This week I am talking to Louis Mendiola, Director of Provider Partnerships at MedArrive (@medarrive) who are mobile-integrated care management solution provider. Louis shares his origin story growing up in rural Nevada in a town called Winnemucca which provided him with great insight into the challenges of delivering local care
We talk about the last mile of health care delivery and the importance of boots on the ground able to work with and support people in these communities and how the local support services are often the first call for help when things are not going well. They have created a program of longitudinal care program that was aimed at high utilizers with chronic disease problems that have evolved to not just be the person that’s drawing the blood or checking the blood pressure, but really delivering care into the home connecting with the nurse practitioner, the physician when needed, and really allowing the paramedic and the EMT to power that care delivery, keep that patient out of the hospital.
They announced their partnership with Ouma Health, a total maternity telehealth services company, to bring comprehensive maternal-fetal care directly into the homes of vulnerable women on Medicaid.
Listen in to hear about the early days of this project and the tremendous opportunity to bring better care to a wider population and start reversing the jaw-dropping negative trends in maternal and neonatal morbidity and mortality
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Raw Transcript
Nick van Terheyden
And today, I’m delighted to be joined by Lewis Mendiola. He is the director of provider partnerships at Med arrive. Lewis, thanks for joining me today.
Louis Mendiola
Thank you so much for having me today really looking forward to this conversation.
Nick van Terheyden
So if you would, as I do with all my guests, I think it’s always important to get the origin story. Tell us about your journey to this point and how you arrived here, if you would,
absolutely, you know, a lot of coincidences and a little bit of luck along the way. But I grew up in a small rural community in Northern Nevada, named Winnemucca. And when I was 18, I got was fascinated with the work that the local ambulance service was doing and became an EMT at 18. And was really lucky to work with a great CEO, that hospital based ambulance service and an amazing EMS director in chief. And we were doing a lot of kind of emerging innovative work around, you know, community paramedicine, as we call it, our mobile integrated healthcare, and in a rural community, with limited providers and physicians, EMTs, and paramedics and nurses and medical assistance, you know, that they’re kind of the first line of defense for the community and let people come with questions. And so we were really trying to build out the CPE program, as we call it, our community paramedicine program, and so worked with that team for 10 years, but a lot of amazing work out in that rural community. And then I moved in and started working with Renza, which is the air and ground Ambulance Service in Reno, Nevada, that had received a $10 million grant a part of the Affordable Care Act. To study how can EMS systems better provide care to patients in more of a metropolitan area, so did some work around provider partnerships and care partnerships with that, spent a little bit of time in Bozeman, Montana, as a service line director for the health system up there overseeing the telehealth program and received an inbound call from ina plum, our most amazing co o now, she was working as part of a redesign health, the ink healthcare incubator that we came out of. And she had questions about community paramedicine. And how could you foster and develop care models and power those care models into the home by using paramedics EMTs. So that started a conversation, which evolved into an advisor ship for about two and a half years, and I’ve been full time in this position for over a year now at met arrive where I work on operations teams oversee our network of field providers, which are primarily paramedics, few EMTs, nurses and social workers and work on on that team powering the care delivery models that we’re so excited about at MetLife.
Nick van Terheyden
So, as always, it’s really cool to hear that sort of background and particularly, you know, first of all, what a great name, where did you where did you grow up? Winnemucca I love that I just think that’s a really cool place to have come from and to be able to talk about and that rural component that obviously shapes your sort of insight and understanding. And you know, the other thing that strikes me about this is, you know, here we are, again, redesign health is really doing an amazing job of incubating companies. This is now the second one I interviewed Adam from Jasper, which is another one of the redesign companies they’ve really, I think worked out a great model to sort of help nurture these startups that quite often struggle, not because the idea is not good, but because it’s a difficult process. And obviously, that’s been, you know, extremely positive. So I think it’s important to understand a little bit of what it is that you do at this point. Tell us a little bit about med arrive and what what they’re doing at the moment.
