How to Market Value-Based Care in Medicaid’s Evolving Landscape | EP 4

In this episode of Healthcare Marketing Edge, Tim Bouchard and Dr. Enrique Enguidanos, Founder and CEO of CBCS discuss the evolving landscape of healthcare marketing, focusing on value-based care and the importance of community-based solutions. Dr. Enguidanos shares insights from his extensive experience in emergency medicine and care coordination, emphasizing the need for effective communication and listening to patients’ needs. The discussion highlights real-life examples of how connecting patients to care can prevent crises and reduce costs, as well as the role of navigators in bridging gaps in the healthcare system. The conversation concludes with a focus on storytelling as a powerful tool for healthcare organizations to convey their value and connect with patients and managed care organizations.

Tim Bouchard (00:06)
Okay. Welcome to Health Care Marketing Edge, where we share stories and strategies for healthcare practices. Tim Bouchard, Luminous in Buffalo, New York. Today we’re exploring how to market value-based relationships in healthcare’s evolving landscape. Our guest is Dr. Nerygre Anguillianos. I really hope I didn’t… I wanted to be the one that got it. I hope I didn’t mess it up. Yeah.

Enrique Enguidanos (00:27)
Close. It’s about as good as most people the first time too. And ⁓ Guidanos.

Tim Bouchard (00:34)
Okay, all right. CEO of CBCS, which is Community Based Coordination Solutions. He’s a visionary in care coordination and an emergency medicine physician. Enrique, I’ve known you for a couple years now, but I’m stoked that you’re on the podcast. So why don’t you introduce yourself, tell people who you are, what you do, and then we’ll go from there.

Enrique Enguidanos (00:48)
Thanks for having me,

Thank you. Thank you. Thanks for having me today. Yeah. As you alluded to, I’m an emergency medicine physician based here in Seattle, Washington. You see a little of my son back in the background, which is, it’s a nice day in Seattle today. I’ve been in the healthcare field 30 plus years now. You know, started as a firefighter in LA and had a chance to go to med school. ⁓ did that specialize in emergency medicine. And so I bring, ⁓ about 30 years of clinical experience. I’ve also had the chance to.

Tim Bouchard (01:04)
Yeah.

Enrique Enguidanos (01:24)
⁓ play several administrative roles in the healthcare both at the hospital level and a hospital system level and for the last 10 plus years as you alluded to have been running a business as well community-based coordination solutions so have that aspect of CBCS is what I affectionately call a 24-7 navigation service so ⁓ the quick and dirty is that

While I was serving as an emergency department medical director at the biggest hospital here in Washington, we had a lot of folks that would come into the ED, the emergency department, 100, 150, 200 times a year, a couple of dozen. And thanks to the wisdom of ⁓ my dyad nursing director at the time, we started a program based out of our hospital.

that really met with the individuals outside the walls of the ED, heard their stories, and realized a lot of what brought them to the emergency department wasn’t really medical. had to do with social determinants of health issues. And so we started a program trying to address those, and it was so successful. That program at that hospital continues to this day.

Tim Bouchard (02:28)
Mmm.

Enrique Enguidanos (02:35)
But as the word of the success expanded, I was asked to bring that model to other hospitals, other regions, other states. And from there, the business of CVCS developed. So we basically have live personnel in each community we serve. call it navigators. And about 3 to 5 % of…

the healthcare population, whether it’s a state Medicaid agency or MCO, about three to 5 % of their personnel, their enrollees, they have names and maybe a phone number and address that works or doesn’t, but they don’t know who they are. You know, on average, enrollees have about five care coordinators assigned to them and ⁓ no one is really working with them. So our task is to find them and bring them back, hear their story.

find out why the miss is happening and bring them back into the fold back into the existing services in a way that works both for them as well as for the healthcare system. So that’s the short and dirty of what CBCS is all about.

Tim Bouchard (03:45)
This is where the value-based care kind of comes into play.

