Episode Transcript
Brandon: What's up, everybody? Welcome to another episode of Get'n Down with Digital Health. I'm your host, Brandon Worley. Joining me today as always is my fellow co-founder and CEO, Matt McBride.
Matt, what's up, man? How are you doing?
Matt: I'm doing great, Brandon. Great to be here.
Brandon: We are very excited about this episode today because we have some very special guests with us from Grace Medical Home.
Joining us today, we have Stephanie Garris, the CEO, but we also have Liza Baradona who is the front office manager of Grace Medical Home.
Stephanie and Liza, welcome.
Liza: Thank you.
Stephanie: Thank you. Great to be with you.
Brandon: Stephanie, we would love it if you wouldn't mind sharing with the audience a little bit about Grace.
Stephanie: Thanks so much for the opportunity. It's my favorite subject matter. Grace Medical Home is a comprehensive medical practice for the low-income, uninsured right here in Central Florida. We're a local nonprofit that came about in 2008 because there was a huge community need.
We saw that people in our community weren't able to access primary care, preventive care, or ongoing care because of their insurance status or cost barriers. We wanted to fill that gap of having a medical practice or a clinic just like your doctor's office where the low-income, uninsured can go again and again as often as they need to to get well. That's exactly what we did.
We opened our doors in 2010 coming out of the Great Recession as a privately funded nonprofit. It's been just a wild ride ever since. We are a comprehensive medical practice. We have primary care, preventive care, and also specialty care.
Because we are that medical home, we employ a clinical staff of physicians and nurses to do primary care, but then we have lots of volunteers. We have more than 500 physician volunteers. Most of them are retired. They come to give back to their community, see patients, and practice medicine the way they were taught in medical school.
Right here on-site, we offer 35 specialty clinics. You'll come for your primary care visit, but then the doctor may say, well, come next week. Let's see the endocrinologist, ophthalmologist, orthopedist, cardiologist, and gynecologist. It goes on and on. We have 35 specialty clinics to do that comprehensive, whole patient care, and our patients are so grateful.
Our patients are housekeepers, theme park workers, and retailers. Maybe they're taking care of parents, young children, and things like that.
To qualify, our patients have to be living at or below 200% of the federal poverty level which for a family of four is about $50,000, and they can't have any insurance. They can't have Medicaid and Affordable Care Act.
We do a very rigorous screening to become a patient. If they have another reimbursement source, then we enroll them or help them enroll in different insurance programs. But there's still a huge gap of 180,000 people in Orange County alone.
Remember, we're a non-Medicaid expanded state, so you still have a gap where health insurance is just not attainable for many people.
That's who we are. We're open five days a week just like your doctor's office, same-day sick visits and really outstanding care.
Brandon: Stephanie, that was a really great introduction and overview of Grace Medical Home. Thank you so much for that.
Matt, if you wouldn't mind, just share with the audience how our paths crossed with Grace and how fortunate we are to be a partner of theirs.
Matt: A number of years ago back in 2018, I was aware of Grace Medical Home. I had been to a fundraiser event, so I knew Grace Medical Home. I knew the story, the mission, and what they were doing.
One of our sales reps, I think, bumped into somebody from Grace at church. He came into the office one day and said, hey, why don't we donate our platform to help out Grace Medical Home with digital forms and maybe some other things? I said, yeah, that sounds like a great idea. Let's give them the software. It seems like a great way to have an impact and make a positive impact in the Central Florida area.
From there, that started a whole cascade of things that were really helpful to the patients of Grace Medical Home.
Stephanie: Not only to Grace patients but really to other free or charitable clinics in the entire state of Florida because when we got that call and such a kind and generous donation, we had to make sure that we could take advantage of a state law that provides very comprehensive malpractice protection. It's a Good Samaritan statute.
I talked about over 500 clinical volunteers. They all use that protection. It's called sovereign immunity. It's been a state law since 1992.
Florida has the strongest Good Samaritan protection in the country. It's a wonderful law, but it does have very strict administrative features and functions that must be followed.
