Designing for Health: Interview with Melissa Welch, MD [Podcast]

Show Notes:

[00:00] Intros

[00:06] Melissa’s early influences and career

[06:21] Starting her role at Sprinter Health

[08:14] Sprinter Health’s mission and care

[12:05] Who are the “Sprinters”

[15:18] The importance of support and training

[18:02] Personalized, data-informed care

[22:02] Closing the care loop

[25:18] Leading through empowerment

[28:00] Melissa’s favorite well-designed thing

[32:07] Outros

 

Transcript:

 

Dr. Craig Joseph: Doctor Welch, welcome to the pod. How are you doing today?

Dr. Melissa Welch: I'm good. Thank you for having me.

Dr. Craig Joseph: Well, we're excited to have you. I'm using the royal “We”. Why don't you tell us a little bit about yourself. How did you get into this? This current role at Sprinter Health. I assume that when you were a small child in second grade, you thought you would work for a startup.

Dr. Melissa Welch: Probably not. Although, I would say that Sprinter does represent a culmination of the ideals that I've had for my career. And health care. You know, I've always had a passion to serve people, irrespective of their socioeconomic or demographic backgrounds. Aand probably that emanates from my experience as a child actually growing up in impoverished communities and East L.A. and getting my preventative care in the parks. Back then, my mother would take us to get our immunizations, and then we would go play. So, it's just a vivid memory for me. So that's where my passion, really to serve, has come from. And to serve underserved populations. And then, as a result, I've always wanted to create programs that were targeted to that same population, to help vulnerable populations. And the mission at Sprinter Health and expanding, you know, access to high quality preventative care, focus on patients experience in the home, and deliver it at scale is something that is very exciting to me.

Dr. Craig Joseph: That's great. That's a complete circle from getting your preventative care. I remember going to the health department and getting, vaccines. It was not a building that I really enjoyed going to. So, the park would have been a better option for me.

Dr. Melissa Welch: Yeah. They had these little, you know, clinics in the parks with people who looked like the community, talk like the community, and very welcoming, which is similar to our approach, at Sprinter Health. Now, I've had a really long career in medicine and 40 years, in June, actually, of this year that I would have been a doctor, and I knew I wanted to be a doctor at nine years old.

Dr. Craig Joseph: Okay. So, let's get into that. So, I'm a pediatrician, and I assume that every child wants to be a pediatrician because we are clearly the best kind of doctor. I think everyone agrees.

So, you wanted to be a doctor from age nine? Did you say like, oh, I want to be like the pediatrician or family doctor that was taking care of me? Or did you want to be a brain surgeon? What do you want to do?

Dr. Melissa Welch: I think it was probably always inclined to primary care, although I didn't know that I would have characterized it as that as a young child. But if you ask my family, they all would say, oh, Melissa's going to be a doctor. From the time she was a kid. And I was really inspired by my mother. She was in Louisiana at Kaiser in LA. I grew up in Los Angeles, and she, at a time during her journey in health care, took care of cancer patients, on the wards at Kaiser. And just the vulnerability that she shared, that what people were going through during their cancer journey and being there for people at that time, vulnerable place in their life, was something I felt like I had to be a part of. And caretaking, I think, is just innate to me. It took me a while over the course of my adult life to realize you're a caretaker, just like, deal with it, right.

Dr. Craig Joseph: That's fair. And I, you know, I have four children, and one of them has the same type of kind of mentality, like, she's a caretaker. And we knew this when she was four, and it hasn't changed. Yeah, it sounds like this is destiny for you. So, tell us a little bit about your professional career. You went to medical school, you did, residency. And then what happened from there?

Dr. Melissa Welch: Yeah. So, I'm a primary care internist by training. I was ambivalent between primary care and psychiatry, and I realized that I would do over 50% of my primary care life doing psychiatry. So, it became a very easy decision ultimately. And my career actually started in public health. So, I have a Masters of Public Health that stemmed from my background in wanting to go serve underserved communities. So, my first job out of training was really in the public health sector, working in, essentially what would have been an UHC way back in the late 90s and spent the first, probably couple of years, in that setting and then first ten years of my career in public sector. And then from there I had a real deep, cross-sector experience.

