The Granite List Live

One of the biggest barriers to individuals being proactive in their healthcare is the time it requires off of work, especially those in an hourly position.  This has a trickle-down effect on adherence to preventive measures such as cholesterol checks, EKGs, and logging in family history when minor symptoms present themselves. By the time an issue escalates, plan members may find themselves needing an ambulance, ER visit, or worse. National Diagnostic Services has a soft spot for emergency workers in municipalities and is dedicated to going to them at their stations, offices, schools to help them stay ahead of their health concerns. Many employers will compensate employees for their time visiting the drive-up medical van because it makes sense. It saves lives, time, money, heartache. Join Leigh and Sally as they start this conversation with Michael Ketslakh, CEO of National Diagnostic Services to learn more.

About our guest:

Michael studied Epidemiology at the University of Michigan School of Public Health. In 1997 he founded National Diagnostic Services (NDS), an independent diagnostic testing company servicing Michigan communities. Our traditional services began with management and operations of Primary Care and specialty clinics in the field of Cardiology, Physical Medicine & Rehabilitation, and Neurology.

In 2003, Michael and his team developed a Mobile Diagnostic Division, the first company of its kind to be awarded the prestigious ICAVL and ICAEL Accreditations from their National Boards. These high honors reflect the ongoing commitment to the highest levels of quality patient care and customer service and are the keys to NDS’s continuing success.

Michael has frequently lectured on the state of our health care, cost of care specific to manageable conditions, and methods of integration between employers and local health systems.  His content focuses on the need to establish program performance goals and guidelines.

The full transcript to this episode is here:

Announcer: (00:07)

Welcome to another episode of the Granite List Live. Navigating a sea of benefit solution is daunting at best, and new vendors emerge every week. Host Leigh Dill and Sally Pace bring brokers and employers a solid resource when it comes to uncovering what's new, what's needed, and what is happening now, to allow for the best plan design possible. By staying on top of trends brokers and employers can in turn stay on top of spending, while improving employee engagement and outcomes.

Announcer: (00:36)

One of the biggest barriers to individuals being proactive in their healthcare is the time at your requires off of work, especially those in an hourly position. This has a trickle down effect on adherence to preventive measures, such as cholesterol checks, EKGs and logging in family history when minor symptoms present themselves. By the time an issue escalates, plan members may find themselves needing an ambulance, ER visit or worse. National Diagnostic Services has a soft spot for emergency workers in municipalities, and is dedicated to going to them at their stations, offices, schools, to help them stay ahead of their health concerns. Many employers will compensate employees for their time visiting the drive up medical van, because it makes sense, it saves lives, time, money, heartache. Join Leigh and Sally, as they start this conversation with Michael Ketslakh, CEO of National Diagnostic Services.

Sally Pace: (01:44)

Thank you for joining us again today everybody. We are excited about the topic that we're going to cover. It's very timely and Michael and his team are some of the leaders nationally in what they're doing around chronic disease and cost containment. So Michael, why don't we start with you telling the audience a little bit about your business model? What does NDS do?

Michael Ketslakh: (02:09)

Yeah, so our business model really took the experience from the traditional healthcare. And right now there's a tremendous amount of articles that are written about the uncontrolled cost of healthcare and that diversification of that cost. So the examples of going and receiving an MRI that may cost manyfold of difference, whether it's done in a particular hospital setting or it's done in a particular outpatient setting. And that's applicable for almost every healthcare procedure.

Michael Ketslakh: (02:37)

What we try to do was to create a concierge, transparent, cost effective delivery of healthcare, primary care services. Really targeted toward self-insured employers, who are able to determine their costs and determine the area of healthcare focus for their population. And then it is becomes our responsibility to come in, to engage those employees, to educate them on the state of risk they may be in for cardiovascular disease, for different pulmonary diseases, chronic diseases, early cancers, depending on their occupational risk. Provide necessary blood work, physical examinations, and then engage them very importantly, appropriately into local area of care. Whether it is a primary care setting or a specialty setting depending on their needs.

Michael Ketslakh: (03:30)

And then expand it from that, we try to continue to have touch points with those individuals throughout the year to make sure that that coordination of care plan, that was determined between the primary care provider, our primary care team and them is continued to get followed. If somebody has had challenges following that coordination of care plan, we try to again develop a different guidance strategy to help them get to that outcome without ultimate focus of really reducing the different risk factors for progression of cardiac disease. Those risk factors are your basic lipids, your sugar level, your blood pressure, your cholesterol, things of that nature.