Yeah, so, you know, I would tell the audience, take yourself back to March of 2020, April 2020. We see, you know, COVID
Nick van Terheyden
out on a second. I’m saying you’re saying go back and relive this, what is your Lewis What is wrong with you?
Hey, hey, I’m a paramedic and EMT. You know, we always have a little bit flawed view of the world, I guess you could say, but you know, we see this explosion of telehealth, everybody’s doing telehealth, you’re able to connect with your physician on zoom on FaceTime. I think that they were even allowing Facebook Messenger or telehealth
Nick van Terheyden
visits. Yes, they were. That’s right.
And what we realize is, is that, you know, for so long we’ve been funked. We’ve been focused in healthcare delivery on the technology and the gadgets and the hardware, but really, we had evolved to where we could do virtual visits anywhere with with the devices that we all carry. But there’s so many limitations. Telehealth really only made sense for those really cognitive, you know, patient presentations and we still needed to be able to do liberate humanity, touch the patient collect labs, and really be the eyes and ears. And so med arrive was born out of this idea is that we could be the eyes and ears of the provider of the physician into the home. You know, whether it’s collecting blood assessing a blood pressure, or really just doing patient navigation and education, you needed that that human touch into the home. And that’s what Mehta ride is about, you know, we always connect back or we will frequently come back to a virtual provider, but our paramedics and EMTs are in the home providing that that touch that you can’t get with telehealth alone.
Nick van Terheyden
So as you’ve sort of developed that, and built it, particularly on the foundation of what I think was, you know, everybody that was in that space goes, well, of course, all this stuff works. And you know, even the patients, I think arrived at this week. And I’ll be frank, I’m, I’m a geek, but I don’t know that I’d used a lot of telehealth to that point, it was sort of there. But you know, I’ll get I’ll get in the car and drive and, you know, park up and do all of those things that you don’t need to do. So you saw this explosion, you saw this capacity, but it didn’t quite work as well as it ought to. Right. There was some, it’s that last people talk inches, miles, whatever you want to call it, but it’s that last element that I think you’re really getting involved in. Tell us a little bit about that.
Yeah, you know, you know, we often call that the last mile of health care. And so you know, what we what we found was, is that, again, a lot of things that you can do over telehealth, but there’s limitations to telehealth. And so by having paramedics and EMTs, that are so familiar, and frankly, so good at delivering care in a home, or in some type of unusual environment, by sending them into the home and either facilitating the visit, or doing the, you know, procedure that that you couldn’t do over telehealth the collection of blood or blood pressure, you really built a not only the, you know, upon the experience of the patient, but you were able to keep them out of the hospital. And then you know, it’s there’s a flywheel effect, right. And so if we could do this, could we could we create and craft a longitudinal care program that was really aimed at high utilizers with chronic disease problems. And then that’s what we’re doing now in many of our markets, where we’re we’ve evolved to not just be the person that’s drawing the blood or checking the blood pressure, but really delivering care into into the home connecting with the nurse practitioner, the physician when needed, but really allowing the paramedic and the EMT to power that care delivery, keep that patient out of the hospital when it’s unnecessary and navigate them to the most appropriate while still doing the more episodic care delivery that we do, which is around things like HEDIS gap and quality programs, where it’s much more transactional, if you will, we’re able to identify those patient populations, we’re often able to impanel them in one of our longitudinal care program. So we’re really we’re this isn’t just going in and holding an iPad and collecting blood, but rather saying, let’s meet our patients where they are.
Nick van Terheyden
Right. So, you know, this is all, I think, really important delivery, and, and actually the spreading of care into the community that, you know, we’ve struggled with, especially in rural, you look at the concentrations of health care in, you know, cities, and it’s disproportionate, and it’s just inevitable, it’s much harder to deliver some of this care in these rural communities, it sounds like men arrive is starting to create the relationships that we have in, you know, our privilege of close, you know, higher density with these patients in those rural settings. So, are you finding that there’s, you’re developing and building a sort of community almost in what is a very distributed environment?
