Welcome to SurgiSnacks, a podcast that serves

up tasty insights for your surgical practice.

Join Al Norweb and Justin Rockman of Surgimate

as they deliver bite-sized episodes that feature

actionable insights and real-world examples to help

you conquer the challenges of surgical scheduling and

unlock your practice’s full potential. Let’s dig in.

Hello and welcome to SurgiSnacks.

My name is Al Norweb, and I

am the Chief Growth Officer of Surgimate.

And if you like to geek out about

the business of surgical practices, then you’ve come

to the right place. Here on SurgiSnacks.

Our goal is to give you bite-sized content 10, 12

minutes long, something that you can hopefully pop in your

ear in the shower or at the gym and get

something useful to help you think about your surgical practice.

I am delighted to be joined by my host or my guest

here, Ozzie Delgado, for the second of a two-part series.

Ozzie, welcome back to the show.

How are you doing today? Great, Al.

Excited to do this again with you.

Agreed.

I really enjoyed the first part of our discussion.

I encourage anybody who hasn’t listened to the first

one go ahead back and take a listen.

I know, Ozzie, you go in a little more

in-depth around what is HOPCo and your bio.

But quickly, for our audience here, could you

give us like the 20 second elevator pitch just

so people are up to speed? Yes.

My name is Ozzie Delgado.

I’m the Chief Operating Officer for HOPCo.

HOPCo stands for Healthcare Outcomes Performance Company, and

we pride ourselves on being the best value-based

musculoskeletal care company in the country.

Impressive.

And just to recap, this is an organization 20

years in the making, delivering this kind of

value-based model and getting better and better at

it over time in many different markets.

So true experts in this world.

And so we’re excited to have you on the show.

And so you may have guessed that our

topic for the discussion is the interplay between

value-based care and the delivery of surgery.

We always have a snack on our show

that’s representative of the topic of the day.

So our snack is dark chocolate because it’s

the perfect balance between bitter and sweet, which

is we’re always trying to find with value-based care, finding that sweet spot.

And we picked Trader Joe’s because obviously, that was the

best budget value for the quality that you get.

So, Ozzie, when we spoke last, we left off

talking about how value-based care, in a lot

of ways, is about delivering appropriate care to the

right patient at the right time.

In some cases, surgery actually being the cheaper alternative

because if that’s ultimately where the patient’s going to

go, that can end up being better than directing

to the right site of care.

Maybe avoiding overnight stay and other expensive

parts of the care is another way

to deliver quality and reduce costs.

Now the question I’m sure many people ask – I know

I think about too, when thinking about how to drive

value-based care in a private practice world –

how do you get your doctors and your organization to

rally behind the value-based protocols you put in place

and the structures that you want them to deliver for

those better outcomes at a better price and cost?

Yeah, I think that’s probably one of the more

frequent questions we get going around the country, Al.

And I’ll tell you a key driver behind that

is, number one, it’s what all the physicians have

been trained to do, I mean, truth be told,

and they see that during a residency and fellowship

training that they end up coming across that.

And now that they’re in practice, it’s about how

do we align the incentives so that they are

doing what they’ve always wanted to do.

But potentially there could be barriers that did not

enable them to deliver what they wanted to do,

but ensuring that we could actually align the incentives

around them that allows them to be able

to deliver how they trained along their path.

And that might include anywhere between quality incentive payment

models to just utilizing surgical scheduling decision support tools

that allows them to be able to align not

just how they practice and manage the care of

patients but how the receiving facility or how aligned

providers other specialties align in the care of the

treatment of that one patient overall.

So HOPCo has a lot of excellence through evidence

based protocols – care paths that we have.

And we certainly bring those to markets that

end up choosing to engage with us overall.

Are they primarily proprietary,

Ozzie you’ve developed them over time

as an organization?

We do, and I’ll tell you we’ve developed them

over time, but

I will tell you it’s not set in stone because

anybody who sets something in Simon, it’s not static.

You have to continue to evolve them as new

research comes out, as new findings come out.

In fact, when we engage in markets, this

is not really a hard push down.