Sally Pace: (04:11)

I know I've had the privilege of being alongside your team when they've actually been working with firefighters. Describe for those listening, what that looks like. And you're running mobile units, so how does that work?

Michael Ketslakh: (04:25)

The keys to the success of the program, and what I mean by the keys to the success of it, is really having the outcome for those individuals over time of reducing those risk factors, and frankly improving their health. That starts out with the basic promise of lowering the barriers for folks to be able to participate with a primary care provider. So most of us, when we have a tooth ache, when we have a particular pain, we'll seek those healthcare services in an ER setting, physician setting, because they're symptomatic. With most chronic disease, they're frequently are those [inaudible 00:05:01] individuals is at risk factors or already may have the early stages of that chronic disease. They are asymptomatic in a large component of the labor force, especially for the folks who are dependent on an hourly type of wage that we often see in a manufacturing setting. Individuals who are asymptomatic will not seek primary care early on when chronic disease frankly can be stopped and reversed.

Michael Ketslakh: (05:28)

So the key component of our services is... What we did was we build mobile clinics and we take those mobile clinics to the place where people spend frankly majority of their lives, they're employers, and we operate 24 hours a day. So make ourselves available during shift times and the employers compensate and pay their employees to participate in these different services during their work hours. One of that is a form of reduction in the barrier of participation, is a key component of the success of the outcome of the program.

Leigh DIll: (05:59)

So do the employees come to you when they have an issue or are hurt or are they coming to you for check-ins like they would their primary care doctor?

Michael Ketslakh: (06:09)

Yeah. So the program that we're discussing right now is centered around the Annual Wellness Visit. So centered around your basic blood work, your lipids, your hemoglobin A1c, sugar, cholesterol, blood pressure, full physical examination, review of systems by a primary care provider, and really an in depth discussion about what that health history, what the blood work means to those individuals. So that particular program is a plan program. So it's structured individual signup for the program and they participate in it during those work hours. So in that particular program, we do not see acute care patients. The focus of that entire service is really to identify individuals with early stages of chronic disease, educate them, help them develop a care plan and then guide them using our nurses and care coordinators to guide them to appropriate level of care around where they live.

Leigh DIll: (07:08)

So how do you find the appropriate level of care? Do you have doctors in your system that you refer out to, is that part of their network? How do you find the appropriate care?

Michael Ketslakh: (07:19)

So on the mobile clinics, mobile clinics are staff or the providers, one or two providers depending on the size of the program. Nurses and MAs and technologists, depending on what kind of. Whether they're getting x-rays done, whether they're getting ultrasounds done, whatever they may be getting done. Prior to an event, we do determine what area providers are in the provider network of those particular individuals based on their insurance, based on are those physicians still accepting new patients, and we try to create really a soft transition from our unit to coordination of care by a local doctor. Which is important in many cases to make sure to get that individual engaged in that primary care level. So you don't wind up frankly, in ER with a heart attack.

Sally Pace: (08:05)

I mentioned the firefighters earlier. Can you talk about some of the verticals or the types of employers that you see being drawn to these services or that need them that maybe are not tapping into them?

Michael Ketslakh: (08:19)

So the example of a firefighters is very relevant. So the firefighter group of individuals are much higher risk than the general population. So as I just described our traditional program to the general public, involves very basic blood work, you're really looking at your cholesterols, your sugars, your blood pressures, basic physical. In the firefighter space, it becomes something else. Because firefighters are at 12% higher risk for cancer. They are at much higher risk for heart disease because of everything they have to wear and in a breathing apparatus as additional stress.

Michael Ketslakh: (08:59)

So for them, the actual event is a much more comprehensive event and the blood work involves over 90 different points of measurements of the blood work, looking for different heavy metals, looking for the traditional risk factors, but also a more risk factors that are pertaining to them. Firefighters undergo a stress test to determine the level of fitness that they have. Take a look at if there's any kind of EKG abnormalities in their heart. And similar program is actually operated for the police department too, because the police and fire, both of those emergency responders are under a significant risk of heart disease and cardiac events as well as cancer. So some of their testing is a little bit more specific to their particular occupational risks.

Sally Pace: (09:45)

But are you working only with municipalities?

