Revisit: Wound & Ostomy Care Gaps | With Joe Ebberwein

Jason talks with Joe Ebberwein. Joe is the Co-founder and Chief Financial Officer of Corstrata, a technology-enabled care management solution focused on improving outcomes for wound and ostomy patients. We gain data-oriented insight into this often-neglected area of care and how Corstrata is working on solving this care gap; then, they discuss how virtual care and telehealth are viable solutions for any provider to utilize.

Joe & Corstrata can be found at:

Corstrata.com, Twitter, Facebook, LinkedIn

Transcript of the interview


Credits

Production Assistance & Editing: Nyla Wiebe

Scripting by: Aaron C Higgins

Show Notes & Transcription: Aaron C Higgins

Social Media Management: Jeremy Miller 

News Co-Hosts: Aaron C Higgins & Jason Crosby

Interview hosts: Jason Crosby

Executive Producers: Mike Scribner & John Crew

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Technology Solutions for Wound Care

Aaron Higgins 0:32

Welcome to Beyond the Stethoscope Vital Conversations with SHP . As we take our summer break to prepare for the exciting Season 5 , we're revisiting some of our most impactful episodes to keep the conversation going . In this episode from Season 1 , jason Crosby sat down with Joe Everwine , the co-founder and CFO of Corstrada , a technology-enabled care management solution focused on improving outcomes for wound and ostomy patients . Joe provided data-oriented insights into this often-neglected area of care and discussed how Corstrada is addressing these care gaps . They also explored how virtual care and telehealth are becoming viable solutions for providers to enhance patient care . So don't miss this opportunity to revisit a thought-provoking episode filled with valuable information and practical solutions . And , as always , if you enjoyed this episode , please be sure to rate and share our podcast in your favorite podcast app . It really helps the show . Thanks for joining us and let's dive back into our vital conversation with Joe Eberwein .

Jason Crosby 1:43

Hey everyone . Hey everyone , I'm Jason Crosby , with Strategic Healthcare Partners and your host for Beyond the Stethoscope Vital Conversations with SHP . Today , we are joined by Joe Eberwein , who is co-founder and CFO for Crestrata , a tech-enabled solution provider for the wound and ostomy care markets . Joe , thanks for joining us today and welcome to the podcast .

Joe Ebberwein 1:59

Yeah , great to be with you today .

Jason Crosby 2:01

Look forward to it . Well , we've got some questions lined up for you , but first let's start with just some background information on yourself and kind of your journey in the healthcare industry .

Joe Ebberwein 2:10

Absolutely yeah . So my background is actually accounting and finance , got an undergraduate in accounting and then did the CPA route and worked for both and this will age me , but both Arthur Anderson and Price Waterhouse and started working in healthcare early in that career doing cba work auditing . Was in atlanta for a little while and then moved back to savannah and actually began work with memorial medical center , now part of hca , but worked primarily on the post-acute side and the for-profit entities which back then were the air ambulance and MedStar , the ground ambulance and then all of the other ancillary in-home services such as home health , dme etc . So I've really spent most of my career in that space , just about anything that could be done in the home , from nursing , traditional home health , hospice , private duty care and then , as the years went on , back in the early 2000s , the agency that I was involved with , we got into telehealth in a big way and the use of vital signs monitoring in the home . So we were one of the early adopters really nationally and kind of became known as national thought leaders around implementing that use of technology in the home health space and we saw some pretty amazing results . We saw improvement in clinical outcomes and improvement in financial outcomes . So we were much more equipped to manage patients with chronic conditions like CHF , copd etc in the home using this equipment Again back in the early 2000s clunky , expensive equipment , but fast forward .

Joe Ebberwein 4:08

That was really kind of the initial groundwork for what my business partner , kathy Pate , and I ended up doing at Corstrada about seven years ago . And really what we did is we took that concept of how can you apply technology to a healthcare problem and we had experienced a big problem in managing chronic wounds for patients that were in home health . So similar to the teleradiology model , we thought kind of came up with a thesis that we could move images similar to radiographic images to a distributed workforce and that workforce happened to be board certified wound and ostomy nurses . So we started doing a lot of R&D into research around how could we come up with a technology solution to that problem . So that's really kind of how Corstrada was born seven years ago . But that's my background . You know finance , accounting but a whole lot of other hats along the way in early stage companies .