One of those is that every time a patient comes for their appointment, a form has to be signed. Technically, that form is that person giving up their right to sue that named individual because one of the best features of the law is that if a malpractice suit is brought against somebody in the free clinic setting, all the named clinicians are dropped and they are actually suing the Department of Health.
The Department of Health has strong in-house lawyers and it caps damages, so there's never been a lawsuit against a clinician in a free or charitable clinic setting.
There are 110 of us in the state of Florida. There are 110 free or charitable clinics that serve low-income, uninsured Floridians. That law and specific form that I talked about where the patient has to sign before every patient appointment, we didn't have clarity or guidance from the Department of Health that an electronic signature would be sufficient.
It was 2018, but it just hadn't been updated. There hadn't been guidance about electronic signatures. They were in the middle of issuing rules and promulgating rules. I had to go to Tallahassee actually, pound on some doors, and talk about how this should be permissible, how there's a way to timestamp it so that you know that the signature was obtained before the visit, and so forth and so on.
It took a while to work through the process, but it worked. We finally got their assurance that electronic signature would be sufficient and electronic transactions of this form were permissible, and then we were able to really start to customize it and talk about how we wanted to implement it in our clinic. That took six months to a year of working through that regulatory mess, but it was great. It was incredible.
What happened is we were moving into our building. We were under a massive construction project in our building. Our building is just north of Downtown Orlando very close to Mills and Colonial intersection. We were in the middle of renovating a building. It's 19,000 square feet. It's a beautiful building, a big, big clinic, adding dental and so forth.
We toured Mayor Demings. He had not seen our facility and he was excited to see that we were moving into a larger space. I was with their health person. At the end of the tour, the mayor said, I'm so glad you guys are going to be in this space. I'm so thankful we can support you.
We're big fans of the Orange County government and things like that, but the reality was they weren't supporting us, so I pulled this health person aside and said, if the mayor is interested, we'd love some support from the County. What does that look like? They said, we would love to talk to you. What you're doing is commendable, so let's talk to you.
You can imagine that it took a long time of talking with the County. I said, well, what are the priorities of the mayor? They said, he really is interested in telehealth, whether telehealth is an option for a very disenfranchised and vulnerable population which is who we serve, whether they could use telehealth the way it's available to people with greater means, and things like that.
That was amazing because one of our struggles with launching Mend was the time that it would take to do the scheduling to make sure these forms were filled in advance and things like that. When the mayor said that that was a priority, that was our answer. It was that we could get a position funded to help us up at the front desk.
I will be very candid. I thought that was just going to be a one-time grant and then we would assume that position in our operations. They funded it every year in perpetuity.
With the ability to have Mend and have a platform where we could immediately say, yeah, we can do that priority, we can look at that, and we're ready to go as long as you can help us find a position, we were able to leverage the gift of Mend to hard dollars through the Orange County government. It's incredible. It is being funded by the Orange County government year after year, which is amazing.
Then, we hired someone. We actually hired the second patient we ever enrolled at Grace. She was a patient for a couple of years. She went on to get a better job. Her health was stabilized. She got a better job and didn't really like it. She originally was a housekeeper. She developed asthma, some health complications, and things like that, was our patient, and then went on and got insurance but didn't like the job, so when we were hiring for this telehealth position, she interviewed. She is amazing and is one of our staff members to date.
With her onboard, customizing all the documents, and getting clearance from the Department of Health, we said, okay, we're going to do this. This is so exciting.
Do you know that our go-live date was March 1st, 2020? Then, this little thing called the pandemic shut everything down. We were good to go. We'd had the training, scheduling, people, forms, and legal protection. It really is just an extraordinary God sighting as we call it, a story about providing so much more than we ever asked for or thought we needed.
Brandon: Stephanie, that is such a wonderful story. We have to commend you because we know all of the diligence and effort you had to put into getting the signatures approved, working with the mayor, and all of those hurdles that you had to jump over. It's nothing short of astounding. Congratulations on being able to accomplish all of that.
Stephanie: Thank you.
Brandon: Liza, we all know COVID. That tested all of us. I would love to hear from your perspective how the onslaught of COVID, the patients that you're serving, and the clients you're serving were like for you.
