Healthcare in Color: Dr. Iyad Houshan on Seeing Patients in Their Natural Environment | Nursing Home Series | Senior Care

AnthonyCodispoti : Welcome to another edition of the Inspired Stories podcast where leaders share their experiences so we can learn from their successes and be inspired by how they’ve overcome adversity. My name is Anthony Codispoti and today’s guest is Dr. Iyad Houshan, Chief Medical Officer at Wellbe Senior Medical. They specialize in providing personalized in-home care for older adults dealing with complex conditions. Founded in 2014 and based in Chicago, Wellbe is on a mission to change how care is delivered to older patients, ensuring they stay healthy at home.

They deliver compassionate, patient-centered services including 24-7 urgent care, medication management and therapy support. Under Dr. Houshan’s guidance, Wellbe continues to grow and help seniors receive the care they need from the comfort of their own homes. Dr. Houshan draws on his leadership background at Alignment Healthcare, Remina Health and Caramore Health where he helped achieve a four-star rating. He has recognized for his work in improving patient outcomes and developing better care models. Now before we get into all the good stuff, today’s episode is brought to you by my company, Add Back Benefits Agency, where we offer very specific and unique employee benefits that are both great for your team and fiscally optimized for your bottom line. One recent client was able to add over $900 per employee per year in extra cash flow by implementing one of our innovative programs. Results vary for each company and some organizations may not be eligible.

To find out if your company qualifies, contact us today at AddBackBenefitsAgency.com. Alright back to our guest today, the Chief Medical Officer of Wellbe Senior Medical, Dr. Houshan, I appreciate you making the time to share your story today.

Dr. Iyad Houshan : Absolutely, thank you very much Anthony for this opportunity.

AnthonyCodispoti : So let’s jump in. So I see you graduated from Ross University School of Medicine in 1999 and since then you’ve led multiple organizations specifically focused on seniors with chronic conditions. Tell us Dr. what initially drew you into the field of senior care?

Dr. Iyad Houshan : Yeah, so I kind of started my career teaching at the University of Nevada School of Medicine and this really helped me kind of deepen that knowledge, retention of knowledge, enhanced critical thinking skills and really improve on communication skills, strengthening diagnostics and clinical resourcing and also develop leadership and mentorship skills. Then from there I kind of cut my teeth in Medicare Advantage Health Plans where I joined you know, Caramor Health Plan which is a Medicare Advantage built Caramor Health Plan in Nevada from the ground up to be a four star health plan less than two years. For the folks that are probably on the health plan side, they will understand the challenges that you have to go through to really achieve this in a short period of time.

AnthonyCodispoti : What were some of the big ones?

Dr. Iyad Houshan : Some of the big ones is you’re actually trying to get into finding the right network that will support your care model and at the time Caramor was a unique care delivery model that is run by the health plan so you have to find the right clinicians, the right primary care, the right specialists, the right network, the right home health agencies. All of those need to be aligned for you to be able to deliver the right care to those patients in a short period of time and we’re talking about you go in and you probably end up with, let’s call it six different, let’s bring cardiology as an example, six different cardiology groups.

You got to do the homework and try to study and make sure that those groups are going to provide the care you intend for your patients because not all of those are creating equal and that’s similar to every other network per se so putting that together and making sure that in the process you’re delivering on the promises of those patients who said I want to sign up for this health plan and they promised all of these benefits on all of this care so you want to make sure that you stay true to that statement while building the network you know to the specifications that you really would want for a family of yours.

AnthonyCodispoti : And so what state was that in? Was it a one or two star, three star when you first came in?

Dr. Iyad Houshan : That was we started in Nevada in Las Vegas and then from there we actually ventured into Arizona. That was the second state where we actually ventured outside the two states we ventured outside of California.

AnthonyCodispoti : But what was the star rating before you came in or did it not have one? I’m just trying to get an idea of how much you increased it by.

Dr. Iyad Houshan : Yeah the star rating there you start you get fathered into a three and you got to make your work you know into a four and that’s kind of the delta. And when we talk about star rating you know, PEDIS and quality measures are normally very hard to accomplish and this is kind of where the government told us those are the quality measures that we’re going to be really great you on and they’re actually excellent measures. So you know how when you go for example to the hotels right there’s a three star hotel, a four star and five star. When you go to a three star hotel you have certain expectation versus a five star hotel. This is the same thing as the services that you’re going to provide the quality of services you provide to your patients. And normally the patients who are joining Medicare Advantage and start now this is not a health plan. What I gave you the answer is like mainly on the health plan side but the patients will come in at probably at 2.3 to 1.5 stars meaning that this is a sick population and there’s a lot of work that needs to be done to make sure you close all of these quality gaps from you know let’s call it you know colonoscopies, breast cancer screening, medication adherence which seems to be the big one that you have to go through. So those are some of the challenges that you would get to to get them to a four star. Now the star program is bigger than PEDIS and you know it has a lot of you know technical terms here you know CAPS and HOS. It’s patient you know care gaps and also more of objective service measures where we ask the patients you know after you’re being with this health plan for a year do you feel like your health care has improved or not? Do you feel like your well-being has improved? There’s a lot to it than what I just mentioned. I just wanted to bring up those examples just in case we have any experts listening to us it’s a big program and I’m just trying to highlight certain pieces. Got it.

