Interview: Jiseki Health on wrapping services around patients

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Jiseki Health is a company that connects people with complex health status challenges with the social supports needed to complement their health care services.  They take a systems-level approach to wrapping services around an individual to support better health outcomes.

Jiseki Health is a new venture that currently is doing work in Honolulu and in San Antonio.  I caught up with Jiseki’s CEO, Tushar Vashist, and COO, Susan Bowen, to get a sense of the work they are doing.  They’ve recently started working towards a CPC+ grant from CMS, which is a focus of their current thinking, as you’ll see below.

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Karianna Wilson:  Tell me about Jiseki Health, how you got started, and what you intend to do in Hawaii.

Tushar Vashist: We started Jiseki Health because of my own personal experience at Kaiser Permanente being part of the team that wrote the section 2402a of the Affordable Care Act, which is home and community based services.   For certain segments of the population, care is best delivered outside the building, outside of the in-patient or acute setting.  And, it turns out we believe the community and the patient itself are the most underutilized resources in supporting health in most health circumstances.

I found that actually that it was not the question of whether resources were available because sometimes there were plenty of resources that were available.  They were just being underutilized and extremely mismanaged.  Moreover, hospitals are not equipped to handle home and community based issues. So, we asked “what are those issues that hospitals cannot address?”  I recognized that certainly for a Medicaid population there were social determinants of health, which hospitals had no idea about. Yet, from the hospital perspective, one thing was very clear was that these social determinants had an impact on a hospital’s overall quality score.

If there are social determinants and they are happening outside the building, the solutions are not inside the building. We must go find these problems from the outside.  That way forces us to engage people with where they were in their home settings and more importantly in their community setting.

So that’s what Jiseki Health set out to do. Fortunately for us, CMS came and put forward the accountable health communities grant where they said “Go find 75 thousand people and they must be from within the community. Run an assessment, find the available resources that could be deployed to support them, and weave together community supports and health resources to connect them into a new model of care.“

So we came up with three key areas of focus which we distill into this:  find, connect, coordinate.

 

KW:  So Jiseki’s task is to find the people, connect them to services, and coordinate those social services.

TV:  Correct.

 

KW:  Walk me through how that works.

TV:  Interestingly, we were still dependent on hospital systems to recognize the importance of solving the social determinants from the outside. What this means is that we still need hospitals to provide us with the names of people who would qualify for such an assessment.  It’s a harsh sell because the person may not be motivated enough to handle and assign a company like us to go and manage the care management aspect of social issues outside the building.  So, we also recognized that nothing was stopping us from engaging the members in their own community, outside of an acute setting.  So, this community focus is where we continue to evolve and direct our resources.

 

KW: Who are the partners that you’re working with?

TV: So the clinical partners are FQHCs through the HPCA. The other clinical partner is the Kohuku Medical Center, which is a 24 bed ER on the north shore.  Ke Ola Mamo is our biggest partner, which is the native Hawaiian clinical system.

 

KW:  So your clinical partners would help identify the 75 thousand patients or members?

TV: That is correct. Because these two entities, the FQHCs and Kohuku Medical Center had a total of 83 thousand people.

And then we partner with Lyft to support transportation for these clients.  From a technology standpoint, Christine Sakuda and her office provided us with a letter of intent, a memorandum of understanding to help us aggregate and share our data across a range of providers.

 

KW:  If CMS awards this to Jiseki, then you would be the bridge organization which would then work to identify, provide the community service connection, and the coordination through the partnerships, these partnerships that you’ve already identified. Would you entertain new partners or do you need to work with just the current partners as part of the award?

TV:  We could add partners, new partners, that’s not a problem.  We have met the burden but as things evolve and we could find people, maybe Queen’s is a better clinical system or some other better clinical system then clearly this is something we would consider so long as our focus is on Honolulu County.

 

KW: And Jiseki has technology that will allow you to do this in partnership with let’s say the FQHCs?

TV: That is correct.  Our greatest strength is technology. Because we can scale, it’s not a resources problem.  In an ideal situation we use the existing resources that a community will have, the FQHCs have, but we are not limited by their, by whether they have the resources or not. Our technology will allow the existing resources and in the case where if there are no existing resources, we will design a system by finding resources within the community.

Susan Bowen: I think there are two ways to think of this. There’s a CMS grant which provides a point of view of how you access and engage with this community. Which of course we have to follow the rules within the CMS model, but even without these grants, we would engage in Hawaii.

 

KW:  What’s the value proposition to someone who’s going to pay for your services?  How does a CFO see the ROI? What does that look like for them?

TV:  So the lure of making money and creating a superior human experience, patient experience for their population are the two motivational drivers.  We believe there are only two things that moves the hospital system:  the fear of penalty and the other is the intent of making more money, right? So what CMMI has done is they have sort of dangled this carrot and stick.  So the lure of making money and creating a superior human experience, patient experience for their population are the two motivational drivers.

SB: I think that most people’s point of view is that there will be a single source of payment to support a program. We tend to think of it more as the construction of a partnership and ecosystem that has the ability to pull from a variety of funding sources, some very small, some very large. But to build something that in and of itself becomes sustainable overtime without any one benefactor or driver for that. So the answer lies within the partnerships that we create with a variety of different entities.