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Brad Smith is attempting to resolve some of the intractable issues in U.S. well being care — the dwindling variety of suppliers in rural communities.
He calls it “fun.” And he is making some huge cash doing it.
Smith, 40, is chairman of the fastest-growing company within the nation, the Nashville-based telehealth providers firm CareBridge. He launched Russell Street Ventures 2021, a well being care-focused enterprise incubator. And, The Tennessean has realized, his Main Street Health rural well being care enterprise stemming from Russell Street simply closed a $315 million financing deal and can develop from 18 to 26 U.S. states.
Smith’s success has come from discovering enterprise alternatives in areas of well being care which were historically uncared for. And Tennessee, the place well being care deserts are increasing — notably in rural areas — is fertile floor for such enterprises.
“I think what we’ve focused on is populations that were typically needed but also underserved,” Smith instructed The Tennessean. “Whether that was end-of-life care, whether that was hospice or whether that was rural (health care), it turned out nobody was focusing on that and it was a massive market.
“It’s this good mixture of with the ability to assist lots of people however, on the similar time, construct actually large companies.”
Smith isn’t exactly a household name.
But his fast-growing East Nashville-based business and his attempt to address shortfalls in rural health is quickly making him one of the biggest names in Tennessee. Quietly, he’s already a well-connected player, with ties to former U.S. Sen. Bill Frist of Tennessee, members of the former Trump administration, the Tennessee state government and his mentor, former Tennessee Gov. Bill Haslam.
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Main Street places “well being navigators” in more than 900 partner primary care clinics in rural communities to help coordinate patient preventative health screenings, patient scheduling, hospital discharges and related needs. The average partner clinic has two to three navigators and is located in a town of 3,000 to 5,000 people, according to Main Street.
Unlike the more traditional fee-for-service model of health care, Main Street Health uses a “value-based” reimbursement model that rewards providers for health outcomes. Ideally, this improves patients’ health and saves on overall medical costs.
Main Street already claims to have produced a 23% reduction in hospitalizations for its clients and a 9% reduction in medical costs.
Smith’s supporters talk about him like he’s a wunderkind.
“His insatiable must be taught, develop and enhance at the whole lot he does has made every firm extra profitable than the final,” said Ann Lamont, the co-founder and managing partner of Oak HC/FT, one of Main Street’s leading investors, and Connecticut’s first lady.
“Yes, they’re financially profitable, however much more vital is their monumental impression on the healthcare system. These usually are not copycat firms. Each one is fixing points within the healthcare system in a manner that nobody else has tackled the issue.”
Meteoric rise in health care
Smith’s meteoric rise in the health care industry seems almost inevitable.
He first made a big name for himself in Nashville when he co-founded Aspire Health with Frist in 2013. The two had collaborated years before on the Tennessee State Collaborative on Reforming Education.
And, as Frist recounts, it was a perfect fit. Smith pitched Aspire Health to him in 2011 as an in-home palliative care company that would be a “home name” service for patients with serious illnesses and/or needed end-of-life care. Frist said, as a physician and a member of Congress, he knew this was a service that was sorely needed.
“Aspire Health is profitable as a result of it faucets into an actual affected person want and void within the bigger healthcare system,” Frist said. “Most people don’t know the phrase ‘palliative,’ so we described ourselves as a ‘home name doctor apply’ accessible across the clock for individuals who’re battling most cancers, affected by a number of hospital readmissions, or dwelling with a debilitating continual sickness.”
It was an enormous success. Within 5 years, the corporate had 750 workers and served greater than 100,000 sufferers in 25 states. It was later acquired by well being insurer Anthem for an estimated $440 million.
Smith went on to function chief working officer of Anthem’s Diversified Business Group, a multibillion-dollar portfolio of 5 firms, earlier than he was tapped shortly thereafter to serve within the Trump administration.
There, he moved around quickly, building an impressive resume: deputy director of the White House Domestic Policy Council, senior adviser to the secretary of the U.S. Department of Health and Human Services, deputy administrator at the Centers for Medicare and Medicaid Services and director of the Center for Medicare and Medicaid Innovation.
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During his time in government, he got an inside look at attempts to cut health care costs, so-called “innovation fashions.”
