Episode Transcript
[00:00:01] Speaker A: You're listening to the Doc Lounge Podcast. This is a place for candid conversations with the healthcare industry's top physicians, executives and thought leaders.
This podcast is made possible by Pacific Companies, your trusted advisor in physician recruitment.
Welcome to the Doc Lounge Podcast. I'm your host, Stacey Doyle. And today we're diving into one of the most under recognized challenges in healthcare and the powerful solution that's transforming it. Joining me is Dirk Sung Sen, co founder and CEO of Seresti Health, a company leading the charge in dementia care designed for value based care. Dirk is a seasoned entrepreneur with a background in digital pathology and healthcare innovation. With Soresti, he's tackling one of the costliest and least managed populations in medicine, dementia by empowering family caregivers through a tech enabled platform that's reducing avoidable hospitalizations by over 50%.
We'll talk about the hidden impact dementia has on physician performance in value based care, the opportunity offered by CMS's guide model, and how Suresti's no cost, no risk approach is driving real results without burdening healthcare providers. So let's jump in. Welcome to the podcast.
[00:01:14] Speaker B: Thank you. Thank you very much. I'm excited to be on here, Stacy.
[00:01:17] Speaker C: Yeah, well, let's get started here. So tell me, what was the problem Soresti was trying to solve?
[00:01:25] Speaker B: So when we first started the company, the goal was to improve the experience that families have living with dementia at home.
There's a lot of thinking that maybe there's a medication that will cure dementia. I think people have now recognized that dementia or Alzheimer's disease and other types of dementia is as complicated as cancer. There isn't going to be a magic pill that just cures it.
And so we felt it was important to focus on the people who are struggling with this in the home.
So that was the impetus, was just to improve the experience.
The business case was we didn't want this to be a consumer pay type of a service. So we really decided early on that we wanted to be value based care oriented, which means that we had to prove outcomes, reduced medical costs or improved revenue or something like that that would make this interesting to a value based care organ.
[00:02:24] Speaker C: I was just going to say what makes dementia a challenge in the value based care models? I'm assuming it's like you just said, you have to prove the effectiveness and the worth.
[00:02:34] Speaker B: Yeah.
So dementia is very different than most other conditions that we think of. We think about diabetes or COPD or congestive heart failure. If you're in value based care, meaning you could be a physician in an account care organization or you might even be a physician employed in a health plan.
Your approach is to deploy care management teams.
The goal of care management resources is to engage the member or the patient in improving self care. You might talk to them, you might coach them, you might provide them with materials.
It's proven that effective care management can actually bend the cost curve and get better outcomes.
So why does this not work for dementia?
Well, somebody with dementia can't remember their care plan.
If you talk to them today, they might not remember that they talked to you yesterday. They can't articulate their symptoms. So this is a population that's largely not engageable in traditional care management programs.
If it was not a very expensive condition, you'd sort of say, well, it's okay, right? It's not a big deal. It doesn't cost much money. I can live with the fact that I can't engage people with dementia. But it turns out that when you look at Medicare claims data, dementia is the second most expensive condition in Medicare.
Most people, Stacey, don't know this.
[00:04:02] Speaker C: Yeah, I bet. And is there a dollar amount associated with it that you know from your research?
[00:04:10] Speaker B: Yeah. So the average cost of somebody with dementia is $30,000 a year.
The average Medicare patient costs $12,000 a year.
So there's a huge difference.
It's kind of hidden in claims data. So on our team, we have a chief medical officer who ran a health plan and tons of experience. One of our other board members is somebody who ran a national health plan. The whole thing. He said dementia was never a priority.
Now they will tell you, oh yeah, it should have been because they now understand that if you look for it in claims data, it just jumps off the page.