AnthonyCodispoti : So you guys you started out in Nevada you went to Arizona I believe Caramor is a lot bigger than that today right?

Dr. Iyad Houshan : It’s grown quite a bit. Yeah they’re bigger they’re they’re multiple states and the model has changed since and yeah that’s what was Caramor. Then kind of you know taking some of those learnings from Caramor went to this other company where we founded tried to get into call health essentials get into hospice and medical group. So this is a hospice where we’re about seven states I’m sorry you know seven sites three states and about a thousand patient hospices. So if you think of a hospice this is a medium to high size normally than the few hundreds but a thousand gets you into the medium size there and seven sites. We also had a medical group with about 170 clinicians and at the time we built a model to enable taking risk for duly eligible patients and long-term care patients to establish you know palliative care program.

Now when I say duly eligible so those are the folks who in California we call them Medi-Medi and you know it’s like you have Medicare and you have Medi-Cal in California or Medicaid so you’re eligible for estate support also for the you know the CMS support as well. And normally to get into that you’ll probably have propensity to be sicker and have a lot of issues aside from chronic conditions there’s a lot of psychosocial issues that you really have to address to be able to manage this population properly. So the example I give for you know you could be sitting down with a patient I can talk about diabetes for hours but the patient is worried about they can’t afford food they might be evicted there’s no home for them and they’re worried about paying rent. Until you address those issues would be very stressful for the patient to pay attention it’s like how and also how do you expect me to say well these are all the following for example diets you have to be on for diabetes is like I can’t afford that you know I really can’t afford what are you talking about so then you got to be more innovative and that’s a funny learning I had you know I’ll give you a story is at every juncture you have tons of learnings where you know one of our nutritionists taught me I never knew that there’s a quote unquote healthy menu at every fast food place but there is it’s like you know you could come up with you and McDonald’s you can make some choices healthier than others and any other fast food place they have that so that actually made a big difference when we talk to our patients you know you say here’s some options because most of us I was one of the folks like really healthy and fast food didn’t go hand in hand in the same sentence but it’s there now

AnthonyCodispoti : it’s healthier maybe not as healthy as you want to get but working within the realms of their world and what’s accessible to them exactly you can help them make better choices

Dr. Iyad Houshan : right right and then from those you know from all those experiences kind of took all those learnings and insights kind of you know seeking really trying to answer one question what do patients want this is how we came to find well so today you know when we talk about well be where we are now we’re like the largest independent home-based medical group in the country and we’re providing transform transformative outcome based care for Medicaid advantage we’re about 150 000 plus patients nine states and revenue will over three billion dollars now taking all of that all of those learnings is when I say what do patients want right today if you look at our system we have one size fits all if you have problem A you know the solution is B and if you have this issue you go to that so it’s more of a very rigid workflow type of stuff but in humans that doesn’t really work right so we’re trying to attend to their to their unmet needs and there’s a lot of those unmet needs if you ever go to the hospital I don’t wish it on anybody but let’s say you go to the hospital you probably have to tell your story to six or seven different people before you get admitted now what happens is just telling the story over and over again you tend as a human to emit a lot of information because you’re tired of saying the same thing over and over again and with that you emit important information that could be you know pertinent to the care that you should receive at a hospital the other thing that we found in our systems today is that at the time when people are sick fragmentation gets worse so we have a lot of fragmentation no healthcare system today but when you’re sick the fragmentation gets three x four x worse

AnthonyCodispoti : what do you mean by fragmentation like they’re only remembering parts of this of their health story

Dr. Iyad Houshan : yeah well no it remembering you as a body part so meaning that let’s say you’re you’re seeing cardiologists and a gastroenterologist and a endocrinologist they think of you as a body part so it’s like now you have a cardiology problem that really want to go and fix whereas there’s many other systems to go look at holistically at the patient but when I get to what the patients want most of the time we never start by what are your wishes what would you like for your care how is your care how do you want your care delivered we’re mainly actually telling the patients what they should do versus knowing what their unmet needs and try to match it with the services that we have

AnthonyCodispoti : so that’s interesting yeah I go to a doctor I sort of expect them to kind of guide and and run the show what would be an example answer that I could give back to a doctor about what I want from my care I mean at a base level I just I want to be healthier and I don’t want to be here but like what what would be some feedback that you get from your patients on that question

