Episode #12 - Jennifer Rabiner, Chief Product Officer at Pearl Health
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Description
Jennifer Rabiner is the Chief Product Officer at Pearl Health, where she leads the development of innovative technology solutions that empower primary care practices to excel in value-based care models like ACO REACH. With over 20 years of experience in healthcare, Jennifer has a rich background in both the health system and independent provider segments, as well as direct primary care. Before joining Pearl Health, Jennifer served as a product leader at Hint Health and athenahealth, focusing on value-based care. Her expertise also includes healthcare revenue cycle optimization and system implementation at Deloitte Consulting and Triage Consulting Group, as well as pharmaceutical reimbursement strategy at Millennium Pharmaceuticals. In addition to her role at Pearl Health, Jennifer is an advisor to several health tech startups, where she lends her extensive knowledge in product development and healthcare innovation. In our conversation, Jennifer shares insights on:
Transforming Healthcare Payment Models: Jennifer discusses the shift from fee-for-service to value-based care, highlighting the introduction of ACO REACH.
Company Growth: Pearl Health’s evolution from supporting small practices to partnering with larger physician groups and health systems, driving product innovation and integration.
Driving Engagement: Strategies to enhance engagement for both patients and providers, focusing on action-oriented and patient-centric design.
Key Features of Value-Based Care Products: The importance of patient risk stratification, real-time data, workflow integration, and goal setting.
Leveraging Diverse Data Sources: The role of claims, clinical data, and social determinants of health in supporting value-based care.
AI in Healthcare: The role of AI in enhancing clinical decision-making, supporting providers, and maintaining ethical and transparent practices.
Building in a Capitated Environment: Approaching product development with a dual thesis, focusing on outcomes, iterative development, and usability.
Integrating Customer Success: The strategic integration of customer success into product development for continuous evolution based on user feedback.
Future Plans for Pearl Health: Expanding the number of lives covered, entering new markets like Medicare Advantage, and scaling the platform for broader impact.
Jennifer’s insights highlight the strategic role of technology in healthcare and the importance of aligning product development with real-world provider and patient needs. Her approach underscores the transformative potential of data-driven, user-centered solutions in advancing value-based care and driving innovation across the healthcare landscape.
Some takeaways:
Transforming Healthcare Payment Models:
Shift from Fee-for-Service to Value-Based Care: The traditional fee-for-service model, which rewards volume, is being replaced by value-based care, which emphasizes patient outcomes and cost control. This shift aims to improve health while reducing unnecessary services.
Challenges of Implementing Value-Based Care: Transitioning to value-based care is complex, requiring providers to align incentives with patient outcomes. This shift often demands significant changes in workflows, technology adoption, and care management practices.
Introduction of ACO REACH Model: The ACO REACH model focuses on proactive, preventative care, rewarding providers for keeping patients healthy and managing chronic conditions. It also emphasizes equity in healthcare access, addressing disparities and promoting long-term health outcomes.
Financial and Operational Impacts: Moving to value-based care involves financial and operational changes, such as adopting capitation payments and new technologies. Providers must focus on effective resource allocation and collaboration to succeed in this model.
Pearl Health’s Mission and Solutions:
Pearl Health is a healthcare technology company focused on helping primary care practices transition to value-based care models like ACO REACH. By addressing inefficiencies in the traditional fee-for-service model, Pearl Health incentivizes proactive care that reduces unnecessary medical utilization, improves patient outcomes, and lowers costs. Their platform simplifies complex data, providing actionable insights that help providers efficiently manage high-risk patients and deliver better care.
Growth of Pearl Health's Footprint and Product:
Initial Focus on Small Practices: Pearl Health started by targeting small, independent primary care practices across the U.S., helping them stabilize revenue and improve patient outcomes during the financial challenges of the COVID-19 pandemic.
Attracting Larger Physician Groups: Success with smaller practices led to the expansion into larger physician groups, such as IPAs, IDNs, CINs, and MSOs, requiring enhancements to the product to handle more complex organizational needs.
Engaging Regional and National Health Systems: Pearl Health further expanded by partnering with regional and national health systems, adapting its product to support larger entities with more sophisticated coordination and management tools.
Product Evolution and Integration: To support growth, Pearl Health integrated advanced data sources and improved its predictive analytics, making the product more scalable and adaptable for a wide range of healthcare organizations, including new programs like Medicare Advantage.
Broadening Impact Across the U.S.: Strategic growth enabled Pearl Health to expand its footprint to 43 states, allowing a diverse range of healthcare providers to enhance patient outcomes and reduce healthcare costs nationwide.
Key Differences of ACO REACH Model:
Capitated Payment Model: Jennifer Rabiner highlights that one of the most significant differences in the ACO REACH model is the shift to a capitated payment structure. Unlike traditional fee-for-service models, where providers are paid per service rendered, ACO REACH gradually transitions providers to a capitated model. This means providers receive a fixed monthly payment per patient, regardless of the number of services provided. The transition to capitation begins with a small percentage and increases over time, reaching full capitation. This approach incentivizes proactive care and financial stability for providers, as they focus on keeping patients healthy rather than maximizing service volume.
Simplified Quality Measures: ACO REACH also simplifies the quality measurement process compared to previous models. Instead of managing numerous quality metrics, ACO REACH focuses on just three clinical quality measures and one patient satisfaction measure. These measures primarily track the prevention of hospitalizations, reflecting overall patient health and the effectiveness of care management. By reducing the reporting burden and focusing on key outcomes, ACO REACH allows providers to concentrate on delivering high-quality care without being overwhelmed by administrative tasks.
Driving Engagement for Both Patients and Providers:
Action-Oriented Engagement: Pearl Health’s product is designed to help providers quickly identify and address urgent patient needs, ensuring that engagement with the product leads to meaningful actions that directly benefit patient outcomes.
Earning Engagement: Recognizing that their platform operates alongside existing EMR systems, Pearl Health focuses on making their product easy to use, seamlessly integrated, and clearly valuable to providers, thereby naturally encouraging regular engagement.
Patient-Centric Design: The product is built on the principle that there is always a “right next thing” to do for every patient. This design ensures providers feel confident and proud of the care they are delivering, fostering consistent and meaningful engagement with the product.
Engaging Providers for Active Participation in ACO REACH:
Personalized Engagement Strategies: Jennifer explained that engaging providers in ACO REACH requires understanding their unique needs. Pearl Health tailors its approach by offering customized training and support, ensuring the platform fits seamlessly into each practice's workflow.
Support During and Between Appointments: Pearl Health’s platform aids providers during appointments by facilitating real-time decision-making at the point of care. Pearl Health enables providers to access Pearl Health’s Conditions to Review feature in the EHR. Pearl Health is able to expose this feature in the provider’s respective EMR through a partnership with a middleware platform called Vim.
Embedding Good Behaviors in Product Design: The platform is designed to encourage behaviors that lead to better outcomes by setting clear, achievable goals that guide providers toward actions that improve patient care and reduce costs.
Demonstrating Value Through Data: To motivate participation, Pearl Health provides data-driven insights that show how provider actions impact patient care and cost savings, helping users see the direct benefits of their efforts.
Ongoing Support and Feedback: Continuous support through regular check-ins and feedback ensures the platform evolves with providers' needs, reinforcing the behaviors and goals that drive success in the ACO REACH model.
Key Features for Building a Value-Based Care Product:
Patient Risk Stratification: Essential for identifying high-risk patients and prioritizing their care, helping providers focus on those who need the most attention to improve outcomes.
Real-Time Data and Insights: Provides actionable information during patient interactions, enabling informed decision-making and proactive management of chronic conditions.
Workflow Integration: The product must seamlessly fit into existing healthcare workflows, reducing administrative burdens and ensuring consistent usage.
Support for In-App and Out-of-App Engagement: The product should aid providers both during and between appointments to manage ongoing patient care and ensure follow-up tasks are completed.
Data-Driven Decision Making: Offers insights that demonstrate the impact of provider actions on patient outcomes and healthcare costs, guiding better practices.
Customization and Flexibility: Adapts to the specific needs of different practices, with customizable dashboards, alerts, and reports that help providers focus on what matters most.
Goal Setting and Behavioral Nudges: Encourages best practices by helping providers set clear, achievable goals and including features that nudge them towards actions that improve patient care and reduce costs.
Importance of Data in Value-Based Care: Jennifer emphasizes the critical role of diverse data sources in driving value-based care.
Total Cost of Care Claims Data: Used to track and analyze overall medical expenditures. Pearl Health leverages this data to identify cost trends, opportunities to reduce unnecessary utilization, and assess patient outcomes.
Admission, Discharge, Transfer (ADT) Data: Enables real-time monitoring of patient transitions, helping to prevent hospital readmissions by ensuring timely follow-up care.
Clinical Data: Provides detailed insights into patient health, allowing for more effective management of chronic conditions and personalized care plans.
Social Determinants of Health (SDOH) Data: Helps identify non-clinical factors affecting health, such as access to food and transportation, to offer additional support services.
Medication Fill Data: Tracks prescription adherence, reducing the risk of complications from non-compliance with treatments.
Appointment Data: Ensures high-risk patients receive timely care, particularly when predictive models indicate a likelihood of emergency room visits.
CMS’s Beneficiary Claims Data: Pearl Health is also working on reducing the latency of claims data by using more real-time sources like the CMS’s Beneficiary Claims Data API (BCDA). By integrating these various data sources, Pearl Health enhances its predictive analytics, enabling more proactive and effective care management.
Building from Zero to One in a Capitated Environment:
Thesis-Driven Development: Jennifer highlighted the importance of a dual thesis approach: a market thesis that foresees value-based care as the future, and a tech thesis that uses technology to enhance care delivery. These guide the entire development process.
Focus on Outcomes Over Features: In a capitated environment, the priority is on driving outcomes that lower healthcare costs and improve patient care, rather than simply adding features. This outcome-driven approach ensures that the product directly supports the financial and clinical goals inherent in capitated care models.
Iterative Development and Close Feedback Loops: Jennifer emphasized the importance of building iteratively, with continuous feedback from users (providers) to refine and improve the product. This approach ensures that the product evolves to meet the real-world needs of providers, where every decision can have a significant impact on patient outcomes and costs.
Simplicity and Usability: Given the inherent complexity of capitated care, the product must be simple and intuitive to use. Jennifer stressed that the product design should integrate seamlessly into providers' workflows, minimizing the learning curve and administrative burden while maximizing its impact on patient care and cost reduction.
Customer Success Integration with Product Development: At Pearl Health, Customer Success Rolls Up into Product. This structure creates a seamless feedback loop, ensuring the product evolves based on real-world user needs.
Close Feedback Loops: Integration allows the product team to quickly respond to user challenges, ensuring continuous product evolution.
User-Centered Improvements: Aligning customer success with product development prioritizes changes driven by user feedback, enhancing provider satisfaction and patient outcomes.
Proactive Problem-Solving: This structure enables the product team to identify and address issues early, improving user experience and the product’s effectiveness in delivering value-based care.
Future Directions for Pearl Health:
Expansion of Lives Covered: Pearl Health plans to significantly increase the number of lives under its value-based care models, scaling operations to reach more patients and providers across the U.S.
Entering New Markets: The company is set to expand into new markets, including Medicare Advantage, applying their value-based care approach to a broader range of healthcare models and populations.
Product Enhancements: Pearl Health is focusing on making their platform more adaptable and scalable, enhancing it to support a wider variety of healthcare providers and organizations, including larger and more complex systems.
Vertical and Horizontal Scaling: Pearl Health aims to deepen its impact within existing markets while also expanding into new areas of healthcare, ensuring their value-based care approach continues to grow and evolve.