Enrique Enguidanos (03:48)
Yeah, that’s exactly true. you know, healthcare, I mentioned Medicaid. Medicaid often helps cover services for those that are disenfranchised, that don’t have a way to cover their care. And a vast majority of our enrollees are served by Medicaid. It’s not an exclusive Medicaid program, but we’re often dealing with individuals that are homeless.

struggling with behavioral health or substance use issues that ⁓ if not intended to evolve into crisis events and you know if the crisis happened after hours or in weekends often times the only place available I say this jokingly but it’s really real is the the emergency department ⁓ the jail system or the morgue and we’re probably the better of those three options and so ⁓

Tim Bouchard (04:41)
Hmm.

Enrique Enguidanos (04:46)
As I’ll say as Medicaid got developed in what we call a fee-for-service system, you you provide a service and you get paid a certain fee when it got implemented back in the 60s ⁓ and whole industries evolved around that fee-for-service to take advantage, know, good people trying to do good work, but it’s evolved into this mass where currently, you know, way back in the early 60s

Healthcare was about 6 % of the GDP and today it’s almost 18 % of our gross domestic project. So the animals just gotten out of control and one of the ways to try to address this is what you mentioned, value-based care. So really our focus at CBCS and much of healthcare is turning in that direction, is trying to find out how do we bring and how do we demonstrate value.

for the care we’re giving, rather than expect some automatic service, some automatic fee for the service we’re providing. And I can provide so many examples of that. mean, my wife had needed an MRI the other day, right? And it wasn’t an urgent emergency thing, but ⁓ she went to our health, our insurer and said, hey, just tell me how much this MRI is gonna cost before I order. And they wouldn’t tell her.

Tim Bouchard (05:52)
Yeah.

Enrique Enguidanos (06:07)
They said, well, you gotta go and get it done and we’ll bill after the fact. And so she finally said, nah, I’m gonna go. She found an outpatient provider. She found out how much it was gonna cost and found someone that would do it for a third of the cost. And she got her issue addressed. Yeah, but that’s our healthcare system.

Tim Bouchard (06:22)
Yeah, that’s a whole other topic where you can. There’s

there are some I’m hoping to get someone on the podcast in the future about this, where you can, you know, ask for direct billing quotes versus insured quotes. Completely different topic. But yeah, it’s hard to communicate how that actually works, too. And you’re trying to get MCOs to buy into this type of program.

and understand what it can do for them and the costs it can save and the people that it can help. And ⁓ in our work with CBCS in the past, we’ve leveraged storytelling a lot to do that. We’ve created fictional characters to talk about where that person’s journey might find them and what they could get ⁓ when they receive help or guidance, I should say. And then even what it does on the back end for the organizations too, in terms of ⁓ prevention and financial.

Enrique Enguidanos (06:47)
Yeah.

Mm-hmm.

Tim Bouchard (07:17)
prevention as well.

Enrique Enguidanos (07:18)
Yeah, mean, fortunately or unfortunately, we haven’t been at a lack of real stories to be able to share. And, I can think of a simple example where, you know, oftentimes when we’re engaged by a customer, by a state Medicaid agency or Medicaid MCO, they’ll have a list.

of a few thousand individuals in say the state of Virginia or New Mexico or Alaska or Ohio where we’re working in, you know, five, 10,000 individuals that meet their criteria. And we’ll get a name and a phone number and an address which may or may not be valid, instructions to go find them and connect them. So we had one individual who…

you know use dialysis but they were missing their dialysis appointments frequently ⁓ and setting up they they claim because of transportation and when that’s not attended to in a regular fashion it can develop pretty quickly into crisis events and they were in fact using the emergency department very frequently much more than you expect for dialysis related issues and when we spoke to them they said look we’d love to

get better care of it, I keep on calling this transportation service and they’re not showing up at the time. They said they’re gonna show up for my transportation to Dallas. So we called the transportation service and said, yeah, they’re never at the place that they told us they’re gonna be to meet us. So we showed up on a day that dialysis is…

that they were supposed to be picked up and it was an apartment complex and the transportation service was coming to the front of the apartment complex. The patient was waiting outside their door and the two never connected, both well intended, know, but multiple times this transportation service was just showing up where they thought was the right place. And once we made that connection, her ED visits disappeared and the admissions that were related to it.

