October 11 2021
Dr. Michelle Schmerge, DNP, is a doctorally prepared nurse who has spent over a decade working as a front-line provider in post-acute care. Dedicated to helping change the care paradigm, Dr. Schmerge has focused her recent work on strategies placing the patient at the center of care, driving clinical outcomes and value across the care continuum. She is the CEO and co-founder of Remote Health, which providers a hybrid of virtual primary care and home-based primary care leveraging nursing and physical therapy.
Morgan: Welcome to PointByPoint. This is Waller's Chief Business Development Officer and the host of the podcast, Morgan Ribeiro. On today's episode, we are continuing our "Women in Healthcare" series with a conversation with Dr. Michelle Schmerge, DNP, the CEO and co-founder of Remote Health. Michelle, welcome to the show.
Michelle: Thank you so much for having me.
Morgan: Absolutely. So to get us started, I want to provide our listeners with a little information about Remote Health, which is a hybrid of virtual primary care and home-based primary care that leverages nursing and physical therapists. Can you tell me more about the company?
Michelle: Yeah, absolutely. I started out that way wanting to create a home-based primary care practice, but we've evolved since then, largely because of COVID into three main service lines. So we offer home-based primary care. We offer COVID care at home, which is pretty high-level COVID care in your home and acute care at home. The goal of the company or why we started out was to solve for the problem of people with multiple chronic conditions who are really frail and often overwhelm our current system.
It's super-fragmented and it causes four main problems. One - that patient wants to be home. So it's really difficult for that patient to be mobile or moving around, or they have so many different specialists that it's hard to get access to care in a timely way.
Those patients also cost a lot of money. So the second thing is that they cost a significant amount of healthcare dollars. We all know that 5% of healthcare utilizers account for about 50% of spend. And so those patients overwhelm traditional brick-and-mortar practices. Their needs are often too great for a traditional 10-minute visit or however long you normally have in a clinic. So they end up showing up in emergency departments and nursing homes and hospitals so that they can receive extra levels of care that we traditionally don't offer in the United States.
What we've seen with COVID is that those patients then will overwhelm the system. So whether or not they have COVID or heart failure or any number of chronic ailments, at some point the health system lacks capacity to manage those patients. And we see that every year, it's not just COVID, there's often tons of inflection points throughout the year where patients overwhelm the system.
So our company set out to solve for those various problems, and so we did that with this nurse-led interdisciplinary team that's trying to defragment the system and provide medical, physical, and social care directly to you into your home.
Morgan: Remind me, when did you launch?
Michelle: We launched in January of 2020, which is a funny story in and of itself. I had this beautiful idea that I'd spend six months in R&D, travel the United States and then two months in, I started hearing about how serious this virus is. And then the world shut down about two weeks after that. We really had to get moving quickly and solve for this almost overnight.
Morgan: I was going to ask how has your company evolved since COVID, but it sounds like really that was the start of your company. And has it evolved since that point over the last 18, 24 months or so?
Michelle: Yes. In a big way. So we got our start managing critical cardiac patients in their homes, and then we really moved on to home-based primary care patients and those patients were really sick and scared. We would encounter many people in those early days who didn't have any food. They were afraid of going to the grocery store. And so they were willing to starve to not get a virus. And so it was fascinating to us, how much we needed to change our ideas and think about healthcare differently. Do you have all your medications and can you get access to your medications? Are you having any trouble breathing? If you have heart failure, too, do you have access to food and do you have enough money to pay for those things? And it was really interesting to me how open people were because of COVID to having people in their homes and to really test with us models of telehealth.
We also do a lot of remote patient monitoring and we've tested a lot of different devices. So patients have been incredibly gracious about letting us do all sorts of different things, to see if we can improve their access to care and improve the care that's directly delivered in their homes. So I suppose it's been a wonderful experience for us, despite the fact that it's been so difficult on us as a society.
Morgan: Absolutely. How did this whole concept come to be?
Michelle: Yeah. I think about that a lot. I think that you have all sorts of various stages of your career that sort of inform your ideas. And I think I'm certainly an example of that. But we started out just as a frontline nurse practitioner. My whole career has been in geriatrics and I love to interact with older people. But I got a crazy idea in my twenties that I was going to start a company and change the care model in nursing homes and nursing facilities.
So we started a company. We structured it like a law firm. We partnered physicians and nurse practitioners. And what I learned most of all, 1) was how hard it was to start a company, but 2) nursing homes or skilled nursing facilities are really revenue models. They're not clinical models.
And so it was really hard to actually improve clinical quality in that setting. So I carried that with me and from there got recruited to Novant Health, which is a large Southeastern health system.
And again, I was struck by how patients want to go home. They want to receive care in their home. And so I launched a "Why Not Home?" campaign there, which resulted in be getting lots of interest from home health agencies. So I went to a not-for-profit home health agency, which I thought at the time sounded wonderful.