Jason Crosby 5:20

Yeah , it sounds like a natural evolution from the early 2000s . You know you got to see telehealth early on and home health and now that's kind of all you're hearing about , right . So kind of makes sense now that you mentioned with Corstrada . So let's dive into that . You've touched on it . Tell us a little bit more about the operations of Corstrada , the problems you're trying to solve and who you're trying to solve them for , right . Who's your typical client , what type of provider setting ? Dive into that a little bit for us , Sure .

Joe Ebberwein 5:50

Yeah , you know wounds are an interesting problem because no one really owns wound outcomes . You know you've got cardiologists that are dealing with cardiovascular issues or endocrinologists dealing with kidney and diabetes function and that kind of thing , but nobody really owns wounds because they cross multiple comorbidities . You might have wounds related to vascular issues , lower extremity wounds , a huge prevalence of diabetic foot ulcers in the diabetes population . One in four diabetics will get a diabetic foot ulcer in their lifetime and one in four of those will have an amputation . And then the five-year mortality rates are off the chart crazy for people that recover from an amputation . So those are the kind of wounds . Additionally , you have a multitude of other wounds related to different conditions , whether it be pressure injuries from immobility or you know . A lot of times you hear them referred to as bed sores and unfortunately that's highly prevalent in skilled nursing facilities and a lot of them can be prevented with the right education , with the right techniques , the right surfaces , etc . So it's a $96 billion problem . 15% of all Medicare patients members have a wound and the real problem that we're trying to solve and chipping away at it is that there are only 15,000 board-certified wound nurses in the country and that equates to about one nurse for every 600 patients . It's not sustainable .

Joe Ebberwein 7:44

The number of diabetics obviously we know that that's growing . We've got about 37 million diabetics and another 96 million pre-diabetics . Million diabetics and another 96 million pre-diabetics . So it's a really , you know , it's like a freight train going down the track and it doesn't have a good ending . There's a big wall at the end of it and it's all around access to these specialists .

Joe Ebberwein 8:10

So , as I said , no one knows wounds across multiple specialties , multiple provider settings , whether it's home health , skilled nursing facilities , where about one-third of the patients have a wound , ltac , rural hospitals All of these different care settings have patients that present with wounds and yet we don't have the expertise to really manage them and get evidence-based care . One out of 10 nurses that are certified in wound and ostomy care practice in the post-acute space . So and that includes home health , hospice , snfs , rural hospitals 90% are practicing in the hospital settings and outpatient wound centers . So I mean you can see there's such a disparity with where the experts are . We're solving that problem with technology in a number of different ways and I can go into that if you want .

Jason Crosby 9:12

Yeah , so with that , the key obviously being technology adoption on the provider side and some are a little bit more accustomed to that adoption , some aren't . With that and with the gap in qualified nurse on the outpatient side , as you just mentioned , are you seeing those as your key barriers or what other barriers are you seeing to entry into those spaces ?

Joe Ebberwein 9:39

There are a number of barriers . One of them that's really interesting is some providers don't want to take wound images of their patients' wounds and you can kind of see that right because of litigation discoverable in the chart et cetera , because of litigation discoverable in the chart , etc . But what's interesting is most of those patients say with a pressure injury or pressure ulcer , if it gets bad enough , somebody is probably photographing that wound and what we try to get across . Our client says do you want you know a qualified professional taking photographs of the wound over time to show the progression and have the medical records support that decline or , hopefully , improvement ? Or do you want you know the patient's nephew to have the photograph in a court of law ? So a lot of times we can get over that barrier pretty quickly .

Joe Ebberwein 10:38

The other barrier is we're really a value add to our customers . So whether it's home health or hospice or skilled nursing facilities , because we are a nursing model , we're not billing any Part B , we're not billing any commercial Medicaid , we bill our clients and our clients get a return on investment from having access to experts . So we can reduce , you know , nursing time , home health visits . We can reduce those . We can reduce their spend on advanced wound dressings and also really , to be honest , help them with coding and reimbursement as well , because a lot of times they're misidentifying wounds and they're leaving dollars precious dollars on the table from a reimbursement standpoint .