Tim Bouchard (09:12)
Mm-hmm.

Enrique Enguidanos (09:25)
You you think about the cost of an ED visit, you know, $3,000, $4,000, depending on the case, and the cost of an admission, $10,000, $15,000. Just that simple act of finding where the transportation service should meet over the course of a year is saving over $100,000 for that individual. Both parties well-intended, right? We just hadn’t made the connection about where to get picked up.

When you think about value-based care and how to make those connections, it’s really all parts. It’s not just the ED visit, but it’s listening to what services the client’s needing. Where do they see the disconnect? And where does the other party see the disconnect? And then just trying to merge those as best possible. And there are umpteen stories in any given community about those disconnects.

Tim Bouchard (10:21)
I was going to say the scale of that when you really think about taking an isolated case like that and then applying it to what the actual volume of need is becomes pretty mind blowing when you think about it. And we’ve talked about that in the past and you have a cornerstone theme in the CBCS messaging, which is that this type of preventative action for underserved patients or patients that have these disconnects with the system, ⁓ it’s

Enrique Enguidanos (10:36)
Yes.

Tim Bouchard (10:51)
It’s savings ⁓ on the cost side for the MCOs too. And it also helps with the Medicaid programs not being inefficient, essentially.

Enrique Enguidanos (11:02)
Yeah, and you know, it’s in some ways so simple, right? It’s about listening. You know, the health care system was created by people like me, for people like me, for doctors and administrators in a convenient fashion. You know, 8 a.m. to 5 p.m. we’re going to offer these services and life just doesn’t work in that way. So as we listen to the stories of those we’re serving,

and find out where the disconnects are. It’s often really, really simple issues, like making sure a transportation pick-up happens at the right place, ⁓ a translation service. The emergency departments in our country have been pretty good about incorporating live translation services for hundreds of languages, right?

⁓ But that’s not true across all of healthcare. So I can’t tell you the number of times that CDCS encounters individuals that are going to an emergency department because that’s where things can get translated best for them. And we then will just bring a simple solution like a translation service for multiple languages and that grabs the individual.

early on and prevents crisis development, prevents them having to go to an expensive ED just to get good translation. you know, just that listening is such a pillar, such a cornerstone for what we do and translates into the value that you had mentioned.

Tim Bouchard (12:41)
What’s interesting about that is that act and that service, if you will, that you’re helping make the connection on there isn’t even technically about the health care itself. It’s about facilitating. You talk about the listening side, that’s empathy. It’s understanding who you’re serving, what their scenarios are, where they may find themselves. And your navigators actually contribute to that, too, with the backgrounds and the types of people that you bring in to help with that.

Enrique Enguidanos (12:53)
Exactly.

Tim Bouchard (13:11)
But it’s actually about helping them with these aspects of their life to help get them to the right care. And then that also benefits the organizations on the back end too.

Enrique Enguidanos (13:22)
Yeah, you mentioned our staff, you know, they really deserve all the credit. They are the magic that makes it happen. you know, we hire for lived experience. It’s not a requirement, but when you have wonderful staff like we have, bring in that knowledge of lived experience, the street knowledge, the empathy, the capacity to listen, and can then merge that.

within the healthcare system. That’s really where you start to identify the gaps that you can start filling effectively. And it’s the magic of this. Go ahead.

Tim Bouchard (13:57)
If you.

Yeah, I was going to say if you could indulge me for a second, this actually could apply more generally to just health care practices in general to where they if you can think about the patient scenario and what patients are going through, you can, of course, improve your patient experience on location in the treatment and systems and processes you have in the practice. But from a marketing side, we’re a marketing podcast.

You can also take more empathetic communications out to the patient recruitment process or even the provider recruitment process for a growing practice. And so there’s something, there’s a bit of you know, connection there into what you’re doing from actually reaching into the community to what practices, small practices could do trying to reach patients and providers too. But I thought there was a nice.

Enrique Enguidanos (14:51)
Absolutely.

