Why Healthcare’s Old Processes Can’t Keep Up with Medicaid Changes with Asya Rudikoff, Co-Founder and CEO of AccessIQ

[00:00:03] [SPEAKER_01] Hello everyone and welcome back to the Outcomes Rocket. I'm excited to be chatting with Asya Rudikoff today. She is in charge of AccessIQ Health, a physical therapist by training. She's an amazing healthcare operator and I'm excited to dig into her experience and exactly what they're doing for this very important space. So Asya, thanks for joining me today.

[00:00:32] [SPEAKER_00] Yeah, thanks for having me. I'm excited to be here.

[00:00:35] [SPEAKER_01] Yeah, and so you've done a lot of things from Solis Pediatric Home Healthcare to directing strategy at Team Select Home Care. I'm excited to help you unpack sort of the area that you cover. So talk to us about what got you into healthcare and why the area that you've decided to focus on.

[00:00:53] [SPEAKER_00] Yeah, so it's been an interesting journey. So I started out as a physical therapist and was very determined never to have a desk job and now I have a desk job. But I think what I loved the most was this ability to create relationships with patients and families and create this whole community of coordination. So that was really my entry point into this whole healthcare space is I was treating patients.

[00:01:19] [SPEAKER_00] I went the typical orthopedic route and my husband and I moved out to Denver and the whole trajectory of my career changed when I started in pediatric home health. So I was treating and I just started to see all the time what kind of impact, what kind of incredible impact we could have when we met patients where they were at. And that for me was really this vulnerable place called home. Going in and saying, how can we impact their day to day? What does that family dynamic look like?

[00:01:48] [SPEAKER_00] How do we actually take all the things that we want these kids to learn and transfer it out of the four walls of a clinic into a more meaningful space where they actually live their lives? It really changed my perspective on this entire kind of healthcare industry and the beauty and the value of having that care be in a place where the person actually lives versus goes to visit. So I started seeing back when I was still treating, I started seeing kids at the time just get kicked off randomly is what I felt off my caseload.

[00:02:17] [SPEAKER_00] They were being discharged because they weren't eligible anymore for Medicaid. And at the time, I didn't really know what questions to ask. I thought that was maybe that was just the norm of home care. I didn't know enough to even ask questions. And then I started to see over the course of my career, both as a treating clinician and then as I switched kind of sides of the house to the admin side, just this was happening at a crazy rate. People were getting kicked off without any sort of warning, without any sort of, hey, this is what you need to do.

[00:02:46] [SPEAKER_00] And it was an overwhelming sense of anger, to be honest, both when I was, again, still treating and working with these families every day. And then when I saw the impact of what these disenrollments were doing on the operating side of the house. So after COVID and the unwinding, so many people got kicked off. 25 million people lost coverage. And 70% of that was because of procedural errors.

[00:03:11] [SPEAKER_00] And so when you look at those numbers, if that doesn't fill you with rage, then maybe we need to have a different conversation. But just the thought of all of these people who this system was designed to protect falling through the cracks without any sort of warning system. It just doesn't sit right with me. It's just not okay.

[00:03:28] [SPEAKER_01] So Asya, tell me about the procedural errors piece so that I could understand that. I'm not sure that I'm connecting the dots.

[00:03:34] [SPEAKER_00] Yeah. So when we think about procedural errors, when you think about the world of, we're talking specifically about this Medicaid space, right? Medicaid is not constructed the same way that Medicare or your commercial payer is. There's not this kind of fall open enrollment season where you get coverage for a year, then you don't think about it until the next year. It's this kind of monthly cadence of are you eligible for the next month? Are you not eligible?

[00:04:00] [SPEAKER_00] And even though you have an annual redetermination of whether or not you're eligible, it's really finicky. And a lot of that has to do with just the volume and how many hands have to touch one person's enrollment package for them to actually get coverage to begin with and then maintain it. So you've got the state involved in the actual Medicaid. If you are in a state with MCOs and managed care organizations, there's another whole layer. So is it getting, you know, you've got the hands in the pot from them.

[00:04:30] [SPEAKER_00] You've got the people at the county level in certain states that are responsible for getting those packets to the people. You've got the people themselves who have to fill it out. And do they have the appropriate proficiency in the English language to complete that paperwork? Do they need help from an intellectual standpoint to be able to complete the paperwork? So there's just so many opportunities for error that have nothing to do with whether or not the person actually is eligible for those services.