Liza: Definitely, Mend was a Godsend to us. There were a lot of volunteers that couldn’t come in because of their compromised health, so we were down to mostly staff. Our front desk staff actually got on the phone with patients and said, you need to download to your cell phone this Mend app.
We got on the phone. We told the patient to go to Google or Apple Store and download the Mend app. We ran them through, they got logins, and we were able to get the doctors actually into Mend and teach them how to use Mend so that they can see their patients which was amazing.
During the time of the pandemic where everybody was scared, for the patient, it was amazing to actually be able to still see their doctor. They would get so excited. They were seeing their doctor on the other end of the screen. They didn't need computers or a tablet because a lot of our patients will have a phone. They might not have a tablet.
Most people nowadays have a cell phone, so we were able to use this platform with just their cell phone, which was amazing. Until this day, we actually use it.
I think I have Rosa at the front desk. She's on Mend all day just sending the forms and affidavits. She sends all kinds of forms to the patients.
If there's a patient that's new to Mend, she actually goes through the whole process and helps them set them up. We actually started. Last year, we had 1223 telehealth visits. This year, actually, from January to today, we had 2410. That's double the visits of telehealth.
Brandon: You just led to where I was going to go next. Obviously, COVID forced you to have to scramble and really implement telehealth right away. Can you talk a little bit about how that doubling happened?
In the way you care for patients now, how has telehealth become a part of it? How are you deciding who's going to receive telehealth and who isn't? Just talk a little bit about your workflows.
Liza: Basically, what happens is when patients come in and see their doctor for their chronic visit, we still have a lot of what we call rechecks. The doctor just wants to reach out on the patient's follow-up for just a quick visit on how is your medicine working that I gave you two or three weeks ago? How is that working?
Instead of having the patient drive all the way here, take off work, or possibly take the child out of school to get here, we just tell them, listen, we're going to do a telehealth visit. We're going to schedule telehealth. We're just going to check on you real quick. You don't have to drive over here.
It's become very, very handy because a lot of our patients have a hard time getting off work, or the kids are in school, so the parents aren't running around between schools and getting their kids. It's become very, very handy because a lot of our patients also have to pay somebody to get them here. In that case, they could do it from the comfort of their home or during the lunch break.
We have patients that have taken their lunchtime around the appointment time so they could get on Mend and see their doctor. It's been a huge, huge blessing to our patients.
Brandon: In what you said about some of the obstacles where they have to pay for transportation, arrange for childcare, and may have to leave work, by eliminating some of those obstacles, is it safe to say that your no-show rate has decreased very significantly and you're able to get more people?
Liza: Yes, most definitely. As a matter of fact, a lot of patients, if they have trouble getting off work or they can't get here because of transportation, they will call and say, can we do telehealth instead? I was supposed to come in. Can we do telehealth?
We start rolling off to get the form going, send it to them, they sign it off, and then we schedule them in Mend. It's been very, very convenient, and our patients love it. They just love it.
Stephanie: Let me just elaborate if I can. We have about 1300 unduplicated patients, but they come, on average, 13 times a year. Only 3% of our patients have ever had a doctor's office. If they've sought care, it's been very episodic. At an urgent clinic, it's to treat whatever that urgent issue is so that they can get back to work. They haven't had preventive, primary, or chronic disease management.
Thirteen times a year is very medically complex. That's a lot. Those are medically necessary appointments, but the ability to offer some virtual where they don't physically have to be here is a game-changer for them. It's a game-changer for having them understand why it's important to take the meds or whatever the issue may be and continue on with physical therapy.
We've done Mend appointments for so many of our different specialists, and it really has benefited our patients tremendously in terms of patient education and compliance.
Brandon: Matt, I know you have some questions that you'd like to talk about. I know one of them is centered around the FCC, but there may be some others as well.
Matt: Stephanie, I know you were actually visited by some high-profile folks from the FCC. We've worked with customers that have received grant funding. Maybe talk about the FCC visit and what the process was like for grant funding. That might help other organizations like yourself or some of the other ones that need funding because they're treating important populations.
