Listen in as Brian Lobley, the innovative CEO of Tango, joins me to unravel the complexities of post-acute care and its crucial role in patient recovery and healthcare economics. Brian shares his journey from his Philadelphia roots to reshaping healthcare through technology (with a passionate nod to Philly sports teams along the way).
We explore Tango's mission to revolutionize home-based care for seniors, especially within the Medicare Advantage space, and how this aligns with the growing preference for patients to recuperate in the comfort of their own homes, potentially reducing costly hospital readmissions.
As the conversation unfolds, we examine the transformative potential of redirecting resources from financially strained hospitals to more community-centric and home-based healthcare services. We dissect the intricate balance between the need for accessible critical beds and the service demands of diverse patient demographics, encompassing Medicare Advantage, commercial insurance, Medicaid, and dual eligibles. I highlight the vital role of patient and caregiver engagement in the realm of home health, and Brian sheds light on the importance of effective communication and robust support throughout the continuum of care.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
Listen in as Brian Lobley, the innovative CEO of Tango, joins me to unravel the complexities of post-acute care and its crucial role in patient recovery and healthcare economics. Brian shares his journey from his Philadelphia roots to reshaping healthcare through technology (with a passionate nod to Philly sports teams along the way).
We explore Tango's mission to revolutionize home-based care for seniors, especially within the Medicare Advantage space, and how this aligns with the growing preference for patients to recuperate in the comfort of their own homes, potentially reducing costly hospital readmissions.
As the conversation unfolds, we examine the transformative potential of redirecting resources from financially strained hospitals to more community-centric and home-based healthcare services. We dissect the intricate balance between the need for accessible critical beds and the service demands of diverse patient demographics, encompassing Medicare Advantage, commercial insurance, Medicaid, and dual eligibles. I highlight the vital role of patient and caregiver engagement in the realm of home health, and Brian sheds light on the importance of effective communication and robust support throughout the continuum of care.
Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.
0:00:11 - David Williams
Post-acute care is a challenge. Patients want to get out of the hospital and back to their homes, but care transitions can be challenging and sometimes result in a hospital readmission. That's a disappointing and costly outcome. Today's guest, Brian Lobley, is CEO of Tango, which helps patients get quality care at home. I'm eager to learn how it's done. Hi everyone, I'm David Williams, President of Strategy Consulting from Health Business Group and host of the Health Biz podcast, a weekly show where I interview top health care leaders about their lives and careers. If you like this show, please subscribe and leave a review. Brian, welcome to the Health Biz podcast. Thanks for having me, David. I want to talk about what you're up to now, but first let's wind the clock back and love to hear a little bit about your background, your upbringing, any childhood influences that have stuck with you through your career.
0:01:00 - Brian Lobley
Well, a lot of childhood influences. So I was born and raised in Philadelphia I'm actually calling you from here in Philadelphia right now as well so I spent most of my life here, although Tango is headquartered out in Phoenix, so kind of doing the warm weather joint when necessary as well. Spent most of my life in healthcare, so worked for the Blues, so as Chief Operating Officer of Independence Health Group was a Blues plan in the Philadelphia area. But I would say a lot of my influences are kind of the Philadelphia story, you know, raised in a city and blue collar, and influenced a lot by my sports teams, the Good, the Bad and the Ugly, as you think about the Eagles, philly, sixers, flyers, et cetera. So die hard sports fan and kind of. You know, in some ways live and die with how successful or unsuccessful my Eagles are.
0:01:53 - David Williams
So that's probably still one of the big influences for me Sounds good. Now, does it live up to its city of brotherly love reputation, or is that just what people from outside Philly call it?
0:02:01 - Brian Lobley
No, it lives up to its city of brotherly love and sisterly affection, as we've added in, so it still holds true today.
0:02:08 - David Williams
Yeah, very good. Now I say it takes two to Tango, so you got to be in Philly and out in Arizona at the same time. Maybe that's the reasoning for that. Good, now, what did you do after you know, after high school, in terms of education, I went to.