Yeah, exactly. You know, I think for any of us that have worked in healthcare for some time, whether we’re on the business side, or on the clinical side, you know, we take for granted the fact that we could have four or five nurses, five or six doctors that are, you know, in our cell phone that we can call when there’s a rash or something comes up, but for the average American for the average, you know, Medicaid beneficiary that we’re that we’re providing care to, that’s not the reality, but they often know the emt or paramedic down the road or the nurse down the road. So we really are starting to create an ecosystem for these underserved areas, not just rural areas, but also, you know, in inner city where, you know, are they gonna be able to pick up a phone and call the Doctor No, but they’re gonna be able to pick up the phone, call Matt arrive, and we’re going to connect them with an emt or paramedic almost instantaneously. And then we’re all we also are backstopped by virtual providers that can, you know, help them stay out of the ER it If it’s you know, just a simple laceration or something like that, that needs to go to the urgent care. And so I again, I love that analogy. And and that’s truly what we’re doing is creating this ecosystem, if you will. But we’re embedding our, you know, providers into the communities, almost shoulder to shoulder, if you will, with the patients that they’re serving.
Nick van Terheyden
So, let’s talk a little bit about the skill sets, how are you matching the skill sets, particularly for that last mile, so the virtual providers, you know, just push to one side, the ridiculous notion that, you know, somebody that’s in a different state can’t deliver care, whatever, but, you know, you can deliver care virtually, I think, relatively effectively with the qualifications, how are you helping place the right skill sets in those EMTs and those local providers to be able to deliver? Because it sounds like they’re delivering some of that care, how’s that going?
Yeah, you know, paramedics very, very broad knowledge base, right. So able to deliver baby take care of a burn victim, stabbing, and then a heart attack all in one shift in a very small environment and environment that they’re not, they’re not used to. And one of the things that, you know, when I was in college, I worked as an ER tech in a trauma center, and then I worked on the ambulance, I was always blown away by, you know, what a paramedic and EMT could do that often took a team to do in a facility, right. So however, a lot of that, that knowledge bases, it’s much more in the built out of the context of emergent or acute things that we have to do is we do have to invest in we do invest in making sure that our providers really understand the why of longitudinal care, for example, a paramedic can hang up a bag of saline or hang an antibiotic, that’s easy. But what we do have to train on what we do have to develop in these people is an understanding for like social determinants of health, what is the actual cause of the patient going to the hospital, and I’ll be honest with you, most of the time, it’s not clinical, right? It has to do with not getting, you know, access to proper food when they’re diabetic or not having transportation to their dialysis appointment. And so what we do is we put them through an education program, depending on the program that we’re running, that really builds that, that that broader understanding of the community factors in the social factors that actually result in the rehospitalization. Doing so. And by developing these care delivery models, we’re able to show a significant decrease in the number of times these patients go to the hospital.
Nick van Terheyden
Right. So I think, you know, important aspect of this is not just the pushing out of the care, but also the skill set and improvement, the building of that resource that I think is essential. And importantly, I think, you know, something that US healthcare doesn’t do very well is including all the things that actually really contribute to the health or wellness of patients, which, you know, we ignore, we say, No, here have this tablet and, you know, have this procedure, but it’s actually much more than that. And I think people in the community have a far better sense of that, because you see it actually being in the home, it reminds me a lot of my experience, you know, in home visits, which we used to do as clinicians. And I used to do a home visit with my mother every week on FaceTime as it was at the time. That was my version because she lived in another country. And you know, I was over here, but it really was a home visit. I you know, I’m I’m her son, but I’m also a physician can’t help it. So fantastic news. For those of you just joining, I’m talking with Lewis men, viola, he is a director of provider partnerships at Med arrive. We were just talking about all of the experience and the pushing out of all of the capabilities into the community. But you’ve got some really exciting new news around an area that my god it’s just it’s depressing to even say this, but we have declining healthcare in the maternal space, we’re seeing, you know, an increase in maternal complications, increase in pregnancy complications, and importantly a decline in you know, outcomes from the Neo natal natal areas, and you’re addressing that in in a specific area. Tell us about that.
