Rula Health co-founder Gabe Diop identified cost as the primary challenge facing the healthcare and payer industry in a recent interview. Diop emphasized the need for a greater focus on prevention to address rising costs, pointing to the impact of behavioral health on physical well-being. He also highlighted the importance of balancing access and quality in healthcare, arguing that awareness is crucial for improving care and that a more holistic approach is needed.
Watch the interview to learn more.
Stephanie Butler:
Welcome everyone. I am delighted to be here with Gabe Diop, who is the co-founder of Rula Health. Welcome, Gabe.
Gabe Diop:
Thank you, Stephanie.
Stephanie Butler:
I want to start with a little more general question, because I'd love to hear your opinion on what you think is the biggest challenges facing the healthcare and payer industry today.
Gabe Diop:
Yeah. I'll start with one word. Cost. I know we've been talking about cost for ages, it seems like. But the reality is cost is still the biggest problem that payers are facing today. I was at a conference last week, and a payer executive, we were catching up and chatting and he was like, "Gabe, don't forget, we are a financial institution. It comes down to cost and revenue." And this was a medical director.
Stephanie Butler:
Wow. Yeah.
Gabe Diop:
It's just a stark reminder that, at the end of the day, cost is really the biggest problem that they're facing. If you look at the news today, Medicare rates going backwards. They just announced what's going to happen in 2025, going backwards again. Medicare membership is growing. About one in five members are going to be covered by Medicare, when we look at 2030.
If you look at Star's ratings, going backwards. What does that mean? That means less bonuses for payers. It seems like every day there's a new payer suing the government. If you look at Medicaid, [inaudible 00:01:27] announced that, and rates are typically not high enough. And then not only does that affect payers, but providers don't want to work with Medicaid. So, the cost is a really important aspect.
Stephanie Butler:
No, I was just thinking you can't underestimate the importance of the cost issue.
Gabe Diop:
Correct. If you then also take a step back, it's like, "Well, who's winning here?" You look at health systems, most of them are losing money. Employers are upset that their healthcare costs are going up.
We as consumers or employees, our premiums are going up. Or if you're out of network, your costs are going up. It's been a while since I took my last economics class, but this is unsustainable, when you look at that.
We think about the root cause, I think it's the lack of focus on prevention. If you look at something like behavioral health, it's not just behavioral health, but the impact that has on physical health and everything downstream, all the data's out. When you give access to behavioral health, you save a lot downstream, improve your physical health conditions.
It's not just behavioral health. But if you think about primary care, I still think about a third of people don't have a PCP. If you think about dietitians or if you even think about something simple as a walking treadmill. I walk about 10 to 15 miles a day, when I'm not traveling. I'm normally on the road, but when I'm at home. It's things like that that can help prevent issues before they actually arise. So, we can't wait.
Stephanie Butler:
And then we'll end up saving us considerable money in the long run for everybody. Right? I think there's also a critical point when we talk about access. But I'd love to hear your thoughts on, how should we think about access versus quality.
Gabe Diop:
Yes. One of my favorite questions, so I'm glad you asked that.
I'll start by sharing a quote that one of my good friends and advisor, Trent Haywood, former Medical Director, Blue Cross Blue Shield Association, shared with me early on when we were starting Rula. He was like, "Gabe, if you can't solve access, you have no point in even talking about quality." Access is that first step in quality. However, I actually think we misuse the word access. I actually start with awareness. Do you even know where to go?
Stephanie Butler:
Oh, interesting. Okay.
Gabe Diop:
If you take this back a little bit, when you talk about geo access or network adequacy, it was really just dots on a map. It was really just to check a box. It wasn't then saying, "Can you actually get care quickly? Is it the right provider," and all that?
So first, I think about awareness. Do you even know where to go? Now, if you know where to go, is it super easy and simple to actually find a provider? And if you're thinking about something like behavioral health, it's not just any provider. This is not just, "I need the best ACL surgeon." This is may be "someone who looks like me," or whatever that might be. The best provider for me is not necessarily the best provider for you.