0:02:19 - Brian Lobley
Yeah, I went to college at Lehigh University, so I was an engineer. Just about an hour and a half north of Philly, one of the rare people started in the business school and transferred into the engineering school, and the Dean of the engineering school said we're usually having the reverse conversations yeah, why do you want to become an engineer? But you know I'm an analytical kind of zeroes and one guy at my heart. So did industrial engineering, which had, you know, kind of a more of a business tilt than, say, mechanical or civil engineering. So then did a quick IT consulting stint after college, moved to DC, loved my time there, worked for a company called America Management Systems, was working on federal government for projects, but you know, kind of home call. I wanted to come back to Philly and started at Independence Blue Cross, you know, way back in 2001 as an analyst. You know, just kind of built my career from that point forward.
0:03:13 - David Williams
Sounds good. And what was it like at Independence? I mean, they're like big blues there, you know big influence.
0:03:19 - Brian Lobley
Yeah, I mean it was great, it was a great career. I would say the mission orientation kind of has followed through with me right A nonprofit, blue oriented kind of mission driven healthcare company. So really not having to answer to kind of the public market is a unique challenge there. In many cases you're seen as the insurer of last resort, so it dictated. You know products and services and strategy, but I would say kind of that kind of hallmark of kind of community focused care and you know kind of patient centricity. I mean everybody believes in it but I think as when you work for a blue, it's kind of an endemic and all the business practices.
So yeah, lived and breathed it. I mean I loved it and you know have a lot of fond memories for my time there.
0:04:04 - David Williams
Now, how did Tango come about? Was that connected to what you're doing at Independence?
0:04:09 - Brian Lobley
Not quite exactly. I left Independence in June of 22. I was very fortunate that one of my accountabilities there, when I was Chief Operating Officer, is all the lines of business reported up to me. So Medicare was a big line of business. We were very successful and fortunate. Upon departure there we had a back-to-back five-star plan in the urban market.
Really hard to do. So loved Medicare business, thought big growth market. I was looking for something that was really growth oriented. I had accountability for a lot of our strategies and partnerships as well, so I'd done some stuff with Comcast. Actually there's a joint venture we launched called Quill. We were trying to activate the home as a healthcare setting. Right, it's where everybody wants to do everything anything, recover etc. So I had this interest in getting to a company that could go on a pretty significant growth journey.
So I knew that more of the private equity sector was going to be something that appealed to me and, quite frankly, when I had the outreach of what was called PHCN we rebranded the Tango Professional Healthcare Network. It seemed to be this perfect blend of the right market segment, which is primarily seniors and Medicare Advantage, the right care setting, which is the home. I mean I have older parents and they want to age at home, they want to care at home and then a market that needed some disruption. So you mentioned in your intro like what post-acute is, while it's kind of like the last frontier of healthcare, we've spent our time on cardiac and ortho and inpatient, and when you think about that discharge, usually it's coming out of sight, out of mind. The reality is what happens when you're discharged you get back in the hospital in the emergency room. So it's kind of that last frontier that hasn't been taken on yet. So I was really interested in the challenge and loved the business model.
0:05:53 - David Williams
Now, how has the role of the home changed in healthcare? As you're saying, in the healthcare industry it's maybe it's been a little bit of an oversight, sort of considered outside the system, but it's sort of also where care started, I mean with house calls and stuff, back before you had hospitals. I mean that's where care did occur.
0:06:10 - Brian Lobley
You're completely right. The misnomer is that the home is now an important part of care. It's always been, To your point, that's how doctors started Primary care docs went door to door. I think what was kind of lost is what could actually be done in the home Right, obviously, medical advancements, treatments, imaging, med device, that is, an inpatient setting, Right. So this ability to kind of pull people into the hospitals was critically important. But I think, as that happened, I think we've lost sight of a little bit of like everybody still eventually gets home to recover, Right. Even if you're going to like a skilled nursing facility as a layover on the way home, you ultimately want to get home.
So I don't know that necessarily the home has changed as much. Really, what happened is the priority was like how fast can we get someone there? So COVID's a great example. Right, Everybody was like COVID changed it. It actually wasn't. It wasn't an accelerant. It's like gasoline on the fire. It just made it like more prevalent that, oh my God, you're sucking this institution. Things are happening. You're there too long when the realities are like let me just get back to my own bed, right. So I think this last couple of years nursing shortages, things that have happened to maybe exacerbate the length of stay is because we don't have enough supply side on the home. So I don't think it's this like dramatic, like realization, that everybody woke up and said, oh, the home's a great place, we all knew it. Now it's actually getting the right pieces of care that can be delivered there, and technology has helped, but I think also the rising costs of healthcare has helped a lot. It's certainly a lower cost setting.
