On July 1, 2024, the CMS Innovation Middle launched the Guiding an Improved Dementia Expertise (GUIDE) Mannequin, with 390 collaborating organizations constructing dementia care applications that may serve tons of of 1000’s of individuals with Medicare nationwide. One of many GUIDE contributors is a Seattle-based startup known as Rippl, which lately raised $23 million in Sequence A capital to fund its multi-state enlargement. Rippl Co-founder and CEO Kris Engskov lately spoke with Healthcare Innovation in regards to the alternative for value-based fashions in dementia care.
CMS has stated the GUIDE Mannequin, which can run for eight years, will probably be one of many first Innovation Middle care fashions to concentrate on longitudinal, condition-specific complete care. At present, almost 7 million People dwell with Alzheimer’s illness or one other type of dementia, and, by 2060 the variety of People residing with dementia is predicted to double to 14 million.
After working for a few years as a Starbucks government, Engskov spent just a few years working an assisted residing firm earlier than launching Rippl.
HCI: May you speak about what led you to co-found the corporate and the chance you noticed there?
Engskov: Each my mother and father had very close to misses with the long-term care system. They dwell in rural Arkansas. I admit that I used to be essentially the most naive individual in healthcare at that second. Nonetheless, I made a decision that I used to be going to carry some gentle into that trade. I invested in and went to run a reasonably large assisted-living firm primarily based in Seattle known as Aegis Dwelling.
This was a yr earlier than COVID. We acquired into COVID fairly shortly caring for a extremely acute inhabitants, principally of us who had been cognitively impaired. That was a struggle, making an attempt to deal with essentially the most frail individuals in America. I acquired a front-row seat to it, and I am grateful for that have. However I knew pretty shortly that I wasn’t going to have the ability to make an impression in getting higher outcomes in senior residing.
Rippl was catalyzed out of an commentary I made whereas I used to be there, which was that I used to be shocked by the variety of instances we might ship our residents to the ER, as a result of we couldn’t handle their signs, virtually at all times associated to dementia. The households would name me and say we simply handed our mom to you two weeks in the past. Why is she within the ED? They’d say, ‘I assumed that is what you guys did,’ and I agreed with them. So I began to go searching, and noticed this was a giant enterprise downside. A major share of the time when somebody left considered one of our our communities and went to the hospital and acquired admitted, which occurred usually, they did not come again to us.
I started to go searching to attempt to discover an intervention with a licensed clinician that we might entry that will assist us maintain of us in place. What I spotted was, and this sounds tremendous dramatic, however it’s 100% true, is that there is no person in America who is aware of something about dementia at any scale. We have by no means paid for that care, so we have by no means constructed the infrastructure. The medical piece has at all times been kind of compensated at some degree, however the elementary factor that really retains individuals at residence, which is the caregiver, has by no means been supported.
HCI: So how will you assist sufferers and caregivers?
Engskov: We discovered nice work carried out each at UCSF and UCLA. The UCSF mannequin was all digital and had superb medical consequence outcomes, notably round impression a caregiver to then impression a affected person to remain at residence. In the end, they had been capable of translate that into decrease utilization, which clearly is the secret when making an attempt to get this care paid for with an insurer. They had been capable of considerably scale back prices for these sufferers.
HCI: So what’s the enterprise mannequin that you simply developed impressed by that work at UCSF and UCLA?
Engskov: We began serving sufferers in January of 2023 with a value-based orientation. We had been going to go to payers and payviders and different threat holders and say, ‘Hey, look, this can be a actually costly illness.’ We imagine that is costlier than plenty of the opposite power ailments individuals usually speak about, and it is simply not well-known for quite a lot of causes. We determined that we might do a care mannequin and take threat with payers to essentially have pores and skin within the sport, and scale back value by having this service accessible. The large UCSF breakthrough was recognizing it is not only a affected person; it’s a must to have the caregiver concerned. That is actually the one method value-based can work, proper? The caregiver is as a lot the affected person because the affected person, particularly as they get to a spot the place they’ve lowered capability, proper? So it actually good setup for value-based care.
HCI: What are among the the providers Rippl provides? Are all of them telehealth-based, or is it really going into the house?
Engskov: It’s completely telehealth as we speak. Every thing’s delivered nearly. CMS’ GUIDE mannequin got here out this yr. We began in that program in 4 states in July. That is a reasonably large breakthrough from CMS, proper? We now have a Medicare various fee mannequin for delivering dementia navigation, coordination, and training.