Typically, we've made that pretty hard to find. But now let's say you actually solve that. The next thing becomes quality. This is healthcare. And you can't just overemphasize on, "Oh, we have to solve the access problem or the awareness problem." You have to do both. It's like work-life balance or work-life harmony, as we talk about. You need both. It's a trick question, which would you prioritize? You need both.
When it comes to quality, that's also a loaded term. What do we actually mean by quality, especially in something like behavioral health where less than 10% of providers have ever collected a single measure?
Stephanie Butler:
Wow.
Gabe Diop:
Imagine if I was talking about a physical health condition, I'm like, "Your doctor's not going to take measures."
Stephanie Butler:
You would be like, "What? What do you mean?"
Gabe Diop:
Let's fast-forward 10 years from now, people probably look at me like I'm crazy when you're like, "Wait, Gabe, we didn't collect measures when we're thinking about behavioral health?"
Then, it's like, "Okay, well what measures?" Today a lot of people like to talk about measurement-informed care, PHQ-IX, GAD scores, and those are all very important. And we do them. Everyone should be doing those. And quite frankly, some providers still aren't doing them. So, we need to do that. But I think we really need to start thinking about functionality. Are we seeing progress with functionality? So, think about things like, are we seeing more work days? Are we seeing someone who is too anxious to get in front of people now be able to deliver that great keynote that we just heard?
Are we seeing less ED visits, etc? We have to be thinking about those types of functional measures, and not just, how is someone doing on depression [inaudible 00:05:52].
Stephanie Butler:
Yes, exactly. See, that leads me to the next one, which is, you're talking about multiple factors. We talk about access and then quality and then multiple factors and how it improves the person's health. That leads me to, how do you think of, and how should we think about, this whole person care? When you're talking about the physical symptoms, can be the result of mental health issues. How do we think of them? How should we think about it?
Gabe Diop:
I'll start by saying you can't treat the physical without treating mental, and you can't treat mental without thinking about the physical. Going back to that work-life balance, you need both. So, I always say, behavioral health has to be integrated with the rest of the healthcare ecosystem, especially something like primary care.
We chat with a lot of primary care providers, and I just went to my one medical provider a few weeks ago, and of course I have to put on the investigator hat and I'm, so how often does behavioral health come up? And it's a lot.
From research, we see about one out of every three patients, some aspect of behavioral health. And then you start to ask, "Well, what do you do about it?" I asked my provider. And it's like, "Well, I know a group, or maybe go to this website. I don't know if they have availability. I don't know what happens." We hear things like, "I tell them to call Optum," or, "I don't know what to do." That's honestly one of the biggest responses that we hear.
When I think about that, it's how do we make it super easy for primary care to be able to make referrals to the right behavioral health provider? And it's not just primary care we need to be thinking about. We need to be thinking about specialists as well.
Stephanie Butler:
Right.
Gabe Diop:
Think about dietitians, think about endocrinologists, oncologists, physical therapists. I was just exchanging emails with the co-founder and CEO of Midi Health, and they help patients with menopause. And I was like, how often is behavioral health an issue? And it's 85%, but probably 100% either have mood fluctuations, depression, and anxiety, and they need an easy way to be able to connect to behavioral health provider and vice versa. To me, it all just comes back to, we have to make that integrated. We have to make it super simple.
Stephanie Butler:
Right. Make it easy so that, "Here are the things you should look at," and "Here's the place you can just go here, do this, and this will help. Easy for the provider, but also for both the provider and the patient.
Gabe Diop:
Exactly. I'm glad that you brought up the provider, because we have to always be thinking about the quadruple aim.
Even going back to the quality aspect, if you want providers to actually collect surveys and do outcomes, and you don't give them the proper tools and software tools to do it, and the training and the why and nudges of like, "Here's how you should...", it's not going to happen.
Stephanie Butler:
They don't have time.
Gabe Diop:
They don't have time. My mom, dad, sister, they're all doctors. I'm the odd one out of the family there. And I know if you don't make it super simple, it's not going to happen.