Michael Ketslakh: (09:47)

Yeah well, we work with a lot of municipalities. We work with a lot of cities, city of Philadelphia, Cincinnati, Cleveland. We work with state police departments. We work with unions. Union leadership has recognized and has supported the need for the membership to be identified early for cancer or chronic disease to engage them early. Most of the states with the support of the union have presumption rules now for cancer for firefighters. So in other words, if a firefighter develops cancer after their employment, they are covered under different plans within the state. But like anything else, with cancer, one of the large components is early identification of an individual with cancer has a much higher probability of a cure, of a resolution, whether it's a hundred. Especially in the United States today. The further down the progression of cancer becomes, the higher the cost of that individual and the lower the probability of having a successful outcome. Now frankly, we just had a screening program yesterday and I believe it was in Baltimore. And one of the chiefs we're able to identify a significant early stage of cancer that was asymptomatic, that will be managed.

Leigh DIll: (11:05)

So will you be doing screenings just through blood work for early detection, or is it the ultrasounds?

Michael Ketslakh: (11:12)

There's a different modalities that are beneficial and you look at different things that are appropriate for different people based on their age, based on their sex, based on their occupation. So with us, because we are a traditional healthcare provider and our beginnings started out with diagnostic radiology, where we still provide ultrasound services, vascular services, computer tomography, CT services, MRI services to healthcare systems; what we do is we use a combination of those modalities Leigh. So in certain cases, the ultrasound is a great modality for identification in determination of certain vascular disease and screening for certain cancers. In a scenario where you're looking at lung cancer, CT is the best modality for screening for lung cancer. That's considered to be the gold standard. Also addition of calcium scoring during a CT scanner for folks who are 40, 50 years old. I take a look at blockages, potential calcium blockages in their arteries, in their coronary artery. So we use those modalities too.

Michael Ketslakh: (12:16)

So it really depends on the group. One of the things that we've been able to do, and we've taken this approach from really the beginning of the formation of our business and our company, our services. We're very customized to the needs of the employer. Specifically based on what is their culture, what are their risk factors? Because just like Sally and yourself are different and your health needs are different, same thing in a group setting too epidemiologically in group setting. It's also the same. So it's not really one size fits all. And that's, I think one of the reasons why we have been successful and that's why we've retained our customers and have grown, because we do provide tremendous amount of customization to clients. Not just on the services they're provided to them, on the communication strategies it is really not one solution that fits all.

Sally Pace: (13:13)

So we talked in great detail about the municipal sector and what you're doing. Can you describe on the corporate side, what trends you're seeing with the clients you serve there?

Michael Ketslakh: (13:26)

Well, we've seen in the last seven years in a self-insured for-profit corporate side, is a much larger a awareness of loss of revenue and ineffective solutions and specifically in the healthcare spend. So we've found that with the new analytical tools and software that's available, self-insured employers, and a lot of times were part of those discussions, we're able to take a look and identify the health spends, and take a look at where those health spends are ineffective. Ineffective, meaning they're too high and there outcomes are not particularly significant. And then create a solution, whether it is a annual wellness solution, whether it's a screening solution, whether it's a mental health solution. That's one of the things that we've seen really on a rise in the last two years. We started putting in a lot of mental health providers and providing mental health support for employers, because of anxiety and stress that folks have been dealing with.

Michael Ketslakh: (14:22)

But a lot of it in a self-insured space is actually becomes much more customized. Because employers, with their employees are very different. You may have older population, you have a younger population or population that's predominantly female or predominantly male. And based on those, and not just based on those, but as some of those factors that they should be considered when we're taking a look at trying to present a program. And most programs are multi year programs, you certainly to address healthcare. There's no solution, no cure of chronic disease. It definitely takes time and there needs to be commitment over usually at least a three to a five year period for a particular program to see significant outcomes. But again it's always customized. And I do from a standpoint of the difference between municipalities or government entities and for-profit entities, the for-profit entities are much more flexible. And it doesn't matter the size that they are because we deal with employers that are as large as 40,000 employees. They generally much more flexible and willing to take a look at what they can do and how can they measure the difference.

Leigh DIll: (15:34)

So if an employer wanted to engage you, what would implementation look like? Would you look at their data and say, "These are the lines of service that I can provide to you to help bring down costs." Or do you roll up your mobile clinic and start looking at their patients? How does an employer decide how to engage your services?

Michael Ketslakh: (15:55)

There's different levels of services that we provide. We usually would like to start with a foundational base of the Annual Wellness Visit. The reason we like to start with that particular service, is because it is really the foundational structure of identifying what are the chronic disease and what are the risks in the population. So once we have that aggregated data, then from then we can take a look at additional programs that need be much more targeted toward particular individuals or particular groups. The engagement process usually needs at least a three month lead time. It's got to be effective communication. One of the strategies that we found effective is onsite seminars to the employees, explain to them the differentiation of who we are versus the employer. Making sure that the employee feels comfortable. That their healthcare records remain private and we are a healthcare entity, and by law their personal records are now at shared with their employers. And then educating them specifically on the use of that program and its benefits, and then rolling it out. So usually takes approximately three months lead time.

