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Appointments that focus on empathetic listening practices and forming meaningful connections are one of the cornerstones of Vera Whole Health’s clinical experience. While the average appointment with a provider lasts just 7 minutes nationally, Vera’s appointments are between 30 minutes and an hour. But as Vera CEO Ryan Schmid says, “it’s not just time for time’s sake.” To find out more about the impact of Vera’s appointment model, we sat down with Ryan to discuss how more time and more empathy drive big results and better health outcomes.
Q: What do you think, in your own words, is unique about Vera’s approach to this relationship-oriented clinical model?
Ryan: For me, it goes to the core of our mission statement, which is to help people change behaviors by esteeming them through empathetic listening. I can remember vividly when the initial spark of an idea for Vera came to me. I was in a leadership class at Seattle U and we were studying emotional intelligence. A big part of emotional intelligence is empathy and empathetic listening. I remember thinking that to actually sit down and take the time and put the energy into listening empathetically to somebody is extremely rare. Most people go through their days without anybody ever actually listening to them. There are lots of interactions but having that soul-piercing "I felt heard" moment is extremely rare.
What was profound about that is that it connected a lot of dots. If you really want to help folks change their behavior, you have to address their needs and meet them where they’re at, but you also must have the time to develop a relationship and establish a rapport with them.
For me, what I think is unique or special about Vera is that it’s not just time for time’s sake. You can check off a lot of items on a list in an hour, but it’s not where the real value occurs. The real value occurs for the member, for the patient, when they walk away feeling heard. When that happens, they now see the care team, the provider, the coach, and the medical assistant as being a part of their inner circle. They’re trusted advisors. They’re trusted allies in a person’s health and their journey.
Oftentimes, when folks come to Vera, they find out that something social or mental is at the root of their problem. Having plenty of time during appointments and being trained in empathetic listening really allows providers and coaches to pull that out so that the patient can start to address the root cause of whatever’s going on. It dramatically increases the odds that a person’s health improves.
Q: How does that time and empathetic listening drive patient outcomes? How does it result in cost savings?
Ryan: That’s the critical point. If a patient ends up leaving an appointment and doesn’t really have that esteemed moment then the likelihood of them sticking to the care plan, or following up, or perhaps even understanding what the root problem is, or having a clear understanding of actionable, smart goals is low. All of that becomes jeopardized.
And I do think that it is the trust and the relationship that’s created that drives outcomes. Whether you’re talking about adhering to a particular care plan or even making a referral, if the patient really trusts us, they’re much more likely to follow our recommendations. If they don’t trust us, they’ll be much more likely to trust the recommendation of their friend who may have had a really good experience at a particular provider, which is extremely subjective. So, driving outcomes, both financial and health outcomes, it all starts with trust.
Q: What would you say to people who say, "Sounds great, but you can’t really have it all. Rich empathetic experiences can’t lead to any savings because you’re seeing fewer patients"?
Ryan: I would challenge them with the results of our client experiences. We see across the board that patients are actually receiving more care, but it’s appropriate and higher quality and 80% of that care is delivered through a primary care setting like Vera. That dramatically reduces a lot of the downstream costs.
But also, I get it. It’s a total paradigm shift in terms of how people have always evaluated healthcare spend, and in particular primary care. But what they’re doing is comparing something like Vera, this exceptional clinical experience, to what is across the country just a loss leader. It’s a perversion of economics, frankly. And again, this isn’t just hypothetical. We’ve got the data to support it. Our evidence is validated by the Validation Institute.
Q: What is it about the equation of more time, more value, better relationships, better patient outcomes, and cost savings that’s hardest for people to wrap their minds around? How do you overcome that perspective of people coming from a lifetime of living in a broken system? What are those "aha" moments as you’re talking to them about Vera?
Ryan: I think that most people that are objectively looking at the problem, they already get it. Meaning, they don’t have to have this big "aha" moment. It’s just that the economics of how the rest of the system works are completely misaligned. So, their "aha" moment is more like them saying “Well yeah, everyone knows that it starts and stops at primary care and 80% of healthcare people receive really could be delivered through a family office.” But, that’s just not how the system works.
Ultimately, primary care is a loss leader for a very specific reason. That reason is that people make a lot of money off of a broken system that uses primary care as a loss leader. The "aha" moment is realizing there’s an economic model where someone is willing to pay for the right thing, the right kind of care, time, and place. And now, this can actually work.
The importance of downstream referrals surprises people the most. It’s hard to change provider-clinician behavior. But then again, even for them, when you do have a model that allows for more time it’s not just about the patient, it’s also about the people providing the care. If they have the time to really dig deep and explore what’s really going on with the patient, you’re going to reduce a lot with the referrals. When they do make the referral, they have the time to make sure it’s appropriate. Wrap a financial model around all of that and it saves everybody money.
Q: From an employer perspective, do you feel like people approach a solution like Vera to improve their employee and dependent patient outcomes or are they more motivated by the cost savings?
Ryan: It’s probably 60% cost, 40% outcome in terms of their decision. If that were flipped, they wouldn’t do it. First of all, if they didn’t care at all about outcomes, then they would probably have fairly high turnover because they’re not really investing in their people. If they have fairly high turnover, they probably have the old-school thought of "Why would I care about or invest in my employee’s health? That’s a long-term ROI and they’re not going to be working for me long enough for me to reap the benefit."
For someone to do something like this, they generally are looking at both financial and health outcomes.
Q: If you were a CEO considering a solution like Vera, what questions would you ask?
Ryan: How are you going to drive participation? How are you going to manage everything that doesn’t happen inside Vera? In other words, how are you going to control referrals and downstream care? And, I would ask, how much skin are you willing to put in the game? How much do you believe what you’re telling me right now?
Q: And what’s your answer to the last one?
Ryan: 100%. That’s why we fully guarantee our fee.
Q: What do you think is the number one problem people are trying to solve with a solution like Vera?
Ryan: Number one is the never-ending rising healthcare costs for both medical and prescription. I think prescription tends to get a lot of buzz because it’s growing at a faster percentage, but you’re still looking at almost double-digit growth with medical. I heard a quote from another CEO who said, "Within a couple years, we’re going to be in business just to pay for healthcare." In other words, it’s so quickly gobbling up all of their profits that it’s becoming not even worth it. That’s pretty powerful.
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