[00:04:57] [SPEAKER_01] And is that what you mean about procedural errors, the procedure of getting approved for that month again?

[00:05:04] [SPEAKER_00] Yeah, the procedure of getting approved or almost like the reverse of that, of not getting kicked off for that next month.

[00:05:11] [SPEAKER_01] Of not getting kicked off, man. Yeah, I didn't realize that it was a month to month. That's fascinating. That's fascinating.

[00:05:17] [SPEAKER_00] Yeah, and so technically it's not, but operationally it is. So any provider agency, anybody that you speak to that serves a Medicaid population, you'll often hear this kind of age-old tale at this point of it's the beginning of the calendar month and we check eligibility and we make sure that they're still active on their Medicaid, whether it's a waiver or just the Medicaid program of the state.

[00:05:40] [SPEAKER_01] Wow. Now that's fascinating. And so talk to me about your company.

[00:05:44] [SPEAKER_00] Yeah.

[00:05:45] [SPEAKER_01] What are you guys doing to help with some of these challenges?

[00:05:48] [SPEAKER_00] So AccessIQ is really here to help be proactive in this inherently reactive space. So what we're typically doing, and we saw this during the unwinding, we're going to see this, well, we see this now in its current state and it's going to get significantly louder, I think, as some of the One Big Beautiful Bill policy changes come down the pipeline at the beginning of next year, is everybody is just putting out fires all the time.

[00:06:14] [SPEAKER_00] So they wait for, and they don't wait, but these people inevitably get kicked off at some point. And then there's this whole chase of how do we get these people back onto coverage? Did they miss a form? Who do they need to talk to? How do I get a hold of their case manager? And in the meantime, the providing agency needs to say, okay, well, do we continue giving services? Do we continue rendering nursing care and therapy and wound care? And that in and of itself becomes this whole kind of ethical dilemma with all of this.

[00:06:43] [SPEAKER_00] But what we do is we help these people be proactive. That's like the number one thing that we do is we say, hey, who is at risk of getting kicked off and why? And what can you do about it before it actually happens? How do we empower this community, the patients, the caregivers, the healthcare providers to have a little bit of this crystal ball to say, hey, Mr. Smith is actually at high risk of getting kicked off. And maybe it's because he gets kicked off at the same time every year.

[00:07:12] [SPEAKER_00] Maybe it's because his mail has been bouncing back and the likelihood of him actually getting a redetermination packet is slim to none if his regular mail isn't making it. So we take all of these different risk indicators, these signals that can say, hey, who on your census, who in your community is at risk of losing coverage and why and what can we do about it before it actually happens? And that's really the biggest thing that Access IQ brings to this industry.

[00:07:39] [SPEAKER_01] That's great. Asiya, what's your entry point? Are you working with governments? Are you working with FQHCs? Talk to us about that.

[00:07:47] [SPEAKER_00] Yeah, it's a great question. So we started really pointedly in the home care space. It's the space that I've been in for over a decade and where I've seen a lot of the painful ripple effect of people losing coverage. It quickly expanded. We're talking with safety net hospitals. We're talking with mental health providers who are also primarily serving the Medicaid population. We're even having conversations at the MCO level, at the state level.

[00:08:13] [SPEAKER_00] Everybody kind of up and down this entire chain gets impacted if somebody loses coverage. And that's really a big message that we're trying to educate about. It's not just that person loses coverage and that person loses their benefit, but it really impacts the entire health care ecosystem.

[00:08:30] [SPEAKER_01] Got it. Yeah. Because it also means that facility loses revenue, right? Absolutely. I mean, and so this is the both sides of the equation matter.

[00:08:40] [SPEAKER_00] Yeah. The facility loses revenue. They're already in survival mode all the time, especially if it's a smaller organization. Think about our rural communities, right? And then that person doesn't just all of a sudden get better and not need services, right? So they're going to seek out where are they going to go? If they're not getting that service in their home, they're going to go to the hospital. They're going to go to the urgent care. And when you think about the price tags attached to those more expensive services, those are state dollars, right?

[00:09:08] [SPEAKER_00] So it really impacts everybody up and down this chain.

[00:09:12] [SPEAKER_01] Yeah. No, I love it. I love it. The work you're doing is important. What would you say you do different or better than what's already out there?