Show Notes
Where to find Jennifer Rabiner:
Pearl Health: https://pearlhealth.com/
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Where to find Angela and Omar:
Angela Suthrave
Omar Mousa
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Referenced:
Pearl Health: https://pearlhealth.com/
Keep up with Pearl Health by following their Blog: https://pearlhealth.com/blog/
Athenahealth: https://www.athenahealth.com/
Hint Health: https://www.hint.com/
Value Based Care Explained: https://www.cms.gov/priorities/innovation/key-concepts/value-based-care
ACO Reach Explained: https://www.cms.gov/priorities/innovation/innovation-models/aco-reach
Pearl Health’s EMR Integration partner, VIM: https://getvim.com/
Athenahealth Payer Solutions: https://www.athenahealth.com/who-we-serve/payers
One of Jennifer’s favorite books, Melissa Perri - Escaping the Build Trap: How Effective Product Management Creates Real Value: https://www.amazon.com/Escaping-Build-Trap-Effective-Management/dp/149197379X
Jennifer’s favorite productivity tool: https://clickup.com/
Denver’s StartUp Week, Outcomes Based Roadmap Presentation: https://www.slideshare.net/slideshow/denver-startup-week-outcome-based-roadmaps/251218296
What is Direct Primary Care: https://www.elationhealth.com/resources/blogs/what-is-direct-primary-care
Check out our website: https://www.concepttocare.com
Subscribe to our newsletter: https://concepttocare.substack.com/episode-12-jennifer-rabiner
Transcript
[00:00:00] Jennifer Rabiner: We've invested a lot in research. We invest a lot in our design to make sure that it's easy to use the product and that it's compelling to use the product. We often say that the feelings we want people to leave with are that they feel proud, you know, that they did the right thing for the patient. I remember an early, early thing talking about when we were designing the product is there's always a right next thing to do for a patient.
[00:00:23] Jennifer Rabiner: Patients who are very sick and needing to use a lot of health care resources, they're going to keep needing to use health care resources. There's always a right and there's thing to do for them.
[00:00:31] Angela Suthrave: Welcome to concept to care where we hear candid stories of success and failure, discuss strategy and dive into the details that offer advice on what to do and what not to do in health tech.
[00:00:43] Omar Mousa: Whether you're a seasoned pro growing your career or just starting out. Our aim for this podcast is to be relevant, real world and tactical. We're dedicated to not only entertaining you all, but also empowering you with actionable insights that can be applied beyond the podcast one concept at a time.
[00:00:58] Angela Suthrave: This is Angela,
[00:00:59] Omar Mousa: and this is Omar.
[00:01:00] Angela Suthrave: Welcome to Concept to Care. Hello, Angela here. Welcome to another episode of Concept to Care, where we dive deep into health innovations. In today's episode, we are thrilled to have Jennifer Rabner. She's the chief product officer at Pearl Health. Here's a little bit about Pearl Health.
[00:01:18] Angela Suthrave: They help doctors and providers deliver better care to their patients by changing the way they get paid. Instead of paying for each visit or each treatment, Pearl Health's approach rewards providers for keeping patients healthy. And they do this by offering the tools and the technologies that help doctors track their patients to deliver more effective care and to allow providers to make better decisions.
[00:01:40] Angela Suthrave: This ultimately leads to improved patient outcomes and reduced costs. Jennifer is at the forefront of this transformation, and we're going to dive into how Pearl Health is tackling these challenges by engaging providers in the ACO REACH framework. Whether you're in health tech, product development, or healthcare management, this conversation is packed with insights.
[00:02:00] Angela Suthrave: So let's get to it.
[00:02:06] Omar Mousa: Hey Jen, welcome to the show.
[00:02:08] Jennifer Rabiner: Thank you so much. I'm so excited to be here.
[00:02:10] Omar Mousa: Yes. Yes. We were so excited. We've been waiting for this one for quite some time and we know you've been on the podcast circuit. So we're very grateful that you were able to spend some time with us.
[00:02:21] Jennifer Rabiner: Yeah, my pleasure. Thanks so much for the invite.
[00:02:23] Omar Mousa: So we'll just start pretty simply. Tell us about yourself.
[00:02:26] Jennifer Rabiner: Uh, sure. So from a, from a career perspective, I have been in health care My whole career. So over 20 years now, starting first as a consultant for large hospitals and health systems, mostly in the realm of revenue cycles. So how things got paid for and how they got paid for correctly or incorrectly.
[00:02:47] Jennifer Rabiner: Uh, and spent a lot of that time also learning how to implement systems and what technology could do to help or hurt in, in healthcare settings. After that, I took a brief little detour into biotech. For about three years and then, uh, I started my career in product management and value based care. Twelve, almost thirteen years ago, when I went to Athena Health, which is, you know, pretty much the domain I've been in, uh, ever since.
[00:03:12] Jennifer Rabiner: Uh, and certainly, you know, I feel like I found, uh, the, you know, domain that I really enjoy working in, uh, so that's. That's how I, when I got into product management and, and, you know, kind of where I've stayed. And I would say the real through line of all of this is, you know, really thinking about how healthcare gets paid for, what works about that, what doesn't work about that, what needs to change.
[00:03:32] Jennifer Rabiner: And, you know, when I sort of discovered product management, if you will, it felt like such a good fit of being able to work in that space and being such a problem solver and also having really tangible outcome and tangible output of my work. So I really love being in that space. I'm excited to talk to you more about that today.
[00:03:52] Jennifer Rabiner: And then personally, I'm originally from Northern California. Uh, but I have lived in the Boston area for over 18 years now. So consider myself, uh, as bi coastal as you can, you can be. My family and I live just outside Boston with our two boys who are 15 and almost 13 and our dog Duchess. And we are a very busy family, but the kids in school, our jobs, and both of the boys play competitive baseball.
[00:04:17] Jennifer Rabiner: So that keeps us busy for a good chunk of the year too.
[00:04:19] Omar Mousa: That's awesome. I think we need a headquarter in Boston cause it's been unintentional, but we've I've met with a couple Boston tonians in the health tech space, obviously, probably not a coincidence, but I think it's funny.
[00:04:31] Jennifer Rabiner: Yeah, there's a really great community here around health care in general and in all different kinds of segments and subsegments, but also just a really great community of people working in, in different innovative ways in health care here.
[00:04:45] Jennifer Rabiner: So come on
[00:04:45] Angela Suthrave: over. Um, Jen, you know, you said something that really struck me, which is about how we pay for health care. And that's obviously a really important piece. Um, can you tell us a little bit about payment models, how it impacts the overall health care system and specific changes that you think are necessary and maybe just give us a little bit of a lay of the land, because I think that'll help us segue into what you're working on now.
[00:05:10] Jennifer Rabiner: And I think, as I mentioned, you know, really starting at the very beginning of my career, career, I've been very deep in all of the ways that healthcare is paid for. So all of the mechanics, the different parties, the processes, so we've spent so much time here and you know, we really, as, as you know, most of your listeners probably know, most healthcare gets paid for in what we call fee for service.
[00:05:32] Jennifer Rabiner: So a service is rendered and then it's paid for, which sounds pretty straightforward, but then, you know, on a couple of dimensions, one there, it's actually tons of complexity in between. The delivery of that service from a health care provider to the patient to how it gets paid for. It's far from straightforward in terms of how things are, you know, what is, what does anything actually cost?
[00:05:55] Jennifer Rabiner: I don't know if anyone actually knows, you know, then how, what is the contract? How many different parties are involved in adjudicating the difference between what gets charged and what gets paid? I mean, there's so much complexity there that although it sounds simple. Uh, it's hugely inefficient, you know, wasteful, and then, you know, just you kind of can see where all of the dollars add up between what we think something costs and what actually ends up getting paid.
[00:06:20] Jennifer Rabiner: So I think that's something I've observed since the very beginning of my time. And so, you know, the world of revenue cycle, revenue cycle, intelligence process optimization, I think some exciting things happening in AI there. So that's one kind of whole area of it. But when I think about What does that incentivize?
[00:06:37] Jennifer Rabiner: You know, and the scarcer our resources are around health care, the, the more volume needs to go through this system. And so I think we've hit that point where the volume that's going through the system, which is, you know, the more volume, the more you get paid. You know, we can see the impact of that on physicians who are getting burned out, people not wanting to go into being a physician, particularly, you know, seeing the scarcity of primary care doctors as well, because we're just creating this unsustainable environment.
[00:07:08] Jennifer Rabiner: And that's not only to do with our payment model, but our payment model is incentivizing that volume. And then, okay, you know, over 10 years ago. value based care as a concept starts getting introduced in lots of different shapes and forms. But I'd say, you know, spending some time in that space. Everything still stayed fee for service.
[00:07:28] Jennifer Rabiner: And then we said, okay, but there's also these extra requirements. We also have these quality measures. We also need to enroll a bunch of patients in chronic care management. Uh, and so we essentially, I think, even if for the very right reasons, added a lot of burden, more work onto this burden system. So the, you know, most of the money, the cash flow.
[00:07:48] Jennifer Rabiner: That is needed to pay people salaries and pay for the office rent and supplies was coming through fee for service. And then you have this extra work, and maybe you get an incentive for that, but maybe it's not going to come for a year and a half. And so when I talk about needing to change the payment model, I don't think that there's, it's a solved problem and that there's this, here's the answer, because there's so much complexity, even in the traditional way.
[00:08:10] Jennifer Rabiner: And then we add in value based care. We're on a really good path, but there's just still, you know, a ways to go. I think everybody would philosophically agree with saying, well, we want to pay for value and not volume. How do you measure value? We've tried to measure value in a lot of different ways, tried to measure clinical quality in a lot of different ways.
[00:08:29] Jennifer Rabiner: Like any physician would tell you how problematic that can be sometimes when you have a specific number that may or may not be the right number for that patient at that time, but it doesn't mean progress isn't happening. So I think we have a ways to go. But I think, you know, continuing to work towards that place where payment is transparent, it's efficient.
[00:08:47] Jennifer Rabiner: And that it actually does create, enable the right care model, if you will, to deliver that high quality care is where we need to get to.
[00:08:55] Angela Suthrave: There's so much complexity there. Some, I'm glad that you touched on so many of those elements. You know, it's not like going to Jiffy Lube where there's a menu and you know what service you're getting and exactly how much you're paying for.
[00:09:06] Angela Suthrave: And if we don't know how much it costs, it's actually different costs depending on, you You know, how many members they have covered and their negotiating power and everything like that. And it's interesting to watch the market because I think that Walmart did try to do something where you do have a menu of services with a, a price.
[00:09:24] Angela Suthrave: And, you know, you see this consumer price. Movement. I think that it's worked to varying degrees. So yeah, this is definitely a topic that I'm glad we're getting into and hugely challenging and nuanced and a lot of different players.
[00:09:38] Jennifer Rabiner: And, you know, it also begs the question, which could probably be its own whole podcast of when you think about things, you know, you mentioned Chiffy Lube, when you have car insurance, you don't use your car insurance for the basics and oil change.
[00:09:51] Jennifer Rabiner: Cleaning your windshield, putting gas in your car, uh, but we use insurance, which is a vehicle for risk and uncertainty, uh, for even the most basic of services in healthcare. So another kind of interesting side topic there too.
[00:10:04] Omar Mousa: So you did a fantastic job of Describing sort of the innovation that's happening on the payment model, and I think that's a good segue into what's going on at Pearl.
[00:10:14] Omar Mousa: So you are the chief product officer at Pearl Health. Can you, for the audience, kind of describe what is Pearl Health, some of the problems that are being solved? And, I Talk about the technology and go to market.
