Better Patient Outcomes as the Foundation for Growth | EP 21

In this episode of Healthcare Marketing Edge, Tim Bouchard interviews Nicholas Messina, COO at Gabby Health, about how technology, AI, and outcome-based services can transform healthcare practices, improve patient outcomes, and drive growth. They explore strategies for implementing new systems, overcoming resistance, and building a reputation for excellence.

Tim Bouchard (00:02.491)
Welcome to Healthcare Marketing Edge, where we share stories and strategies to grow your practice. I’m Team Bouchard from Luminous, a healthcare marketing agency in Buffalo, New York that specializes in helping practices acquire patients and grow their practice. Today we’re talking about improving patient outcomes and running a more efficient operation and what you can learn from someone who’s seen dozens of facilities do it well and some do it poorly. Our guest is Nicholas Messina, COO at Gabby Health.

Because Nick works across so many skilled nursing facilities, got a rare view into what actually moves the needle on outcomes, how teams adopt new tools without panic, and why the strongest operations tend to win business without chasing it. Whether or not you’re in post-acute care, there’s a lot here for any practice owner or marketer to learn from. Nick, welcome to the show. Why don’t you tell everyone a little bit about who you are and what you do?

Nicholas Messina (00:48.832)
Hey, I appreciate it, Tim. Thanks for having me. It’s so awesome being on podcasts that really be able to share and drive value because we see so many podcasts out there and it’s just nonsense. So this is great. I actually, you know, I was looking into your podcast, and yeah, a lot of really good speakers, so I’m honored to be here. But I’m Nick, I’m with Gabby Health. We operate in multiple different skilled nursing facilities and then also in the ALF world across multiple different states. We help.

Tim Bouchard (00:58.535)
Yeah, this is awesome.

Nicholas Messina (01:14.614)
Lower rehospitalization, that’s our goal, and we’re owned and operated by two different providers. Our ultimate you know MO is that we love to service patients and keep them out of the hospitals.

Tim Bouchard (01:26.621)
Cool. And now you have a lot of different skilled nursing facilities. what separates and may and I you know, you work with all sorts of them. What separates the ones that improve outcomes and run efficiently from the ones that might struggle?

Nicholas Messina (01:43.212)
Yeah, I think it it really comes down to providing them with the right technology so that way they can understand their patients. The more data that you have on your patients, the better outcomes you can actually create. The knowledge that is built behind that is is phenomenal.

Tim Bouchard (01:58.448)
And as a COO who kind of sees both the operation side and the growth side, what do you notice that most practice leaders miss when they’re like, you know, they’re like doing their thing, right? They they are owners, practitioners usually at the same time. They are very skilled, very knowledgeable in the health care, wellness practice. But sometimes, you know, they’re also on the business side. They’re the practice owner too. You know, what what do you think they’re missing right now? that kind of how

you know, operations blends into that growth side too, so you have to consider that as well.

Nicholas Messina (02:32.511)
Yeah, I I I’ve seen this in many different industries. you know, I’ve been in quite a few different industries and it’s really just being able to use the tools that are around you. There’s so many different things and I think everybody gets scared about AI. You know, we’re kind of slowly getting over that burden. But AI is not here to replace people. It’s really here to, you know, help your workflows, improve your workflows, and give you access to things that you couldn’t really necessarily get access to before.

Tim Bouchard (02:47.762)
Mm-hmm.

Nicholas Messina (02:58.591)
So, I mean, we we deal with a bunch of different nursing homes, and one of the tools, it’s just like one out of like the eight tools that we give them, is an emission tool. And now some emission people inside of skilled nursing facilities, they may look at that as you know something that goes against them because it’s it’s analyzing a hundred discharge summaries and it’s spitting out the exact breakdown of what they’re looking for. Some people are like, well, that’s gonna replace my job. No, it’s not gonna replace your job anytime soon.

Tim Bouchard (03:13.351)
Mm-hmm.

