A Nashville-based medical group called Imagine Pediatrics is partnering with health plans on a value-based payment model that brings 24/7 medical, behavioral and social care and support to homes of Medicaid-eligible children with medical complexity and special health care needs. . The company’s CEO, George Boghos, MBA, recently sat down with Healthcare innovation to describe the problem your company was formed to solve.
Before joining Imagine Pediatrics 14 months ago, Boghos co-founded and led AIM Clinics, which provided evidence-based applied behavior analysis services to children with autism and their families who come from communities experiencing health inequity.
Healthcare Innovation: Could you tell us about some of the access issues in pediatrics that your company is trying to solve?
Bogos: Pediatrics is generally one of the last places for innovation in healthcare. My mother is a pediatrician, so I have grown up around pediatrics my entire life. My observation is that pediatrics has not evolved one bit since I remember my mother practicing. It is well configured to care for children who are generally healthy. You go to the pediatrician several times a year and spend about 10 minutes with him, and that works for most children. Who it doesn’t work for is children with complex chronic medical conditions. This has led to children and their families using the emergency room at a very, very high rate and, unfortunately, many times being admitted to the hospital for completely preventable reasons, because they have nowhere else to go.
What we’re saying is let’s wrap children with medical complexities and their families in a first-ever, 24/7, in-home model of virtual care delivered by complex care pediatricians, nurse practitioners, therapists, dieticians, paramedics and social workers – a complete interdisciplinary care team that is really investing time to get to know these children and their caregivers, and detect things preventatively through daily or weekly touchpoints, but also being there the 24/7 for these families when they need support. Simply put, that’s what we’re here to do.
HCI: What kind of conditions do these children tend to have?
Bogos: It is 1 to 2 percent of children who suffer from these complex chronic medical conditions, such as severe uncontrolled asthma or diabetes, cystic fibrosis, cerebral palsy, and often have accompanying mental health comorbidities. So for them we are trying to solve this access problem.
HCI: And what is the business model? Do you partner with payers?
Bogos: The way we do it is a completely values-based population health model. We partner with Medicaid managed care organizations. We assume all risk for the entire cost of care for these children who qualify for our program and are here to manage their entire experience and care process. We don’t replace anyone they are working with. Our children have PCP. They have specialists. They have a lot of support, but we are there to fill the gaps. And our main goal is to keep children healthier and happier in their homes and out of the hospital when they don’t need to be there.
HCI: You are explaining that this complements but does not replace your existing doctors. But do your providers need to coordinate care with their existing traditional doctors? How is that information about Imagine shared with the child’s regular doctor’s office and vice versa, so everyone is on the same page?
Bogos: That’s a crucial point, because many of our children and families have five to ten different healthcare providers involved in their care, and the last thing we want to do is be an extra layer on that journey and further complicate things. That’s why we’ve invested heavily in our technological backbone. We work with our families through our patient app. We have a population health tool that we have developed internally. We use an EMR and are connected to health information exchanges in the markets we are in. We have ad hoc individual data integrations and connections with the large providers, pediatric groups, and complex care clinics where we are practicing. We share that data daily. Every time we have an encounter with a child and discuss the care plan that their specialists or pediatrician developed, we consult with that pediatrician and share information so that everyone is informed.
HCI: I read that your company is currently working in Florida and Texas. Can you name some of the managed care organizations you work with?
Bogos: We are working with Superior Health Plan, which is Centene’s managed care plan in Texas, as well as UnitedHealthcare Community Plan in Texas and UnitedHealthcare Community Plan in Florida.
HCI: Is there any particular reason you are in those two states first?
Bogos: There is a lot that goes into it. Much of the value we bring to our plan partners is helping them innovate and solve a need for a population that is historically difficult to manage. So it’s based on states where plans have had difficulty serving children with medical complexity, and those states came out on top. Second, we become an important part of the differentiation in the market for health plan partners, because they are looking to win bids or expand their market share in those states, and this could become an important differentiator for them.
HCI: Do you expect it to expand and expand to other states in 2024?