[00:09:21] [SPEAKER_00] A lot of people ask this question. And I think the biggest differentiator for us is we answer the question, so what? And so what I mean by that is we're in this era where AI is the buzzword and data and technology and everybody wants information. But I think we're kind of past this point of just wanting the information. We want to know, does it matter? If it does, what do I do with it? Is it just noise, right?

[00:09:49] [SPEAKER_00] So we really differentiate ourselves by saying, yeah, not only are we going to tell you all of these signals that we pick up on, but we're going to give it to you in a meaningful way. If you have 200 people on your census that you're serving, why do you need to know about 5,000 other things that might not be relevant to that community, right? You're already trying to do more with less in this industry, and that's not going to change. So how do we help you prioritize that time?

[00:10:13] [SPEAKER_00] How do we help you empower the people who have these connections with the patients, with the community to say, okay, well, this is what we need to focus on this week to have the biggest impact. And then next week when we come up for AIR, we'll focus on that next step. So I think that's really the biggest thing is we give the data in a meaningful way and we tell you why it matters to you, if it matters to you, why it matters, and then what do you do with that?

[00:10:39] [SPEAKER_01] Yeah, that's really valuable. And how do your services get paid for?

[00:10:43] [SPEAKER_00] So we have a monthly subscription fee, and so we really go out to our clients who are the service providers. Your home care agency is providing therapy or nursing, your hospital systems, your physician providers. So what we do is we basically have a subscription model because the whole purpose of this is to keep tabs on what's happening with these people. You don't want to lose sight of that because it is, to our point in the beginning, it's almost like a toggle switch, right?

[00:11:10] [SPEAKER_00] Somebody can be on and eligible and ready to receive services and then kicked off very quickly.

[00:11:16] [SPEAKER_01] Got it. That's really great to know. So for all you home care services, providers out there, and maybe even health plans, you're working with health plans too?

[00:11:25] [SPEAKER_00] Yeah, we're starting these conversations with health plans because they're also losing, right? When they lose members and they can't cover their members, they also have a huge revenue hit from their collecting PMPMs or something of that nature. Exactly. Yeah.

[00:11:38] [SPEAKER_01] Exactly. Cool. This is great. What's been, as you've built the business and expand the number of lives that you guys have on the platform, what's been the biggest challenge that you faced and a lesson that came out of that?

[00:11:52] [SPEAKER_00] I think the biggest challenge has been just the acceptance that our industry needs to move forward and change. And what worked for us 10 years ago, five years ago, doesn't work anymore with the volume that has really been flooding the home health and that post-acute space, the people who need the services, the resources, like the staffing, right? That's not getting any better.

[00:12:17] [SPEAKER_00] So I think the biggest pain point has really been to work through these conversations with these provider agencies and say, hey, why are you doing it this way? Why is this still your process? And moving past this point of, this is how we've always done it. This is how our industry has always done it, right? But everything is changing. Everything is changing so rapidly. Even if you look from a regulatory standpoint, thousands and thousands of regulatory and policy changes every year. We can't.

[00:12:44] [SPEAKER_00] We can't keep doing what we were doing five years ago and still be as effective and as efficient at serving the population that needs us.

[00:12:52] [SPEAKER_01] Yeah, so well said. Asya, I think what you're doing is so important and I want to make sure that people know where to reach you. So tell everybody with us, best place to get in touch with you, the company and how to learn more.

[00:13:06] [SPEAKER_00] Yeah, thank you so much. We're online at www.accessiq.health and I love connecting with people in the community. I love to exchange ideas and brainstorm together. So feel free to reach out to me directly. It's Asya at accessiq.health, A-S-Y-A. And I would love to strike up a conversation.

[00:13:28] [SPEAKER_01] You're in Denver, right?

[00:13:29] [SPEAKER_00] I am. I am in Denver.

[00:13:30] [SPEAKER_01] So if any of you folks are in Denver, that's an opportunity with a neighbor to get together and solve some of these issues that are, you know, community issues. It's important that we have these conversations. And if somebody in your network or somebody that you know could benefit from these types of services, whether it be a patient or one of the provider organizations that Asia mentioned, get in touch as well because that's ultimately how we make progress happen. Thank you all for tuning in to this episode. And Asia, thanks so much for being with us.

[00:13:59] [SPEAKER_00] Yeah, thank you so much.