Stephanie: It was incredible. Another example of how a gift of a platform that you all made was, again, leverage for hardware and equipment is just unbelievable. When the pandemic happened, we have to privately raise every dollar that we spend.
I have a $3.5 million budget, so that's a lot of money. We are statutorily prohibited from any third-party billing and healthcare is expensive, so that's a lot of money that we have to raise.
When the pandemic happened, I was terrified. I didn't know what would happen to our donors. Would they lose their jobs? What was going to happen?
Our events were canceled. We knew we wouldn't be able to do any fundraising events and things like that. Thankfully, in healthcare, we were able to qualify for some COVID money that was becoming available, but I never applied for a federal grant. Then, the FCC had this money for telehealth and equipment.
We applied and had a trial by fire. These aren't the easiest things. We had to get a lot of our DUNS number and things like that. We didn't really know what that was but went through the process of federal procurement and regulatory compliance issues. We got, I think, around $40,000 for all new computers and things like that.
That was incredible, but I was able to talk right away about how we have the platform. We have it in place, but we need more hardware. As Liza said, a lot of our volunteers were high-risk, a lot of them because of age. They were retirees, and they still want to serve. They were concerned for their patients, but they weren't going to take the risk of coming to the clinic.
To be able to say we can bring you a laptop, it's secure, we had telehealth, and things like that, it certainly made our grant compelling and we were awarded the funding.
Probably six months later, I got a call saying that Brendan Carr, the head of the FCC at the time, wanted to come for a site visit. They wanted to come to some agency or clinics that they funded, and they chose ours. With some nice press, he came and toured my clinic. He’s such a nice guy, but I have to laugh. Never in my wildest dreams would I have thought that the first high-ranking federal official to come to see my clinic was going to be from the FCC, but there you go.
Brandon: That is actually funny because I happen to go see him myself. It was 2018 or 2019. They were starting to craft some of the telehealth funding that they were wanting to do specifically around rural areas. I was invited to his office to go spend some time with him and share our views on that too. It's a small world in how it works out. He is a very nice man.
I know this has been a very heartwarming experience for us at Mend to be partnered with you guys and all the wonderful work that you've been doing.
Matt, any last questions before we wrap this up? Stephanie or Liza, anything else you'd like to share with the audience?
Stephanie: I just want to say thank you from the bottom of our hearts. I've talked about the couple of different ways we've been able to leverage your in-kind gift to hard dollar gifts with others. Like I said, one of them is in perpetuity. That doesn't happen. Nonprofits don't typically get that.
It changed Rosa's life. Going from a patient to that person on the front line that can relate to our patients, scheduling them, being able to tell them if they have any fears or share with them her experience, or things like that is really incredible.
The story of Mend for us is very much an affirmation of God being in the details or like I said, answering prayers that we didn't even ask for, to be honest, or know that we needed. It encouraged us and it's been an incredible blessing to our patients. Really, I just wanted to say thank you.
Brandon: You're so welcome. We are just so grateful that we can play a small part in this. Matt, is there anything you want to say before we close it out?
Matt: We had talked about this as well, but there are a lot of new enhancements we've come out with, so we want to continue to support Grace Medical Home. Where we're going from here, there are other features where patients don't need apps anymore. I think there are a lot of ways that we could add value.
We're going to continue that implementation process, review everything, and see other ways we can make life easier because the more we can automate administrative burdens and things of that nature, that's more care that can go toward the patients, the community, and the people that you serve, raising funds or all sorts of other work.
We want to continue to support Grace. We're grateful for the opportunity. Together, we were able to make it.
Stephanie: We can't wait. That'll be awesome.
Liza: Thank you so much. Thank you on behalf of our patients.
Brandon: You're very welcome. Stephanie and Liza, thank you so much for your time in sharing your stories with us and the audience today. We just gratefully appreciate it.
For everybody watching, if you have any questions or comments, please feel free to hit us up below.
In the next episode, we will have another great digital health thought leader for you. Please make sure to like and subscribe. Thank you very much for watching.