We share openly what we have and really

engage in active conversations and saying, “Well, what

are you seeing in your respective market?”

And maybe there’s something that we’ve missed.

I mean, we’re not here to say we’ve solved

all the problems in the world, but I think

that iterative process only stands to make it better

over time and you’re able to stay current.

And with the latest and greatest of

what’s occurring in the care of these

ultimate patients.

Of course they’re evolving.

That’s an interesting perspective.

And over 20 years I’m sure they’ve continued

to and they will for a long time.

Do you actually use different pathways in different

markets depending on maybe the way the contracts

are structured with your payers or maybe even

demographic differences that you’ve identified?

Yeah, so the care paths don’t necessarily

change or there’s different ones in different markets.

I think treating musculoskeletal patients

is treating musculoskeletal patients.

being said, there might be different factors

that need to be adaptive to a respective market

because there are different pressures or forces that you

need to kind of be mindful of.

And at the end of the day, we’re

still trying to accomplish great outcomes for patients

in the most cost-effective way and that’s

not necessarily the same market to market.

So you have to kind of evaluate that and

say, maybe we did this as part of a

screening process in one market, but that’s not really

relevant here because they all do it.

So how do we evolve that further?

Or perhaps we actually have to take it a

step back and add an extra additional step because

this market wasn’t maybe as affluent as another market

that we were in from a patient perspective.

Okay, so similar pathways maybe, but some

of them need to be re-emphasized because

of the dynamics of that market.

Right, reemphasized or potentially slightly altered specific

to that one market as well.

Okay, so you mentioned just a little bit earlier

the element of surgical scheduling and the administrative piece

of it. That’s obviously our bread and butter at

Surgimate and something we’re very interested in.

How does that play out in the interaction with the doctors

as well as the value-based care model for you?

Like, what are the ways that you leverage

technology and you leverage that part of the

process to deliver what you need to deliver?

Yeah, I think as we spoke in the

last episode, we mentioned how having patients receiving

their care in the right location is important.

And in this model, it’s a lot about the

shift that has occurred from inpatient hospital type of

location care to outpatient same-day ASC care.

The scheduling episode is the scheduling episode and

there’s the clinical decision-making component that involves

the provider and engagement with the patient.

But there’s an entire, as you know, in

Surgimate, there’s an entire administrative component that

needs to be really kind of hardwired and

well refined to be able to deliver that.

And I think understanding that there are differences and

nuances that change with different sites of care from

a location standpoint and incorporating that into the scheduling

process overall is important because we could kind of

mitigate any concerns or issues that may arise and

not allow an unfortunate circumstance such as a cancellation

of a case or a patient who really needs

the pain – that has pain and needs to get

it addressed and now is not able to get

that addressed, and then it gets pushed off a

week or what have you, because we didn’t take

care of something administratively involved in managing that scheduling.

And ultimately that gets us to that episode of care

for the surgical episode.

It’s interesting,

I mean, that’s obviously the topic that I think

we try to drive a lot with organizations.

I think most musculoskeleton and many surgical practices, not

just in orthopedics, they sort of view cancellations as

a cost of business. And they are right, inevitably,

cancellations happen for lots of very legitimate reasons, but

being able to minimize those on the margin can

drive a lot of value.

And that’s very interesting to hear your perspective cause

when you’re delivering value-based care and what you’re

saying basically is if I have to wait, deliver

the right care at the right time, like we

we’re talking about in the first episode, that actually

ends up costing you more as an organization.

So not just delayed revenue, which is an issue

in its own right, but actually worse outcome for

the patient, potentially intervening care between now and then.

Yeah, we see it a lot.

I’ll use it in one of our sub-specialties, hand cases,

where you could ill afford to wait too long.

You don’t want a malunion to occur. And

then that actually is even worse off.

Where there could have been the ability for early

manipulation and treatment of a patient, which could have

set the course off straight, waiting too long actually

becomes detrimental to that outcome of the patient.

That’s a perfect example.

All right, so we only have a few more minutes left.