Yeah, you know, we are we are so excited to recently announced a partnership with an in home Maternal and Fetal Medicine partner called uma health, who was led by an incredible you know, maternity care specialists Sina, Harry, and really this this partnership was cultivated by our amazing ceo dan trigger you You’re at Med arrive and really was about providing access to these internet of these very important vital maternity care services, specialist level services, I should say, in underserved areas, like, like you mentioned, you know, unfortunately, there’s a lot of maternity care deserts in our in our communities, and not just in the rural areas, but also in more in growing number of urban areas and getting that high level, or that quality care that that is, you know, backed by a specialist is very challenging. And through this partnership, we’re able to power that care delivery into the home. And so you know, I, you know, I, some of the viewers or audience, listeners may be saying, Wait, are you guys delivering babies? No, that’s not what we’re doing. But we’re going in, and we’re helping those virtual providers. On the other end, the OB GYN is the Maternal and Fetal Medicine Specialist, do assessments into the home, so that these individuals aren’t facing a two and a half, three, four hour drive, you know, into a specialist at a tertiary care center. And so really excited about this, this partnership of being able to go into the home, do some, some assessments connect with the team at Luma health, to really drive improvements and really, you know, create a solution for these maternity care deserts.
Nick van Terheyden
So, for the benefit of the listeners, I think it’s important to sort of understand some components to this. And, you know, for many of us, we’re lucky if you’ve gone through the process. And to be clear, this is a man talking, I haven’t gone through the process of having a baby, I’ve just been the supporting act in this instance, but you know, have a pretty close association for a variety of reasons and pregnancy, it’s, you’re essentially building another human, and that puts an enormous strain on mothers, and you know, their bodies and the requirements, and it requires an awful lot of support to actually do well, most people are lucky, they have that. But those in rural communities, you know, and all of the things that we talked about before, tell us about some of the things that are happening, and you know, how that’s working for that, you know, individual experience, because as you said, You’ll now the eyes and ears of those extended providers to be able to provide some of that support.
Yeah, as the clinical listeners, you know, will understand is that there can be some very subtle and simple indications of problems for a mother and for a child that she’s bearing in the for instance, like blood pressure, you know, an elevated for blood pressure can can be a sign of something much a much larger problem that needs to be dealt with, at the specialist level. And so, you know, obviously, that’s just one of the things that we can go into the home, we can assess, you can report back to the specialist on the other end via the virtual health, and then these individuals can continue to have access to the UMA health providers, even when we’re not in the home. So maybe there’s the decrease movement of the child, they can report that, you know, to a woman directly and really have somebody within a matter of minutes, you know, following up on the phone with them getting more information, and triaging, you know how best to deal with that clinical presentation, if you will, you know, other things that we can do is just education. And a lot of the a lot of the people that we’re serving are in, you know, these underserved areas where, you know, especially if they’re a first time parent, there’s not educational programs, and we can navigate them into programs or resources that are available. One of the things that we’re different, and people often call is concierge care, or very, you know, similar to concierge care,
Nick van Terheyden
I’m just gonna say concierge care for the rest of us.
Exactly. Know Exactly. And if you look at the numbers, I believe over half of the the babies that will be born, you know, in the next decade will will be Medicaid beneficiaries. And that’s who we’re working with, we’re working with as MCOs. Partnering with the MCO is partnering with the houmas Health to really understand the benefits and the resources that these mothers can have access to. And so you know, it’s not just about you know, an ultrasound or a blood pressure check or something like that. But really, it’s it’s care across the continuum for these new and exciting mothers.