It's the largest unmanaged risk that anybody has in a health plan or an account organization. And it's largely, I don't say ignored, but it's largely unmanageable because nobody has the ability to engage this population, by the way. We have no magic bullet. We can't engage somebody with dementia. But if you work through the family caregiver who is actually taking their loved one to the doctor, giving them the medications, can have the conversation with a physician. You can have amazing outcomes. We've built a care model around enabling the family caregiver, then we have some technology and other things that make that happen. But the basic approach is you simply think about this is a population that is not engageable in traditional programs. But if you have a caregiver centric approach, you can engage them through their family caregiver, and you can get really good results.
[00:05:43] Speaker C: Well, I'm assuming that dementia, those figures are just going to continue to increase with the aging population, with boomers and all that. I'm assuming this is going to become even a larger problem from a numbers standpoint, like you were just speaking to.
[00:06:00] Speaker B: I think the fact that the.
The baby boomers are aging and people can run these sort of models to say, well, how many people are going to be at what age? At any period in time, the number of people that will have dementia will increase dramatically. I mean, estimates are today there's 7 million that are diagnosed. That will increase to 12 or 13 million over the next 15 years.
So that's a huge problem for the country, for our healthcare system.
And this is also why CMS has established now this guide model, GUID Guiding and Improved Dementia Experience.
They have established this model to really provide an opportunity for companies like Seresti, who are participants in that model, to offer dementia care services. And then CMS will reimburse us directly.
Maybe the most noteworthy thing is they require the family caregiver to be in the care team.
That's a really big insight. So cms, through their research, largely through academic institutions, has learned, unsurprisingly, that the family caregiver is really valuable in getting better outcomes for somebody living with dementia. It's a requirement, something we've been doing for years. It's kind of the basis of our model.
[00:07:19] Speaker C: Amazing. Well, walk us through a little bit about how this platform activates the family caregivers and why that is so effective.
[00:07:28] Speaker B: Yeah. So the word activate means different things to different people.
So when we think about activation, I just kind of like, you get somebody going, right? You get them to do something. So we think of it as improving somebody's knowledge, somebody's skills, and somebody's confidence.
And in our work, we've actually realized that confidence is the biggest thing that family caregivers lack of. Sometimes they say, I kind of know what to do, but if I see something, maybe I can just wait till tomorrow, the day after. And by that point, it's too late, and you end up in an emergency department.
So the way we activate a family caregiver is we provide them. And typically it's a spouse, an adult child. In fact, in our engagements, half of the caregivers are spouses. So they're 75, 80 years old, probably not really good at using a smartphone. So we send them a tablet. The tablet's connected to a cell provider.
It's locked down. So you can't watch a movie or check your email.
Then on that tablet, we deliver personalized education. We've built this huge content library. Think of us like a Netflix of dementia education, where that is delivered through smart software. Some people call it AI, but smart software that sort of says, well, for this patient, given their risk factors and what the caregiver is doing, this is kind of the right series of educational models for them. They get that on the tablet, they get two or three a day. They finish that, they get two or three the next day.
Maybe the most valuable thing, Stacy, is we pair that caregiver with a social worker. SERESTI EMPLOYED COACH so this is like you're a caregiver. You didn't apply for the job. You don't know what you're doing typically. And you now have a coach who understands where you are at and who can augment what's on the tablet with what you need in the moment.
There's a degree of dynamic personalization to this program that caregivers find incredibly valuable.
The conversations we have are very deep. We become an extension of the family.
Then the thing that we do that really is important is we ask the caregiver to report what they observe in their loved one. This is the most important thing clinically, Stacy, because in somebody with dementia, I always like to try to give an example. Think about somebody who has a urinary tract infection. They don't have dementia. They might say, I go to the bathroom all the time.
It hurts when I pee.
I have back pain, and I generally don't feel very good.
Most people would say, okay, I suspect there's a UTI going on.
Somebody with dementia can't do that. What you might see is you might see agitation, you might actually see lethargy. You might see a change in appetite. You might see a change in sleep. But a family member who knows that patient really well would say, something's off with mom or dad or my spouse. That changing condition is a trigger that says if you have three days or four days at most before you end up in a hospital.
