George Brandes of Pacify: In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System

An Interview With Luke Kervin

Use positive incentives. Positive cost incentives can be a powerful way to guide behavior change for better health. Say, for example, giving people a financial reward for joining a smoking cessation program. Though this will cut into an insurer’s margins in the short-term, in the long-term, quitting smoking is exponentially less expensive than lung cancer treatment. We need to find ways to drive small behavior changes that add up to massive benefits long-term — everything from healthier patients to lives saved.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview George Brandes, CEO of healthcare technology company Pacify.

George Brandes is a healthcare entrepreneur and CEO of Pacify, the leading virtual value-based care solution for maternal health. George co-founded Pacify in 2014 and led its successful transition into the innovation arm of Advantia, the national healthcare provider transforming the care model for women. Having managed physician practices and helped shape public insurance programs, George is passionate about bringing the power of the private sector to solve public health problems.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

I’ve been in and around healthcare and public health since I was a kid. My mother is a neurologist who owned her own practice. She made a point of accepting patients on Medicaid and instilled a belief in me that everyone should have access to the best possible care.

After college, I became her practice manager and navigated its sale to one of the largest hospital systems in the country. We saw the macro shift of smaller practices joining larger systems and the economics made sense.

At the same time, the industry was also shifting towards increased access to health insurance through the Affordable Care Act. I recognized how massive a change the ACA would bring and I wanted to be a part of it. I decided to do my graduate work in healthcare finance and insurance regulation in the European Union, which had several countries that provided working models for the type of insurance market created by the ACA. They were like petri dishes for understanding what would (and wouldn’t) work on the new insurance exchanges.

I got back to the U.S. in 2011, right before ACA implementation started. All the decision-making was happening in government so I had the privilege to serve as a public official in Tennessee’s Medicaid program (TennCare) working to prepare the state for Obamacare.

What’s interesting in terms of Pacify is that this seismic shift in the U.S. healthcare industry dovetailed with the smartphone revolution. At TennCare we were seeing women go to the ER for all kinds of non-emergency issues, including infant feeding. We launched Pacify around the idea that we could help solve that problem by offering pregnant women and new mothers access to reliable, instantaneous advice via smartphone.

Pacify was formed in the spirit of helping more people access healthcare, particularly through our public insurance programs. Now, seven years later, the technology has gotten faster, better and cheaper, but there are still significant gaps in access to high-quality care for women and new parents across the country — that’s something we’re working on every day at Pacify.

Can you share the most interesting story that happened to you since you began your career?

One of the more interesting stories of my career happened in the runup to the health insurance exchange launches in 2013. I had moved into the private sector — at Jackson Hewitt Tax Service — where we were turning tax filing into an opportunity for families to buy health coverage on the exchanges. We realized that the Obama Administration was going to exclude many of the very people they hoped to help by allowing exchange plans to refuse payment for premiums by any means other than ACH bank transfer. Understandably, the plans didn’t want to pay 3% of their premiums to Visa, but we felt we needed to advocate on behalf of our customers (who would face tax penalties for not having health insurance).

The administration had overlooked the fact that many of the people who would be eligible for premium assistance in the healthcare exchanges didn’t have a banking account! We worked with a Vanderbilt health economist named John Graves on a piece of original research that showed that 1 in 4 adults on the exchange would be “unbanked.” Without a policy change, they wouldn’t be able to pay for their new insurance.

We sent that research everywhere — to lawmakers, to peers, to the press. It took the better part of six months but ultimately the press coverage helped the administration see the light. Right before the first open enrollment period began, HHS released a rulemaking that required all exchange plans to accept premium payments via check, credit card, prepaid debit card, etc.

It was fascinating to see this play out in the public arena and know that it probably wouldn’t have happened without our research and advocacy on behalf of our tax prep customers.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

We were convinced when we first started that nutrition advice would be a huge part of the Pacify app. So in addition to lactation support and nurse advice, users could call a nutrition professional, 24/7.

But the thing was, nobody used it. It was a classic example of a problem that a lot of founders face — you can’t build a product based on what you think people need, you have to build the product around what they actually want. Who wants to call a nutritionist and hear that you need to eat better? I don’t.

But issues like infant feeding or other acute health issues really do have urgency. They necessitate instant help at the touch of a button. Because nutrition is a longer-term, behavioral issue, it just didn’t get the traction through the app that we thought it would.

