This article is brought to you by ERPHealth. This article is based on a Q&A discussion that took place during the BHB Value conference with Eric J. Gremminger, CEO of ERPHealth. The panel took place on April 26, 2022. The discussion has been edited for length and clarity.
Behavioral Health Business: I’m here with Eric Gremminger, CEO of ERPHealth. Eric, could you give me just a quick overview of what ERPHealth does?
Eric Gremminger: We are an enterprise-grade outcome tracking platform. We leverage the power of technology to personalize patient care, promote health equity, and position providers for the changing landscape in behavioral health, mainly value-based care.
Catherine mentioned PHQ-9, recovery capital scales. By using these scales in advantageous ways, you can now identify which of your patients are responding to the care and which are not, so that you can “course correct,” which was the terminology used by the previous speakers. What we’re talking about here is measurement-based care, and that’s what our technology does. It makes it easy and seamless for providers to do.
BHB: That was interesting. They kept talking about how the outcomes and what people are tracking continue to evolve, and I guess I’m curious, are you seeing that from your customers, whereas they continue to test things and see the different outcomes? Are they evolving over time to meet the needs of the insurers?
Gremminger: Yes, but there’s some gold standard and that’s where the sweet spot is, especially if you’re a new startup company. Don’t get too creative. We know that the GAD-7 is considered the gold standard to measure anxiety. We know that the PHQ-9 is considered a gold standard to measure depression, things like this. Using that in a systematic way, and this is a very key point too, that wasn’t mentioned, but third-party. We’re a third-party provider.
What that means is we don’t have a horse in the race. When we’re sharing the outcomes, there’s no way for anyone to manipulate our outcomes. At the end of a day, if I’m asking you how depressed you are and I’m doing a PHQ-9 interview style, there’s a chance I could put in the wrong number, accidentally, after a very long day when I’m tired. We kind of take away that human error component and then act as a transparent engagement vehicle between the provider and the payor.
BHB: Of your clients, how many of them do you think are starting to really look at value-based care as what they need to be doing?
Gremminger: I would say all of them know that it’s coming. I’d say about 75% of them are using our platform to make sure that when it comes, they have a seat at the table to determine what constitutes a successful outcome. There’s no consensus on that yet, but if you don’t have anything and you’re showing up with just anecdotal evidence, well, you’re not going to have a whole lot to talk about with Aetna and Optum.
BHB: What recommendations do you have for your customers that are looking to move there? You said there are the gold standards, but do you help them present themselves to the insurers to help prove that they’re providing those?
Gremminger: That’s one of the services that we offer. We’re very lucky. We’re a Philadelphia-based company. We have built it out with not just the payors in mind, and I’m really proud of this, but also policymakers in our corner, and I’m actually lucky enough to have Jim Carroll [Former Director of the White House Office of National Drug Control Policy], here with us today, who’s worked alongside of us interpreting some of these changes in policy to make sure that anybody that signs up with ERPHealth is truly positioned. We wanted to be a US standard, kind of a North Star if somebody’s like, “Well, where do I go?”
All these market opportunities bring companies, and it should, that’s the way it goes, but we wanted to provide a way to differentiate what is valid, and that’s not to say others are invalid, but we built this out step by step with the payors in mind, the policymakers, and the patients, which is an important point too.
BHB: I’m curious, do you think the policymakers will get more involved, in terms of defining those outcomes and defining what they want to see from providers?
Gremminger: I think there’s a potential for that. I think, maybe not the specific outcomes but mandating some sort of measurement, because if resources are continuously being allocated and the outcomes continuously underperform, well, then it’s just a matter of time before somebody speaks up and says, enough is enough. I believe we’re very close to that.
BHB: I’m curious, of your customers that are moving in value-based care, is there a pretty steep learning curve that you’re seeing that they have to get used to or can they learn it as they go?
Gremminger: Yes, there’s a learning curve. There’s a learning curve for everybody. I’ll tell you that. I mean, there hasn’t been a set standard for what constitutes an effective
outcome in the behavioral health space. I mean, is that abstinence? Is that somebody who finds gainful employment? There’s a whole lot of metrics. The important point to consider is, start tracking in a multitude of domains, so that when, finally, consensus does come or we establish what might constitute this, you already have the information available. Get ahead of it.
BHB: We’ve started to see more companies get more sophisticated with care transitions, in terms of directing people to different places to get the care they need. Are you seeing your customers start to use your software for that, to be able to start tracking those outcomes in different settings?
Gremminger: Yes, when we were building this company out, we wanted to make sure throughout the whole patient journey that we were with them. I’ll give you an example of our technology in action. Somebody goes for a routine primary care visit to get something checked out, they are presented with an ERPHealth tablet in the waiting room. They fill out this tablet, and we’re measuring for alcohol use, substance use, depression scales, anxiety. Let’s say in this hypothetical scenario, we noticed that there’s been excessive drinking during the pandemic, when they finally get to meet with their primary care physician, on their screen, it’s highlighted, “Problematic drinking.”