So we teach the caregiver to look for that changing condition and not ignore it. And we teach them how to engage the healthcare system.
And when we do that, we find that we see, I mean, almost unbelievable reductions in hospitalizations due to things like falls and sepsis and unmanaged diabetes and UTIs and pneumonia.
So clinically, it's that change in condition that is the trigger. And the family member has this superpower to actually recognize that. So a Big part of the program is to kind of almost do continuous monitoring of that person with dementia through the family caregiver.
[00:11:00] Speaker C: Yeah. And I know you've said that you had a 50% reduction in avoidable hospitalization. I mean, those are huge numbers.
[00:11:06] Speaker B: So, Stacy, most people, when they look at our outcomes, including like, our chief medical officer who spent, you know, 30 years in, in health plans and provider groups, he said these numbers are not believable.
All I can tell you is we have now two studies with two different health plans and two different geographic locations at two different time periods that have shown the same results.
There's something about this model of care that yields these high reductions in hospitalizations and significant medical cost savings.
So, you know, I think time will tell. I mean, we're just reading out the data as it is. Right. Typically, you do these studies and you find a comparison group, so you kind of match people, same age, same sex, same cost, same geographic location, so that, you know, you really can then, with statistical significance, say, you know, we caused this.
So that's kind of what we've done. And I think part of the reason we're getting these amazing outcomes is that this is a population that has not been managed before, unlike diabetes or COPD. People have been doing that for 20, 30 years, and maybe you can't get a big improvement because everybody's pretty good when it comes to this. I think most people who are honest will say, we have no idea how to do this.
By the way, providers, physicians do not want to tell people they have dementia. They don't want to talk about dementia. There's a stigma here, which is another problem that contributes to the overall sort of poor outcomes for this population.
[00:12:40] Speaker C: Well, I love that because it sounds like this is really empowering the population of people that are caring for all those that are affected by dementia. So it sounds like a tool that really can provide, I think, probably over well, better happiness to the caregivers and their families when they feel more empowered. And, okay, these are things I need to look for and make sure everything stays on course with my loved ones. So I think that is huge.
Tell us a little bit. I know that.
What's the implementation about? How does this work? Because I'm sure people at home or physicians are saying, well, what do I have to do to get this going?
How does it work?
[00:13:27] Speaker B: Yeah.
So, first of all, a couple of things that I think that are noteworthy. So I mentioned there's a tech enablement piece. I mentioned that we provide a tablet to the caregiver. We Provide a coach. We do everything remote with one or two small exceptions. So under the guide model, we're allowed to provide our services entirely remotely.
So a lot of people in the guide model are academic groups that maybe have a facility based practice. Maybe they were doing some of these things and now they can get paid for that. I think that's fine. So they have 100, 200 people that are in the model.
Our goal is to build a nationwide capability of providing dementia care anywhere in the country because we're remote. So for that we have to administer everything we do through technology.
So the tablet is one important piece that we provide. And because it's configured in such a way that you can connect it to cell service and if that doesn't work, it still kind of gives you pretty good performance. So we really try to optimize the user experience.
One of the things we have to do in this guide model is we have to make a diagnosis. We have a partner who will actually make the diagnosis. It's a virtual neurology partner.
There are things that we have to do as part of the guide model that really I think make this scalable in terms of if you're a physician, you say, how do I get my patient referred to this on July 1st? A company like Seresti, who is. These are details. We're kind of in the new track of the guide model. People can come to us and, and as long as we're providing services and those zip codes, we would be delighted to take them. So we're probably a week or two away from standing up a website where we'll start taking a waiting list of people and then we will work with those folks to offer them the program. A big caveat is you have to be on traditional Medicare or original Medicare. Right. If you are in a Medicare Advantage plan, then you're not eligible for the guide model.
[00:15:28] Speaker C: Okay, great. Thank you for that clarification. And that sounds really exciting that it will be easily accessible for people starting in July and they can kind of go, you know, to your website to indicate interest. So let me just clarify one thing though. They need a referral from a physician or they can. Or a patient could get a referral directly through Seresti.