Dr. Iyad Houshan : so some of the things that when you ask like an open-ended question would be let’s say what are your what are your healthcare goals what do you what do you want so you could bring it down so that’s very broad and then you bring it down to okay I have a patient with let’s say severe congestive heart failure I know that this patient probably based on the stage of their chronic illness when I ask him what are your goals and this patient comes back and tells me you know I want my I want to be around for college for my two-year-old grandson I want to be around for that I’d be like okay that’s a great goal but with where you are we probably have to readjust expectations and it could happen but we are just readjust and you start the conversation by really having them understand their disease process and understand how these chronic conditions were evolve over time because we in medicine we can manage symptoms for chronic illnesses we can decrease the slope of progression of a chronic disease but I can’t prevent it from going you know if there’s nothing else and if you live to be 150 years you will die from that chronic condition eventually so that’s kind of you know level setting of what are the chronic conditions however we tend to go and to say yep your diabetes is very well controlled and stuff we never talk about what else right or your diabetes not very well controlled and try to control it today but what are your goals what are your personal health care goals and how does that fit in your life goals

AnthonyCodispoti : so the the whole model is um complete care at home I think you’ve actually trademarked the term complete care can you walk us through maybe a real world example where you’ve kind of seen this this mission of complete care at home come alive for a patient right

Dr. Iyad Houshan : so the complete care you could also call it when we try to attend to the patient’s physical psychological spiritual and emotional needs at home that’s complete care somebody asked me and I’ll get back to a little bit more specifics on your earlier question but this just came as a thought here somebody asked me what’s the difference between um internal medicine and geriatric care because we provide geriatric care so this is a little bit highly clinical but folks will probably understand what I’m saying here is like internal medicine we I’m an internist and a geriatrician but internal medicine we actually try to tend to manage chronic conditions and to manage the numbers and the metrics within the chronic condition in geriatric care we try to manage your functional capacity meaning if my patient is getting up walking around walkie talkie they’re doing their daily activities they’re comfortable they’re no pain if they’re doing all of that I can actually be confident that their chronic conditions are well controlled so try to look at your functional capacity as a surrogate of how well your chronic conditions are doing by looking at it holistically because they all interact with each other right so you know when I you said an example would be when I go talk to the patient sometimes you know we say what do you what do you want today what do you need and they’d be what do you mean you’re a doctor what can I have from you I said tell me I could actually I can change a light bulb for you what yeah I can’t you know I can figure that out for you seriously okay and then we get into more of a here’s all of these needs right and that can get to be overwhelming but you can go through it really understand it stratify it and make sure that you here’s the top things that I can help you with right and then we can get into view as a person first before we get to your chronic conditions and the disease management that we’re going to work on so mainly asking the open-ended question with the patients like what do you need you know and we’ve had and you can get several different reactions to that all the way from shock to very specific needs that you may or may not be able to really address or help but just the fact that the patient sharing that with you that’s creating the trust that’s what you need in health care to be able to manage because they we have to trust that the patient will take care of we ask them to take care of and they also have to trust that we’re giving them the right direction to get there and be there for their full journey in health care

AnthonyCodispoti : Do you only see patients in their homes or are there times where you visit them sort of in the hospital before or after you’ve sort of taken over their at-home care?

Dr. Iyad Houshan : We actually so the main care we provide is what we call this tailored care at a familiar setting and that is a home but when our patients end up going to the hospital go to skilled nursing facility or if they end up living in an independent living or assisted living or boarding care we see them there so we follow the patients to home whatever they call home but even in acute episodes we try to follow the patients to help them during their hospitalization or if they’re transitioning between hospital and home in a skilled nursing facility

AnthonyCodispoti : So you’ll obviously see them when they’re in those more needful situations you’ll see them at home do you act as their primary care physician as well by visit you know and visit them in the home to kind of provide that I don’t know the routine physical or checkup?