Very quickly, we learned an important lesson in health tech, or any business: Don’t get too attached to a feature or service until you have data that shows people are going to use it.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“A leader is a dealer in hope.” — Napoleon Bonaparte

Starting or joining an early-stage company is a fundamentally hopeful act. It requires a leap of faith in yourself, your team, and even in your customers. The one thing uniting everyone around your company and product is belief in a vision of the future that is, at its core, hopeful. As a leader, you have to keep that vision alive and make it real for everyone. In that way, hope becomes the currency that fuels your growth and supports your path to success.

Are you working on any exciting new projects now? How do you think that will help people?

Yes, one of the more exciting things we have going on right now is that we’re broadening our on-demand services to include doulas. Pretty soon, Pacify will be the first provider of national, scalable doula care in the country.

There’s good evidence that expanding access to doulas could move the needle on health outcomes, particularly among pregnant Medicaid members. According to the March of Dimes, access to doulas provides a number of benefits including fewer unnecessary C-sections, improved infant Apgar scores and a better birthing experience. So far, it has been difficult for parents to get reimbursed for doula care through their insurance. We’ve got the right model in place to fix that.

How would you define an “excellent healthcare provider”?

This is a question that’s deeply relevant to our work at Pacify. Under the leadership of our Chief Clinical Officer, Melanie Silverman, we have a rigorous screening process for the maternal health providers who join our network. And she’s not just looking for people who can diagnose quickly. We also need people who can truly listen to patients and make them feel seen and heard at a time when they’re extremely vulnerable. Also, because we provide care via telehealth, we need people who can bond with patients via video. We call it empathy: that magical ability to create an instant emotional connection with a patient.

As a whole, I think the industry is only now recognizing the importance, not just of technical skill, but also the ability to empower patients to change behavior. Our country’s most devastating health issues are not acute and immediately treatable with a scalpel. They require a very different kind of provider to address mental health issues, substance abuse and general behavioral change. Soft skills like empathy are going to be increasingly critical.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

This is a real and important issue for Pacify, which primarily serves Medicaid members and WIC participants, many of whom struggle to access care.

As for where the healthcare system struggled during the pandemic, that’s an interesting question. In many ways, the pandemic revealed that the system is functioning exactly as it was designed.

Take hospitals, for example. During the pandemic, they dealt with an unknown pathogen and a lot of uncertainty. They transformed their operations from being dependent on elective procedures to keeping very sick people alive.

Given how hospitals are structured, they adapted quickly. The problem is that neither hospitals nor insurers are designed to maximize access to care for a public health crisis, or any public health initiative really.

One of the clearest examples of this is the vaccine rollout. Low-income and minority groups were vaccinated at dramatically lower rates compared to the general population. The rollout revealed that the country’s healthcare infrastructure is disproportionately designed to take care of people who are higher income and have commercial insurance.

The best way to correct these issues going forward is to invest in public health infrastructure outside of the hospital doors. Private investment dollars can be a crucial resource here, which I’ve seen first-hand at Pacify. We were able to bring venture capital dollars to improve access to services through Medicaid — which is out-of-the-box, for healthcare and venture capital.

While most maternal and infant health investment dollars are slugging it out in an employer benefits arms race, there are a lot of economically rational opportunities in Medicaid, but it’s a complex program. We have to do a better job of bringing innovation and private investment into the public health space.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

From our perspective, one of the bright spots is that the pandemic dramatically shifted people’s general acceptance and utilization of telemedicine. We saw this even in maternity care. Of course, you can’t virtually give birth. But during the pandemic, parents and babies were being discharged from the hospital in about half the normal time. That meant many families missed out on lactation support in the hospital, which is a critical way to establish healthy infant feeding.

When that happened, Pacify stepped in and filled the gap for our partners. We saw a 50% increase in call volume during the peak of the COVID-19 pandemic and filled some gaps in access to lactation support through telehealth.