[00:15:51] Speaker B: They can self refer. They. So in other words, in fact, CMS later this year will send out a letter to people they think might be eligible for the program. They'll say, here are the guide participants in your geographic region and people will become aware of it. So anybody can self refer to us, which I think is there's no referral required. You just come to us and then we have to go through the process of demonstrating that you have dementia through a neurology examination. We submit that to cms, they say, yes, this person is eligible to enroll the guide model.
So Resti can then be reimbursed for our work through, like, a CPT code. It's called a G code.
I should mention, one of the really amazing aspects of the guide model is I don't think it's for everybody, but for a certain subset of people that qualify, you can get $2,500 worth of respite care paid for by the government.
So if you think about it, that's. That's 20 visits to your home for four hours, where somebody, you know, through our home care partner would come to your home and you as a caregiver could go do something and you could. You could, you know, go watch a movie, you could go shopping, you know, whatever would be, have lunch with a friend. And I think when you really think about it, that is an incredibly valuable benefit. So I think the respite portion will be very attractive to families, and I think that'll be one of the reasons why they will want to make sure that their loved one, if they're eligible, participates in this model.
[00:17:27] Speaker C: Tell us a little bit about. I'm sure you've worked with a lot of physicians.
What is their feedback about dementia in general and how do they tackle a patient that has that within their setting?
[00:17:43] Speaker B: Yeah. So just think about it. If you're a physician and you have a family with dementia, you're probably seeing the patient with dementia and their family member together. You have two people in your office visit, and you might be running yourself sort of, hey, I'm going to spend 15, 20 minutes per patient. Invariably, when you have two people and one doesn't track very well, it's going to take much longer. And then the issues that are raised, many of them have nothing to do with what the doctor's trained for. They're like, my loved one is incontinent. I can't get them to take a shower. I can't get them to eat. The doctor is not trained on this.
So these are the psychosocial challenges of dementia that are providing a burden. And then before and after the visit, there's typically an extraordinary amount of effort that the front and the back office staff have to spend with the family.
So we take all of that off the plate of the provider.
And then when the caregiver, let's say, goes with their loved one to the doctor. We teach the caregiver how to talk to the doctor, how to have a very specific conversation. They understand medications, they understand chronic conditions.
So we, we kind of teach them. This is how you make the most out of your 15 minute visit. So from the provider's perspective, we're unburdening them and, and we're in a perfect world, only trying to bring the medical things that they can address to the table and all the other psychosocial things like family dynamics and so forth. We're tackling that through our social workers in our program.
[00:19:16] Speaker C: And I'm assuming this is one of the hidden costs of dementia that you were previously referencing.
[00:19:22] Speaker B: Well, so there's a couple of hidden costs. So the costs that I was talking about are the ones that are incurred by Medicare, that are healthcare costs.
You can just imagine the burden on the family. I mean, there are caregivers who have to quit their job or go part time to support a parent. The financial burden, people have tried to calculate that, I think the Medicare burden is over $200 billion. I think the family burden is north of $300 billion if you add up all the hours and opportunity costs of being a caregiver, yet alone the stress.
So one of the things we pride ourselves on, Stacy, is we improve the mental health of the caregiver. We actually measure that as part of the program.
And so as people go through our program, if they start hair on fire at the end, I mean, we don't succeed with everybody. But at the end, many of them have a clear understanding of what's going on, why their loved one is behaving the way they do, what they can do about it. They feel more in control.
It's pretty amazing. I mean, satisfaction scores, net promoter scores are close to 80 for many people. When we hear the testimonials, you need lots of tissues, right? I mean, it just makes you cry. We are a lifeline for many of these caregivers because they don't know what to do. They're isolated and people don't understand what's really happening when somebody has dementia.