I want to shift a little bit to some forward thinking.

That’s a little bit of a grab bag, Ozzie.

But first topic, this one I found interesting

listening to a recent discussion on the emergence

of GLP one inhibitors in the U.S.

Maybe a tidal wave that’s sort of

coming in terms of their use and

their apparent effectiveness in lowering weight. Right.

And weight bearing is comorbid with

a lot of musculoskeletal conditions, right.

So heavier people tend to have

more issues with joints, etc.

Have you guys been thinking

about this as an organization?

Is this a threat or is this an opportunity in a

value-based care model that we might be looking at a

real drop in the obesity rates in the U.S.

Which is a wonderful thing, right.

How does that affect your business?

Is it good or bad?

I think we embrace it as a positive welcoming

because when you look at all of the professional

society recommendations out there, BMI is an indicator that

leads to poor outcomes for surgical outcomes.

So some patients that are morbidly obese

and just have too high of a

BMI are ruled out for surgical interventions.

So I think when you look at these new

kind of options for patients that actually allows them

to lose weight, from our perspective, we see that

that allows them to rule in.

Now for a surgical intervention that gives them a fighting

chance to really fix the cause and issue and allow

them to kind of return to maybe a more active,

healthier lifestyle with their ability to be able to kind

of shave off that weight overall.

So we actually see that as a

very positive outcome and welcome it.

I love that perspective.

So ideally and optimally, you have less patients who

have issues because of their weight, but the size

of the patient pool that you can address actually

because of these comorbidities and these risks during surgery

being reduced actually presents as an opportunity.

Also to our discussion around ASCs, obesity tends

to be one of the driving factors of

not being able to operate inside the ASC,

so you continue to allow for that trend

to go forward, which I think is good. Great perspective.

All right, so hopefully we have time for one

more, so I’m going to squeeze this one in.

Love your perspective on this thinking for what’s on

your wish list for – particularly as we talked about

the administrative side of scheduling and preparing,

coordinating surgeries – what would be on your wish list,

or what do you think is coming down the

pike in the future that hopefully will lead to

better results for patients and for your organization.

Yeah, I think… You’re going to give me a wish list.

There are a lot of administrative burdens that are

put on health care in general, whether that be

private practice providers or health systems or what have

you. Or the payers have to put certain barriers

in place to protect themselves as well.

My wish list is to say, look, we are all

practicing under a kind of an earned-accreditation principle that if

you do things the right way and determine what the

right way it is to care for the health of

a population, you earn your badge, if you will, and

you eliminate these unnecessary barriers and hurdles that are currently

fraught within our industry.

That only adds excess costs and excess waste

and an excess burden in actually impeding the

ability to treat and manage more lives and

more healthier, more populations in general overall.

So my wish list would be that we would kind of come

to some model that allows us to be able to deliver that

and streamline that.

Yeah, I think Texas has been working on this, and I think

New York, but like Golden Laws, for example, once you

heard of them, but they’re not common enough, right, where

if a doctor passes a screening period and shows that

their prior authorizations are appropriate, etc, etc, then

we go to like a TSA model.

Maybe once in a while we’re going to hit you with a

prior auth, but why do we need it every time, right?

And actually, it’s better for the payers as

well, because they’re spending a fortune on all

the administrative work to evaluate them.

And so there’s a lot to be

gained on that side, for sure.

Those are the costs that are taken from the system

that could be reported back into the system overall.

Yeah, to help patients at the end of

the day, because none of this stuff is

really helping the patient that much.

It’s more just how we organize ourselves.

Well, we continue to want to be at the forefront

of those changes and be part of the solution.

Ozzie, it’s really been a pleasure having

a chance to speak with you.

I can’t thank you enough for joining us, and I

hope our audience enjoys the insights that you provided.

As always, please leave us your comments or

provide any feedback or ideas you have for

future show topics, we’d love to hear them.

Thank you very much for tuning into another

episode of SurgiSnacks, and we look forward to

talking to you the next time. Ozzie, thank you.

Thanks so much. Take care.

Thanks, Al.