Jason Crosby 11:25

Sure , and it sounds like if 15% of the Medicare population have wounds and there's obviously a growing number there I would just imagine there's greater demand for that type of service . Where are you starting to see some of those trends , knowing that you've got the aging population , you've got hospital closures , not only rural hospitals , but you've got Wellstar , for goodness sake , in Atlanta , yeah , at the hospital , large hospital in Ohio , and that's only gonna continue , right . So go down that path a little bit . Do you envision continued demand for such a service , or is that just going to become a barrier for you as well ?

Joe Ebberwein 12:04

I think it's going to become quite an opportunity for further penetration in multiple markets and I'll tell you just a couple of examples . We are we're working with some large hospital systems on the West Coast and these are big hospital systems in urban settings and because of lack of staffing they're closing their ostomy clinics . So literally we're getting that business . Through our virtual consultations . We are able to do a 30-minute live video with the patient in their home , troubleshoot the appliance , save an ER visit and assist these hospital systems that are desperate for staffing of these nurses . On Indeedcom I went on there today there are 4,001 open wound nurse positions across the US . Well , if there are only 15,000 certified period , you can see there's such a disparity and with COVID kind of the great resignation , a large number of nurses who are considering leaving the profession . It's a big and growing problem . So hospital systems , as you mentioned , rural facilities , really just about anybody that in the post-acute space also that is dealing with the wound .

Jason Crosby 13:33

What do you say to those ? Then there's obviously the appetite , the demand for the service that you guys are providing . Many reasons , as you just laid out . There's still slow adoption to that . Whether you're a skilled nursing facility , rural hospital provider , large health system , you know practice setting Across the board , there's not a provider that can't utilize the service . What do you tell those that are just hesitant to look in that direction and start investigating a service like yours ? What do you say to them to get them across the line ?

Joe Ebberwein 14:03

Great question , and I do think that COVID and the adoption of telehealth broke down a lot of those barriers for us , because a lot of facilities had to move to virtual care . They had to put the systems in place not only from a technology standpoint but also all the infrastructure , and so that has actually helped us in that , in telling that story .

Virtual Care Innovations in Wound Care

Joe Ebberwein 14:30

But , for instance , when we talk to , say , rural hospitals that now are either not able to admit a wound patient or they're having to transport them to a higher acuity system because of lack of expertise , it becomes really an amazing impetus to start considering using virtual care so the market's almost telling them itself hey , this is why you need to look into it .

Jason Crosby 14:56

They don't necessarily need the sales pitch . I mean , just listen to the market and let the market tell you you need to look into it now . They don't necessarily need the sales pitch . I mean , just listen to the market and let the market tell you you need to look into it Now that that makes sense . Let's pivot somewhat into that . To me , that virtual health , telehealth , is kind of a you know , a disruptor that we need . So continue looking at that and let's let's also look into your crystal ball right . What are some innovations that you're seeing in these service areas ? What are you seeing coming down the horizon there ?

Joe Ebberwein 15:22

Yes , so interestingly we have and this is one example but we have a diabetic foot ulcer prevention program . So obviously diabetic foot ulcers don't just occur in the Medicare population . These are people that are working . They're 40s , 50s , some even younger , that have severe diabetes , they develop neuropathy and they end up with a diabetic foot ulcer and it's just an incredible kind of cycle . It can spiral down .

Joe Ebberwein 15:54

Well , we have working with companies that have electronic sensors for measuring temperature and pressure in the insoles of shoes . A lot of technology is moving toward prevention and most diabetic foot ulcers are preventable if you have the right early detection . So that's one example . There are sensors built into orthotics for measuring compliance and you know what ends up happening is that data , that sensor data that tells that someone's getting into trouble , that comes to an entity like Corstrada and then we're able to intervene . Entity like Corstrada , and then we're able to intervene .