That’s one example, but there were many instances of providers offering appropriate care through telehealth that should and will become standard components of caregiving.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

1. Bring more private investment into Medicaid and public health programs. Pacify is just one example of how this strategy can be successful. We need to marry the innovation of the private sector with large systems that are already established to reach the underserved. We don’t need to reinvent the wheel. We do need to figure out where we’re going and design the best car to get there.
2. Invest in harder-to-solve health issues such as behavior change. The U.S. healthcare system is one of the best in the world at addressing acute issues. Physicians and researchers are pushing the limits of medical procedures every day. Now, we need to take our collective healthcare strategy to the next level. Rather than treating people and sending them home, we need healthcare to extend to the softer skills that truly help patients change behavior for the long term — skills such as relationship-building, earning trust, empathizing with patients, setting clear, achievable health goals and showing up for people.
3. Continue integrating payers and providers for value-based care. Kaiser Permanente pioneered the integrated care model. Now, we’re seeing the lines between payers and providers blur in all sorts of ways: Providers are building their own commercial or Medicaid insurance plans and startup insurers are providing care. This trend will continue, and it’ll bring more players in healthcare under the same roof to hopefully incentivize better outcomes.
4. Use positive incentives. Positive cost incentives can be a powerful way to guide behavior change for better health. Say, for example, giving people a financial reward for joining a smoking cessation program. Though this will cut into an insurer’s margins in the short-term, in the long-term, quitting smoking is exponentially less expensive than lung cancer treatment. We need to find ways to drive small behavior changes that add up to massive benefits long-term — everything from healthier patients to lives saved.
5. Protect against large-scale data-security attacks. As a country right now, we have such an atomized and varied healthcare landscape with so many independent players, it’s a paradise for malicious actors to attack large systems and pull sensitive information. We need more attention from industry trade groups and government organizations towards protecting against large-scale ransomware attacks and rogue actors or state-sponsored cyberterrorism

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

This is another issue that’s near and dear to our hearts, as a company that’s part of Advantia, a national OBGYN practice with over 200 providers. For many young people entering the profession, the math doesn’t work — meaning the money and time it takes to become a doctor, and especially a primary care physician, doesn’t guarantee the quality of life and salary that merits the cost.

On some level, the way to address it is simple: If we as a country think primary care is important, we should pay for it. We can do that through a number of ways including creating incentives for people to go into primary care, especially in rural areas.

How do you think we can address the issue of physician diversity?

Pacify actually has a good model for this in our Diversity in Lactation Consulting Scholarship. The scholarship covers the costs of the exam to become an IBCLC. Our typical applicant is a woman of color who is already a Certified Lactation Counselor or a WIC peer counselor, so the scholarship is designed to empower this existing talent pool by removing a significant cost barrier that stands in the way of reaching the top of their profession.

The same should happen for physicians. Roughly 40% of the healthcare workforce is non-white, according to the Kaiser Family Foundation. But people of color disproportionately have jobs such as home aids and personal care workers. We have to create channels for people who are already working in healthcare to pursue a more advanced degree. We have talented non-white providers already working in the healthcare system — we must create opportunities for them to advance.

How do you think we can address the issue of physician burnout?

As of 2018, about a third of physicians said they spent at least 20 hours per-week on administrative tasks, according to the Medscape Physician Compensation Report. That’s an incredible waste. It also casts the physician shortage question in a new light. In some geographies and professions, yes, there absolutely is a physician shortage. But we also have a physician time shortage, meaning too many physicians aren’t free to practice top-of-license and are burning out.

To solve this, we need to find lighter-touch ways for physicians to participate in administrative work. We can automate tasks such as data entry whenever possible, and otherwise support physicians by removing mundane tasks from their day and freeing them up to provide care.

What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

Manifesting changes at a hospital system has to start with the top. There are physician-friendly CEOs across the country working tirelessly on this. To make it happen, people in positions to create change need to care about physician burnout and take a risk to implement innovative practices or technologies such as automation to help redirect the physician workday towards clinical work. In this case, leadership sets the standard.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I seriously question my influence on the world, but if I could inspire one movement, it would be to harmonize all of the healthcare payment models that make it so difficult for people to access and pay for appropriate care.

What we have now is a patchwork of healthcare finance programs. I would make it simple for people to transfer from one program to another. We would have a much more functional society and a stronger economy without health insurance being an insurmountable barrier to changing jobs. I think we need to build bridges across these programs that make it easier for the people who administer them and the participants to access the care they need.

How can our readers further follow your work online?

Readers can find the latest information about Pacify on our website, www.pacify.com, or follow us on Twitter, Instagram and Facebook @PacifyApp. They can also check us out on LinkedIn at https://www.linkedin.com/company/pacify.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.