Dr. Iyad Houshan : Yeah we work very closely with the primary care physician network so we don’t like to you know add another you know another way of managing those patients so we work very closely with the primary care physicians now we try to provide geriatric care so we work very closely with the primary care docs now some of our patients they say they want us to be primary care we’ll assume that but for the most part if they have their own primary care we’ll collaborate very closely and then we become the eyes and ears for that primary care in the home because there’s one thing that’s that’s quite important when the patients come to us in the office I’m in an office they come to us they they probably will get in there they get dressed they get ready they’re all looking great they show up in a very clean neat environment they show up to the office you don’t know how they got to where they are by looking at them in the office when we go to the home you actually see healthcare in color was black and white before but now it’s in color you see everything you know you go in you go to their homes and you say wow look you know your your bed is too high I mean I saw a patient where I mean I’m not a tall guy I have to admit but I saw a patient who’s a little shorter than I am and then the bed was high and I’m like how do you actually get into that bed you know and literally she was like I gotta jump on the bed you know so it’s a risk and no one paid attention to it so we try to be very curious when we’re in the home we look in the kitchen we look in the patients you know showers and bathrooms and stuff and we look for any fall risks so we try to manage like that home environment because that’s what got them to where they are today you know we open up the fridge of course with their permission over the pantry what do you have right so all of this to say is when you get in there and you try to see the patient in the home environment there’s a lot of information that you will gather that you’re not going to see in the office so that’s where I said you will become that eyes and ears for the primary care in the home and it’s best when we have that what I call a best practice where I go to the home I’m not duplicating care in the home if things the primary care is doing we’ll build on that and if things that we’re doing and the primary care is not we’ll let them know here’s what we’re doing with the patient so that’s kind of more about collaborating on the care to really get to at the end of the day what do patients want what do they need and attend to those on my needs

AnthonyCodispoti : and so what kinds of specialists are you sending into the homes they’re doctors nurses I don’t know occupational therapists

Dr. Iyad Houshan : we have we have doctors we have nurse practitioners we have social workers we also have likes and social workers and those are the folks that focus on behavioral health as well we provide you know all kind of services in the home we provide quick medic which is an emergency services for the patients at home and those are paramedics that would go and attend to the patient’s needs when there’s acute care episodes we have our nurses that would go to the home and try to provide all the care as well so it’s a multidisciplinary team that they have pharmacy support they have behavioral health support and try again that body mind and spirit so try to cover everything for the patient in the home if there are services where we can’t we don’t have our folks to go we can get you know for example home health to go out and help us with physical therapy for some time we can have them go to wound care centers if needed so but our employed well-being team does the majority of the care for the patient at home

AnthonyCodispoti : so doctor with your track record of launching hospitalist programs and new care models I’m curious what innovation at well-being senior medical are you most proud of

Dr. Iyad Houshan : there’s quite few I think our patient first mentality is the biggest is we’re building around the patient so we’re going after you know patients needs that’s one of our biggest differentiators so we build the tools and resources and the staff and the training to be able to attend to those patients needs so that’s you know kind of most places you already have models that are built and you try to make the patient retrofit into the model or actually building it around the patient and in this case our patient our families of our patients are our patients when we say that unit in the middle it’s patient and family together so if I have to call one thing would be that is one big differentiator providing access 24-7 to the patient we actually have providers that take call for the patients 24-7 it’s not 9-1-1 or it’s not like you know call the emergency room it’s a live provider not an answering machine pick up the phone and talk to the patient directly now there’s been a lot of studies out there when they say why why most of us call line one you know if you think of it why do you actually when in need you call 9-1-1 the main reason is you get a live person you got a person to talk to so we try to emulate that here well you call us anytime you’re not going to get an answering machine you’re going to get a live person to talk to and this person is a provider could be a doctor could be a nurse practitioner and they could attend to your needs and kind of figure out what are your needs now now that’s where the human element comes in because for example you can have some people say well the patient’s calling because oh my god they took an extra little dose of their high blood pressure medication and they’re freaking out well clinically let’s say let’s assume it’s a very small dose they took an extra one by mistake clinically may not be a huge deal but to the patient it is a huge deal and I got to attend to that you got to talk him through it explain you know what can be done and make sure that you’re monitoring that with them and try to help them through that episode so again you know 24-7 is another big differentiator for us when we provide it and then finally providing those acute care episodes at the time of need in the home we can do a lot of work in the home short of 24-7 monitoring I can take care of a lot of conditions that the patients have in the comfort of home so and I could blur about you know a lot of for example clinical things but I don’t know if the listeners will attend to it just you know conditions that normally would land you in a hospital but I can take care of at home you know

AnthonyCodispoti : doctor you mentioned the human element and I’m curious because a lot of folks I talked to in the medical field they tell me how challenging particularly post-covid it’s been to find good folks to work for you and when you find them to hold on to them I’m curious what that landscape looks like for well-being what are some things that you’ve tried and found success with when it comes to both recruiting and retaining good talent