We discovered ourselves in a extremely lucky place, within the sense that we had began the corporate and constructed the care mannequin. And it was the identical care mannequin that GUIDE in the end used to tell their work for essentially the most half.
HCI: Did I see that you simply partnered with the Alzheimer’s Affiliation on that?
Engskov: We have now a nationwide partnership with the Alzheimer’s Affiliation to construct a GUIDE infrastructure. They’ve been an incredible companion. We’re very totally different animals, proper? You’ve acquired a really giant nonprofit that is in each a part of dementia, and you then’ve acquired a tiny startup. What’s humorous about that’s that when GUIDE got here out, we began having this dialog with them about what we might do with this chance, as a result of they’ve an incredible want to ship extra care. They’re the OG of who you name while you get dementia, they usually have very huge name facilities to ship numerous recommendation, counseling and content material. What we’re offering for them can be a medical arm the place they will refer of us in our route who’re acceptable for our care, and we will get them right into a longitudinal care that is paid for by Medicare.
HCI: If you first began with sufferers in January 2023, was that in partnership with a payer in Washington state?
Engskov: It was not. We weren’t getting paid very nicely at first by way of payment for service. We shortly acquired right into a value-based contract with a significant payvider that I can not title publicly. However we’re working for a big payvider within the Northwest as we speak in a value-based assemble. We have got the GUIDE program going now as nicely. So these are broadly the 2 payer fashions we now have, and we now have different value-based contract relationships that we’re constructing now.
HCI: Let’s return to the telehealth providers. What sort of suppliers are sometimes on the opposite aspect of the display? Is it a nurse or a doctor?
Engskov: Our care mannequin is a complicated apply nurse practitioner, a licensed medical social employee, after which what we name a care navigator. They’re all consultants in dementia. These three of us work collectively in a digital pod. They comply with a affected person longitudinally, and once I say they comply with them, they individually comply with that affected person. As a result of one of many key issues right here is that it is not like conventional care administration. You must know the affected person to achieve success on this specific power illness. You must know their historical past.
In lots of situations, a care navigator who’s unlicensed, however is an skilled in dementia is aware of that affected person and is sort of the quarterback for the household. That caregiver is as efficient at avoiding ED visits as extra superior clinicians, as a result of a lot of the issue we’re making an attempt to unravel is behavioral.
One factor that was a shock to me once I first began the corporate was that I assumed this was going to be like a disaster line. You name us when it is 8:30 on a Tuesday night time, and you do not have anybody else to name. You possibly can’t attain your PCP, and we show you how to handle the scenario. Nonetheless, we get only a few disaster calls as a result of we’re to date upstream. One of many nice surprises out of that is that we’re figuring out points earlier earlier than it’s worthwhile to go to the ED.
HCI: What are just a few of the issues that this new funding may help the corporate do?
Engskov: We are going to use the cash for 2 or three important issues. One is, we are going to broaden our geography. We’re in 4 states as we speak. We are going to go to different locations that we expect could be good candidates for this sort of care, and are arrange for it. The second half is an even bigger crew to assist us go discover the partnerships which might be essential to set these up. GUIDE is nice. We will go to a state like Florida and start to serve sufferers due to GUIDE. However we additionally need to discover different companions that we will work with in value-based preparations.
We could be one of many only a few firms in America with a value-based contract round dementia. I believe it is primed for innovation, particularly given the volumes of individuals which might be coming. So partnerships will probably be a giant a part of it. And we now have a number of that we’re actually beginning to construct out.
We have additionally acquired to construct this on a reasonably strong tech platform. I believe there are some actually sensible ways in which AI may help us develop this care with extra precision. The primary method we will use AI is absolutely as a digital assistant sitting behind our care navigators, listening to unstructured conversations and, serving to them seize element, immediate asking the best questions on the proper time, recommend assets {that a} caregiver may want.
HCI: The place did the corporate’s title come from?
Engskov: It’s from a Bobby Kennedy speech in 1967 in South Africa. He had this nice phrase known as the ripple of hope. His level was mainly that while you’re making an attempt to unravel huge societal points, you’ve acquired to start out with a ripple, and people issues have a tendency to construct. We took the inspiration from that, as a result of the issue right here is that we do not have anyone that’s skilled in dementia care at scale. We see ourselves as a lot about constructing a workforce as we do offering this care, as a result of we may help get lots of people proficient. So we like the thought of making somewhat ripple right here round workforce.
HCI: And you then left the ‘e’ off the phrase ripple.
Engskov: Effectively, attempt to purchase a URL. The one factor more durable than beginning a healthcare firm is definitely getting a spot on the internet the place you possibly can exist earlier than you begin.