[00:10:26] Jennifer Rabiner: Uh, so Pearl Health has been around for almost four years now started in late 2020 and I'd say at the highest level are, you know, our goal, the problem we're trying to solve, the opportunity that, that we are partnering with practices on is how to.
[00:10:42] Jennifer Rabiner: bring more practices in to value based care into these innovative clinical and financial models that continue to come out from CMS and other organizations. So how can we enable even the smallest of practices to participate in these models and be successful? And I would say, you know, kind of more specifically, It's, you know, that, that we feel like we are at this unique moment in time, you know, whereas, you know, 12 years ago when I started in this kind of world of value based care and population health, a lot of the things that we were doing at that point, which felt new and interesting and, you know, a huge opportunity are now.
[00:11:21] Jennifer Rabiner: Much more stabilized. We have a lot of data. We know how to use it. But now we've kind of over rotated into here's a ton of information. Now you can manage your patients better, right? So really that marriage between being an innovative financial models, you know, creating that stability for, for clients in terms of payment and starting to kind of move ever so slowly away from.
[00:11:42] Jennifer Rabiner: fee for service kind of marrying that with how can we take all of this data, all of these insights that have been around for a while, and really think about what's the next thing to do with that. It's not about reports. It's not about checklists and having these heavy analytic tools. It's really about synthesizing all of that, distilling it.
[00:12:02] Jennifer Rabiner: Into, you know, truly the list of patients who need your attention today, regardless of program mechanics and, you know, whatever boxes need to be checked, you know, in a particular program. We're really all about how do we help them be successful in these programs, but in a way that feels very authentic to, to being the great doctors that they are.
[00:12:22] Omar Mousa: Okay, and so talk to us a little bit about the technology platform. How are you supporting, like, what are the product offerings and how are you supporting those ACOs?
[00:12:31] Jennifer Rabiner: Sure. So Pearl is actually serving as the ACO. So we are the risk bearing organization. And then we partner with primary care practices to enable them in value based care.
[00:12:42] Jennifer Rabiner: So somewhat of a unique business model. I know we're going to get in a little bit to SAS versus kind of being a risk bearing organization a little later. But PEARL is the ACO, we partner with practices, and when they join us and we're together in a performance year in a particular program, we provide them the technology as the primary way to enable them to be successful.
[00:13:05] Jennifer Rabiner: So that's something maybe unique or differentiated about PEARL is that we really from the beginning have made a strategic choice that we wanted to. Use our technology is the primary way to enable the practice versus it being kind of the secondary way or by putting a lot of people in practices or doing a lot of the direct clinical services ourselves.
[00:13:28] Jennifer Rabiner: So we don't own any practices. We don't employ any physicians. These are all practices who partnered with us. And then we provide our technology to them to. help drive and deepen their performance. And so with knowing that from the very beginning and with a background in the more traditional population health management platforms, where on the surface everything's going to sound really similar, like, okay, you're taking a lot of data, you're creating insights.
[00:13:54] Jennifer Rabiner: The difference is, is who I built for. And so, in a population health management platform, I was building at that time primarily for the people running the ACO, who needed that wide view of what was happening across the network, where the opportunities were. You know where the needles in the haystack were as well as the large trends and coming into Pearl I knew that since we were the ACO and the risk bearer I still need that information to run a great risk bearing organization But for what the product the product was going to be for the practices It was going to be for the people who are working with the patients every day.
[00:14:29] Jennifer Rabiner: And again, they're not our employees We don't own the practice and so from the very beginning we talked a lot about earning their engagement. We knew we were going to be a sidecar to the EMR. Our practices are on every EMR that I've ever heard of. So there are many, many different EMRs. We knew we were always going to be And it's a sidecar there.
[00:14:48] Jennifer Rabiner: And so we talked a lot about earning that engagement. And that really led us to build a very different type of product than I've seen in this space. And that, you know, we, I always say we keep the waterline very high in the product, meaning there's tons of data, there's tons of analytics, there's data science, there's all kinds of program requirements and metrics.
[00:15:09] Jennifer Rabiner: But those don't need to be exposed in the product, if you will. We take all of that and we distill it down into here are the patients who need your attention today. Why do they need your attention? What do we suggest you do? And then they track that action and then we can take that back into our data models and start tracking the outcomes of what they've done.
[00:15:29] Jennifer Rabiner: So we have that segmented into kind of who needs attention today. If you finish that list, who needs your attention next for some of the things that are important but not necessarily urgent. And so we've taken all of these different, different things that have been in the market for a while around the data analytics.
[00:15:46] Jennifer Rabiner: and analytics and the program requirements. And we have all of that kind of under the hood of the product and then have built something that gets, you know, really great and high engagement from our practices and just really thinking in a different way about who the users were in terms of, of who we built for, even though the jobs to do sound kind of similar of, you know, decreasing unnecessarily, unnecessary medical utilization, doing well on quality metrics, Reviewing for accurate risk coding, you know, all of those kinds of things, all similar jobs, but we're doing them in a little bit of a different way.
[00:16:21] Angela Suthrave: So Jen, that that's really helpful. And can you tell us a little bit about Pearl Health and how you think about go to market?
[00:16:28] Jennifer Rabiner: So kind of hand in hand with what I was just saying, discussing around really trying to be tech first in our approach to supporting enablement. When we were founded in 2020 in the middle of, you know, our world being remote, we started targeting smaller independent primary care physicians, but across the whole country.
[00:16:47] Jennifer Rabiner: So we didn't say we're only going to go into this state or that state or only for practices on this EMR or that EMR. Uh, so in that sense, you know, we've really kept, uh, the, the practices that can drain Pearl, you know, pretty broad if you will. But we started with those smaller independent primary care physicians, many of whom were still in the middle of, of figuring out how the impact of COVID was going to, um, hit them especially in a fee for service world when people aren't able to come in and, you know, or, or, can't do telehealth or telehealth was a difficult transition.
[00:17:18] Jennifer Rabiner: Watching revenue also decrease. So this not only, you know, at that time, you know, was a resonant message, but it was also an opportunity for some of these smaller practices to start joining some of these innovative models out of CMMI, like ACO reach. And so it enabled us to, you know, to, to go very broad in our approach of who joined us.
[00:17:41] Jennifer Rabiner: in, in ACO Reach and who were our initial users of, of the products that was our kind of 2022 cohort. We met them all over 2020 and 2021 started in the program in 2022. And then from there, as we've expanded, you know, even further across the country, we're currently in 43. different states. We got a lot of organic pull from different kinds of physician groups, so starting to see larger physician groups interested in participating and doing so in kind of the Pearl way.
[00:18:12] Jennifer Rabiner: Started to see more of this kind of general, you know, different kinds of groups that aggregate physician groups. So IPAs, IDNs, MSO is kind of alphabet soup of all of these different kinds of organizations. So we started to get a lot more familiar with them, started to sign more of those for the 2023 performance year and this year in 2024 and then more and more, you know, we're now starting to talk to health systems.
[00:18:37] Jennifer Rabiner: So starting with, you know, smaller regional health systems, starting to get interest even from some of the bigger ones out there as we're starting to see systems know they really need to invest in value based care and are looking for partners to help them do that. So it's a really started with a small independence and I've really been able to grow our footprint as well as our product, which, you know, really is somewhat size independent in terms of how we do what we do.
[00:19:03] Jennifer Rabiner: Of course, there's different kinds of things that a larger organization might need, but I've seen us kind of grow in the last couple of years. you know, higher and kind of vertical growth as we get into larger and more complex organizations.
[00:19:18] Angela Suthrave: You talked about the alphabet soup of healthcare, which always cracks me up, or almost as bad as the federal government.
[00:19:25] Angela Suthrave: But you, you touched on the ACO REACH program, um, which stands for Accountable Care Organization Realizing Equity, Access, and Community Health. And so I'd love to hear from you, you know, in your own words, what. Like how do you define that? And then how it differs from other accountable care type organizations.
[00:19:46] Jennifer Rabiner: Well, I would say when I started talking to what became, uh, Pearl Health in 2020, I had been familiar with, you know, some of the newer models that were coming out. And ACO Reach, uh, was formerly known as the Direct Contracting Entity Program or DCE. And it was converted to ACO Reach with a couple changes.
[00:20:04] Jennifer Rabiner: In 2022. So been exciting journey, kind of watching, watching some of that evolution as well. But I will tell you the things about a CO reach that were both compelling to me and that I think are materially different from prior models like Medicare Shared Savings Program, which, you know, still very much ongoing, multiple.
[00:20:24] Jennifer Rabiner: And there have been a few other, you know, the, the, uh, pioneer ECO model, next gen model. The two major differences in ECO reach, there's lots of mechanical differences and kind of program requirement differences. But the two big differences to me are that it is a capitated model. So it's where Medicare is converting Fee for service payments into a monthly payment for physicians have been on kind of a ramp starting, you could go 10 percent capitated, so you'd have a 10 percent reduction in your fee for service amounts on your, your explanations of benefits that you would get, and then.
[00:21:01] Jennifer Rabiner: You would get that 10 percent in the form of a monthly payment from, from Pearl. So we get the money from CMS and then would distribute that to our practices. And then it was 20 percent and 50 now coming to a hundred. So kind of a ramp there in terms of capitation. But that was very exciting to me. And also the first time that that's been in one of the official ACO models.
[00:21:20] Jennifer Rabiner: So really starting to flip that script, moving to proactive, you know, care, Stabilizing revenue, which is very welcome after. after the volatility of the last few years and just the volatility of fee for service period. And I would say the second big change is the quality measure kind of profile and, and reporting process.
[00:21:40] Jennifer Rabiner: So all ECO models have, you know, been a big evolution over the last 12 years, but there are a number of different clinical quality measures. At one point, I think up to, I think it was 32 or 33 in, In MSSP, and I believe NextGen, and in ACO REACH, it's three clinical quality measures and one customer satisfaction or kind of patient satisfaction measure, and those three clinical quality measures, instead of being But, Measures where I need a lot of clinical quality data.
[00:22:11] Jennifer Rabiner: There's tons of manual entry chart chasing all of those different kinds of things that are inherent in quality measures today across all kinds of programs. There are 3 clinical quality measures, all based on keeping people out of the hospital, and they're all claims based. And so Medicare has the data they need to calculate.
[00:22:28] Jennifer Rabiner: The. you know, how a particular ACO is doing based on claims alone. So it eliminates a lot of the reporting burden, you know, that is very, very time consuming for, for an ACO, as well as I always call them kind of the rollout measures. So if you're doing all of those other things, keeping blood pressures low, keeping diabetics healthy with low HbA1c's, putting people on the right medications, you're keeping people out of the hospital.
[00:22:54] Jennifer Rabiner: So they're kind of the ultimate quality measures, if you will, but it's It's a very different landscape to build in and to operate in as well. So we're excited to see how CMMI continues to evolve on those paths.
[00:23:08] Angela Suthrave: That's cool that you've been on this journey as, you know, these models evolve. And get updated.
[00:23:15] Angela Suthrave: Can you talk a little bit? So you were saying that for Pearl, you started off serving, you know, provider groups, and now you're entering into health plans, some of the maybe smaller regional ones. How does the. product differ or stay the same when you're serving a physician group versus if you're serving a health plan under the ACO reach model?
[00:23:37] Jennifer Rabiner: Yep. So we, so there's the, we have the smaller physician groups, larger physician groups, some small health systems, and their product experience is all quite similar. It's all, you know, again, the patients who need attention today, there might be a lot more patients. I would say as we move into bigger organizations, there's different ways people divide work.