Dr. Iyad Houshan : yeah absolutely that’s that’s to be on that is a challenge it has been a challenge and I don’t think we have fully solved it yet however what we’re trying to do is when we bring providers and that is all sorts of clinicians to come in and join well-being we’re trying to provide value for the providers is one we’re all compassionate folks we’re all here about our patients so our patient first mission I think everyone is attracted to it’s like something we do we’re doing it for our patients but most importantly is that you come a well-being and you have a higher calling we’re going to address that higher calling for you and this higher calling by providing certain you know training and education that you don’t get anywhere else an example of that is let’s call it advanced care planning advanced care planning is a topic it’s been a hot topic for the past 15 20 years if you go and look at providers across the US probably you might be in the less than 55 percent of folks are comfortable having those discussions the reason is in medical school we don’t learn that you know we learn it day by day but then what happens is if we don’t practice it then that becomes a skill set that’s not built on so we spend a lot of time on that we make sure our providers are actually comfortable having those progressive discussions and it’s really not a one-and-done it’s a process as you talk about it it might take you a year to land as to really understand where the patients are sometimes you could do it in one visit so anywhere in between so that’s a skill set to that we provide to our folks we also provide a lot of education and training around quality of care and that seems to be again a value add to the folks that we get we’ve done a lot of work also at the front end of trying to you know stratify and be able to filter through some of the candidates from all the learnings that we’ve had because the model that we had is not that we have is not for everyone it’s not right or wrong is that we have providers the home environment is new I mean if you ask many let’s let’s take the doctor’s example many doctors who practice shorter the folks that do geriatric fellowships we practice in offices skill nursing facilities and hospitals this is where we actually get our residency in most of us never make it to the home and to tell somebody go to the home it’s actually scary one to me it’s it’s a privilege because the patients embody some of their home and we have to be able to give them enough value for that so you see it as a privilege but you know when you go on there it’s it’s intimidating because now

AnthonyCodispoti : you’re walking into when you show up at your office every day you know the environment to expect when you’re going into somebody’s home it’s uncertain right

Dr. Iyad Houshan : exactly and like I said most folks will see it’s intimidating what am I going to do you don’t know what to expect you know all the way from who’s there the family that’s there and there are other you know animals would be also who else lives with this patient you know it’s really intimidating it takes a lot of getting used to it’s not something that you would just show up yep I can knock on somebody’s door and go on there because you don’t know what’s behind the door and how you’re going to manage it and handle it and again from all of our skill sets that we don’t learn that in school so to answer a question just like the things that we’ve done on the front end you know filtering through all of this and try to have the right messaging for the candidates that come through to explain that this is a home environment it’s a privilege and if you don’t see it as such you may or may not you know be happy doing what you do so those are again some of the some of the things that we worked on to try to find the right talent you know post-covid and providing the right you know the right training for patients is for for providers very important because all of us we learn from the book we go do practice out there and we build on that practice so we try to meet everyone where they are and build on their skills and knowledge as we go

AnthonyCodispoti : Is there more scheduling flexibility for folks that are working at Wellbee versus maybe a more traditional environment?

Dr. Iyad Houshan : Absolutely there’s a lot of flexibility now we look at productivity you need to be productive in doing what you do but you know you could schedule you know you could do your regular life around your patient care so you know let’s say you have something to attend with your with your kids and family or something like that you know with given enough notice you could just make your schedule packed in one area assuming you know the patients are accepting and then you be able to attend that so yeah scheduling flexibility is there but it needs to be done with eyes wide open because at the end of the day we value when the patients tell us you know I’m coming in where you tell them I’m coming in 11 who I respect that so it’s just that balance between what’s scheduled and how to schedule for the future.

AnthonyCodispoti : So Wellbee started either right before COVID or in the early parts of COVID what was the exact time?

Dr. Iyad Houshan : Yeah, so the company formed as again, the entity was formed in 2019. We actually were trying to build around the care model all the way until we launched and we saw our first patient in July 1st of 2020.

Now, it’s literally at the time, if you recall, I can’t remember. We’re actually all in Chicago. There’s just a small number of us. We’re all in Chicago and we heard that Illinois is going to close down. You know, they’re going to shut down the state and stuff.

And I think we did the final round of interviews that we’ve had. We all said, we don’t know how COVID is going to, what’s the effect of COVID or this thing? You know, at the time, we didn’t know what it was.

You know, it’s COVID, but we don’t know the implications, the full extent of the implication. And we said, back up, take your stuff with you. We’re going home.

We don’t know how this is going to affect us. Come to find out actually, COVID was, well, two things. One, COVID actually helped augment and patients really want the care in their home because they don’t want to be in hospitals, skilled nursing facilities or in offices where other quote, unquote, sick folks around.

That was one. But also they really appreciated the care coming to them at home. So you kind of work, we’re attending on them versus they’re attending, you know, they’re attending on us. So that was kind of, you know, the shift that we realized post. But yeah, we launched in the middle of COVID. And I recall our first training where we’re doing the social distancing and stuff and checking temperatures at the door. Folks coming in or trying to do the training, but we had a lot of learnings from that as well. So yeah, we saw the first patient July in Atlanta, July 1st of 2020. And then we saw the first patient in Illinois in August of 2020.