Now there’s an opportunity for us. We did the screening, a brief intervention, and a referral to treatment. Now, we refer this individual to treatment because we were able to screen properly and notice early on that there’s problematic drinking. We send them to an alcohol and addiction treatment center. Day one, we measure, again, are their symptoms as relates to comorbidities, which is almost 90% comorbidities with trauma and substance use disorder. We identify those metrics early. First day of treatment, we take a baseline assessment.
Week over week, we’re continuing to measure. This is where the terminology that was used by the previous speakers comes into effect, “course correct.” The actual academic definition of that is measurement-based care. Course correct is measurement-based care, let’s just say I’m using a CBT intervention, every week I’m identifying whether or not the CBT intervention is effective or not effective for the patient who is in front of me.
There are a ton of effective evidence-based treatments in the behavioral health space. However, they’re not equally applicable to every demographic, and that’s where health equity comes into play. Can I identify whether this evidence-based model works better for females, 18 to 35, than it does for males, 20 to 40? Now we have our finger on the
pulse and we’re taking a very scientific approach to patient care, and individualizing the process.
Then the third step in the care continuum is when they leave treatment, we’re still able to engage with them. That’s the power of technology, right on their phone because if we’re calling this a chronic disorder– chronicity implies management, right? Engaging from diagnosis, through treatment, into management, with the same technology, in a user-friendly way, that puts them in the driver’s seat.
BHB: Have you had a chance to work with Applied Behavior Analysis [ABA] providers?
Gremminger: No, but we’re working towards that now. Honestly, over the past year-and-a-half, as a company, we’ve exploded. We are all around the country at this point, speaking with a variety of different providers, and models. We work with a lot of self-funded plans. People want to see the value, but it has to be third-party. That’s the biggest thing. They have to trust that I’m not just inputting it into the existing technology. Now, we run right alongside seamless integration.
BHB: Can you benchmark off other people that are using the system, to see how you’re performing versus others?
Gremminger: Yes, across the national average. It’s very important. We talk a lot about the payor-provider relationship and getting additional resources. And it is the behavioral health business that’s very important, but what about quality assurance? How are you comparing yourself? We work with a lot of providers who have an ecosystem under them, so there’s a multitude of centers in a variety of states. Well, how do you determine which center’s in the 90th percentile versus the 30th percentile that will allow you to allocate your resources appropriately?
One of the things that we really dialed in on, is that we have an executive report where at the end of each month, on your desk, broken down by facility, I can tell you how satisfied your patients are with the treatment groups, the cleanliness of the facility, and their overall experience. I could also show symptom rating scales, by clinician. Why is that important? I want to be able to identify, how does one clinician, we’ll say Marcy, how does this clinician do with males aged 35 to 44 with alcohol use disorder?
Let’s say I take a look at that and I see social determinants are going down and depression’s going up, that could be an indication to me over time that this clinical profile isn’t a great fit for Marcy. It allows me to better align my clinicians with my patients, which is going to lead to better engagement, reduction in dropout rates, and better long-term outcomes. Also, that fourth aim, of the triple aim. We know now that the fourth aim is provider health. This is going to reduce burnout when you align me with the people who I do best with.
BHB: You brought up the clinicians. Do you typically see any pushback when people start to implement these types of systems? How do you recommend providers approach their clinicians with this, because it could be different to what they’re used to?
Gremminger: Sure. It’s a paradigm shift. It truly is. What we’re talking about is a paradigm shift, a needed paradigm shift. Nobody really wants to change. What we have to do is approach it from an empathetic standpoint, which, again, I like to say “We were built by clinicians for clinicians”, so when we approach this, it’s very much in an understanding way, but it’s also about being in business in the next three to five years. It’s about viability.
There’s a bigger picture here, so while it is uncomfortable, there’s a slight learning curve. What we’ve done, and we’ve already modified our tech several times based on the feedback. Everybody just wants to be heard. If there’s validity to what we’re hearing, we have an amazing, 12-person technology team, everything’s in-house.
We get that feedback, it could go in the queue within a month, two months, and we pivot. That’s the beauty too. You have to be flexible, and that’s something we pride ourselves on. We’re a mission-driven company. We have exploded over the past two years. One thing I’m most proud of, though, is we haven’t deviated from that core mission. We want to save and transform lives by personalizing the behavioral healthcare process.
BHB: Do you feel like the shift of value is starting to happen and being accelerated in behavioral health?
Gremminger: Yes. In 2014 I was showing up to treatment centers talking about this. I’ve been perfecting this process, myself and my team, for many years. I would say it then, I’d say, “I think it’s coming. It should be coming.” Now I’m saying, “It’s here.”
Let me answer your question. No, it’s not coming. It’s here. If you’re a provider, if you’re a payor, if you’re in this behavioral health space, you should understand the importance of third-party validated outcomes as it relates to being viable in the next three to five years.
The mission at ERPHealth is to save and transform lives by individualizing behavioral healthcare. To learn more visit: https://erphealth.com/.
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