Nicholas Messina (03:24.907)
But what it will do, it will speed up your workflow and allow you to not miss things. Same with practice owners. If you can have a report exactly what you’re looking for, speeds up your efficiency. And number number two, you can actually get back to that more thing that you love, which is patient care. I tell people this all the time. You know, use technology to your advantage. So that way, instead of having your, you know, your butts in seats, you’re at bedside with the patients, understanding their needs and giving them more of that time. I think, you know, any any practice, any doctor.

They want to kind of rush through an appointment or rush through seeing a patient because in the back of their mind they’re thinking about all the documentation they need to do, the right, you know, follow ups. It’s giving that, you know, peace of mind of like, look, that stuff’s gonna get done and I can focus more on having that personal touch. And that’s where they signed up for this.

Tim Bouchard (04:11.281)
Yeah, and and that’s a very outcome driven message too, right? So I mean, in terms of growing things, and we talk about this on the patient centric marketing side for practices all the time too, is that if you go towards the outcome and and the end result and work your way back from a messaging and value prop standpoint, it it adds more meat and value to the conversation. It gets the attention better than than other messaging that’s a little bit more, you know, bullet pointy or anything like that. And

Practice owners are decision makers too, practitioners and and you’re working with and reaching them with messages too. Like how important is it for you to focus on that outcome based messaging?

Nicholas Messina (04:52.342)
I I think that what really what separates our business and like our approach is very from the beginning, right? So we do a lot of oversight services. So we do a program called Chronic Care Management and Remote Patient Monitoring. Then we combine that with some technology, which I just mentioned on the mission side, to kind of create this whole full solution. But there is many different companies that do one or two of the pieces, but they’re not outcome-based services. They do something just to be able to build. We’re really looking for true outcomes in inside of our business.

And trying to really lower re-hospitalization because there’s a there’s a bunch of beautiful things that come with lowering re-hospitalization. Obviously, higher reimbursement, you have less fines and less tags that you’re gonna get on your facility, and you know, you’re really gonna have those results that you’re looking for for your team. So, what really separates us is being that you know physician-led organization first. I mean, I’m very proud to be a part of Dr. Naboo and Dr. Neil’s full vision.

Of what this program is looking to be, and it’s constantly growing. We’ve seen a lot of organic growth just by having that type of approach. It may not be as fast as everybody else wants to be, but I think in the long term, our our goal is for us to be actually recognized from the payer source as an access model of like, look, you guys run a very productive service, and that’s really where our end destination is trying to take us.

Tim Bouchard (06:13.521)
Well, the longevity of that sticking to is much better than just like a feature rich pitch, right? Because you’re you’re giving someone something beyond the transactional benefit and also the outcome benefit there too. So that sticks with people and that actually resonates with what you you mentioned vision. That resonates with their vision and their mission too.

Nicholas Messina (06:20.098)
Mm-hmm.

Nicholas Messina (06:36.386)
Yeah, yeah, and and we see this all the time. I’ve seen this in, you know, ALFs, you know, where family members are a little bit more involved. And you know, when we tell them we’re gonna be running an oversight service, you know, they love it. They love that extra line of support for their facility. And you know, if my mom was in a nursing home and I was able to sign her up for a chronic care management service where on top of the building I have somebody else watching her charts, watching her vitals, seeing trends that are going on, that’s an extra layer of support. So

I think that the biggest challenge that we we run into is for those buildings that you know don’t really want us is usually because they’re not really doing the right thing. I think everybody that if they have the right goals and if you talk to the right you know team members that are want the the correct results, we we we fly through. And again, you know, our marketing strategy is a little bit different than most. you know, we see this all the time, but you know, I’ve seen many different practices run a CCM and remote patient monitoring service, even out of their practice.

that can tremendously help their patient outcomes. And if you could provide that better service, they’re gonna continue coming back to you, you know matter if you’re a fee for service or not. So I I I’ve seen this program run tremendously most mostly through the United States. I think there’s very few that, you know, run it the wrong way.

Tim Bouchard (07:49.98)
Now, you’ve you’ve mentioned AI, you mentioned the whole not taking your job thing as part of this too, right? is that the only apprehension people have to AI? Are you seeing other things that are keeping people from jumping on to this sort of like value assist that can boost their operations?