Sally Pace: (17:03)

So Michael thinking about this incredible business that you've built, can you share with us a success story, something you're really proud of that you and the team have accomplished?

Michael Ketslakh: (17:16)

Well, I tell you, I can't take credit for the success of the company. I will take a little bit of credit for leading and being able to frankly, be honored to be part of such a great team. Folks have been... Most of our upper management team has been with us average 10 years. I think all close to 15 years. Our average's over 10 years for the company. So I'm proud of the fact that the folks from a perspective of leadership, they put their trust in me.

Michael Ketslakh: (17:39)

There's personal success stories. I mean, there's personal success stories that we have. Actually, one of them is I believe sergeant. One of the gentleman. He is actually a firefighter, came to us for physical asymptomatic, was physical and distress, had some stresses in the physical. Were very positive right away. We were able to stack his report, we're actually able to transmit his data right from our mobile unit to our cardiology for a second opinion from primary care. Identify the individual at risk. Rushed him right away to the hospital. And he wound up having a quadruple bypass and survived. And that's on individual level that always stands out significantly with you because it's something that the person would not have been there for his children, for his loved ones if those things were not identified.

Michael Ketslakh: (18:31)

One of the things that... And this happens to us fortunately frequently, unfortunately we don't recognize as a society that first sign of cardiac diseases is frequently heart attack. And that's one of the things that we're trying to avoid. On the level of more aggregate successes, we just had one of our longest clients do a third party analytical review of our service and our programs, and besides the fact that it will identified that the program had a return on investment of almost 1.89 times per year. The program economically saving over $1.4 million every year to the client.

Michael Ketslakh: (19:12)

It also showed tremendous success in the outcomes of a very high risk chronic population. They had me show to the folks that were participating in our programs over the period of four years, that their risk factors and their compliance to necessary conditions really was reduced. Not the compliance, but the risk factors. Compliance was improved. That's significant. And we hear them all the time. Just one of our radiologists just identified a significant mass of one of the individuals recently. So it's always a wonderful when you hear the folks later on and they write letters and it's very nice. It's a very rewarding experience. I can tell you that.

Leigh DIll: (19:55)

So timely too, as people really are concerned about their health these days, and they don't have time to take care of themselves. So being on site for those employers and employees is definitely important right now. We surely appreciate you taking the time to share your story and your company, and all your successes that you've done. For those that want to get in touch with you Michael, can you share your contact information on how to reach you?

Michael Ketslakh: (20:20)

Yeah, I can be emailed at [email protected]. Folks can just call to our office at (248) 476-6980. Our website is NDSwellness.com, just like the acronyms in the name and the end there's a contact tab there they can just request a meeting. We'll be more than happy to take a look at their specific needs and see what we can do to help them.

Leigh DIll: (20:47)

And one more thing that we love to ask all of our guests, is what is your favorite industry book? Is there a book that you would recommend to our audience that they need to add to their bookshelf?

Michael Ketslakh: (20:59)

One of the great books I've just read, which really opened up my mind, many different ways. It's called When More Is Not Better by Roger Martin. It's a very interesting book that takes a look and analyzes efficiencies and analyzes the dangers in inefficiencies. And I think actually it's pertinent to our conversation today because sometimes when there's focus on efficiencies, there is reduction of focus on quality. And that book takes a look at that across all industries, whether it is finance, whether it is legislative, certainly it's applicable in the healthcare industry. It's very interesting.

Leigh DIll: (21:41)

We thank you for sharing that and we will be sure to link that on our resources page on the GraniteList.com or CHC-now.com. So be sure to pick up your copy.

Announcer: (21:54)

National Diagnostic Services onsite programs are designed as a supplement to team members existing healthcare providers. Our programs focus on educating participants about their health status, educating them on behavior change options, and engaging them to additional care when needed. Our scope has expanded to onsite programs for municipalities and self-insured corporations, with a goal of removing barriers of participating by delivering a concierge level program at the place where people spend the majority of their time, their work. The demand for this service expanded NDS's reach to a national footprint. Currently servicing employers in 33 states. Learn more at NDSwellness.com. Thank you for listening to this episode of the Granite List Live. Access our entire library by visiting your favorite podcast venue or subscribe in our site, the Granite List.Live.