[00:23:56] Jennifer Rabiner: I take this issue. I take that issue. I take this, you know, pot of doctors. You take this pot of doctors. So looking at how we really efficiently segment work and then the more people who are doing that work, their managers are going to need those roll up views they want to be looking at. Physicians across their networks to understand, Hey, they're doing great in this area.
[00:24:14] Jennifer Rabiner: They need some more support in that area. So I think that the, the bigger and bigger healthcare providers we're serving, we get some of those extra needs, even though the, say the kind of the core job, the core engagement model of the product is really the same. And then we are starting to also go into some Medicare Advantage risk, where we're partnering with health plans, and then, you know, then it's a whole different program.
[00:24:40] Jennifer Rabiner: It's not the ACO REACH program. It's Medicare Advantage. We're into STARS ratings and HEDIS measures, things like that. And so. Our goal with all of that, as we move into different programs, which has, you know, always been our goal, it was great to start in REACH for a lot of different reasons in terms of how we built what we built.
[00:24:58] Jennifer Rabiner: But as we move into these different programs with different requirements, the real goal for us there is to, again, do all, take care of all of that complexity. under the hood of the product. So, okay, this, this patient is in this program, you know, they're with this Medicare Advantage payer, and that means that these are the quality measures that matter in that program.
[00:25:19] Jennifer Rabiner: We don't need a whole Medicare Advantage module where somebody has to go in somewhere separate and do separate things. We want it to follow the same engagement pattern. Here's a patient who needs your attention today. Here is why. And here's what we suggest that you do. So it just gives us more reasons if you will to do that.
[00:25:34] Jennifer Rabiner: But but the goal is all of that happens behind the scenes in the product so that we're really surfacing a patient centric, you know, very action oriented workflow rather than extra modules and more lists and uh. Okay, wait, if I combine this and this together, am I going to get, you know, what I need to do?
[00:25:51] Jennifer Rabiner: So trying to make that really, really simple. But so we, I always say the product is patient centric, action oriented and program agnostic.
[00:25:58] Angela Suthrave: I love that. That's really, that's a nice, succinct way of, you know, setting forth the vision.
[00:26:03] Omar Mousa: Jen, you mentioned we're a sidecar to the EMR. And that you've seen, EMRs you never thought you would see, you've seen.
[00:26:10] Omar Mousa: It's
[00:26:10] Jennifer Rabiner: true. I came across names I'd never, never even heard of before, even after working at an EMR company.
[00:26:15] Omar Mousa: Yeah. I often, I feel for the MSOs, honestly, when I engage MSOs and there's just the stacks that they interact with that post acquisition. It's, it's quite interesting, but let's talk like on the provider side, right?
[00:26:27] Omar Mousa: So you're, you're, you're building products for the provider. How do you engage providers in The ACO reach model to ensure they're like active participation and that they demonstrate they like use the product in a way that would actually demonstrate the medical economics required to make the partnership successful.
[00:26:44] Jennifer Rabiner: I would say part of, you know, kind of twofold part of that is, are they engaging? And second is, are we, are they engaging in the right things? Which is a lot of what we spend our time on, of saying, am I raising the right patients for the right reasons? And then are they engaging? Are they engaging in a way that we can have term high value engagement?
[00:27:03] Jennifer Rabiner: And then on the back end, we're putting all of that together to say, are we actually achieving those patient and clinical outcomes? So that we know that the work that they're doing, the work that we're doing is all in service of the right. Uh, patient outcomes, which, you know, one of the things I love about value based care is how it's really a win win win, you know, it's good for the patient to stay out of the hospital, it's good for the provider, they want their patients out of the hospital, and they'll get rewarded for giving that good, you know, kind of proactive care.
[00:27:32] Jennifer Rabiner: And then the system wins because it's lower cost. So that's what we're always looking for about translating that engagement in that way. So, you know, how do you get them to engage, especially when we're not in the EMR, which is, you know, a challenge that has, has been in the forefront since I started at Pearl, just from my, you know, my experience working in a, population health management platform across, you know, with, uh, health organizations that had a million different EMRs in their landscape as well.
[00:28:02] Jennifer Rabiner: So, you know, one of those is really around keeping the product as, you know, we were just talking about very action oriented. And so it doesn't feel laborious. It doesn't feel difficult. It's not a quote unquote portal. It's not, you're not downloading a CSV. That it, we make it very easy to log in, see what you need to do, get that done, and then move on with your day.
[00:28:23] Jennifer Rabiner: So things like how long does somebody spend in the product? It's not something I want to optimize for. For what I want to optimize for is how well did you do clearing those, those patients who were in a high urgency status today. And so a lot of this goes into the user experience. We've invested a lot in research.
[00:28:40] Jennifer Rabiner: We invest a lot in our design to, to make sure that it's easy to use the product and that it's compelling to use the product. We. We often say that the feelings we want people to leave with are that they feel proud, you know, that they did the right thing for the patient. We, I remember an early, early thing talking about when we were designing the product is there's always a right next thing to do for a patient.
[00:29:02] Jennifer Rabiner: Patients who are very sick and needing to use a lot of healthcare resources are likely, you know, they're going to keep needing to use healthcare resources, but there's always a right next thing to do for them. For every patient in every different scenario. And so, you know, back to that theme of earning engagement, we want people to come in and feel like proud of themselves, like, Hey, I'm taking care of our panel and taking care of all of these patients.
[00:29:24] Jennifer Rabiner: I'm so glad that patient didn't slip through the cracks. So we embed a lot of things kind of small and large into the product and how we design We do a lot of different reporting to them. We engage them with our customer success team. How are you doing? Are you engaging in the right things? There's things in the product that tell them every day or how well are you, you know, how much are you keeping up?
[00:29:46] Jennifer Rabiner: We give them goals in the product. So I'm looking at all of those different kinds of things. It all goes back to, you know, how we might do incentives for them, you know, again, in value based care, the, the. financial reward doesn't come for so long and it's, you know, so many different things are baked into it.
[00:30:02] Jennifer Rabiner: How do we move some of that up into, into the day to day so that the practices feel like they're, that they're doing the right thing as well. And then lastly, you know, most of the things that need to happen in parole are not about what has to happen in a visit. It's about actually in between the visits trying to make sure people are getting where they need to go, whether that's a, you know, visit with their PCP or, or potentially interacting with a specialist.
[00:30:28] Jennifer Rabiner: But when we always say when we need to be in the visit, we're going to be in the visit every time that we can. So if you're in the appointment with a patient and we know something about the patient that would be helpful for the clinician to know instead of doing the swivel chair. You know, split screen into Perl or printing things out.
[00:30:47] Jennifer Rabiner: We have partnered with a company called Vim, which has integrations with a lot of EMRs, where we can essentially put information from Perl into the workflow. Of the provider in their EMR so they don't have to leave that screen and can kind of know what we know, if you will.
[00:31:05] Omar Mousa: It kind of reminds me of a, I think this is, I saw this the other day.
[00:31:08] Omar Mousa: Athena has launched or is launching, might be in beta, a feature, it's like sort of like clinical decision support, but they're allowing payers to provide guidance directly in Athena for the provider to take action on. Is that something similar you all are exploring or? Yeah. Describe the difference, I guess.
[00:31:29] Jennifer Rabiner: I'm not familiar with that particular announcement from Athena, but I know there've been different things like that in the works for a number of years, but it would be similar in that the thing, what is the health plan Uh, trying to achieve same things as any risk bearing organization. They're trying to reduce unnecessary utilization.
[00:31:46] Jennifer Rabiner: They are likely looking at a set of quality metrics. And then there's always accurate assessment of potential codes, as everybody's trying to make sure that the, the kind of benchmarks or budgets, if you will. are based on the true acuity of the patient panel. So it's likely very similar in terms of, hey, getting what the health plan knows, which is actually in some ways more than the EMR knows, just like I happen to know.
[00:32:12] Jennifer Rabiner: more about what's happening with a patient because I'm getting total cost of care claims data. The payer also has that. So there might be different specialists that they're seeing. There might be quality measures that they're overdue for. There might be different codes that are, are being assessed or, or not assessed, I guess, if you will, out there in the rest of that patient's experience.
[00:32:34] Jennifer Rabiner: And so getting the data into the workflow, it's probably a very similar job to be done. What we all put in there could look fairly similar or look different. I think, you know, we, you know, in value based care, there's always the basics, the things that you need to do for program requirements. And we have to cover those just like everyone else.
[00:32:51] Jennifer Rabiner: And then there's the, what else would we show? And so some of the things that are unique about Pearl will also be going into that workflow most likely next year. And so those are, you know, I'm assuming Athena probably has some of that as well.
[00:33:02] Omar Mousa: Let's shift gears here a little bit. Let's talk about like building in the value based care.
[00:33:07] Omar Mousa: space from a product perspective. And let's talk about features. So like, what are the key features that a value based care health product should include to effectively support patient improvement or patient outcomes? And also maybe even the medical economics piece.
[00:33:24] Jennifer Rabiner: So I would say, you know, the real basics, and I talked about this a lot at the beginning of Pearl, when we were building the base of our, our product, I mean, you typically in value based care, you know, Data is kind of your lifeblood.
[00:33:36] Jennifer Rabiner: So you, you usually have that total cost of care claims data in some kind of risk based arrangement. And so ingesting that, making sense of that, you know, is a, is a core foundational element. I did a lot of analogies early on about building a house. So, okay, you have to build the foundation of your house first.
[00:33:53] Jennifer Rabiner: So you have to lay down that data foundation. You have to start putting in some of the utilities, things like quality management and, you know, quality measures are. You know, most straightforward way to describe them are just numerators and denominators, but who qualifies in a denominator, who's compliant or not compliant in a numerator can all be a little bit complex, but you need those mechanics in, you know, one of the systems in your house, you need risk adjustment and risk coding, which again goes back to, are you, accurately assessing and documenting all of the conditions of a patient so that whoever's setting the benchmark or the budget you have, it knows about the right clinical acuity for those patients.
[00:34:32] Jennifer Rabiner: And so those are the real table stakes. It's hard to imagine any value based care product that's participating in risk. program with any kind of payer, like you wouldn't need those foundations of, you know, I just need to understand cost trends. I need all that data. I need to be able to understand how we're doing in quality where, where there's work to do, where there's not.
[00:34:51] Jennifer Rabiner: And then what are those risk assessment opportunities? And so those are the real basics. But then I think the, the harder, but more exciting work is then when you say, okay, well, how am I going to prevent it? unnecessary utilization and getting into those medical economics. Now, if you're in a commercial value based care program, you've also got who's in network, who's out of network.
[00:35:13] Jennifer Rabiner: That's one of the ways to reduce medical costs, not necessarily medical utilization, but medical costs. Uh, in a CMS program, there's no such thing as a, you know, a traditional preferred network. Um, the patients are traditional Medicare patients. They can see any patient or any physician who takes Medicare.
[00:35:32] Jennifer Rabiner: So those are, you know, I would say kind of those building blocks, but then the, I think the real opportunity, the real excitement, and something that I think is very persistent across models is when you can start preventing that unnecessary medical utilization, and that can take a form from you. You know, we're very focused on preventing readmissions.
[00:35:50] Jennifer Rabiner: For example, that's related to two of the clinical quality measures that we have. Those are obviously poor patient experiences as well as very expensive experiences. And so trying to prevent anything from from a readmission to trying to prevent unnecessary procedures. You know, medications can sometimes be unnecessary, but oftentimes, you know, are necessary and actually recommended because those will help decrease the overall medical spend, but that's where things, I think, get really interesting when you're doing that, and that's where I think that persists across programs.