AnthonyCodispoti : Yeah, really uncertain time. You didn’t know what this was going to turn into. Is this going to be good for my business, bad for my business? Did we just invest all this time and effort in putting this new company together just to have it fizzle out?

Well, as it turns out, it was, you know, probably a great force multiplier for you guys. People didn’t want to go into the crowded hospital systems and be, you know, more exposed. They appreciated the ability to have, you know, well become into their homes and care for them. So this has had to contribute, you know, a lot to the growth that you guys have experienced over the last few years. But even as we’ve come out of COVID, you’ve continued to grow. How many different markets are you in today? And where do you see that going?

Dr. Iyad Houshan : Yeah, we’re in nine states. We’re about 150, 160,000 patients attributed to us. And our mission is to deliver this complete care to all geriatric population across the United States. So we want to be across and provide the scare to all seniors and anyone in need of our care model out. Our growth has been, you know, really on an upslope.

It created a lot of challenges as well that come with growth. But what keeps us focused is looking at the results and looking at how patients are satisfied with the services. Like, I’ve never been, I’ve been through a lot of places, but we do surveys every year and through a third party, talking to our patients about, you know, how well you’re satisfied with the services you’re getting from Welby. We’re like 95% satisfied or very satisfied with the services. So when you get that feedback, that gives you is like, I’m doing the right thing. You know, we’re solving the right problem here.

We just got to double down and keep at it and keep moving in that direction. So, you know, all of those kind of, you know, early outcomes when they come in, they, they, they energize, you know, the team and motivate the team to do more of what we’re doing as we’re refining where the opportunities are.

AnthonyCodispoti : What is it that you, I don’t know, kind of what’s the secret sauce here? You guys innovate disruptive, like what, what’s, what is it that you’re doing that has allowed you to grow so quickly to this point, even post COVID, and is going to allow you to achieve this mission of expanding it nationwide?

Dr. Iyad Houshan : The big thing for us is, is we’ve always said, if you take care of the patients, everything follows. That’s the secret sauce. We take good care of the patients. But then, you know, what’s under that? What does it mean to take care of the patients?

I kind of hinted to those earlier. What does it really mean? It’s not chronic disease management. It’s not utilization management. It’s literally attending to the patient’s body, mind and spirit.

And that’s what sounds like what’s missing. If you put all those together and you manage those patients, you know, aside from everything else I outlined, you know, the tools and resources and the services we provide and everything else, I really believe good care is what’s producing those results.

AnthonyCodispoti : It’s that holistic approach that you keep talking about body, mind and spirit, focusing on the whole person rather than, hey, you know, my left pinky hurts. It’s more like, let’s take a look at the whole person.

Dr. Iyad Houshan : Exactly. Yeah, we’ve had multiple cases where, I mean, I’ll briefly tell you a story of a patient where, you know, we try to manage her clinically. I think we have excellent, excellent clinicians. I came on to the care of this patient towards the end, but very, very sick, very frail. And this patient is sitting in a fetal position and even if you uncover her, she is screaming in pain.

She’s got pain everywhere. I mean, your heart drops like, oh my God, what can I do? And, you know, I really looked at the patient and I said, okay, it’s my mission that I will do anything you want. And this patient looked me in the eye and she said, I’m not sure you can.

I said, try me, right? I thought she’s going to come back. I mean, if I was probably in her position, I’d say, I need a lot of pain meds. I mean, she’s in so much pain, right? Like looking at her, she’s really in agony. Come to find out she has only one thing that she wanted. She had a relationship between her and like her daughter and her son really have a very, you know, a very rough relationship. All what she wanted is for us to help mend that relationship so she can see the family again.

Now, I’m not going to bore you with the details. That was her wish. We worked on it. Had a tremendous, you know, teamwork here to get that.

We mended that. Now, guess what? Once the daughter and the son walked into that room, you can see tears in her eyes. You can see that she has no pain. She literally was trying to sit up in bed, which she hasn’t done in a very long time.

Trying to sit up in bed, tears, you know, and then subsequent to that, you know what happened? She actually kind of said, I’m actually ready to go. I would like to get some hospice. She’s that sick. And believe it or not, a week after that, she passed on comfortably. But that’s the one thing she needed that, you know, there’s that emotional obstacle and social. Once we addressed that, she was able to say, I result. I’m good. I’m ready to pass on. That’s pretty powerful. Yeah.

AnthonyCodispoti : And it goes to show the importance of the spiritual and the emotional side of things in addressing, you know, physical care too. I’m kind of curious to hear about the partnership that you’ve formed with Etna and how that’s really helped well be. Yeah.