Nicholas Messina (08:05.964)
Yeah, so I think Dr. Neil, you know, hits this. You know, she’s she’s an MD, but she also has an MIT background. She’s actually the brains behind a lot of our services, growing her and our CTO rule. They’ve seen this kind of change and they talk about this all the time, right? We we were at that stage in maybe 2021, 2022, where everybody was afraid of AI. And then we kind of started to get over that hump. I think that every part of healthcare is adapting AI at this point. This is like

It’s like the internet when it first came out. You know, everybody was afraid of it, no one wants to jump on it. I’m not putting my information out there. Now I think a lot of more people are being adapted to it. So, really, you know, I’m taking the words of Dr. Neil again, you know, she sees the vision of AI where it will go to AI agents. And once they’re AI agents, they’ll be able to help more people with their daily task. The goal, again, is being proficient. I see, especially not even in nursing homes, but in you know, private practices.

Tim Bouchard (08:37.404)
Mm-hmm.

Nicholas Messina (08:57.548)
Where an AI will actually do some of the back end analytics, you know, maybe they’re taking the vitals, tracking the patient every time they come into the doctor’s office, and then the doctor can kind of create those extra things. We’ve seen this in radiology. Why is radiology a dying career? It’s because AI is looking through so many different things. And as humans, we have to come to the realization that we can miss stuff. There always will be oversight, forever. You know, even even in the very future when AI does a lot of different things. But we have to look at it in two different things. One,

Ethically, are we gonna say that we are better than an AI, you know, looking at something constantly? No. Number two is whether we want to adapt with it or against it. You know, there’s a lot of people that are talking about data centers and different things that are going around with it. There’s always a positive to something. And we have to kind of take that accountability, right? You either grow or you watch something else grow without you.

Tim Bouchard (09:51.344)
And there the in terms of the actual like implementation of things like this, you know, it’s one thing for the provider or practitioner to to buy into the idea of needing this, wanting it, want to augment and implement this within their systems. How have you seen people bring full teams on board? Because you are fighting a lot of those micro battles and as part of an implementation process.

Nicholas Messina (10:06.008)
Yes.

Nicholas Messina (10:11.82)
Yes. I I can’t believe you asked this question. This is something that, you know, we work with our team. We actually have implementation specialists and you know, we have breakdowns of how implementation went. And this is the you know, the s the real realization of the struggles is some some of these facilities. you know, skilled nursing facility, they are, you know, more digital now, but the the whole assisted living communities across the entire United States, you know, a lot of them are just now switching to a digital service, right?

Tim Bouchard (10:20.39)
Mm-hmm.

Nicholas Messina (10:40.546)
And you know, they’re doing a lot of paper stuff, paper vitals and different things, and convincing them, look, this is what’s gonna be better for the patient. Sometimes they look at it as more work. and you know, just education. Like I I’m a big believer on, you know, yes, you can get a lot of stuff done faster if you educate everybody at once. But how somebody’s really gonna be receptive to the information is you sit down one time with them. So we believe in one on one integrations and one on one coaching in this because this is a problem.

just kind of showing people how to use technology. You know, my dad, he’s not good at technology whatsoever, but once you set him up with the iPhone, he’s good to the iPhone for the rest of his life. Sorry, excuse me. So once we, you know, really show people the way of how services work and coach them on that process, they do feel more comfortable with it. But like you said, it is a it is kind of a a hill to climb in the beginning.

Tim Bouchard (11:34.693)
Now, once I get these rolling, you know, I’m assuming now it improves their systems too. So I’m assuming you’ve got some good examples or you’ve seen I the representation of systems that are really getting things done within these practices. do you have any good examples or or some success stories about something really improving when this is implemented?

Nicholas Messina (11:54.317)
Yeah, absolutely, absolutely. You know, so we run, like I mentioned before, chronic care management, which is a documentation oversight service. And then we also do remote patient monitoring where we’ll actually monitor patients’ vitals on, you know, either some kind of device. We were able to catch multiple patients that were trending in the wrong direction. You know, we’ve seen their baseline on our systems actually trend in out the wrong direction. We’re able to create interventions prior. We strongly believe.