“It turned out that solely 4 of the 54 (fashions) had saved cash,” he said. “None of them had demonstrably improved high quality. But the explanations that it occurred had been very technical and really particular. The arduous a part of making technical adjustments is, they don’t seem to be all the time highly regarded.”
Ultimately, he said, government work wasn’t for him. Long hours kept him from his wife and three children. He decided to resign from his post, return to Nashville and build a business close to home.
Early beginnings as an up-and-comer
Smith was noticed early.
Haslam remembers assembly Smith when he was a highschool senior at Webb School in Knoxville, Haslam’s alma mater.
During a school event, Smith asked him his advice about where he should go to college. (He settled on Harvard.)
Smith later came back to work on Haslam’s successful run for mayor of Knoxville, volunteer work that began a lifelong friendship between the two.
“I used to be instantly struck by his curiosity and eagerness to be taught,” Haslam said. “He has mixture of being pleasant, clearly, and being very intensely motivated. You do not accomplish a lot in life with out being that manner.”
That relationship led him to more. Smith, at the urging of Haslam, went to work with former Sen. Bob Corker (who had been roommates with Haslam’s brother in college), serving as his personal driver as he campaigned throughout the state.
Smith eventually graduated summa cum laude from Harvard, where he studied government, and later became a Rhodes Scholar, where he received a master’s degree in philosophy.
Why health care?
Smith has really only been serious about the health care industry for the last decade.
He studied government in college and took a White House job as an executive assistant in the Bush administration after Corker won his senate bid in 2006 — shortly before heading off to Oxford.
Smith eventually landed back in Nashville and found a post with Haslam’s Department of Economic and Community Development, where he served as chief of staff. He later served as interim president and CEO of the Tennessee Technology Development Corp.
He left shortly thereafter to work on the Tennessee State Collaborative on Reforming Education, a Nashville non-profit he co-founded with Frist.
Smith said that it was a personal experience with the health care system’s failings that led him to get into the industry.
Specifically, his grandmother’s final days in a hospital.
“I do not know if she was getting excellent care or not, but it surely did not really feel like she was getting excellent care,” Smith said. “She was dwelling by herself after my granddad died. She had a foul hip after falling down some stairs and went out and in of the hospital most likely thrice. And she ended up dying within the hospital.”
Smith said that led him to research best practices in hospice care. That led to Aspire.
Meeting a need
Main Street contracts with health care clinics largely in rural communities where there is a shortage of health care providers.
One of those communities is Whitefish, Montana, population 8,500. This community at the edge of Glacier National Park is home to a booming tourism trade that has made the cost of living increasingly too high for the local population, said Dr. Jennie Eckstrom, a partner at Glacier Medical Associates.
Her clinic has three Main Street navigators.
While they do traditional navigator work, like helping with patient scheduling and medication checks, they also help with making sure patients are getting their other needs met, she said.
One patient, a disabled veteran, needed help finding wood to heat his home for the winter, she said. Another navigator helped a patient make sure they could get a ride to and from the clinic, she said. In one case, a navigator helped a patient find economic assistance while that person was in between jobs, she said.
“Numerous the issues that we all know need to do with affected person outcomes, issues that need to do with how they’re doing with their diabetes or hypertension usually are not simply associated to only to they’re coming to see me and me prescribing a drugs,” Eckstrom said. “It’s can they afford that treatment. Can they afford to come back to their follow-up (appointment)? Do they’ve transportation? Do they’ve cash to maintain the lights on? Do they’ve wooden to warmth their home?”
Tennessee has the second-highest rate of hospital closures in the nation. Many of its rural communities also suffer from a shortage of health care providers. Meanwhile, Main Street navigators are already in more than 70 practices in 52 Tennessee counties, Smith said.
“I feel it simply speaks to the necessity that we’re assembly,” Smith said. “We suppose we’ll be capable of develop from 900 to 1,300. There’s not likely anyone else centered on the sorts of cities and communities we’re centered on. And so it is actually simply form of taken off in methods which are manner past what we anticipated.”
Frank Gluck is the health care reporter for The Tennessean. He can be reached at fgluck@tennessean.com. Follow him on Twitter at @FrankGluck.
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