0:07:42 - David Williams
Well, let's talk about technology for a minute, because, as we were saying, the care started in the home, and then there's some of the high technology in medicine that actually got people into the hospital. But now there's some technology, I think, in the same way that you've got the personal computer first, smartphones, et cetera. Technology is perhaps enabling more to be done in the home that previously would have been more of a hospital level or at least physician office level of care. Do you see that, or is that also not really a big thing?
0:08:08 - Brian Lobley
No, I think it's a huge factor. So, telehealth right. Again, covid helped explode that where people can actually get care, questions answered and a set of diagnostic services done. Right. That eliminates everything from drive time back and forth to maybe more improves efficiency from a physician right. If I can handle three, four, five virtual visits in a row, that's probably a three X factor of what I can do in the home. And then things like remote patient monitoring. I mean, people are going home with blood pressure cuffs and weight scales and things like that.
And that's this world of interconnectivity right. We all have it in our house for entertainment, everything else right. We're in the IoT world, right. Internet of things. And now it's like all right. Well, can I actually upload my BP every three hours so that a doc can see it? Or can I answer an app that's asking me do I have anxiety? 24, 48 hours post discharge? Yes, now that intervention can actually happen with a phone call or with an accelerated home visit. So I think we're a little bit of the dawn of the tech space being kind of bringing more actual care into the home. But I think connectivity is there from communications and follow ups and kind of data aggregation. I think we're in a pretty exciting space right now.
0:09:25 - David Williams
So workforce shortage is such a common issue across the economy, particularly in health care. Maybe we can sort out a little bit how that affects the home. Because on the one hand, if you're saying, yes, obviously it's very labor intensive to send somebody from home to home and you can do more with telehealth, on the other hand, some of the things that I've heard about, like hospital at home, actually probably take more workforce, since a nurse can't be in, you know, I can't serve 15 patients. If they're, you know, they're in hospital at home. How does workforce kind of tie in? How does it net out when we're dealing with Care at home?
0:10:00 - Brian Lobley
Yeah, I think it's a really good point. Right, there is a global nursing shortage, right? If you just think on an aggregate, whether that's inpatient, outpatient, home, right. So now you flip that back to like a simple economic equation like where's?
the financial reward to be able to compensate people for doing the right thing. And I think you know, as we look at kind of the home, how are we making sure that home health agencies, home health nurses, are actually getting Compensated for the holistic total cost of care. Their impact it's not just the 45 minutes to an hour they're in the home, it's the impact they've had in that 45 to 50 to 55 minutes to make sure that the next day that person isn't driving to the emergency room because they have a question or that person's not re-admitting back into the hospital Because their needs aren't met. So I think this realization that you know we have to compensate Holistically from an outcomes base right, it's been long thought of an inpatient care, right, drg payments and the life yeah, pay for an episode will pay for, outcomes will pay for, you know, the ability to keep people kind of home value-based care buzz, right.
I think now in in post-acute and especially home it's it's really driving that education on and saying, well, what are you impacting holistically, right, what was your rate of return to the hospital when it was taken six, seven, eight days post discharge for a nurse to visit the home versus someone being in the home 48 hours post discharge. Right, you get the home each your DME supplies. There you know understanding how to care for yourself. Are you educating the caregiver? That takes time. Well, the sooner you do that, the best. That person's getting on like a routine in the path. So I think on a workforce side, it's really making sure the equation is balanced right inpatient care, critically important right Surgeries, etc. But extending that through to the kind of the whole continuum of care it's. It's really making sure everybody understands what's an episodic cost and how do we pay for it, how do we make sure we reimburse for it. I think that's the, that's the secret sauce, that that everybody in post-acute trying to solve right now.
0:11:55 - David Williams
You know, value-based care is something that we talk about, but it still is a little bit rooted in the fee-for-service world and looking at where the kind of the infrastructure in the capital is, so.