[00:36:24] Jennifer Rabiner: Every program will have their own nuance. Set of quality requirements, different benchmark setting, different mechanics, but every program will benefit once you start learning how to do that at scale.
[00:36:35] Angela Suthrave: All right. So you've touched a little bit on the data. I think this is an area we wanted to go deeper because you have subject matter expertise here.
[00:36:44] Angela Suthrave: So obviously it's an important, um, component for developing these products. Why don't you tell us a little bit more about the data and maybe include like quality. accuracy, et cetera.
[00:36:56] Jennifer Rabiner: Sure. So, you know, again, that whenever you're participating in a risk based agreement with a payer, you should have access to the total cost of care claims data.
[00:37:05] Jennifer Rabiner: Cause what you're trying to do is, is, you know, reduce it. And so you have to have access to what's actually going on out there. So it's a great foundation. Typically this data though comes, it's delayed. It comes in a big batch once a month and all that data is a little bit late just by nature of how long it takes.
[00:37:21] Jennifer Rabiner: to, to pay claims. So I always think of it again as a great place to start. We knew that's where we were starting. So instead of limiting, you know, ourselves like, oh, there's so many issues with it. We said, okay, but there's so much we can do with it. And so what can we do with it? So there's a lot of room to get started there.
[00:37:36] Jennifer Rabiner: But, but really after that, you need to start thinking about. What other data sources can give you the data you don't get from claims? So I might know on a claim that somebody had an HbA1c test, but I don't know what the clinical value of that was. There are some ways that you can use claims and some non billable codes to indicate what ranges they're in called CPT2s, which are great when they're used.
[00:38:00] Jennifer Rabiner: But then, so it depends on what you're trying to do, but do you have some gaps in that data that you need, like the clinical values? And then, or, or data that just doesn't live in claims, like SDOH data doesn't live in claims. And so you would have to get that from somewhere else. Also looking for less latent sources.
[00:38:16] Jennifer Rabiner: So when you're trying to be very, very actionable, if something's three months old, by the time, you know, you can't really do much about that. I will say CMS has enabled an API to get adjudicated and partially adjudicated claims data. It's called BCDA. So we are able to reduce latency When we, when we want to know something a lot faster than we might know three months down the road.
[00:38:38] Jennifer Rabiner: And then you have to think about what's going to be meaningful and engaging to your users. I would say, you know, again, over the past decade, all of this data has become available. You can buy data from so many different places. You can tap into so many different networks. And I think, you know, what I've seen in the last, you know, year or so, as we talk about this is also really think it's expensive to acquire that data.
[00:39:00] Jennifer Rabiner: It's expensive to implement that data. You asked about quality and accuracy. No matter how good a data source is in healthcare, there's always something going on, whether there's missing data fields or why does, you know, from this source, it looks this way and that source, it looks that way. So it's never, it's never inexpensive to get data.
[00:39:18] Jennifer Rabiner: So thinking a lot about that ROI, whether You know, why am I getting this data? I would love to have all the data. Everybody would love to have all the data, but A, you don't want to overwhelm people with data. So, we think a lot about, well, why do I need that data source? How much does that data source cost?
[00:39:32] Jennifer Rabiner: What is it going to tell me that I don't already know? And that's how we really make decisions and, and are very careful not to kind of just kind of spew all of the data that we might know about a patient. We really do try to distill that into why do you need to know what does it mean for patient care here?
[00:39:49] Jennifer Rabiner: But, but yeah, so I think data has become a lot more available, but it's still not the most efficient and not always cost effective to just go buy all the data from all the places.
[00:40:00] Omar Mousa: Yeah, it seems like we need the data to be able to do the right thing to drive the right outcome, right? And the data's disparate a bit.
[00:40:09] Omar Mousa: You mentioned that it makes sense to buy data sometimes. I imagine, you know, we leverage the HIE networks a lot for some data. The payer themselves have a wealth of information that would support us in this, in this endeavor. Like what, what are the other sources outside of, of that, that like someone who's building this space would need to tap into to really do a bang up job?
[00:40:35] Jennifer Rabiner: Yeah, I think, you know, first and foremost for us, given, given the nature of ACO reach was buying admin discharge transfer data. which sometimes is available in HIEs. It's available in multiple different ways. We, we tap into a couple of national aggregators. And as I mentioned, we're in 43 states. So it's, it's difficult to, you know, we can't go to one HIE and get everything that we need.
[00:40:57] Jennifer Rabiner: So we went to these aggregators first that sometimes also connect to HIEs, which makes it a lot easier for everyone as well. So that was our first one. choice of data we would buy because we really wanted, we needed to reduce the latency of knowing about a discharge particularly so that we could kick off the right readmission avoidance workflows.
[00:41:17] Jennifer Rabiner: And so you need to know that information. So that was one of the first, you know, that we bought. I think other places, I mean, there's tons of clinical data exchange options out there, different ways to kind of get those on ramps into that information. There's buying medication fill data. There's buying lab data SUH is I feel a little harder to come by on the patient specific level, but there are, you know, even some, some free, uh, geographic base.
[00:41:43] Jennifer Rabiner: So you can do a lot of work, you know, Hey, based on the, where this patient lives. And we know a lot of things about the availability of grocery stores and pharmacies and public transportation and things like that. I would say the real long road here though, is when you need to get the data out of the EMR itself.
[00:42:00] Jennifer Rabiner: And that can be very, very challenging because yes, there's lots of new great interoperability standards, but there's still work to do on behalf of the practice, on behalf of us to go get it from all of these different places. And then there are some data types. You know, for example, I would really like appointment data because if I am saying I think this patient is at high risk of going to the ED in the next two weeks and we think they ought to be scheduled for an appointment, right now I can tell the practice, Hey, there's, here's a patient who needs your attention today.
[00:42:31] Jennifer Rabiner: We, our algorithm is saying, we think they're going to go to the ER in the next two weeks for a preventable reason. And we want you to schedule that patient for an appointment. If I could text the patient and say, Hey, here's some appointment times, that would be even better. But appointment data isn't, you know, one example of data in an EMR that's not actually covered by a lot of the standards that we look at today.
[00:42:53] Jennifer Rabiner: So it's a, it's all kind of long and winding road as soon as you have to start going into the EMR to get any, any particular data. So that's where you really have to start thinking, what am I going to prioritize? Why do I need it? How much coverage can I get with it? What is the latency of that data?
[00:43:09] Angela Suthrave: I have a lot of questions.
[00:43:10] Angela Suthrave: This is such a great conversation. So you talked about, you know, if. If I'm listening to this and I'm. You know, earlier stage, I'm trying to be capital efficient. You talked about data being expensive. You also talked about prioritization. And so how might you think about the order in which you get this data?
[00:43:29] Angela Suthrave: How you think about like the costs associated versus the ROI of this data? Can you have pieces of it or do you really need this ecosystem to really get that piece picture to make it very timely and actionable.
[00:43:41] Jennifer Rabiner: I certainly don't want to scare, uh, scare anyone off from doing cool things. I think it very much depends on what, what are you trying to build?
[00:43:48] Jennifer Rabiner: Who are you building for? So if you are building and you're going to, you know, maybe buy a practice or run a practice or, you know, connect with just one MSO as your pilot client, For example, that world all of a sudden became a lot more manageable. And so they're probably in one region. You can, you know, maybe go directly to the hospital and get the ADT feed.
[00:44:11] Jennifer Rabiner: You might, you know, just go to one aggregator and be able to get that information. If it's a hospital system itself, they're going to be able to provide you a lot. Are they all in the same instance of Epic, for example, they might have that data themselves. So I think it's just about what choices. you make.
[00:44:26] Jennifer Rabiner: And so when you think about prioritization, it goes hand in hand with go to market. And we're going to go to, you know, Pearl, we decided to go to market across the country. So that gave us a lot of opportunity in a lot of ways that I think has really worked out well for us. And, and, you know, we love kind of being able to, to meet any practice in the United States and welcome them in to Pearl.
[00:44:44] Jennifer Rabiner: There could be different choices where you say, Hey, I'm going to go just with this MSO and we're going to go really deep. And I'm going to do all of these different things and I'm going to learn how to do that and rinse and repeat and go to the next one. So I think that's where your, your go to market is, it has to be hand in hand with your, your product strategy when you're talking about data, but I will say this gets better every day.
[00:45:03] Jennifer Rabiner: You know, some of these things wouldn't even been possible to talk about a decade ago.
[00:45:07] Omar Mousa: Continuing on the thread of just like payments in general, payments sort of sits as an important component of this product offering. And so like, what, what are the features or like the learnings that we've drawn from fintech that drive improvements in payments and health tech?
[00:45:22] Jennifer Rabiner: Well, it's, it's pretty, you know, when we're talking about payments in our world, we are dispersing the monthly capitation payments to our clients. And it's, it's pretty straightforward. You know, there's a set rate every month for every patient, you know, that patient list ebbs and flows every month for different reasons as all eligibility files do.
[00:45:42] Jennifer Rabiner: But the payment itself is very straightforward. And it's, it's, you know, here's all the patients that are active with you this month. Here's the rate. We give them a statement and then we deposit the money, you know, straight into their bank account. So probably not, you know, leveraging all of the latest and greatest around FinTech, but we're able to just leverage, you know, the, the rails that are already out there to do that.
[00:46:02] Jennifer Rabiner: And so yes, if all healthcare could only work, you know, that simply, that's wonderful is, is I don't think we covered, but my last job was at a company called Hint Health. which serves the direct primary care world, which is a membership form of medicine. And that's how simple all of their payments are, is here are my patients who are aligned to me and members this month, and here's what they pay.
[00:46:21] Jennifer Rabiner: And, and it's all really straightforward. So it's, it's the opposite of what I was explaining at the top here, when there's a million different parties involved and all these different rules, and it's kind of abstract and complex of how we translate from, from cost to actual payment. But I would say one of the challenges that was a little bit Surprising to me in the beginning is when you think about these practices, they're getting all of their revenue in the traditional way, except for this, you know, for the most part.
[00:46:48] Jennifer Rabiner: So they're used to that. It goes through certain accounting reels. And then they start getting less on their Medicare EOB in the traditional way. And then they start getting payments from Pearl. And, you know, we can do all the analysis and the data to show how, how, you know, it's intended to keep them whole.
[00:47:05] Jennifer Rabiner: It's not intended to be less than what they were making before for primary care. But it gets very, very complicated. from an accounting standpoint and from, you know, them just looking like, Hey, am I, am I making the same? Their cashflow is so important. So I would say we deliver them the, the money in a very straightforward way, but because it's so different from the rest of their receivables.
[00:47:28] Jennifer Rabiner: That can be complex in the beginning. So something that we, we really support them through as they're, as they're new to Pearl.
[00:47:35] Omar Mousa: I've, I'm someone who's spent a lot of intimate time with Stripe and their APIs and their documentation and yeah, Angela's shaking her head cause I'm like kind of a nerd about it.
[00:47:44] Omar Mousa: And I often look at their documentation and then I try to compare it to the documentation of other healthcare products and I'm just always so, God, I wish. That's so easy. So nice.
[00:47:58] Jennifer Rabiner: Yeah. Sometimes it's, it's so easy that it's almost too easy. It's, it's too different from, from the rest of the way things are paid.
[00:48:06] Jennifer Rabiner: But as soon as we kind of get a few months under our belt, things, things settle down.
[00:48:10] Angela Suthrave: Let me ask you about AI and your opinion on it being a tool when we're thinking about building value based products.
[00:48:20] Jennifer Rabiner: I absolutely think that it has. As a role, we'll continue to have a role, I think, particularly as we look at scaling, you know, these increasingly scarce resources and think about, you know, really value based care, expanding the care model to be much more longitudinal than this kind of transactional model.