But as I got into that company realized they were converting to for-profit and being sold and that my job was to help pitch the company and deliver a vision of the future. And so I spent a year talking about my vision of the future and what I thought we needed to take care of people in their homes and how would we leverage existing assets in the home setting and create some new ones to fill the gaps that exist. And I realized that I wanted to do this. I think that's really where I come to present day in the attempt to do it. And not really on my own, but with community members and all the people along the way.
Morgan: So help me understand - how does this model work? How do patients come to Remote Health and then how do you actually get paid? Are you contracting through other providers?
Michelle: Yeah. Currently we work with providers. I wanted to support the primary care provider in the outpatient setting and so our first client was a large accountable care organization. So we contract with them to help augment their primary care services. We offer kind of 24/7 access to care in your home. We can get telehealth and get that provider or specialist in the home with our visits.
We get patients three different ways, one from a nominated roster from the ACO, or we allow those physicians to refer to us. So both physicians or nurse practitioners in the community can refer or their specialists can refer to us as well. As a result of the pandemic and our COVID work, we also get referrals directly from the hospital in the emergency rooms.
Morgan: And how big is your team?
Michelle: We have a little over 40 people. We are growing really fast and one of the nice things is that we continue to have a waitlist of clinicians who want to come to work with us.
So we think we've built something pretty exciting and magical and people are wanting to come to work there, which is a big difference than most of the other companies currently in our space.
Morgan: Unfortunately, so many of the folks that you recruit and the settings that they're working in right now - it's high stress. So I imagine that it is very attractive and appealing to come work in a setting like yours. So I wanna switch gears a little bit and talk more about your background. You are a doctorally prepared nurse who has spent over a decade working as a frontline provider in post-acute care. And then you mentioned some of your background earlier. Did you always want to pursue a career in healthcare and be involved in direct patient care?
Michelle: I have known from a very young age that I wanted to care for older people. And so that has been a great blessing in my life. I haven't had a lot of angst on, 'Am I making the right decision or what should my career path be?' I feel like I've always known that I wanted to go into care and provide care to patients who are aging. I think that these patients have so much to offer and they are really discarded by society, or we don't often see them or hear their stories. And I've always thought that a society is measured on how you care for your disabled and aging people.
And so I wanted to be there providing that kind of care and helping people who have a lot to give still but who maybe can't get around as easily as before, or who are a little bit more forgetful than before. It doesn't do anything to diminish their contributions.
Morgan: Absolutely. In addition to your work with Remote Health and your prior positions, you've become an advocate for the nursing profession. You were named 2019 "Great 100 Nurses" in the state of North Carolina, and we're the Joanne S. Stevens Political/Legislative Nurse of the Year for 2016.
You're regularly volunteering with the North Carolina Nurses Association. You're advocating for the advancement of nursing. So many other things credentials on your list and you're advocating for nurses and speaking up for the changes and how it will help care can be delivered. And clearly you've shown that and demonstrated that with the start of your company. So can you tell me more about your advocacy work and the causes that you're giving back to?
Michelle: I think you've hit the nail on the head. Nursing is probably my biggest area of passion within my advocacy work, I am a huge nursing advocate. I was so before the pandemic, I am even more as we're in the thick of it.
And I believe that nurses are critical to healthcare and I had begun to worry that we forgot that. And I think the pandemic has really illustrated that we did forget that. I often tell people you go to the hospital or a nursing facility for nursing care. It doesn't matter how brilliant your specialist is. You need a great nurse to deliver on that and to identify when you are decompensating and to be your advocate and your person. And if we forget that we have lost a lot, and I think that's really where we are present state. We have all these healthcare leaders that seem to have forgotten about nursing and what it takes to deliver care. I was just at a nursing conference last week and was struck by the fact that the nurses were saying how we're the only people that are going into the room in an ICU. Oftentimes, your physician is on camera on the little device that they wheel into the room, but that the person who's in there with you - the only person in there with you if you're in an ICU because of COVID - is your nurse.
I think that we've got to do better by the people that are willing to go to the front lines and do that level of care and work. And so we're seeing hoards of people leave the nursing profession. We should not be allowing this to happen. We've got to do better by these clinicians who are willing to deliver care and that's really what we've set out to do.
The reason we decided to get really great at treating COVID and treat patients in their homes that had COVID was that it seemed really scary to me that we were isolating people. How on Earth can you get better if you're alone and there's nobody there holding your hand or looking at you or touching you physically even.
Nurses do that every single day, even in the realm of infectious disease. I could not be a bigger nursing advocate and would just like to state that it's really important that we support our nurses.
Morgan: Are there any specific pieces of legislation that you have backed or been pushing for?
Michelle: Yeah. So all sorts of things I have advocated over the years. Obviously, I think it's really important to leverage all clinicians to the top of their license and expertise. I live in a state where I have started a company, have founded the company and have people working with us where I still have to have a supervising physician and that's a big limiting factor for these types of care models.
We're seeing people who have entrepreneurial spirits or that innovation bug move to states where it's a little bit more favorable and you let clinicians like me kind of practice to the full extent of their license and education. I do not live in a state like that, but I feel so strongly about my state that I feel like I'm going to do what it takes to keep providing care here.