So a lot of the funds go to hospitals, even if we may say that primary care or home care Maybe more cost-effective. We have an interesting situation in Massachusetts now and I don't mean that our teams are as bad as the Philly teams, which is also an issue which we can talk about separately but rather with steward health care. You know there's this concern with, because of stewards financial problems, that all these hospitals are under stress and everyone's looking kind of save them. But it's actually, you know, the other approach would be say this is one of those rare opportunities, maybe those hospitals who just close and have the funds, sort of, you know, reinvested in community-based care home care, primary care and Reset the incentives so that actually works out financially for the providers. People want to be at home, anyway, or, you know, in a physician office rather than go into the to the hospital. So I don't think that opportunity is going to be acted on here, but I do see that opportunity, I do see the possibility of a reset.
0:12:59 - Brian Lobley
Yeah, I mean we've seen hospitals close. Here in Philadelphia, you know, one of the largest hospitals closed a few years ago and I think what you have to map is kind of the need of those services, available beds right across the population, because you got commercial paid Medicare right, duals, underserved, underfunded right. How do you make sure that those critical beds are available for critical access right? So that kind of algorithm or that matching is critically important. I mean you hear all the time, oh the there's, there's too many beds. Yeah, how many times you go into a hospital and see empty beds?
0:13:37 - David Williams
not not a lot right.
0:13:38 - Brian Lobley
So I think it's more of making sure there's really an understanding of it's like a team sport right, like I'm a big believer in providers, insurers, services, like we got to work together as opposed to saying, okay, how do we push the bullet where insurers did really well there in COVID and hospitals didn't, and now there's a bounce back and say, no, we got to, we got to write the system right now we got to take it from the insurers and push it back.
It's you got to look at this longitudinally and, I think, over time, because you're going to have ebbs and flows, utilization increases, elective surgeries, etc. So it is like a complex, you know math equation. So I don't think you can just point to and say, oh there's, there's too many beds because they're financially constrained. It's like, well, what's? What's the root cause of the financial constraint? Is it reimbursement, because this hospital is serving more of the underserved and the remunerations lower versus the suburban hospital that's having higher rate because the demographics are, you know, wealthier? It's? It's a complex economic equation. It has to be looked at holistically.
0:14:41 - David Williams
Fair enough. So you pointed to different populations or different payer types anyway, and I'm wondering, from tango's perspective, what are some of the key differences of serving populations from different payer types? I'm talking about Medicare Advantage, commercial Medicaid, the dual eligible between Medicaid and Medicare.
0:14:58 - Brian Lobley
Yeah, it's really what we look at as a population and what's the percentage of home health use within that subset of a population. So if you think about Medicare Advantage, right, 65 and over, you're going to have the highest usage of utilization within that population of home health. Typically we like to see a number between six and 8% of the population is using home health services. For MA that increases a little bit when you get to duals because you're seeing a higher risk patient you know most likely polychronic, right, and they're going to be probably at the 10% you know kind of utilization or above You're going to Medicaid. Actually the utilization drops significantly because what's usually on a Medicaid book is a lot of you know kids and moms, right, so you're having a lower use of home health and then commercial, you know probably is is the kind of the last mile of pretty low utilization.
If you're thinking about a total book of a large self-funded employer, right, there's not a lot of home health usage. So we prioritize kind of Medicare and and duals as our primary impact because we can manage a larger population. Then I would say Medicaid and then duals but we can go in and activate a market because it's, you know, you don't want to have like duals managed over here and Medicare managed over here. Ideally you're managing a market together, but this is certainly primarily a senior and duals you know kind of kind of problem today.
0:16:19 - David Williams
We hear a lot about patient engagement in healthcare, and what does patient engagement mean when we're talking about home health?
0:16:27 - Brian Lobley
So I think you have to redefine when you're talking about home health, because sometimes it's like the patient cohort, right, it's not necessarily just the patient, who's the caregiver, right? Again, going back to the notion of it's a primarily a senior or duals marketplace, there's probably a caregiver involved. So how do we think of a care circle and are we engaging both the patient and who's the primary caregiver so they're understanding what's available to them, what resources do they need, how frequently did they do those resources and what's available to them kind of outside the visit, right, a lot of things happen. If a visit's on Monday and the second visits on Thursday, what happens on Tuesday and Wednesday? Like what's the release valve, what's the call like, how do you coordinate supplies? So I think kind of patient engagement takes a little bit of a broader term when you're talking about home, right, it's kind of who's all involved in that care, but then it's actually having communication right. So you know we've rolled out, you know, not only some some calls that we make, but some virtual touch points with a messaging system so that we can communicate with that member real-time where if they need to access us, you know they can send a message in or we'll do check-ins like how are you feeling today?
