations, you know, when we bring that back to how consumers view all this, it changes our expectations and it gives us a place to say, oh, okay, at least those parts that I've always thought were really hard to encounter, schedule, access, engage with my provider looks like some of those things are a little easier now and that's progress in my boat.

Agreed, Agreed. Jared I think it's like just to kind of amplify that point where more of some have struggled to kind of operationalize exactly what you just described in terms of what primary care might look like three years from now or five years from now. I think there's groups like Firefly Health and others that are instilling some innovation and technology that's allowing consumers to see that vision, to see like, Oh, this is this is the way it could be. So you're right, it does kind of speak to a broader concept and a broader point. Aside from the use case, an app like this, it also kind of forces the topic and forces others through disruption to kind of move quicker because guess what? People see it now and now they get it. It's literally in the palms of their hands.

Right. Exactly. Exactly. Well, I'll tell you what, I don't think like any discussion about Firefly Health would be fully complete without mentioning the fact that Jonathan Bush is at their reins. So he's one of those minds that he's just fascinating to watch what he's done. He's the CEO of Zeus Health now. He was the CEO and co-founder of athenahealth from its early days. He's executive chairman now at Firefly Health as well. And that tells me even that alone is worth keeping an eye on Firefly to see where they go, because most of the things that Jonathan Bush touches end up growing and exploding and just having all sorts of big things happening. So safe to say kind of understating that. But that's one of the intriguing parts of of the company, their leadership team, because he has the understanding of interoperability. He's always had a vision, even with Athena, you know. Right. For so many years, he had that vision of what interoperability needed to look like to empower and enable certain types of experiences So he could speak about it not just from the business standpoint, but absolutely tech first, digital first. So it would be hard to deny that he understands at least what needs to be done. And again, it's one of those, you know. Will that happen? Will it sustain itself? Will it keep on this trajectory? Will they be able to scale their way they want to? Those are all questions. It's going to take a few years to be able to answer fully. But my final thoughts here on these guys are just that. They're one worth watching and they're worth knowing more about what is possible through direct to employer care. And that if that's not part of the formula in our mind, if it's not in the middle of your radar screen, then this probably is a good time to get it on your radar screen and to pay more attention to them because Firefly and others similar to them in the virtual primary care space, will absolutely be changing what consumers expect from an encounter and how they're able to access it. So one to watch for sure.

Agreed. Agreed. 100%. They definitely fit in that that realm of creative disruption, you know, that that that disruption doesn't necessarily have to have a negative connotation. It can really force us to think differently and to to maybe speed up the thoughts that we have and the ideas that we have forces us to kind of move move quicker because we're starting to really empower consumers and patients with this idea notion of taking health into their own hands. So I applaud them for that.

I love that. Mitch, having the definition of disruption be more about taking our health into our own hands. I love that thought and that's a perfect way to wrap up here. It's been such a pleasure to do this again. Let's do it again sometime.

Anytime you know where to find me.

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