I think that's really important. One we see states often don't let nurses do that in a way that is wonderful and safe and economical. It's significantly less costly to allow nurses to provide the level of care they're trained to deliver. But I also think staffing it is important. The pandemic really isolates how you have nurses that are caring for a lot of patients and it's just not safe at times. Nobody's talking about it, but we actually don't have a bed shortage, we have a nursing shortage. We have a shortage of people able to take care of patients. We have lots of beds open right now. But because of COVID, there's not enough nurses to care for those people.
Morgan: Your work is very much needed I'd say now more than ever. You're also a mom and we hear a lot about working moms and about this whole idea of balance. And for me, and for my perspective, I feel like it's less about a balancing act and really more so a juggling act. So you obviously have just a lot on your plate, just the things that we've talked about professionally and the things that you're passionate about, how do you prioritize and do you have advice for other women that might be looking to pursue a career in nursing or owning their own healthcare company someday and how you juggle all of those personal and professional priorities in your life.
Michelle: Yes, I am deeply passionate about this question as well. I have two children - I have a 10-year-old girl and a 12-year-old boy and I think it's so important to set an example to another generation. So I am a millennial, I'm an old millennial. Most of my friends who are my age hate that I qualify myself as a millennial but I am and they are. I love the idea of balance and I love the idea of having it all. What I have learned is that it takes almost constant commitment of looking at your priorities and looking at what you have in a day or an hour and figuring out how to juggle that, as you say.
I think the millennial generation is the way it is because we watched our parents kill themselves for corporations and to just be a cog in the wheel. My parents were blue-collar workers and it never seemed like the company really cared much about their life or what it looked like.
So I thought what if I could start a company that would care - that would do this, and it would allow space for you to be your whole person. Work is wonderful - it should be something you can talk about and be excited about and passionate about but we are so exciting as human beings, we have all these beautiful differences and we have amazing interests in all these wonderfully different cultures. Work should not be the only side of you that you're developing. I think it makes you more interesting as a business leader. It makes you more interesting as a co-worker and it just feeds your soul. This is something that is really important to me. I want to create a space where if you want to go to an appointment with your child, you have space to do that. If you want to go see that ball game, you can. If you need to care for an aging parent, you can. Many of us as women are juggling both ends of the spectrum. So we have children we're caring for and aging parents or grandparents.
How do we as women start to lead the way and change what that looks like in the workplace? And I'm super proud to say, I feel like I've created that where I am today.
Morgan: That's awesome. I think so many of us aspire to find that balance or whatever you want to call it. I don't know that it'll ever be equal. There's always some days it's more something than another, and I'm with you, I'm also a late millennial and I feel like sometimes I relate more to the Gen Xers, but certainly have a lot of the millennial qualities as well.
A lot of times when I'm talking to women they know either mentors or coaches or others who have pushed them along or showed them or demonstrated how it can be done and the type of career that they want to pursue or achieving that balance or just having someone to bounce ideas off. Do you have mentors who have helped you along the way?
Michelle: I do. I have been so fortunate to have wonderful mentors in my entire career. One of the things that makes me sad to say out loud is they are all men professionally. So my mentors that are female are family members. Or a family member of my friends but I've never actually encountered a female in the workplace that became one of my mentors. So I try hard to change that for the future, because I want to find a way that we charter a new path and create different opportunities for women. It's really important that we support each other and find a way that we help each other grow. Men do this all the time. We see them not only are they creating social circles, they create professional social circles. There's a real blur between who you hang out with and who you work with and women don't do that nearly as much. I hope that to change that in the future and find a way to serve in that role.
Morgan: I agree with you. It's interesting because I've asked this question in different ways of different guests on the "Women in Healthcare" series and many of them have said that most of their mentors have been men, which is an interesting trend, right? To see that it's not a negative, it's not a positive or maybe it's that we are the first to really do what we're doing.
And we don't have those that have really set a path before us. We're the ones charging ahead and whether or not it's a man or a woman who's providing us with that guidance. I agree with you - I mean someday I hope that I can g ive back to the future generation as well and help to guide them in their decision-making and maybe it looks different in that next generation compared to how you and I have done it. Anything else that you'd want to add for our listeners, either about your company or your personal career or your personal goals?
Michelle: No, I think I would just say thank you. This is a wonderful podcast. I think there are just so few people highlighting women and nurses. So I really just want to applaud your efforts. I think this is terrific.
Morgan: Thank you for everything you're doing. And it's certainly a needed service and your advocacy is certainly needed in the industry. And we're just at this point where I feel like the timing of your company was so interesting because I think COVID - for all of the terrible things that have happened around COVID - there have been some silver linings, and I certainly think the innovation that it has sparked in the healthcare industry is one of those silver linings. And so I think, your company is likely to do great things over the next couple of years, so I appreciate your time.
Michelle: Absolutely. Thank you. All right. Thanks so much.