You know things as simple as anxiety, and elevated anxiety could lead to an emergency room visit. So how do we get out ahead of that? So I think it's you know, in engaging the patient is is making sure you're communicating, making sure you're available, but then making sure who's also around the patient. What's, what's the home look like holistically? And it's, you know, look easier said than done, right? As you think about who the patient you know is dealing with on a Tuesday might be different than a Wednesday, right? Maybe the daughters they are on Tuesday and the next day it's son, and probably daughters are taking better care of their moms and sons, right? So we have to kind of play that dynamic as well got it.
0:18:11 - David Williams
Who do you think about as your customer for tango?
0:18:16 - Brian Lobley
first and foremost it's a payer. So we go to a payer and say we'll deal with post-acute, like, we'll activate the home, so we'll be fully delegated, so we take accountability for claims, for network, for utilization management. We're one stop shopping, right. We'll say we'll, we'll make sure we get home health and and, increasingly, post-acute taken care of. But and then the same way we go to our providers and we enable them. So we're we're kind of like the anti-convener.
We say our play is enablement right, we want to enable payers and providers. So it's important that we understand what the provider's capability is in a market. Maybe there's a really great wound care provider. It's complex, you know post discharge case. Well, we want to make sure that patient is getting seen by someone with the right wound care expertise. Or other thing is availability right, the most important thing I talked about earlier is getting that patient seen in the first 24 to 48 hours. So who has availability? So we're looking at acceptance rate. So when we go into a market, we understand the provider's disposition and even these national providers. Right, they're different in the northeast and they are the southeast, they're different in urban versus rural. So while our primary financial customers, the payer, we really think of our partners as the providers as well.
0:19:27 - David Williams
Got it. So you mentioned before that the company's name has changed to Tango, and why make that branding change and what is Tango meant to evoke?
0:19:38 - Brian Lobley
Yeah. So former company PHCN, Professional Healthcare Network, legacy markets were more focused on the traditional utilization management model and Tango signified this new year of enabling value-based care. So we wanted a new brand to kind of take kind of where we see the market moving and this idea of enablement. We wanted an actionary in it word that says we're here to partner. So look, naturally you said earlier it takes two to Tango. So we're having that conversation like it's not just us. We need someone on the other side to partner with us. So there's a little bit of the play on the word there as well. We also wanted something that was memorable, right, what's something that you can say oh yeah, tango's in market, that's great. If we're sitting in discharge planning, oh Tango, yeah, we like them, we know what they can go serve us, versus something that's a nebulous acronym.
0:20:29 - David Williams
Now it sounds good. You just have to make sure not to step on your partner's feed, I guess, is the only exactly right Delicate toes. Good. So my last question, Brian, for you is whether you've read any good books lately, anything that you would recommend to our audience.
0:20:43 - Brian Lobley
Oh, great question. I am a self-subscribed escapist reader, right. So I'm reading articles all week from a business standpoint, I'm reading trend reports and all that. So I like a good escape book. So I'm a big fan of the Mitch Rapp series Vince Flynn, who passed away and has a writer finishing off, so I think the last book I read was probably a couple of weeks ago is the latest in the Mitch Rapp series. So it's good. You know, fun escapism for me.
0:21:12 - David Williams
Excellent, Now that does sound. That sounds good. I think those people need that. Not everybody finds it. They sometimes find themselves back on the phone scrolling, doom scrolling, when they should be. Try to avoid.
0:21:20 - Brian Lobley
I can go out in the social media log, but I'm trying to get some distractions there too.
0:21:26 - David Williams
Great Well, Brian Lobby, CEO of Tango. Thank you for joining me today on the Health Biz podcast.
0:21:31 - Brian Lobley
Thanks so much for having me Appreciate it.
0:21:34 - David Williams
You've been listening to the Health Biz podcast with me, david Williams, president of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.