So, I spent a fair amount of time in academic setting, probably about a 15-year journey in medical and commercial managed care with health plans, spent, for a five-year tenure in what's called the program of all-inclusive care for the elderly, so PACE, which I believe is one of the few full circle value based care models. And throughout my entire journey in health care, I always wondered why was I always getting the quality team? I always had the quality team reporting to me. More recently was quality and the risk team. So, there was something about the way I led or what I did where I always had the quality team. I was always creating programs to address and impact quality of care.

Dr. Craig Joseph: And you were generally kind of confused as to how you got pigeonholed into supervising quality.

Dr. Melissa Welch: I never resented quality. I always loved it because my goal was always to impact people's quality of care. So, it actually clearly made sense. And obviously, the people I reported to realize that it made sense. And I loved leadership. I loved taking teams of people, whether there was quality or my care management teams, and helping them to see a vision for something larger than ourselves that could impact people's lives.

Dr. Craig Joseph: So, we've kind of hinted at your current role at Sprinter, you got this role, you said you got a call from a recruiter and, this was probably a time you were not looking aggressively for a new job. Tell us about that.

Dr. Melissa Welch: Yeah. So, a year ago, my husband passed, actually, we've been married for well over 33, 34 years. And so it was three months after that, and I was lying in bed thinking, maybe I should just retire. But I knew in the back of my head that that was just not going to happen, because I felt like I still had so much expertise to offer. And so, I just sort of said, well, let's just wait it out and have a friend of mine who I worked with during my tenure. And, one of the plans was a recruiter, and he had stayed in contact with me. He had recruited me to the job that I had prior to Sprinter Health, and he called me as I was lying in bed and he said, Melissa, you ready to work?

And I was like, okay, what do you got? And so, he described, you know, this startup and I knew I wanted, I was in Colorado at the time. I knew I wanted to come back to California. I knew I wanted remote work because of where I am in my career. And I wanted that flexibility. And when I heard about what Sprinter was doing and my own experiences, I thought, you know, this sounds like it could be a really great fit. I met with Max Cohen, and he happened to be in Lake Tahoe, where I was relocating myself. And so, he interviewed me. I remember with a beanie on his head, it was cold from the ski slopes and shared with me that he and his son were skiing. And I said, oh, this is perfect. I'm just right down the street from you. So that, I think, really struck a nice camaraderie between Max and I. And, the rest is history.

Dr. Craig Joseph: That is a great story. I'm a little concerned about how this recruiter friend of yours knew exactly when to pounce, but so what is. So, you know, what did what does Sprinter do? How did that pitch for Max work for you?

Dr. Melissa Welch: Well, I mean, I think first of all, I was hooked when they talked about preventative primary care of high quality and vulnerable populations. You know, ultimately, Sprinter Health has really democratized and normalized concierge-like access to care for vulnerable populations, whether we're talking Medicare populations, Medicaid populations, as well as the larger sector of patients. And we bring care into the home to address primary preventative care needs to people, and we keep the individual patient. So you and I, as the primary focus, we really are focused on making everyone have concierge-like experience in health. And that goes from everything to making sure they know what their Sprinter looks like when they come into the home, making sure that we do matching of the demographics that we hire from within the communities for our Sprinters.

To really make it a seamless, comfortable care experience for people. So, in-home care at scale. We use technology to drive what we do and focus on preventative care, that we believe helps to fulfill, one access to care gaps that exist right now in this country, as well as a bridge for primary care.

Dr. Craig Joseph: Let's talk about that. So, you're not trying to take away primary care doctors or offices. You're more of a bridge or an interim kind of solution.

Dr. Melissa Welch: Yeah. And, you know, as a primary care internist, one of the things that I can share that I really resented when I was in practice was people doing things to my patients that I didn't know about or finding out they had a full workup. And I was never involved in that. At Sprinter, we don't want to do that. We don't want to provide redundant care. So, we don't. We do a lot of things to avoid that. We don't want to do anything to patients that they need, that their primary care provider is not aware of. And once we're done, we want to make sure that we loop that primary care provider and that patient back in on what was completed, what we found, and how that looks. And so, we really want to be that bridge.