In proactive care instead of reactive care. That’s kind of like our slogan and our motto. But you know, we’ve helped multiple buildings go from four to five star star ratings. You know, those are what you know the the federal government says, you know, hey, this is what you’re doing correctly. They have a surveyor come in and you know, we’re proud about that. We’ve even had reaches out by you know the payer sources understanding, you know, what we’re doing. And this is something they’re willing to pay for, like CCM and RPM. It’s a newer concept the past couple years.

But we’re seeing a lot more people, you know, be receptive to it because simply because they are creating different outcomes. You know, we’re able to lower rehospitalization on an average rate of 28%. Not all, you know, facilities are the same, but you know, that is a great outcome to be able to do that. But I think anybody can do these type of services if they lead with the right intentions. I think that, you know, AI is something that everybody should really jump on and and be receptive to it, whether that’s some kind of

AI in your current EMR, there’s a lot of EMRs out there, you know, like point-click care, matrix care, simple health care, all these different ones that are out there that are are having these features, just try them out. They’re willing to give you guys access to it and your team has to adapt at some point. Whether you guys adapt now or your competitors, you know, one of you guys are gonna be you know left behind.

Tim Bouchard (13:42.034)
Well, and you mentioned earlier about the idea of boosting a star rating and patient feedback ratings too. And think about that from two different perspectives too. If you can be more proactive, like you mentioned, and you still need the team to be able to act on that, right? You’re just you’re spreading the wealth and you’re moving faster because of the analysis. The boosted star ratings, you have two different sides of this. One is the public perception, which is brand recognition and preference in the market, and two

Nicholas Messina (13:46.998)
Yeah.

Tim Bouchard (14:08.305)
Think about all the referral sources that are vetting you that you could build a your your business off of as well.

Nicholas Messina (14:12.478)
Yeah. Yeah. Yeah. I mean, we’re we’re really seeing this from twofolds like so one of the other programs that we do with hospitals is a TCM program, transitional care management. And hospitals are even considering us for that, whether we you know help them go on that transition back to home or you know to another facility simply because of our services we’re doing out in the field. The way that we want to go with our services in the future is where hospitals look at our platform.

And say which buildings are actually using Gabby Health. That’s really where we’re trying to connect with the hospitals, with the different systems. And yes, they will go to a certain point where it will be access model. You know, I I’ve dealt with a hospital that I don’t want to mention their name, but CMS basically dropped a hammer on them and said, you can only send your patients to these certain nursing homes because you have such a high reemission rate. They can’t pay it anymore. So

You know, when when buildings get to that or or groups get to that, they’re gonna go with the real outcome-based services and people that are willing to adapt to those services. So there’s so many little things that are gonna be, you know, contributing to this stuff that people need to come to recognize. Eventually we will move to full access model services.

Tim Bouchard (15:27.367)
So you mentioned getting traction from other avenues that you’ve promoted too. So let’s we’ve talked about messaging a little bit and how to package this outcome based and how we’re implementing these in the systems. How have you also, you know, thinking about practices too? You know, how do you think about getting more traction in the market? and maybe having this operations boost and systems boost helps with that.

but there’s lots of ways to grow a practice, any business really, but a practice. what have you learned in your experiences in in this role?

Nicholas Messina (15:58.731)
Yeah, yeah, absolutely. I’ve worked for many different companies and you know helped scale multiple different companies to you know zero to millions of dollars. And I think it’s the kind of like the same thing from every company, right? Number one, right, right expectations leads to less frustration. That’s what I strongly believe in. And number two is building something that you would actually use yourself. You know, people want to know not if the product works, whether you believe in the product. That’s what they truly are trying to see on a presentation or anything like that.

like do you really believe in what you’re actually pitching? And you know, this is something that I’ve actually talked to you know with Dr. Neil for quite a while about. She’s told me about, and I had to really wrap my head around this process. And I told her straight honestly, I was like, look, if you’re really telling me everything is in this service is is packaged in and you just want to put it out there, we just need results. And as we as we have these companies and these groups and these buildings, you know, improve their star rating, improve their, you know, reimbursement levels.