Dr. Iyad Houshan : We have Etna was actually our first contract that we’ve had and we’ve established what I call a true risk contract. What we’re saying is we’re going to manage those patients and we’re going to be at risk for the population that we have. But we’re not only going to do it. We’re going to do it at a high quality. We’re going to guarantee for you to have a full order of patients, a four star rating or higher. We’ve been able to deliver and all of that. So that relationship has been very fruitful because we’re fully aligned. Etna wants their members and to us, our patients to be getting the best care possible. And we’re able to deliver on that best care possible to the patients. So that relationship has been very collegial, coordinated very well.

And this is the place where I would say one plus one equals three. So that was more of an augmentation of the services. Thinking of health plan as health insurance, I actually kind of command in health plans like Etna and others that we contract with is looking for certain services to really help their members. That’s most health plans try not to do that because it’s a lot of work and it’s something they don’t take on.

But Etna was able to take that head on. It’s like, okay, if you’re able to provide better services to our patients and elevate the care they get while able to provide on this quality, I mean, there’s nothing else that that could match that. So it’s been very fruitful from that standpoint.

AnthonyCodispoti : Nice. Dr. What’s a serious challenge that you’ve had to overcome, whether it’s personal or professional or maybe it combines the two. How did you get through that and what were some lessons you learned coming out the other side?

Dr. Iyad Houshan : Yeah, it’s been it’s definitely there’s been multiple challenges here. One of them is I actually would give kudos to my family because, you know, kind of working with this population and trying to put this model of care together took its toll on the family. I actually give a lot of credit to my two daughters that I’m very proud of. They’re, you know, 16 and 13 and also big support from my wife because that actually, you know, without enough support to give me the time to be able to spend and be able to, you know, work with the team very closely and spend the time on the road.

And all go to all these states meet all the patients and the providers and everything else. So that was a typical challenge and that was, you know, in the middle of COVID and could have actually been, you know, catastrophic had it not been the support. But what helped me through that is mainly more of the transparency, the understanding. Again, I’m lucky. It looks like the patient first mentality also resonated with my family because they’re like, you know, we know you’re not going out there for quote unquote like pleasure.

You’re not going out to the beach, you know, sipping my tie. You’re out there helping folks like Grandpa, Grandma, you know, uncles and nieces and stuff. So that kind of was very helpful. But it came to a head, you know, where at a time if we didn’t have that understanding, you know, would have been really catastrophic. But that also helped me also focus to say, again, looks like there’s this higher calling and this is the right direction is where we’re heading. So that’s kind of, you know, at least one example of some challenges. And COVID, you know, emotions were very high for everyone.

AnthonyCodispoti : Yeah, very tense time for a lot of people. I have to imagine that, you know, from when you first started up there in 2020 to now here in 2025, you know, almost five years later. And considering the insane growth that you guys have seen that you’ve probably had to change sort of your leadership style, right? It’s one thing is required of you when, you know, you first start and you’re a bit more smaller. And as you continue to level up, you kind of have to put yourself in different roles, different positions, there has to be less of you wearing so many hats and more of you being able to delegate to folks. Is that aligned with your experience?

Dr. Iyad Houshan : Yeah, definitely does. And I, and I also believe that there’s, there’s kind of a what we call a startup leadership. And then there’s a scale and replication leadership style. So in a startup mode, you’re, you’re rolling up your sleeves, you’re in the middle of everything.

And you’re literally in the day to day and you’re diving kind of, you know, micro, macro in any given day. But this, you know, knowing that this is not my, my first rodeo, if you will, in a startup and a scale situation, kind of built this from the beginning where you got to hire the right teammates. That could help you scale and replicate. So doing that from the beginning helped out. So I didn’t have to change on my colleagues for their leadership, you know, kind of hired the right folks who I knew they’re going to help me with that scale and replication once we’re done with the building. So it’s mainly kind of really delegating and finding the right team that could help you get there. And this is absolutely a team sport.

It’s not a one person. Yeah, there’s in any given day, I’m learning, you know, 60 or 70% of things that I didn’t know before, learning from others. But having an eye out where you start with a startup mode and you might have a subset of leadership styles and or skills and knowledge that you would require and building that looking at the future. That was very helpful to the point where having had in the clinical leadership, a lot of changes, it was like all built in as we went. And that was a lot less disruption to everyone. So that helped tremendously.

AnthonyCodispoti : You were really set up for success from the beginning, it sounds like it wasn’t like this was a couple of founders and you know, sort of duct taping things together. It was, we’ve got a vision from the outset of what this is going to become. Let’s get the right foundation in place from day one. Exactly.

Dr. Iyad Houshan : And you know, I think we had it right because our venture capital that actually helped us launch this, all what they have is all their portfolios around healthcare. So that was very helpful. Having a CEO who’s a physician as well for the company that helped tremendously, where, you know, myself and the CEO were fully aligned, we know what to go after and when. You know, so that that’s kind of, you know, again, set the stage right. So we’re looking out to the future, knowing that, you know, we’ve all been through all of these experiences, taking those insights and what we call that, take the insights and well be eyes them, because you could come with an experience from, from a certain, you know, background, it doesn’t fit here.