[00:20:46] Speaker C: So fascinating. And I can see again how a family would just really, really benefit. And like you're saying, like you, you really become an extension of the family and, and really almost like a family helping them along this journey. Tell me, how long is a typical, in, in general, how long do people usually have dementia? You know, how long are, is families dealing with?
[00:21:08] Speaker B: Well, so the unfortunate thing is it is a disease that is, you know, terminal.
The average Person from the time they have a diagnosis will live eight years, but some people live 20 years. So it, it really varies.
So there, you know, and there's multiple different types of dementia, right? There's a typical Alzheimer's where you, where you just can't remember things. But, you know, you have other types of dementia that are, you know, Lewy Body dementia, which maybe has more hallucinations. I'm not a physician, so I, you know, but I mean, there's frontotemporal dementia, and we hear about that in the news. And different people have different sort of behaviors and symptoms based on that dementia. But it is a disease which is degenerative.
I mean, both of my parents had it, and I remember talking to the doctor and he's like, gosh, I sure hope your dad dies of something other than dementia, right, because he had, he had kidney disease, he had heart disease, and I think he ultimately succumbed to that. But, you know, if there's nothing wrong with a person that just have dementia, you know, it's very difficult at some point, you know, the brain stops working and then the command to swallow goes away, right? So most people with dementia will aspirate and then they'll die of pneumonia right at the very, very late stages of the disease.
But, you know, the thing to remember is that people with dementia can feel happiness, they can feel joy.
So there is every reason in the world to do everything you can to make the time that they have as joyful as possible. And that is absolutely the case if the family, I think, knows kind of how to do that. Right? If you, if you look at the negative course, the outcome will be negative. But there's incredible things that people with dementia can, can do. I'll give you a quick sort of personal story. My wife does dog therapy. She takes our dog into memory care, skilled nursing care, to visit people with dementia. It's life changing for them.
So there are many, many things you can do to really improve the quality of life for people who are living with this condition.
[00:23:15] Speaker C: Well, it sounds like obviously a personal story. I'm assuming. Is that why you founded the company or. Tell us a little bit. I know you've been an innovator in healthcare tech for a while, so, yeah.
[00:23:26] Speaker B: So I'll be honest, we tackled this because it was an important problem to tackle. And if you just sort of think about most big diseases, you can think of a big company. So they do heart disease, they do diabetes, they do kidney disease. When it comes to dementia, there is not a single entity that you really Think about that can improve outcomes. This is part of the problem.
We felt that there was an opportunity to build an important and valuable company that could scale this. The scaling is the most important piece. If you, if you have money and you bring somebody in your house, home care, you can solve the problem. If you have money, put somebody in your facility, you can probably solve the problem. But how do you scale this across all the people in the US to bring happiness and quality of life improvements to everybody? That was part of the opportunity.
When I started the company, my parents did not have dementia, but they developed it. So many of the things I learned I was able to utilize in my caregiving role for both of my parents.
[00:24:25] Speaker C: Oh, love hearing that and why you got started. And obviously this makes, you know, can make such a huge impact on so many lives. So appreciate you sharing that. Tell us, where do you think, you know, the future of dementia care is headed? Obviously you're a leader in this in the next, you know, five to 10 years.
[00:24:43] Speaker B: So, Stacy, you know, for the last 10 years we've been this little company flying this flag like you should care about dementia. And now in Washington D.C. there's this huge flag over CMS that says dementia is a national priority. I could not be more pleased with the work that CMS has done to research what evidence based dementia care looks like and for them rolling out this model.
So I think what is very clear is that the conversation around dementia is changing. We're seeing it, people are talking about it more health plans who are not eligible for the guide model are saying we need to prioritize dementia. I mean, there's financial benefits that are great for any, you know, health plan. Any Medicare Advantage plan can save tens of millions of dollars.
Right. Very quickly if they focus on this condition.