Tim Bouchard (14:53)
synergy or whatever you want to call it there between the two.

Enrique Enguidanos (14:57)
Yeah, I’m an expensive technician. I got trained as a medical professional as an ER emergency department doc to learn a certain set of skills. And I and my cohort of fellow physicians and nurses and staff in the emergency department, and in all walks out in the clinics and within the hospital do that job really well.

But more and more we’re asked to do so much in so little amount of time that you’re focusing on the medical side of things. And yeah, people have medical needs, but those aren’t the only needs that they have. And so the role of navigators, someone that one understands the background, but two is also good at listening, that can then complement the medical care that we’re providing.

provides such value and it’s humbling. mean, can’t, every day I’m learning from our staff, their ideas, the things they’ve picked up on that I didn’t because I wasn’t really listening to the full story. I was paying attention to the medical side of things. It’s the, that role of navigation is such a huge compliment. And you talked about marketing and business.

very inexpensive compared to the cost that I bring to the healthcare system as a physician.

Tim Bouchard (16:23)
Yeah, have you found it easy or hard to communicate this type of approach to the MCOs? Just straight up, are they understanding it? Do they buy in? Are they having trouble internally getting buy in? It’s a very complicated thing. It’s, you know, it’s complex really.

Enrique Enguidanos (16:35)
you

Yeah.

Yeah. know, there are MCO being the managed care organizations, right? There are great people. I’ve found a lot of times we practitioners in medicine feel like we’re on the battlefield. Medical providers on one side and the medical industry, MCOs, Medicaid on the other side, and we’re battling each other. We’re enemies. And it’s really not the case. I mean, we’re really too

Tim Bouchard (16:50)
Yeah.

Enrique Enguidanos (17:11)
parts of a system that are working towards a common goal. ⁓ it’s understanding the language. I’ve gained so much by learning the finance side of the healthcare industry and where that’s coming from. And when I start to understand that, I get better. And there’s stuff I have to teach to the MCO industry. I do think I alluded earlier to the

value-based care. do think as an industry, we’re going to gain a lot as we’re in the midst of this transition from a fee-for-service model towards a value-based care model. And I have found, to answer your question, the more I can let our MCO partners, our state partners, know early on how and where I can bring value, I get in the door quicker. I can get into the dialogue.

So it’s on me to recognize where they identify value and find ways to bring that to them.

Tim Bouchard (18:20)
Yeah, I don’t want to oversimplify it, but I feel like right now, health care is very much hammer and nail. And your approach is more like the listing thing is sort of the like head on pillow. maybe it was just a pillow that was needed. Not to get too literal about the head thing.

Enrique Enguidanos (18:32)
Thanks.

Yeah, no,

I think that’s a good analogy.

Tim Bouchard (18:38)
⁓ What do you think is the biggest lesson that health care organizations can take from this? And maybe there’s two sides to it. Maybe it’s just, you know, I have a lot of small and medium sized practices that listen to this podcast, but the larger organizations are learning from this type of approach too.

Enrique Enguidanos (18:47)
Yeah.

What a great question, what a great question. And this is gonna sound so ridiculous to some, ⁓ but it’s listening. I think all of us bring such a great level of expertise in what we do. We’re all caring individuals. The healthcare, the insurance industry, the MCOs, the providers, all want the right thing to be done.

And we’re trying to navigate this system that in the midst of change, we’re talking here at the beginning of July in 2025 and Medicaid, you know, we don’t even know if it’s going to exist here in the next year. So what will it look like? And so in the midst of all that, I think as we listen to each other, as we listen to our enrollees, our patients and understand where each of us find value and

Tim Bouchard (19:26)
Yeah, lots.

Mm-hmm.

Enrique Enguidanos (19:49)
It’s not always a simple solution, but a lot of times it’s surprising how simple the, you know, what a patient identifies as value really is and what an MCO identifies in value and how then I can adjust to that.

Tim Bouchard (20:05)
Now, is there, I always ask this question, this is the wild card, is there anything I haven’t asked you that’s part of this conversation that you’ve been dying to say?