[00:48:40] Jennifer Rabiner: It really does start begging the question of, do humans always need to be the initiators of everything that's happening in this world? sort of, you know, multi touchpoint type of model. And so, you know, for us at Pearl, in terms of the world of just general advanced data science, you know, we've started by employing machine learning models to this big wealth of data that we get from Medicare to, to, you know, basically discover patterns, correlations between data.
[00:49:05] Jennifer Rabiner: It's how we do some of the predictive work we do, like we think this is a patient who has a high likelihood of going to the ED in the next two weeks. So that's where we've really started with all of that. But in terms of the. you know, where do we go next? Where do I think AI could have a role? Is that, you know, a lot of what we're trying to do, again, is trying to make sure that patients get where they need to go at the right time and that people aren't falling through the cracks, which at the end of the day involves scheduling, whether that's with a PCP or a specialist or, You know, down the road, you know, are there certain orders, we would tee up, you know, those kinds of things.
[00:49:37] Jennifer Rabiner: And I think that's a really great place for automation and, you know, potentially AI as we go into that process. It's not exactly like a, an easy admin task that, that can just be completed because we're talking about, where are the open slots in a schedule, which are kind of all locked in those, in those EMRs, as we were talking about, what is the patient's schedule like and finding, you know, the right time and the right place.
[00:50:01] Jennifer Rabiner: But I do think that's a place that I'm looking forward to really exploring. How do we, how do we start taking some of the, the manual work and the phone call back and forth and all of those different things to, to automate? And I think AI has an exciting role there. And then the second place is. You know, we're talking a lot about data, talking about how expensive data is and how it can be so challenging, still so valuable, but I think the best source of data is the patient.
[00:50:27] Jennifer Rabiner: And there's so much, so much that I think we're going to be able to learn by getting data from a patient that doesn't always have to be like I put a wireless, you know, blood pressure monitor on you. Sometimes that might, you know, might be the right answer, but I think there's so much that we can learn from the patient that, you know, really can complement, supplement, strengthen clinical data that we have, but about how they're feeling, reported symptoms, you know, what are the trends and the patterns and some of those things.
[00:50:51] Jennifer Rabiner: too. So I certainly think it has a role. I think that that certainly will be part of our future. And I think there's some unique ways to think about doing that in value based care specifically.
[00:51:00] Omar Mousa: Jen, earlier in the conversation, you mentioned you joined Pearl like fairly early, if not at the beginning. So let's talk about building products zero to one.
[00:51:08] Omar Mousa: What are the key steps and challenges you face when building healthcare products from scratch, especially in a capitated environment? Like how has that been applied to Pearl Health?
[00:51:17] Jennifer Rabiner: Yeah, great question. So when I kind of think back to, to joining Pearl, so I, I was definitely there when they're under 10 people.
[00:51:25] Jennifer Rabiner: So I think I was employee seven or somewhere thereabouts where it was a really small group. And what compelled me to come to Pearl were really two things. So we talked a little earlier about the big differences of ACO Reach versus other programs. And I thought it, it sounded like such an exciting way to build in health tech when there were, there was a little more flexibility, if you will, about what we could build because it was a capitated environment and The way the quality measures were constructed, it, it felt really exciting to me to build in that world, kind of leveraging everything I knew from my time at Athena and population health management, building in a new environment.
[00:52:03] Jennifer Rabiner: And then the second thing was building a product from scratch because I had never done that. In both of my product leadership roles prior to joining Pearl, I had, Come into a product actually working with the founders of those products, which is a whole unique experience in and of itself of coming in to assume product leadership on a product that someone else built.
[00:52:24] Jennifer Rabiner: Um, and so those are great experiences where I learned a lot of different things, uh, in that way, but this was something I just hadn't done and building something, uh, from the ground up felt like a really nice evolution next step for me in my career. So. I would say when I reflect back on that time, and other people ask me about building from zero to one and what you need to think about, I think a lot of it depends, assuming that you're in a, you know, assuming most of the time you're in a brand new company, you could be in a bigger company building a product from scratch, but you have to think about what thesis are we starting with?
[00:52:58] Jennifer Rabiner: Are you starting from a. a market thesis where there's a market opportunity that you want to take advantage of and you, you know, want to have tech be the primary or a major contributor into how you're going to tackle that market opportunity, which is how Perl started. Or do you have a tech thesis where you have some really cool technology, you have something new and you want to apply it to a market.
[00:53:21] Jennifer Rabiner: And so both of those are, are really interesting ways to start building from zero to one. So. Starting with the market thesis, it was just really important to nail down what success was going to look like, what, you know, starting from the outcome, you know, and, and what were those outcomes that we were going to achieve and nailing that down with the company.
[00:53:41] Jennifer Rabiner: Obviously, there are some North Star metrics, but what would be the most important things in the first year? If you're in any kind of funding environment where either you're trying to get internal funding from, you know, your big company to continue, or you're going out into the market, what are you going to, what story are you going to want to tell?
[00:53:57] Jennifer Rabiner: What are those proof points? So you need to know that from the beginning and, and I think a market thesis too is generally pretty broad. So how do you refine that down into how are we going to enter the market? Who are we going to build for? And then really, really thinking about what is going to make you differentiated.
[00:54:13] Jennifer Rabiner: What is something that you're going to be able to say, this is something that we do or the way that we do it is very, very different. And so there's a lot of refining into, okay, what, you know, what are the most important things? And one of the things I did pretty early at Pearl that I think anybody should do regardless of what product stage you're in is writing product principles, which is not a product strategy.
[00:54:35] Jennifer Rabiner: It's not a product roadmap, but I talk about them as the guardrails. What are the things that are going to be important to us? What are the things that are going to make us different? And when I have a choice of two paths, what are the, what are the product principles? Where do they lead me to? So when I say things like being patient centric, that's one of our product principles.
[00:54:51] Jennifer Rabiner: And so when we build, I'm not building to just check a box. on a requirement I need to build in a patient centric way. I think when you're building with a tech thesis, you have to do the opposite and then go to find your market and say, well, who is going to buy this? Why would they pay? What would they pay?
[00:55:06] Jennifer Rabiner: What's the business model around this? And, and so, you know, both of them are just very different starting points. And I think when you're building zero to one, Know which one you're starting in and then know which questions you have to get answered with the rest of your team. It's not just yours alone to answer.
[00:55:24] Jennifer Rabiner: You need to make sure you're aligned on, on what are the metrics, what are the business outcomes that are going to be most resonant with both our clients and the people paying for our product and anybody who might need to invest in or kind of give the go no go on what you're doing. Oh, and I was going to say too, one of, I think in either situation, the thing not to ever skimp on is talking to your users and your buyers.
[00:55:49] Jennifer Rabiner: And sometimes your users are your buyers, sometimes they're not, but that's not a step to skip. That you will, you will not leave any conversation with someone without learning something that changed in a big or small way a decision that you might make. that day or, or down the road. So something to not skip in any part of product development, but zero to one, it is crucial.
[00:56:08] Angela Suthrave: Can you give us an example of a learning from a user where it changed directionally what you were building?
[00:56:16] Jennifer Rabiner: So one story that I remember very clearly from my first year at Pearl is that one of our initial customers was a small practice. It's still a small practice who's, who's still with Pearl, which I love that we have clients that are continuing with us.
[00:56:30] Jennifer Rabiner: for, for multiple years, but I remember speaking with her on the phone and she had her camera on and she was showing us how many different stacks of paper that she had from different health plans. And I have to do this and I have to do this and I have to do this. And then she was telling me she had 12 portals.
[00:56:47] Jennifer Rabiner: that she had to log into for all of these different health plans. And she spent most of the hour talking to us about the complexity of dealing with pairs and all of these different requirements and all of these different things. And she knew every single thing like, okay, now this one, I have to call this person and go do this.
[00:57:03] Jennifer Rabiner: And so she, she had sort of the organized chaos, you know, where she knew all the things she had to do. It drove her nuts. And when I heard her say, I have to log into 12 different portals and then this one looks this way, this one looks that way, it really started to, to hammer home and I would say reinforce the fact that we, yes, I could quickly build something that was like another list for her and say, Hey, do this, do this, do this.
[00:57:27] Jennifer Rabiner: And it was at that moment, even though care gaps had been, you know, part of my lexicon the entire time that I've been in. in, you know, kind of value based care world. And I said, you know, we're never going to have that in our product. We're never going to have a list called the care gaps list or this care gap or that care gap because it, it puts everything down into that checklist and another stack of paper on her list.
[00:57:50] Jennifer Rabiner: And I do remember that. So it was just so powerful and it really reinforced and kind of brought to the surface a lot of that. Uh, the reason why we needed to be a patient centric platform and be different and feel different because we were going to have to earn her time in the middle of that crazy desk with all of those things.
[00:58:07] Jennifer Rabiner: I can't fix all of those problems yet. So in terms of focus and prioritization, you know, we were, we were launching in this Medicare program. It was going to be something else, something new for her. And I wanted it to feel really, really different. I wanted her to be able to log in really easily, of course.
[00:58:21] Jennifer Rabiner: Since she was talking to me about all of her different passwords, but I wanted her to feel like that was something different and that it was about taking care of patients. And I wanted her to leave feeling good and proud and not rolling her eyes for more paperwork that she had to do. So that one always sticks out in my mind is a really impactful conversation.
[00:58:37] Jennifer Rabiner: And that was, you know, just one conversation over the phone. I've since visited her in person and I got a whole tour of the practice and I love the pride that people feel in these, in these small practices and they're serving their communities. It's, it's. It's such a cup filler, uh, to go talk with them.
[00:58:53] Angela Suthrave: And it doesn't, you know, we all, all of us have worked in health tech for a long time. I don't think that her experience is unique, right? And so like, that's just so great that you were able to do something about that problem.
[00:59:04] Jennifer Rabiner: And it's one of the most fun parts of building zero to one. Yeah. is that you do have a blank slate, which can be alternately terrifying and really exciting.
[00:59:12] Angela Suthrave: Let's talk about building products in risk based versus traditional SaaS. You know, maybe help us understand the difference when you're thinking about prioritization and customer success and how does that tie in with product success?
[00:59:27] Jennifer Rabiner: Yeah, I think it is very different to build as a risk bearing organization rather than, than pure SaaS.
[00:59:33] Jennifer Rabiner: I mean, there's a lot of things that about building are, are the same, but you know, one thing that is so unique is that because we're the risk bearer and then we sign practices to, to participate with us in that risk and in this program, they don't pay us to, to use the product and that can work out in your favor and it can present challenges because in our favor.
[00:59:55] Jennifer Rabiner: You know, there isn't that, well, I don't think your product is worth this, I'm, you know, negotiating on price in that way. And then the harder part is nobody bought it. And so, you know, when somebody, when you spend money on something, you want to get a lot out of your investment. And so it does change sort of how you engage with your customers.
[01:00:13] Jennifer Rabiner: But it also in our world, not only do they not pay us, but we pay them. And so it just completely changes the whole relationship with a client where. You know, on one day I could be explaining their capitation to them, and the next day I'm talking to them about three patients, uh, who are algorithm flagged as, you know, potentially going to the hospital in the next month.
[01:00:31] Jennifer Rabiner: And so, it does change the relationship with the client a lot. And then in terms of how we build, I think, you know, there's also a little more of the dynamic. When you're in a SaaS world, you're thinking all the time about top line revenue and renewals, which we always are thinking about. Of course, you know, our business and our revenue and our, our renewals as well.