So I think what we're seeing is we're seeing an increased awareness that dementia is something that is expensive, that requires attention. And of course, as the population ages, the problem just gets bigger and bigger. So you can't really say, well, I don't have people in my population. Because every baby boomer, I would say if you're over the age of 85, you have a 1 in 3 chance of having dementia. That's pretty scary.
[00:26:02] Speaker C: Those are big numbers like you're saying. So it seems like, yeah, now the attention that dementia deserves, it's starting to build. And I'm glad that you're on our podcast to help build that awareness and get more people familiar with this program and how seresti can help tell us leaving with for Our audience, they're typically physicians. What is a piece of advice you'd give to physician leaders or administrators who want to better serve their dementia patients?
[00:26:33] Speaker B: Well, far be it for me to give advice to a physician, but here's something I would think about.
If I was a physician and I had somebody with dementia. I have no incentives to tell them that they have a terminal disease that they don't understand.
It's a hard conversation to have. They'll be upset.
And I've talked to some physicians who say, look, that's your job, is to be honest so that the family has the information they need. I've talked to other folks who said, look, this is just difficult. I'm uncomfortable. And I think part of the reason, Stacy, people are uncomfortable is there's nothing they can offer.
Most of the time when you tell a patient a diagnosis, well, I have a medication for you. You can do this. So historically, the medications for dementia, they don't work very well.
Once you're symptomatic, most physicians say, well, okay, this is at best one or two months of benefit, then it goes away. With a guide model, you now have something to offer the family.
I think that's the game changing piece. I would encourage physicians to become aware of the benefits of the guide model and then to identify participants in your geographic area does not have to be soresti. There's, I think, 330 guide participants. Not all of them are nationwide the way that we plan to be. But this is an amazing model. It's evidence based and now you can offer the family something. So I think most people, I think, become physicians because they want to help people.
So here's an opportunity to actually now say, look, if we can demonstrate that something's going on cognitively, you can have access to this amazing program.
I think that's the opportunity for physicians to say, you know, and I mean, I would imagine that people will come back and the testimonies we'll get will go to the physician. Thank you so much for recommending this program. Right. This has changed my life.
That's what we hear when we get testimonials. Some of the families that we support.
[00:28:31] Speaker C: I love that advice because it's, you know, you're able to then give, you know, give the caregiver something that they can use to obviously empower themselves and just take, you know, better care of their loved ones and, and like you said, bring some more joy and happiness to, you know, their lives. So I really appreciate you, you sharing all that, the work that Sarasky has done and to innovate in this space and it be, you know, really one of the leaders. Now tell us again the best way for anyone listening, should they go to Soresti's website or what's the best way to kind of, you know, be able to take the next steps?
[00:29:08] Speaker B: Yeah, so I mean we have a website so resti.com, you know, we'll have a, we have some information about the guide model. We have a place where in the next week or two you'll be able to get onto, I'm going to call it a waiting list only because we can't start serving you until July.
The other place to go, if you're interested, I mean, if you just type in CMS guide, right, you'll be taken to the CMS website and they have really, really good information about why they are standing up this program and why it's so important.
It is the most expensive condition in healthcare and a big goal of the program is actually to avoid skilled nursing home placements because you can imagine as a population ages, not only the federal government but also states are paying for skilled nursing facilities.
There's not going to be enough of those. So you really want to find a solution where people can age with dignity in the home.
[00:30:01] Speaker C: Thank you so much, Dirk. I appreciate your time and really found this so insightful and learned a lot today about dementia and how there are tools out there to help families that are caring for a loved one that is suffering from that.
[00:30:15] Speaker B: Great. Stacy, thanks so much for the opportunity. Really appreciate it.
[00:30:19] Speaker C: Thanks so much.
[00:30:20] Speaker A: Thank you to all of our listeners. If you would like to be notified when new episodes air, make sure to hit that subscribe button.
And a big thank you to Pacific Companies. Without you guys, this podcast would not be possible.
If you would like to be a guest, Please go to www.pacificcompanies. com. Thank.
[00:30:46] Speaker B: You.