Enrique Enguidanos (20:15)
you know, you were very welcome of the listening side of things. I would have to say we all have to do that really well. think continuing to be innovative, continuing to think about where value lies, what each of the, you know, if you think of healthcare as a spoken wheel model.

where you have the enrollee, the patient in the center, and all the services that the individual interacts with as a spoke in that wheel. Just trying to figure out how we communicate with each other and how we identify value and avoiding duplication to the extent that’s another big part of the healthcare industry. I don’t think we communicate.

If you think about the air traffic controllers navigating planes coming every 30 seconds in and out of an airport, we don’t do that well. People are transitioning in and out of hospitals very effectively, in and out of their appointments very effectively. And so to the extent that we can communicate better, slowly work towards a common communication language.

within the healthcare industry, between hospital systems, between healthcare systems, I think there’s a lot of low-hanging fruit that will identify there as well.

Tim Bouchard (21:52)
Yeah, there’s going to be a it’s a hard shift to do a mindset shift to. And I think both on the health care side, providers and insurance and government are all trying to figure out how do we not do the nail and hammer approach. And I think the general public is trying to figure out how to come around to that, too. So I guess that’s not that’s not very good. I’m saying everyone’s lost. ⁓ So maybe it’s not that. But it will take a lot of people.

putting out messaging and communication that makes sense to both sides. To be able to pull this stuff together, it’s not easy to do that. And I think something that CBCS is doing, and I know you’re doing it primarily to get buy-in from navigator recruitment and from bringing this concept to the MCOs is ⁓ really leaning into the stories, the relatability of it. And I think if you just take that

Enrique Enguidanos (22:28)
Absolutely.

Yeah.

Tim Bouchard (22:51)
at high level, the relatable stories and understanding people’s situations doesn’t just apply to CBCS and this type of prevention. It just applies to very good, succinct messaging from people that know more than the people they’re serving to try and bring them comfortably into the system.

Enrique Enguidanos (23:08)
Yeah.

think you’re spot on, Tim. And you asked what more would I suggest. What you just said, I think for my cohort, physicians, the healthcare industry as we’re transitioning to value-based care and having to have that dialogue with ⁓ individuals holding the purse strings, whoever they are, MCOs, states, governance, ⁓ there’s no better storytellers than…

healthcare industry. We have such powerful stories we can share from our clients and listening to the industry, understanding how we identify, how we can bring value and creating a story around that. I think that’s going to be really helpful for the healthcare industry as we transition to this value-based care model.

Tim Bouchard (24:04)
Yeah, I’m all about the patient centric side of things. You hear it a million times on my podcast and on our website and my LinkedIn and everything, but I couldn’t agree more with that.

Enrique Enguidanos (24:11)
And you guys do a great job. I’m glad we’re aligned with you all because as far as

storytelling, know, shout out to Chris, our VP of business development and his work with you has been tremendous in the story.

Tim Bouchard (24:25)
Cool. Well, this has been great. Where can people find out more about you and CBCS?

Enrique Enguidanos (24:32)
Yeah, welcome. If anyone wants to visit our website, so www.cbccharlieboycharlie-solutions.org. We have some nice work that, thank you, and your routines have done around the work we’ve done around the different case scenarios, different projects we’ve had around the country, and we have our outreach numbers there on the website as well. So thank you for it.

Tim Bouchard (24:59)
Yeah, and there’s

there’s more to come, but we won’t get into that right now. All right. Listeners, if you want to take your practices, branding and patient recruitment to the next level, you can take advantage of our patient pipeline blueprint session offer. You can look up on our website, luminous that agency slash blueprint. Sixty, ninety minutes of workshop to uncover how you can attract new patients and convert more inquiries into appointments. If you want to hear more like this, you can watch us on YouTube, subscribe on Spotify or Apple podcasts.

Enrique Enguidanos (25:02)
Amen.

Tim Bouchard (25:29)
And Enrique, thanks again. This was a great conversation.

Enrique Enguidanos (25:33)
Tim, placer. It’s been a pleasure, man. Thank you.