Nick van Terheyden
Yeah, and again, for context, I think it’s important to understand, you know, and for the listeners out there, if you if you’re good, and you measure your blood pressure on a regular basis, which you should be doing, let’s be clear, and you have a blood pressure cuff and an automated cuff, I challenge you to actually measure that. And I can show you easy demonstration, have your arm actually at a higher level, and then put your arm down and see the difference in the measurement. And that’s one of the things that clinicians bring to this experience. And I think, you know, it sounds simple, oh, just measure the blood pressure, you can send out a blood pressure. It’s not as simple as that. And, you know, particularly in health literacy and capabilities, and even in the case of translation with, you know, different languages, I think there’s some capabilities that are going on there. So I think, you know, all of this is exciting. This is a relatively new announcement. Have you already had some experiences with this as this being rolled out? You know, can you tell us any stories about that? Yeah,
you know, we’re in the implementation kind of phase right now. And so unfortunately, I don’t have like, you know, a great success story that I can share today to the announced I think went out earlier this week. And we’re really looking forward to our first impediment patients and partnering with a number of different payers on this. But you know, I actually had the I actually worked with Dr. Harry at Bozeman health in Bozeman, Montana. And the man is just a Firestarter if you will, like everything he does, there’s a level of excitement, there’s a level of understanding, and there’s always a focus on quality. And I think that that’s, that’s something that that we’re so lucky to kind of bring into the fold here at Matt arrive, and really looking for continued success in this program as we continue to roll it out.
Nick van Terheyden
So as you think about the future, you know, at the early stage of this, obviously, you’ve got lots of experience in, you know, delivering both personal, you know, clearly with your background, and also through, you know, this innovation that sort of takes this expands the capabilities. Tell us where you see this going. I mean, we have enormous problems in our healthcare system. And I don’t know, I’ve never really thought about what the percentage is, but it feels like an enormous part of the percentage of our challenges is in that final mile, it feels like this is really critical to our future. So
so, you know, really quickly, I think that, you know, first of all, there’s going to be inherent cost savings to the payers, to the consumers, or the patients, which is, which is really important for us, you know, as as a country and as a company. And as anybody who really cares about health care delivery, we’re able to, you know, see patients provide a quality experience and deliver better outcomes, when it’s one on one, give the patient more time more understanding to really take hold of their their overall wellness and health status. And so by doing that face to face in their home, understanding what they’re up against, that’s really important. Number two, quality. I think that by getting a bigger picture of what’s going on in the home, understand that the devil that the diabetic thinks that orange juice is a good idea, and being able to actually see what’s in the frigerator, what’s in the cupboards, asking the patient, what’s all the candy for, oh, that’s for my brother that likes to come over and his kids? Well, when was the last time they were here, oh, two years ago, addressing those red flags talking about that meeting, the patient where they’re at, where they’re at, is, is so so key. And then, you know, really understanding how our modern health care system is evolving, and not forgetting the folks that are often disenfranchised, from our society and from our healthcare system. So whether it’s a Medicaid beneficiary, it’s the single mother, or you know, it’s the elderly rancher in a rural community that just doesn’t understand how to use telehealth or access it, but meeting them where they’re at. And I really think that those three things are being able to deliver care more efficiently and more cost effectively, by doing it at a high quality and doing it in a manner that really resonates with a diverse patient population is key. And then that’s really what I think matter, right has the ability to do with provider network that is entrenched and understands a patient’s understands the community and is quite frankly, I think the best at delivering and parenting care in the home, paramedics MPs.
Nick van Terheyden
So I would say exciting times, I think, a real solution that, you know, has obviously been developed. It’s interesting to hear someone called a fire starter. I’ve not heard that term, but I like it, you know, they start the whole process, keep things going. And importantly, you know, it’s just, it really, it hurts me greatly to even talk about this decline in maternal health decline in outcomes for babies. And, you know, you brought up the statistic with, you know, over 50% coming in and that, you know, subgroup or subcategory that is even worse when you sort of separate it out. But here’s the solution. Here’s an opportunity and indeed a partnership. So definitely exciting times. I’m looking forward to seeing what’s happening and you know, look forward to an update. Unfortunately, as we do each and every week we’ve run out of time. So it just remains for me to thank you for joining me on the show. Lewis, thanks for joining me.