Now, let me share an example of when you do make it super simple. There's a health system, Memorial Care, in California, and they have a best practice advisory alert that pops up in Epic. They do the PHQ, the GAD, their PCPs, and if it's a certain or above up pops, "Do you want to send this patient to Rula?" One click of the button and boom, we get the referral. And what happened? Referrals went up about 400%.
Stephanie Butler:
Of course, because all they had to do was answer a couple of questions and click a button.
Gabe Diop:
Exactly. It's not because your patients got sicker. It's because we inserted it into the provider workflow.
When I was at One Medical and I said, "Okay. Go to this link," would that be an easy referral? Three questions? She's like, even that is still hard. Point at the EHR, and it's got to be integrated there. It makes total sense.
Stephanie Butler:
That's fascinating. But no, totally makes complete sense. I would love to hear from you, what do you think is going to be the biggest disruption or innovation in healthcare maybe 5, 10 years down the road?
Gabe Diop:
I could take the easy way out, and I could say AI.
Stephanie Butler:
You could. And I've heard that. They're not wrong.
Gabe Diop:
They're not wrong.
I'll always say it's like, if you don't think AI is going to fundamentally change our lives inside and outside healthcare, you're wrong. If someone wants to argue with that, it's like, hey, we didn't have internet until 1983, and look what happened.
Stephanie Butler:
We'll talk to you in 20 years.
Gabe Diop:
So, that is going to happen. But the consumerism of healthcare, I think is really the focal point. A year ago, I was on stage giving a keynote for the Oliver Wyman Health Innovation Summit, and it was actually right before Amazon, and this time we see where this is going. Right now, we're actually speaking at the same talk track.
I gave the example of, before my flight, I realized I ran out of my razors. So, what do I do? I open up Amazon, hit a few buttons, same day delivery. I have my razors a few hours later. I make my flight freshly shaven for my keynote. And that was great.
Now, if you think about what Amazon Pharmacy is going to do next year, where one out of every two Americans is going to be able to get same-day delivery for Rx, that fundamentally is going to change.
Stephanie Butler:
It changes the expectations of the consumer, and also how the entire healthcare system and ecosystem can function.
Gabe Diop:
Exactly. And we deserve that. That experience that we have with Amazon and other things in our lives, why don't we have that for our mind or our physical health or Rx? So, I'm happy to announce that we just partnered with Amazon.
Stephanie Butler:
Oh, exciting! Congratulations.
Gabe Diop:
Thank you. Thank you. That went live last week. But it's to be able to give access to behavioral health and high quality behavioral health to millions of Americans who deserve it.
Stephanie Butler:
With the same ease that they can order a razor.
Gabe Diop:
Exactly. Then, of course, we talked about quality earlier. So, it's not just access, like we said, but the good quality providers.
What is going to, I think, advance consumerism is regulatory. If you look at what happened in California where they came out with the access laws around, someone needs to be able to get an appointment within 10 days.
Stephanie Butler:
They should be able to.
Gabe Diop:
Right. Then, people played games, getting people in quickly, but then you couldn't have a follow-up appointment. So, then they made the edit to the law, well, now you have to do a follow-up appointment within 10 days. And they just came out with an edit, Senate Bill 855, I'm very familiar with that, because it keeps coming up, basically saying, payers, if you can't give access, well, guess what? You then have to physically schedule someone with an out-of-network provider.
Stephanie Butler:
Wow.
Gabe Diop:
And that has put pressures on the payers. But what does that mean? That means that they're now leveraging tools like we have for direct booking to be able to get members directly scheduled. If those regulations weren't there, would those payers be using those?
Stephanie Butler:
We don't know. But we do know that they are and they should.
Gabe Diop:
Exactly.
Stephanie Butler:
This has been great. I'm really excited to see what's going to be next for you. It sounds like you've got some great things in the works. So, a year from now, we should be talking about some of those. So, thank you so much, Gabe and to Rula Health, for your time today.
Gabe Diop:
Thank you.