We also are finding out, I think over the last year or so, that we are also a portal for access to care. The access to care crisis in this country has existed since I actually trained. So primary care internists were at a shortage when I trained and that has just continued and has continued. So, in many ways, we can be the portal for entry into primary care, so patients can access us because we're easier to access. We go into the home to do what's necessary and then hook them into primary care later. Or we can be a conduit for continuity care when the primary care provider has initiated something that we that need to monitor and follow up on.

Dr. Craig Joseph: So, it's complimentary for sure. Who's engaging you? Who reaches out to Sprinter, is it the doctor? Is it the hospital? Is it the insurance company? Is it all of them?

Dr. Melissa Welch: Prior to my arrival, I think we toyed with direct to consumer, but we really found out that our primary partners are health plans. So, we contract with pretty much all the large payers nationally and for all lines of business, as we would call it. So commercial, Medicare, Medicaid, and exchange populations. So those are who our partners are. We get information or files, patient files from those partners. We use those files to identify what the needs of those individual patients are and then target their preventative care interventions based on what we find. And we use technology to drive that.

Dr. Craig Joseph: We can talk about the technology maybe a little later. I like to focus on a term that you used. You kind of threw in there without explanation. A Sprinter, I love it. So, who is a Sprinter? What kind of background does your typical Sprinter have? What kind of training do they have? I think you had mentioned that you prepare your customer, the patient, to say like, hey, this person's coming. This is what they'll be dressed like. This is what they'll do. Tell us more about that. I'm fascinated by that job title.

Dr. Melissa Welch: I love the concept of the Sprinter. Coming from a public sector background, I love it because our Sprinters are more than just phlebotomists. So, they have to have the ability to draw blood. But we take those, individuals and we train them in medical assistance skills. So, in your provider's office, when you go in, there's usually that very friendly person who makes sure everything's together before you see the doctor, right? So, we train them in those skills, but we also hire them from within the communities that we serve, and we teach them community health worker skills. Now, where in public health we call those child workers community health outreach workers because they know the community. They talk to the community they're from, the community. They're comfortable with the community.

They speak the language, and they create an experience that's concordant in the medical literature. You probably, I don't know if you know, but there is a lot of evidence that concordant providers actually enhance the patient experience in care. We use Sprinters who go out and we couple them virtually with other skilled licensed nurses or nurse practitioners. And we also have the ability, by the way, to escalate any cases that would be necessary to MD staff that works for us. The Sprinters are also W2, so we don't hire 1099 workforce. We have a W2 workforce. You know, I used to run an in-home program as part of another work the job effort that I did. And we used 1099 and they were impossible to manage with the W2 workforce. They're benefited. They're a part of us. They show up in uniforms. They can be consistently trained and follow protocols, and it allows us to have a better way of distributing them into the community, using our technology, our routing technology. And then from the community, we hire them from the community.

Dr. Craig Joseph: And I think that's really important. Not everyone might know the difference between a W2 employee or 1099, but like a 1099 is a contractor. Essentially, they're a business unto themselves and they don't get all the protections that come with being an employee. They generally don't get the fringe benefits. And they're kind of considered, hired, got.

Dr. Melissa Welch: Absolutely, absolutely.

Dr. Craig Joseph: Which is fine, for certain things. But it sounds like some of your secret sauce is, hey, you're an employee of ours, and you're we want you to be a long term employee of ours, and we're going to pour a lot of time and equity and time and money and sweat into making you the best version of a Sprinter that we can have.

Dr. Melissa Welch: That's exactly right. And, you know, we do give benefits as well as incentives. And we love our Sprinters. I mean, they're so excited to come and work for us. They feel like they're really meeting the needs of patients. And it's visible. You can see that in their experiences that, you know, every patient that we interact with, with a Sprinter does a survey, and we get immediate feedback from our patients on how did you like your Sprinter. What was your experience like? And that's very important to us.

Dr. Craig Joseph: When I first heard about Sprinter Health and what you were doing, I assume that there were Sprinter vans, Melissa and, they're not. And so, I think we just need to we need to be clear right now, there are no Sprinter vans at Sprinter Health. And, I think that was a big miss. I'll talk to Max about this. You just have regular vans or regular cars. I mean.