[01:00:53] Jennifer Rabiner: But it just, it, it makes the business outcome very different. Cause my business outcome in our model is to reduce the cost of care. So kind of a big, bold goal there. It isn't. to enable other people to do that and have them pay me a fee to do it. And so it's, it's just, I might be building some of the same things, but my mindset and the outcomes that I'm tracking are so much more directly related to total cost of care and succeeding in these risk programs, um, as my primary business outcome, rather than saying, okay, really need to make sure we're renewing or I'm adding modules so we can increase our PMPM, like all of those different things.
[01:01:34] Jennifer Rabiner: So, uh, not about one being, you know, better or worse. I will say it's been a little freeing to be able to build a product roadmap very squarely with those things. those business outcomes and those patient and clinical outcomes as well. So I have really enjoyed being able to build. In this way. And then of course, you know, it doesn't mean clients don't ask for things.
[01:01:57] Jennifer Rabiner: Of course they ask for things and we listen. We seek the information. We do tons of user research. We love talking to our clients. We do site visits with them and our product is better because of the feedback that they give us. That client I was just talking to you about. You know, with the big busy desk, she always tells us, she'll tell us when, you know, I don't like this.
[01:02:15] Jennifer Rabiner: I really do like this. And we love it. Uh, so it isn't that clients don't ask for things, but it's, it's just a very different way rather than, you know, Hey, we're paying for this. And we thought this, and here's, you know, here's my list of things you need to do. I think that's inevitable. I think that comes the more complex of your product, the more complex your clients are.
[01:02:33] Jennifer Rabiner: But I have personally really enjoyed building in this environment because it keeps us incredibly close to those ultimate outcomes.
[01:02:40] Omar Mousa: Going back to like putting our product hat on you're running a large product organization at a tech startup or health tech startup. And you mentioned earlier that you don't really, you're not really interested in measuring that folks were in your dashboard longer today than they were yesterday.
[01:02:58] Omar Mousa: You're more interested in the outcomes. Um, so how do you ensure that in the product development process, that everything is outcomes based and you're making prioritization decisions around outcomes?
[01:03:10] Jennifer Rabiner: Yeah, I, I think there's been a lot of chatter about this in the last couple of years in the product world.
[01:03:16] Jennifer Rabiner: And. I think it, you know, maybe a little easier said than done sometimes, but I think it really comes to, again, aligning with your company. What are those business outcomes? I sometimes, especially in health care, those outcomes, you know, I always say we're trying to do nothing less than bend the cost curve, you know, of the cost of health care in the United States.
[01:03:34] Jennifer Rabiner: Those outcomes can take a little while to happen. So what are the right leading indicators? So, you know, maybe you've got the long term. Uh, lagging indicator. How do you create almost a system of leading indicators to lagging? We've invested a lot in our framework of how do I, how do I translate product engagement into, into patient and provider and Perl business value.
[01:03:57] Jennifer Rabiner: And so we've invested a ton of time with that with our data analytics team, our data science team. I do have dashboards I look at, you know, every single day. So I spent a lot of time in a, in my dashboards. I'm looking at how that engagement translates into business outcome. And for us, that means am I reducing total medical expenditure?
[01:04:16] Jennifer Rabiner: And so we have created a way to do that, which I feel like has really like revolutionized my ability to to be able to make prioritization decisions, start getting really targeted, instead of just saying, Hey, everybody, our goal is to reduce total medical expenditure, or even in a particular, you know, domain of spend.
[01:04:33] Jennifer Rabiner: We're able to get very targeted about that, that engagement. So again, feel very fortunate. It's, it's the most data empowered I think I've ever been as a, as a product leader. So I would definitely say, you know, understanding the, the, what is the business outcome? What are the lagging indicators? What are those leading indicators?
[01:04:52] Jennifer Rabiner: But not just writing those on paper once a quarter in your OKR. Like, those are the things we live and breathe, you know, every single day in what we do. And so I can tell you how long people have been in the dashboard. I can tell you how often they log in. It's not that I don't look at them. I look at those trends.
[01:05:07] Jennifer Rabiner: I look at, you know, I think of them almost as the canaries in a coal mine if, if a trend doesn't go the way that I want what's going on there. But what I'm really looking at every day is how, how much value are we creating every day? And that, I think, has really transformed and really started to help instead of making As educated guesses or assumptions or using every all the data that I could, you know, making those best decisions at a high level, it helps us be a lot more granular and active about saying, hey, I put this change in the product.
[01:05:40] Jennifer Rabiner: All right, am I seeing a lift over here? Am I seeing a lower false positives? Am I seeing this happening? And so it's really still only the tip of the iceberg about what I think we can do. But I think it has been incredibly powerful to make the right decisions and be able to calculate ROI, be able to say, Hey, I think we want to invest in this.
[01:05:59] Jennifer Rabiner: What would the ROI be? And then when we do it, I can track it. And so I feel like it's not just helped me be a better product leader. It helps me be a better business leader. So it's going to be different for every business, but I think you have to really, really invest there, really partner with your, your business analytics functions.
[01:06:15] Jennifer Rabiner: and make sure that it's just infused in, in like the language, the, you know, the, the presentations, everything that you're doing all of the time. Jen, it's
[01:06:24] Angela Suthrave: incredible that you talk about being so outcomes focused. I was wondering if you could give an example of how do you know that You know, you're having success and reducing readmissions when a lot of the times when you're trying to improve quality and bend cost curves, it's the, it's the absence of an event.
[01:06:44] Jennifer Rabiner: I would say number one, make sure you're working with a really great data science team who can help help. do a lot of this assessment for you, but I'll tell you a little bit of the journey we've been on around a very common use case of trying to avoid readmissions. We're a classic example of if nothing happened, that's the, you know, that, that's the win.
[01:07:02] Jennifer Rabiner: You don't want the patient to have to go back to the hospital after they've been discharged. And so, you know, that started the first, I would say it was first data feed that we acquired. the ADT data, the admin discharge transfer data, and we would alert in the product that, hey, here's a patient who just got discharged, and we would have people taking action.
[01:07:20] Jennifer Rabiner: And the way that we start there is we look at what's available in the academic literature. And, you know, best practice is to, uh, get in touch with that person within two days and then schedule an appointment. Medicare takes it a little further in the, in one of the quality metrics specifying for certain patients.
[01:07:38] Jennifer Rabiner: Within which time frame those patients should have an appointment, uh, but the key is to have that contact within the first two days. So we set this up based on on that kind of industry information of, okay, here's a discharge. We are saying you should schedule an appointment and you should, you should make sure you schedule that appointment.
[01:07:56] Jennifer Rabiner: You get it on the books within two days. And, uh, and then have the appointment within these different timeframes. So I would say that's a classic case of we, you know, kind of knew the right thing to do. And then we tracked the leading indicator of how many appointments are getting scheduled within two days.
[01:08:13] Jennifer Rabiner: And so that's what we were tracking. We track it in the product. We let them see how well they're doing on that metric. And then over time, as you aggregate enough data, Then you can start looking at the rates of people who had readmissions, the rates of people who didn't, comparing that to industry averages, but it does take some time and some data, so it isn't like you're going to have your full outcomes, you know, framework from the very start.
[01:08:37] Jennifer Rabiner: This is where. You know, the, the classic question of is product management an art or a science? I mean, there's science to what we just talked about. And then the art is saying, okay, I have, you know, you're making bets, you're making hypotheses, all of these different things, but that's a clear case where we had leading indicators until I had enough volume where I could work with our data science team, do a rigorous analysis and say, Hey, yes, we actually are.
[01:09:01] Jennifer Rabiner: helping reduce readmissions, but you have to start somewhere. It's one of my favorite things to say when everybody feels very overwhelmed by how many different things we could do or how many different paths we can take is, is just think about where do we start? We don't have to figure out the whole thing right now.
[01:09:16] Jennifer Rabiner: We have to say, where do we start? And usually that's what you have capacity to do anyway, is to start and not to take something through to completion. So, you know, you can't be afraid to make those educated. Um, that's backed with as much data as you can, but we did start by, by tracking lagging indicators until I could understand that those lagging, I'm sorry, leading indicators that led to the right, the right outcome.
[01:09:38] Omar Mousa: You hit your comment about, uh, art or science that's in our, uh, closing call. So it's, it's, uh, you hit that, uh, let's talk about, you've mentioned, you've actually given some very good stories about, You know, being patient and provider oriented, even I want to talk about, I heard from you in a conversation that we had previously that customer success rolls up into product.
[01:10:00] Omar Mousa: And I want to understand, can you explain why that decision came to be and like how that's helped inform and build product?
[01:10:09] Jennifer Rabiner: Yeah, well, it happened, you know, a little organically all the way back in 2021 when we were, a very new company and we did, you know, we did have customers. They were going to be starting with us in January 2022 in ACO Reach.
[01:10:23] Jennifer Rabiner: And so we, you know, the management team said, okay, we have customers. We're going to have to have a customer success organization. We had somebody in our growth organization who had wanted to move into that space. And I raised my hand and said, Hey, she, you know, she can report to me. We'll, we'll figure out, you know, how to build this, not knowing that this was how we were going to be moving forward for the next few years.
[01:10:44] Jennifer Rabiner: Cause those early days, everybody, you know, everybody does everything. And I was happy to take that on, but it has evolved into. a really, you know, I would say cohesive and aligned organization. So in my org, I have product and experience design, you know, on the tech front, I have customer success and an organization called performance operations, which handles any partnerships or services that we can kind of deploy at scale to also help perform it.
[01:11:10] Jennifer Rabiner: So You could call my organization like the client performance organization. Everything that we do is all about helping our clients perform. So we always say, you know, we have the same goals here across this whole organization. We just have different roles to play and levers to pull to do that. And so we, you know, strategic choice of Pearl, try to do most of that through our platform.
[01:11:30] Jennifer Rabiner: And so that's where product and experience design come in. We have our people and customer success who do a lot of performance coaching with clients, which It has heavy overlap with engaging in the platform, so it's not only customer, you know, traditional customer satisfaction, they'll, they'll answer payment questions, they're responsible for renewals, all of those classic functions, but they do tons of performance coaching, whether that's something, a trend that we're seeing that isn't in the product that still needs to be addressed by the practice for it's engaging in something or engaging in it differently inside the platform.
[01:12:04] Jennifer Rabiner: And then in performance operations, you know, again, those can be partnerships. This can be services. But, uh, it's also a great testing ground when we want to try something new, test a bet, uh, test a hypothesis, want to do so in a low tech way. And then that can be productized if it ends up working, or if we try a partner.
[01:12:23] Jennifer Rabiner: And it really bears fruit. We can invest the integration into our product. So it's turned into just this, you know, again, very aligned and cohesive group of people where we just, we have the same goals. And then I don't think all being under the same leader is the only way that that can be created at an organization.
[01:12:41] Jennifer Rabiner: But I will say having those aligned goals at the top has been very helpful.
[01:12:45] Angela Suthrave: It's incredible to hear about what Pearl Health has built thus far. I would love it if you could share maybe a sneak peek for what's next. So growth
[01:12:54] Jennifer Rabiner: is definitely what's next and growth in a lot of different directions. So not just bringing on more lives for 2025, which is very exciting, but also growing kind of vertically as we talked about into larger and larger organizations, and then kind of building horizontally into more programs.
[01:13:13] Jennifer Rabiner: So we talked a little bit about Medicare Advantage. and also the Medicare Shared Savings Program. So just giving some different options and, and being able to find the right risk tracks for providers depending on where they are. So we're busy getting the product ready for all of those different kinds of growth, just in volume and client type.