And we’re starting to get that traction. It really comes from you know providing the best level of care, everything else is second. That’s in every practice, you know, that you can possibly think of. If you want to grow, number one, take care of your patients in the way that you want them to be treated, and everything else will follow. That natural marketing everybody you know wants to have and they think it’s a fantasy, it’s really not. It will come, it will come. And the more that you push that and focus on that, everything else will just flow into this. And we’ve kind of seen that. You know, we went from

having zero buildings on our platform last year to you know being able to scale almost to a hundred different buildings, you know, having 8,000 patients nationwide and even in our provider group. We have a small provider group down here in Florida. We’ve helped you know grow that tremendously just because everybody wants us. We were featured in little magazines here and there too. So everybody’s like, how do I, you know, join that group? How do I have that as my doctor, my provider? And it’s simply because you know they’re able to hit these

you know, these marks, these accomplishments, you know, with with Loran rehospization, providing the best level of care possible and, you know, really taking care of their patients. I’m I’m so proud to be a part of this team.

Tim Bouchard (18:05.021)
Yeah, and that’s the type of thing that will naturally also reach beyond you too. If you develop the reputation, the reputation carries. And you know, if we want to take another angle from AI into this too, and I bring it up often on the podcast, is if your reputation can spread without you actively putting it out there, I mean you have to participate a little bit too. It will help in things which you know, s search online whether it’s through the chats or whether it’s through

traditional search still is still heavily reputation and citation based. So if you’re if you have good reviews, you’re going to show up higher in Map Pack clusters or you’re going to show up higher in recommended chat responses. If you have more articles out there, you participate with your news stations, whatever it is, right? So mission driven means also helping in the community and spreading the knowledge of your care, of your care approach and reaching the people that you want to work with. So I think, you know, that’s important here too. And

Nicholas Messina (18:36.365)
Yeah.

Nicholas Messina (18:41.378)
Yes.

Tim Bouchard (19:01.425)
And what you’re talking about is kind of playing the long game and not just playing the shortcuts, really.

Nicholas Messina (19:05.964)
Yeah, yeah, it is, it is. And we’re we’re trying to go that route. You know, maybe we’re not having the as much growth as everybody else. You know, you know, I heard Grant Cardone say this, you know, saying, you know, if you don’t know me, you can’t do business with me. And and I understand that and and that’s the goal is to get your name out, but let everything kind of flow. I think everybody, you know, nowadays wants that instant gratification. It’s not always gonna happen like that. you know, especially me, you know, I I I’ve been a part of many different groups that moved very, very quickly. and it was fantastic.

But the end of the day, you know, the slow and steady, that’s what really wins the race. And you know, people joke about it, they’re like, well, sometimes you have to be the aggressor. Not all the time, you know, not in this industry. I think, especially in healthcare, it’s about providing the best level of service. There’s multiple different medical devices that are out there that just try to rush the market. Maybe they get this one piece FDA approved and they they miss out on all these other things like integration, pushing data, and different things. So

I I I I think that slow and steady wins the race and you know whoever’s has that real mindset of like this is the best level of care I possibly can give will will really dominate the market and we’re gonna see that kind of separate every AI will will kind of close the gap between a lot of different practices and groups, but it will also kind of separate from who’s actually doing the outcome-based services.

Tim Bouchard (20:25.788)
Yeah, I think one thing that that you were talking about too is if you go too fast, a fast rise can also lead to a fast fall. You can you can overplay your hand sometimes, whether you’re marketing too much or you’re growing too fast, if you can’t do the operations and fulfillment on the back end, whether you’re you know, you’re a systems or software or a provider and simply you can’t manage the patient census that you have coming in, the volume’s too high. You go you end up back in that like

negative feedback cycle where your ratings will start to dip and then your reputation starts to dip and then your referrals might pull back a little bit. So, you know, sometimes rapid growth is not always the answer. And sometimes it is playing the long game, building off of strengths, building the reputation first. And then, you know, you can push the envelope a little bit when you feel comfortable with it.