Dr. Melissa Welch: Show up and, you know, let me talk a little bit about our routing and how we treat Sprinters. So, we have technology similar to some of the GPS, routing. And so, we actually know where our Sprinters are at any place in, across the country at any one time. So, if somebody needs an appointment, you know, let's say in a couple of days or even the same day, we can deploy Sprinters because we know exactly who's in that area, what the density is, what their schedule is like. And if they are the right match for that individual patient through the technology and the routing, the precise routing that we do and the precise matchmaking.

Dr. Craig Joseph: And is there any special technology in the home when they go in, or is it kind of, you bring the tools that you need for what you're doing? Are you drawing blood? Are you?

Dr. Melissa Welch: Let me speak to that a little bit. So, we have a hybrid care model and it's patient interaction in the home first and virtual as needed as dictated by the clinical condition of the patient. So, our Sprinters, go into the home and our nurse practitioners, or nurses who are licensed, our virtual care providers, and they can be telehealth in, so to speak, on a pace that we create for them. The Sprinters are also trained with protocols. I actually had to take all those trainings when I first got hired, every single one. And we have a Sprinter app that is homegrown that we've created. And the Sprinters, when they go into the home, we know exactly what each individual patient needs. So, if you or I need a Sprinter services, it would look very different depending upon what our health care needs are.

And that is because we use information from health information exchanges to personalize what your needs are, because we can see care that was already rendered to you. So, we're going in. We're not duplicating services for you, but rather providing services that may be a gap in your care or that prospectively you may need before you go back to your provider. It's on a checklist and how to do that. Service is delineated in detail for the Sprinters and they've been trained on that. For example, if you needed a digital retinal eye exam, and I was really impressed with this in the training when I took it, our Sprinters eye exam. We have set that up. Exactly how to educate you on what they're going to be doing at each step of that retinal eye exam examination, and they have that equipment in advance to go into the home before that visit. And you and they know that they're going to be doing that particular intervention on you.

Dr. Craig Joseph: You really have kind of taken a design view to ensure that everyone involved kind of knows what's happening, to set expectations appropriately, kind of keep things as transparent as possible, so that there are no surprises. Because I think that would be, I mean, that happens to me even as a physician, when I go in to see a doctor and they're like, oh, we're going to do this thing. I went to go see a cardiologist and they're like, before I saw the cardiologist, hey, we're going to do an EKG, okay? But I, I like well, I didn't know that was going to happen.

I thought, like, maybe I would talk to the doctor and then we'd figure out if that was, you know, something to do it now, obviously, it was a low risk, endeavor, but still kind of even those little surprises really do kind of put you off for a little bit.

Dr. Melissa Welch: Yeah. Now we use data to provide us with insights. We actually have a new product we rolled out this year called relay that allows us to access, as I mentioned earlier, information across, health information exchanges. With our intent to treat provisions. So, we have a complete record of what you need before we go on the visit. And we spend a lot of time prior to the engagement of the patient, letting them know, here is the array of items that your personalized plan of care dictates. And here's what you can expect. Here's what your Sprinter looks like. Here's the car they're going to show up in. Do you prefer for them to park on the street, or do you prefer for them to park in your driveway Do you have a dog in your home? Here's what we suggest you do. So, it's a very, very personalized experience that's very different.

Dr. Craig Joseph: Yeah, yeah. And prescriptive to that. I love that those kind of details can really make it better. It's funny. Again, I have, let's focus on me for just a second. That's a joke. I got that joke. Thank you, thank you. I know most people can't see this. They're just listening. I have this little dog that just likes to bark a lot as little dogs tend to do. And, I have seen grown men who are, tower over me move back in fear of this little dog, who's 11 pounds, right? She's not really a threat to you. She just thinks that she's a threat to you. But, you know, you do have to buy. So now, when people are coming to my house, I always tell them, like, hey, there's a little dog. She's going to bark a lot. She's harmless. Just ignore her and go about your day. And you can't make assumptions that the people are okay with that, or that they're going to expect that, and those are things that's a low risk. And, as opposed to, hey, having someone come in with a needle. Yeah.