[01:13:31] Jennifer Rabiner: And program type. So we're doing a lot of work there. Exciting plans on how we keep, uh, deploying more opportunities to capture value. So, you know, leaning into those machine learning models that I was talking about, developing new ones, refining the ones we have. And one that I'm really excited about that we're just starting to pilot is really how to pull the patient into these workflows as well.
[01:13:54] Jennifer Rabiner: So, You know, communicating with patients and doing giving them reminders, those kinds of things, nothing brand new in the industry. But as we talk about kind of capturing that value that we're putting out there in the product, all of these opportunities, instead of just relying on the practice to be picking up the phone and calling the patient, it's where we can now start.
[01:14:14] Jennifer Rabiner: communicating with the patient to say, hey, whether that's a reminder about if it's a patient for whom our model thinks they're going to go to the ED in the next two weeks, can we be calling them and reminding them, texting them and reminding them about their practice's 24 hour hotline? Can we take them deeper and deeper into that self service?
[01:14:32] Jennifer Rabiner: scheduling, which again, a long road given all of the different EMRs that we're working with. But I'm really excited to essentially move into the patient being one of our, our users, if you will, and really pulling them into that workflow.
[01:14:46] Omar Mousa: All right. So last question. I, you know, Angela and I. I have come from specialty care environments.
[01:14:52] Omar Mousa: She came from kidney care. I am currently in heart failure and in the value based care arena and you know, specialty care is undergoing tech enabled services wave right now where they're working, innovating on payment models. Are there any exciting opportunities in the value space of healthcare that, you know, that is in need of technology products in the, in the specialty realm?
[01:15:13] Jennifer Rabiner: Of course, you know, my, my day to day, I'm working with primary care physicians. I feel like I should be asking you both the question about, about tech and specialist care and would love to learn from you there as well. But I would say from the kind of PCP centric point of view, there are absolutely times when the patient needs to go to a specialist.
[01:15:30] Jennifer Rabiner: And that might be for a moment in time for a consult, for a procedure. And then they're coming back to their primary care doctor. And I think there's a lot of opportunity with technology to help that coordination be a lot smoother, instead of the faxes and missed phone calls and all of the different ways that they communicate or don't communicate today.
[01:15:50] Jennifer Rabiner: And then I think very interesting is when a patient actually needs longitudinal care from their specialist. So thinking about a patient with heart failure and the kind of relationship they might have with their cardiologist, and so thinking about the roles between those two. But, you know, really in either model, I would say that where it's more of a procedure or a consult, it makes more sense to pay fee for service, and they have tools that they're using today.
[01:16:15] Jennifer Rabiner: So how do they coordinate with the primary care doctor if they're in a value based model? How are they being measured? I think all of those same things would apply nudges, mindset shifts that we're doing in primary care. And then when the specialist is acting a little bit more like the primary care doctor, do they need more of the things that we're building in primary care?
[01:16:34] Jennifer Rabiner: How do we handle the things that are happening in primary care? For that are needed for the patient that may not be delivered by that specialist, even though that's really their primary point of contact, we see it pretty often in the model we're in where a patient, you know, will do an outreach to a patient or the practice will do an outreach saying, you know, Hey, you're due for your annual wellness visit and the patient replies.
[01:16:55] Jennifer Rabiner: I don't need to come in. I see my cardiologist or my oncologist all the time. And so how do we make this more fluid for the patients in between the providers so that there's that kind of clinically appropriate you do, we do. And then how does everybody act in service of doing the right thing for the patient instead of kind of that siloed, you know, what are siloed clinical thinking or siloed.
[01:17:18] Jennifer Rabiner: Financial thinking when we're talking about value based care. So I would be excited to learn more and figure out how these two worlds can start combining a little bit.
[01:17:34] Angela Suthrave: Jen, we have reached the very exciting concept closing call portion of our interview. And so the first question that we'd love to ask you is, are there any frameworks, methods, processes that you've found to be especially useful in your work that others might find useful as well?
[01:17:52] Jennifer Rabiner: Yeah, well, I think whenever someone says, you know, what's your favorite product management book, for example, I always refer them to Escaping the Build Trap by Melissa Perry.
[01:18:01] Jennifer Rabiner: Had the pleasure of working with Melissa at Athena where she was for a while during the time that I was there as well as we were doing some kind of refactoring of product management there. And so loved that book, loved her teachings and kind of her way of thinking, which really opened up a lot of different kind of thinking for me.
[01:18:19] Jennifer Rabiner: And she has a lot of great kind of tools. And almost workbook like things that I think are helpful whenever I'm feeling stuck. You know, you can kind of go back to one of those and say, Hey, if I tried to fill this out, uh, what would I say here? And I would have a little aha. So I do like that book and I have referred a lot of people to that book.
[01:18:35] Jennifer Rabiner: And then there is another article and kind of presentation I stumbled across online that I could provide the link so you can put it in the transcript. But it was a Denver Startup Week presentation in December, I think December 2019. And it was a whole presentation on outcomes based roadmaps, and they have a diagram that I absolutely love that really starts with what are your, you know, what's the company vision, what are the company goals, and works all the way down to different levels that you can think about in terms of customers, customer challenges, and And how eventually that forms your bets, your hypotheses, your epics, your stories, uh, that you're going to work on.
[01:19:11] Jennifer Rabiner: And I've used that time and time again. I've even done big kind of exercises with my teams, you know, on the wall where we have post its kind of representing each stage of that framework. So that's one I've always really liked as well. So happy to provide that link.
[01:19:24] Omar Mousa: Yes, please. We will list that in the show notes.
[01:19:27] Omar Mousa: Jen, is there a tool that is highly valuable to you that you think others may not be using?
[01:19:31] Jennifer Rabiner: I don't know. I'm still, I, you know, my to do list is still on a post it, so not the most innovative tool, but I would say we use ClickUp at Pearl, which we also used at Hint. It's been around for probably over five years now, but we do use that for task tracking, but we use it for a lot of other things.
[01:19:47] Jennifer Rabiner: And one of my favorite things to do as a product leader, when I want to understand it. either understand what we're investing in and gut check that or I want to explain to anyone else in the organization. It's just really a simple pie chart of where the time is going to what strategic initiatives.
[01:20:03] Jennifer Rabiner: There's some tools and things I like and ClickUp that help us do that more automatically, but it's a great way to look at the highest level of, you know, how am I allocating my portfolio really of resources against what strategic initiatives and is that what I intended? Did things change over the course of the quarter?
[01:20:21] Jennifer Rabiner: When I'm having conversations about trade offs and, and capacity and things like that, it's very helpful. And I particularly like a pie chart because it is a zero sum game when you're talking about where your resources are going to go. So not necessarily the newest thing on the block, but I do like how ClickUp can help.
[01:20:36] Jennifer Rabiner: If you spend the time configuring it correctly, how it can really help give you those tools that I find very helpful as a product leader.
[01:20:42] Omar Mousa: Is the numerator denominator in that Bower's engine, like working on that project or is it just like, like portion of the core, like number of days, months, weeks.
[01:20:51] Jennifer Rabiner: I've done it before at the highest level by, by scrum team.
[01:20:55] Jennifer Rabiner: So this scrum team is like 20 percent allocated here, 40 percent allocated here. I think with ClickUp, you can get a lot more granular. And however, the teams are, are kind of whatever they're using to, to divide up their time and prioritize and plan, uh, you can use, but even in a spreadsheet, if you, you know, however many scrum teams or engineers you have, even making high level estimates, I think precision is probably not.
[01:21:19] Jennifer Rabiner: needed in this, it's really more of the high level, you know, Hey, we've got 40 percent as I was, you know, talking about what is Pearl doing, how much of my portfolio is going towards growth initiatives versus, you know, total medical expenditure capital. And so being able to talk at that level, I find it really helpful to translate and also to manage and say, Hmm, I wonder, you know, if we should be reallocating a little bit of what we're doing.
[01:21:40] Angela Suthrave: And then we'd love to hear from you, if there are any concepts in healthcare that really excite you right now.
[01:21:47] Jennifer Rabiner: Well, everything in healthcare excites me. I, I love healthcare and as challenging as it is, I can't imagine working in any other, you know, really any other field, but I do love to see anything, you know, that as we've been talking about a lot that, you know, when you're seeing tech and service and financial model innovation, all kind of coming together.
[01:22:07] Jennifer Rabiner: I always find that really exciting. I, uh, you know, as I mentioned before, I worked at Hint Health before Pearl and the whole movement around direct primary care. I don't think I've ever seen physicians who are so happy and satisfied in what they do. I'm a direct primary care patient. I love, you know, my experience.
[01:22:24] Jennifer Rabiner: So I like to see any kind of innovation, you know, whether it's specialty care. Uh, pediatrics, uh, senior care, um, so much exciting stuff happening there. But I have to say, you know, even outside the world of value based care, I'm so excited to see, um, funding and energy and ideas going into women's health, uh, as well.
[01:22:43] Jennifer Rabiner: And I think that, you know, understanding how much is actually not known about women's health at all different, you know, levels. phases of a woman's life and seeing, seeing all of that come to life and start to get all of the energy that I see coming and the funding following all of that energy, I think is really, really exciting.
[01:22:59] Jennifer Rabiner: So I love value based care, but also really, really excited to see all of those ideas flowing there.
[01:23:04] Omar Mousa: You, you, you hit it earlier a little bit, but do you think product management is science or an art?
[01:23:09] Jennifer Rabiner: Well, I, you know, as, as I think everyone would say, it's really both. I think that it, It has to be science backed in the way that, you know, your products exist to, and most of the time, not every single instance, but most of the time your product exists to achieve business value.
[01:23:24] Jennifer Rabiner: And the great thing about healthcare is you can build great businesses and do great things for patients and providers. So the science, you know, you have to understand your business. You have to understand your business model. How your product is contributing. Is it delivering ROI to your organization?
[01:23:38] Jennifer Rabiner: And then that should really, really flow in how you prioritize, which again, is easier said than done. But then the art is where you have instinct and you have bets, you have hypotheses, which you can be very also science about, but I find that's where those product principles have really come into play about, you know, how do I want to build a product?
[01:23:57] Jennifer Rabiner: Not what am I building? Why am I building it? But how do I want to build it? What are those things that are important? And I think that's where a lot of the art can come into play. But of course I think it's, it's really both, but whether you call it learned experience, instincts, crazy bets that you're going to take, I think that's the part where you can really make breakthroughs as well.
[01:24:16] Angela Suthrave: And last, but certainly not least. least, where can people get in contact with you? And do you have any shameless plugs?
[01:24:24] Jennifer Rabiner: LinkedIn is always a good place to get ahold of me. Just write a little note, letting me know so that I can, can, can see that highlighted since there are so many messages out there today, but probably the easiest way, and then, you know, my main shameless plug is just to follow us at Pearl, we love to be out there.
[01:24:40] Jennifer Rabiner: We write a lot. You know, we've had a few things published by different people, uh, Pearl, we like to rate on our own blog, we're always putting out content, but you know, we just all really love what we're doing. We're really excited about it and we'd love to have, have all of you follow along.
[01:24:53] Omar Mousa: That's Jen Rabner.
[01:24:54] Omar Mousa: Jen, thank you so much for coming on to Concept2Care.
[01:24:57] Jennifer Rabiner: My pleasure. It was really nice to chat with you both.
[01:25:03]Omar Mousa: Hey, thanks so much for listening to the show. If you liked this episode, don't forget to leave us a rating and a review on your podcast app of choice, and make sure to click the follow button. So you never miss a new episode. This episode was produced and edited by Marvin Yue with research help from Aditi Atreya or Angela and Omar, and you've been listening to concept to care.