Joe Ebberwein 16:41

We had a really interesting this is just an anecdotal story , but we had an interesting encounter with a gentleman who was using one of these monitoring systems and every weekend he would alert , and so we knew something was going on on the weekend where he was getting elevated temperatures , which is a precursor to ulceration . And so one of our nurses said okay , let's dig into this , let's do a video call . I want you to show me every shoe you have . I want you to tell me what you're doing on the weekend . Well , turns out he had a part-time job at a funeral home and he had to wear a certain kind of black shoe and it was not the proper shoe to relieve that pressure . So we got him in the right shoe . The alert stopped coming in , but that's the . That's the illustration of . You got all this great sensor data , but what do you do with it ? And then that human intervention , that biofeedback and coming up with a plan to to really prevent that ulceration Wow that's a great , applicable story that anybody listening can certainly resonate with right .

Jason Crosby 17:49

I mean that's great Appreciate you saying that . What's now the strategic roadmap for Castrata ? What are you guys working on today and over these next couple of years ?

Joe Ebberwein 17:58

Yeah . So it's been interesting over this last year where we had predominantly really been working mostly in the post-acute space like home health , hospice , skill nursing facilities . What we're starting to see are some of the emerging models for really acute care services in the home hospital at home , if you will and we're working with a number of those organizations that really help facilitate a hospital building a hospital at home program . Where that becomes really interesting is and this was really accentuated during the pandemic you've got these acute patients who really , when there weren't enough beds in the hospital , could be managed in the home with the right equipment . And when I say hospital at home I'm talking there is hospital-grade equipment , hospital bed , vital signs , monitoring , all going back to kind of a Star Trek central station , constantly monitored , you know , daily nursing visits , nurse practitioner visits , et cetera . So you know , imagine that they're really setting up a command center in the home that is , you know , transmitting data .

Joe Ebberwein 19:15

So hospital at home is an emerging market and a lot of those patients have wounds and ostomies and so they're engaging with us to do virtual consults for the people , that maybebased care bundles . We are in discussions with some payers that also have mobile clinical teams . So , yeah , it's really kind of been an interesting year and it's a shift in who's approaching us for those kinds of consults . Ostomies is a big deal as well . Kind of consults . Ostomies is a big deal as well . Even though it's not a big number like the wound population , it's a really high 30-day readmission rate into the hospital and so ostomies kind of go hand in hand with wounds because of the certification of their nurses .

Jason Crosby 20:21

Interesting that you know here you just talked about what 20 years ago the focus was all on the skilled nursing facility . If that and now you can span across any provider setting , acos , practice setting , it doesn't matter Come a long ways , and it's just the last 20 years . So another exciting few years ahead , I'm sure .

Joe Ebberwein 20:40

We're seeing such incredible stories , both with individuals living with ostomies that literally were driving to an ostomy clinic four hours away that can now do this in the privacy of their home to people with long-term chronic wounds that just never had the right evidence-based treatment plan and we're getting those wounds closed , obviously saving a lot of money for the providers , but the human impact is amazing as well .

Jason Crosby 21:12

Finally , Joe , if our audience wants to learn more , how do they go about doing so ?

Joe Ebberwein 21:16

Sure , so lots of ways to contact us . Obviously , our website course stratacom . We're on LinkedIn and Twitter and Facebook and just about any social media , so very easy to get us .

Jason Crosby 21:31

Well , some great information and an even better conversation , Joe . Lots of lots of data to support . You know what you guys are doing is a great thing . It's a service that's needed out there in the marketplace . So really appreciate that , and I'm sure the listeners will find it just as useful as I did . You definitely opened my eyes to a lot of things there . I appreciate that , and I'm sure the listeners will find it just as useful as I did . You definitely opened my eyes to a lot of things there . I appreciate that , and we really appreciate your time and joining us today . I want to thank our listeners , too , for your time . We look forward to our next podcast and until then , everybody , have a great rest of your day .

Joe Ebberwein 22:00

Thanks for having me .

Aaron Higgins 22:03

You've been listening to Beyond the Stethoscope Vital Conversations with SHB . This has been a production of Strategic Healthcare Partners . Your news hosts today were Jason Crosby and me , aaron Higgins . It is produced and edited by Nyla Weave . Our social media content producers are Nyla Weave and Jeremy Miller and our executive producers are Mike Scribner and John Kroop , and our executive producers are Mike Scribner and John Kru . For more information about SHP and the services we offer , including the back library of episodes , episode transcripts , links to resources discussed and much , much more , please visit our website at shplccom . Thanks for listening .