Dr. Melissa Welch: I mean, you really have to go in with no assumptions and make sure that people understand the ABCs of what you're doing.

Dr. Craig Joseph: So how do you close the loop? How do you get that information back to them to say, hey, this is what we did so that they don't try to repeat that at some point.

Dr. Melissa Welch: Yeah. So, in the case where it's normal, let's say we do the interventions, and the results are all normal. We would have a summary of everything we did, including the results, and that gets sent electronically back to the provider's office, as well as to the individual patient. So, they get all of that information. In the case where there may need to be interventions that we believe are a high priority, we will also contact that PCP, primary care provider, try to make sure we do a warm handoff and clinical care.

Warm handoff as you know, is person to person to make sure that that provider knows this patient needs earlier access and continuity care. We can play a role in helping to bridge that, but we also want to make sure that we get them back in to see their PCP, and we can facilitate that continuity of care for services like yours. That is often the missing fact.

And you've been on the receiving end of that, as a primary care doctor, as have I, and it doesn't feel good. It doesn't engender confidence from the patient. And, you know, you're killing yourself trying to get these patients the care that they need. You want to work in a complementary fashion. I think, yeah, that closing that circle is important. Where do you see Sprinter Health kind of moving in the future? Are you just looking to scale at this point? Are you looking to do other things that, you know, expanding the horizons?

Dr. Melissa Welch: I mean, you know, because of my inclination to develop health care programs for underserved populations, you know, I can see the moon and more for us. Yeah. I think Sprinter will have a huge play in health care for the next foreseeable 5 to 10 years. You know, we already mentioned the access to care crisis. We will continue to play a critical role there. The pandemic really forced the need for virtual care. Our hybrid model in the home is one that will be needed for a long time. Many of us are not only patients, but we're also caregivers, and we don't have as much time to be going into brick and mortar. So I do see Sprinter Health playing a role there.

The other thing is that we not only provide quality care visits in the home, but we also have the ability to impact a patient's level of risk score, which is something health plans and provider groups know a lot about. A risk score really is how sick is this patient and how would you grade that sickness on a numerical scale to give a risk, which then is allocated a certain amount of funding. So, we also do risk visits. And one of our newest hybrid care models that we're going to be going out with this year is IHS, or an integrated health assessment that includes both quality first, but also the ability to capture their risk, and in a value-based model of care delivery. Which is what the U.S. has really moved into and will continue to move into what you're balancing cost, quality, and efficiency of care. I think Sprinter is well positioned, to address all of those pieces.

Dr. Craig Joseph: You know, you've been an innovator and in your career kind of always focused on public health moving from kind of providing the care to overseeing certain aspects of it to now more of technology, sort of, extension and play from an innovation standpoint.

You mentioned that you like leading teams. How do you get folks to kind of come along with you with some of these things that you've done? I say this in that innovation is often like, well, that sounds great. It's different than what we normally do. So, I'm going to stick with what we normally do. There's a lot of inertia. How do you get folks to kind of move with you or how have you, we've seen that be successful.

Dr. Melissa Welch: Yeah, I mean I think my first experience out of training was instructive for me in that regard and really shaped my journey into leadership. I mentioned that first, efficacy like clinic in San Francisco that I worked at, was fresh out of trainings and I was zealous, you know, the newly trained primary care doctor who was going to go out and make sure the community had access to care and primary care.

Well, it was a complete colossal failure. The first day that we delivered our first primary care clinic, I had probably 30 or so patients. It was just me and the clinic staff had no idea what they were doing. And it was my first lesson in leadership. That day, at the end of the clinic, we communed over food as you do in the community, and we talked about what went well and what didn't go well in the clinic setting. And they said, well, we don't know what you want. We want to please you and we just don't know what you want. And I took a step back and I said, well, wait a minute. The goal is not to please me, but to create programs that can meet the needs of the community. You are all experts in the community. You need to teach me what works.