Bogos: Yes, that’s our plan. We have many conversations with a variety of health plan partners in Texas and Florida, as well as a variety of other states. Our goal is to be in a couple more states next year.
HCI: It seems like sometimes startups have a chicken-and-egg problem: A payer would want to see evidence of quality and return on investment before agreeing to a partnership, but it’s a challenge to get there when you don’t have that initial contract. How do you show them your value before doing it with an organization that size?
Bogos: In two ways. One is that part of our founding team had done exactly this. We’re talking about a high-touch virtual model for children with medical complexities within a hospital system in the Midwest, and they had great results doing it. Not only in terms of satisfaction in the commitment of families, but also in terms of drastically reducing unnecessary visits to emergency rooms and hospitals. So we had tests and data points, and published work was being done. But most importantly, because the model is values-based in nature, we are really putting our money where our mouth is. We are assuming all the risk. If we are not able to achieve results, in terms of improving quality measures, preventing unnecessary hospital visits and reducing costs, the plan will not get worse. That’s the beauty of a full risk model. Some of the plans are willing to trust us with that because they know we are perfectly aligned to do the right thing for patients.
HCI: Did Imagine get venture capital investment to get you started?
Bogos: We were founded out of a group called Rubicon Founders, which is a Nashville-based business incubator group made up of very experienced healthcare entrepreneurs and operators, who are trying to solve big problems in healthcare primarily through business models. value-based care.
HCI: Could you tell us about any results you’ve seen early on in your work with these managed care organizations?
Bogos: We are still early. We launched with our first plan partner in January 2023. What we have been able to achieve is a fairly high participation rate of the population we serve. So we are currently taking risks on about 20,000 patients in those two states, Texas and Florida. We have been able to engage a very large percentage of them in a fairly short period of time. We communicate with our families, on average, about four times a month. This is anything from a chat in our app to a virtual visit or a home visit. We have completed more than 50,000 patient interactions in the first 11 months alone.
More importantly, we have early claims results, so we’re tracking healthcare claims data after engagement with Imagine versus pre-engagement, and what we’re seeing is about a 15 percent reduction in impatient volume and about 20 percent. reduction in the total cost of care for these families, driven primarily by the prevention of unnecessary emergency department visits, which often turn into prolonged hospital stays.
HCI: One of the challenges is finding clinical teams to support scaling this up?
Bogos: I thought it would be our biggest challenge, but I was pleasantly surprised at how well we were able to attract some really amazing teammates here. And a big part of the reason is that this is very different than anything in pediatrics, right? We’ve been able to attract incredible teammates outside of the PICU or NICU in a hospital or outside of traditional pediatric practices who really crave the opportunity to develop deep, very, very long-term relationships with families and caregivers in a virtual environment. the first model in which they are truly capable of generating impact. Instead of a transactional type of relationship in a hospital where you see a family at their worst, then they are discharged and you don’t see them again, it is a great value for our care teams to be able to care for these families longitudinally and form those really deep relationships where you’re not limited by the time limits of 10-minute dates.
The other beauty of our model is that, first of all, it is virtual and we also serve children in very rural areas. We may have a team based in Houston that serves children throughout the state of Texas, for example. So in terms of improving health access and equity, but also allowing us to hire the right talent and the best talent and being able to serve kids and not necessarily within driving distance, it’s a really good way to scale.
HCI: Do you think these virtual models will continue to evolve and stand out as ways to address shortages and direct resources to traditionally underserved patients?
Bogos: I think so and I hope so. You know, we spent a lot of time on our philosophy that virtual care will never completely replace in-person care. But you can dramatically increase it and dramatically improve access issues. If you think about a small PCP office in rural Texas, we are increasing their capacity. We can be available 24/7 for these families, just minutes away from when they need us. Improving that issue of access is of great importance to us and I think that many virtual models will be able to do it to improve families, patients and, really, the entire health system. So my hope is that we will see many more of these, not as a replacement for in-person care, but as a way to dramatically increase the impact of in-person care.