Nicholas Messina (21:15.34)
Yeah, yeah, yeah. And that that’s that’s the thing that, you know, we we we struggle with is like, you know, we get signed contracts and you know, we want to create implementation, but we kind of are trying to pace it out on the right perspective to make sure we can fulfill those needs that we’re talking about. Because, you know, when you’re talking about patient level of care, you know, it’s not something you can play around with. You don’t just start it just because you can start it. You have to start it when you’re clinically ready and making sure your back end team is ready to take on those challenges. So, you know, those are some of the things that we face.

Tim Bouchard (21:26.014)
Mm-hmm.

Nicholas Messina (21:44.836)
I I would say that would probably the the biggest thing that I face is trying to grow and trying to grow into new states and and new markets. you know, and it’s like, Hey, do we have the right team to start that program?

Tim Bouchard (21:57.043)
What do you think is the one habit that the successful practices have that the ones that you’ve seen struggle don’t have?

Nicholas Messina (22:05.154)
Systems. Systems is is is something that’s big. You know, taking time to create the systems and also, you know, editing the systems. I think a lot of people think that one time I can I can set up a system and everything’s gonna flow. It’s not. It’s it’s it’s gonna change as you grow. You know, you had four employees back then when you started the system. Now you have twenty, or or maybe you have ten. And things need to change. People need to have accountability through systems. I’m a big systems guy and a details person.

So, you know, what I like to do for our team is create different guidelines. And you know, just as today, I heard another step that we need to add in another component because we hit certain milestones. So every time you you know hit new milestones, you have to think of new challenges, whether you have them come right to your face or whether they’re coming in the future, prep for those solutions and prep for those systems. You know, so if you are starting practice, let’s just say you have, you know, 100 patients in your facility.

That’s gonna change rapidly once you hit, you know, 125, 130, you know, your teams when you bring on a nurse practitioner, or maybe you know, you wanna bring on more nurses or some office manager, or maybe you’re growing in the sniff market, you know, all of these different things, you have to have systems. Every big company has systems and they’re constantly editing and improving their systems as time goes on.

Tim Bouchard (23:24.848)
Yeah, and then imagine having a new location, now you’re multi-location, you start to lose that like direct touch so quickly. those are great growing pains to have, but if you grow without the foundation underneath, it can just turn into complete chaos. is there anything I haven’t asked you that you want to make sure we touched on before we wrapped up?

Nicholas Messina (23:29.751)
Mm.

Yeah.

Nicholas Messina (23:40.056)
We can.

Nicholas Messina (23:46.923)
No, no, I would just say, you know, listen, AI is out there. We don’t use it fully in every one of our services, but I would be open to the changes with it. You know, I would explore what what you could have to make your life easier. you know, there’s a lot of things that can be automated and some things that shouldn’t be automated, but I would be open to change and understand that this is coming whether you like it or not, but you know, it it really could be a benefit. And we’re seeing benefits.

From a patient level. So think of a patient first before you do anything, you implement any service. Think of a patient first. How would the outcome be for them? And you know, I hope everybody got some value out of this podcast. Tim has a lot of great podcasts. So hopefully we we’re up there on this podcast. Thank you so much, Tim.

Tim Bouchard (24:29.456)
Yeah, yeah, this has been a good episode of lessons. I think a lot of practices can put to work, you know, whether it’s how you message stuff, how you roll out change, where AI fits in, how you build a reputation off of all that stuff. I think we touched on probably too many things to wrap your our heads around in just twenty-five minutes or so, but why don’t you tell everyone where they can find out more about you and Gabby Health.

Nicholas Messina (24:44.643)
Yeah.

Nicholas Messina (24:53.036)
Yeah, absolutely. You can go to gabbyhelp.ai. You can see a full breakdown of our services and how we’re able to help your current communities and even if you’re a private practice or in the SNF or ALF world. Thank you guys so much.

Tim Bouchard (25:05.756)
Yeah, yeah. Listeners, if you want to build marking that aligns with your operations and actually scales, check out our patient pipeline blueprint session offer. It’s a workshop to uncover how you can attract new patients and convert more inquiries into appointments for your practice. Learn more at luminous. And don’t forget to subscribe to Healthcare Marketing Edge on Spotify, Apple, or YouTube for more insights like this. See you on the next episode.