And that was the day that I learned that leadership is partly about understanding the added value, as I call it, of each individual's perspective, and it actually shaped my consulting career perspective of differences. But I never forgot that that added value as individual perspectives that can come together collectively to create and lead programs. And so, I bring people in as a leader. My motto is leadership empowers others, is accountable, and drives change. So, it's a collective accountability to drive to something bigger than ourselves. And I think that everybody aspires to that. So, it's an easy thing to get people behind and involved in, because they know that they will bring their own credible expertise to the table.

Dr. Craig Joseph: All right. I've written that down because I normally, let's be honest, I normally do want people just to please me. And so that might have helped me, held me back in my career. Doctor Welch and I'm going to try to be better, moving forward, not.

Dr. Melissa Welch: Work for me. So.

Dr. Craig Joseph: Yeah, no, it's good. I used to joke when I had a practice, that my practice would run much more smoothly if it weren't for the patients, myself, and my staff. We were ready to go. We were always on time. We were prepared, and it was the patients coming early or late or being sicker than we thought they should be. That always threw a monkey wrench in the into the show. So, yeah, you do have to kind of keep the focus where it belongs. Well, this has been a great conversation. I've learned a lot.

One of the last questions we always like to ask our guests is about is about design. You've been designing programs for public health, for folks all throughout your life. All of us do design work, whether we call it that or not. Are there things in your life, is there one or two things in your life that is so well designed that you love interacting with it and thinking about it? What is that thing?

Dr. Melissa Welch: There's definitely is one thing as a busy physician, you know, at a time in my career, I have three under five, husband who was a surgeon, and me doing all this stuff that I love to do, right? So, I learned very early how to balance my personal and professional life. I was very good at it in my professional life, you know, quarterly milestones and setting out the ideals at the beginning of the year. And so I had to take a step back once and ask, you know, how do I make that happen in my personal life and what brings me joy? And joy for me was hiding in my garden, call myself gardening. It was more digging in dirt, and also interior decorating and I just know that I walk in a room and I want to make it beautiful and balanced.

And I was always looking for a level. And I realized one day that the level was really a metaphor for me to keep my personal life in balance. And every time I see a saw level, it was my reminder to take a step back and remember your personal life as well as your professional life and take time for yourself. And so, I brought my level. You can see it. I carry it in my purse everywhere I go. This one is from art.com.

Dr. Craig Joseph: I love it.

Dr. Melissa Welch: But you know, the level comes in all shapes and sizes. This is a teeny one. I have a huge one, but every time I see a level it reminds me to keep balance in my personal life. So that is my one instrument. It doesn't require any wires, although I think they have technology ones now that are the little, little radar screens. But I love this old-fashioned one with the little liquid that you have to keep balance at it.

Dr. Craig Joseph: It's a good reminder. It sounds like it's TSA compliant, which is a big deal. So, you don't get stopped at the airport. Well, that's great. And I, that's a, It's so simple. Like you said, it just puts a bubble inside some liquid, but it does work effectively to level things, but even more to kind of help you level whatever it is that you're working on.

Dr. Melissa Welch: Absolutely. And my purse goes everywhere with me. So if I'm digging in there and all of a sudden I see my level, I literally take a step back and pause and breathe.

Dr. Craig Joseph: That's great. What what's going to go when this spiritual health thing is done? When are you going to open up your interior design consultancy? That's what I want to know.

Dr. Melissa Welch: Well, the one thing I learned throughout my career is that they are experts in everything. And I am not an expert interior designer. It's a nice hobby, but I think I will leave it at that.

Dr. Craig Joseph: All right, that's fair. All right. So Max is okay? He doesn't have to sweat that you're going to be leaving soon to open up some shops. Well, it was great. It was awesome speaking with you. Thank you so much for all that you're doing and for kind of explaining where you're going with mental health. It was an eye-opening talk and thank you.

I look forward to seeing what you're what you're going to do in, with the rest of your career.

Dr. Melissa Welch: Yes. Well, thank you for having me. It was so much fun talking with you. I appreciate all your wonderful jokes as well.

Dr. Craig Joseph: What jokes? I didn't hear any jokes. All right, we'll talk again when you win the Nobel Prize.

Dr. Melissa Welch: How about that? You know Max will win it.

Dr. Craig Joseph: Oh, well. All right, we'll talk about it. Thanks.

Dr. Melissa Welch: Thank you.