And we learned that early on, it’s like, don’t bring your old experiences, bring them to highlight them. And let’s see how we can actually well be eyes them within the model of care that we’re actually building.

AnthonyCodispoti : Well be eyes them I like that. Define what that means. What does it mean to well be eyes something.

Dr. Iyad Houshan : Well be eyes it to make sure it fits with our initiatives. It fits within our culture. You know, we have a patient first culture, we have a culture of transparency, we got a culture of openness, and we have a culture of, of, you know, manage patients first and then think later. So you go on there, you take care of the patient, and then you build processes afterwards. You know, it’s like the patient care takes precedence over everything. So that would be kind of, you know, the general example around, you got to well be eyes it.

And there could be an experience where it worked in a, in a certain situation and circumstantial, and it works very well. How can I take the bits and pieces that that actually fit within the model that we have without totally like out of, you know, without, you know, saying, oh, this doesn’t fit here, we’re not going to think about it. We take all commerce, all ideas, all thoughts, all innovations. Let’s take those, curate them, if you will, and to say, yeah, this this those pieces we can actually put together to create this new chassis. That’s called a well be chassis to build on. Well, Dr.

AnthonyCodispoti : You know, a lot of times I talk to founders, C suite executives, and they rely heavily on a particular daily ritual habits that, you know, they, they go through every day that keep them centered and on track. Do you have anything like that?

Dr. Iyad Houshan : Yeah, I’ve, I’ve improved over the past five years on those a little bit, embalished, but there is few things that I live by is that, you know, I’ll start there and then I’ll give you those rituals. So, you know, I think of leadership more about building your team you give them direction, a producer results, those are the top three definition of my leadership. So you build your team, and then you give them direction, it produce results. So my, my high genes are I always have weekend high genes where I’m looking back at the week prior and see what’s coming ahead the week after. So that’s kind of more from a managing a day to day and managing the calendar. So I’m sure I’m prepared for everything that comes during the week. The other thing is I, I, I’m very keen on data and analytics. In the heat of battle, you have a hard time trying to look at numbers and I probably anywhere between an hour and a half to two hours a day, I go in and I look at all of our dashboards, all of our numbers and everything just to make sure that one I understand it. One, it makes sense.

And what are we going to do about it. So trying to do that the those are kind of, you know, from weekend hygiene and data analytics. Then I spent a whole lot of time. This is weekly and it happens during the week of, you know, what am I doing strategically? Am I really heading the right direction myself? So I got to reflect say, okay, is this the right direction? And then the other half of that time I spend on the people that we have.

Did I invest enough in the people? Those are kind of, you know, the big things that always top of mind for me. And I keep repeating those on a weekly basis.

AnthonyCodispoti : So the time that you spend looking at the dashboards, I’m curious if you can think of a specific example, whether it’s recently or not, you’re looking at the data, you see a red flag, you see something that draws your attention to it. What’s the actionable step that you take?

Dr. Iyad Houshan : Well, there’s one that happened, you know, just this weekend. So I’m looking at the dashboard. And again, I look at it every week. And I looked at it, it’s like, this looks very different. Something went wrong here. It’s really off totally off.

What is what’s going on here? So of course, my mentors in the past, they said, do not reach out to your team on the weekend. They need their time. You know, but here I am, I’m struggling.

What do I do? I mean, there’s those things I try to to really discover the reason for it myself. I could not do that, but I was able to hold tight till Monday morning and literally picked up the phone spoke with the data person responsible for it. Come to find out this person was by two steps ahead of me is like, yep, we realize this, we just got a new data dump. It’s going through our curation and things.

So that’s kind of the action is I tend to ask a lot of questions, a lot of clarifying questions just to make sure we understand. First of all, is it accurate? And if it’s accurate, then what’s the intervention? Another example would be, you know, you could wake up one day say, wow, look at this, you know, we have, we have a big gap here between what were goals, where our goals are, and where we sit. And the action for me there is like, okay, on our team meetings on Monday. Okay, guys, here’s what I found.

What should we do? So it’s more of a team approach to solve the problem. I could highlight it, but I think the team is much smarter than I am, they’d be able to figure out solutions that I haven’t thought.

AnthonyCodispoti : If that’s true, then you’ve hired well. You said the team is much smarter than you are. Yep. That’s the goal. They are. You know, in my experience, sometimes our mistakes become our greatest teachers. I’m curious if there’s an early moment in your career that maybe seemed like a setback at the time, but actually propelled you forward as you look back on it.

Dr. Iyad Houshan : Yeah, this was actually early in my teaching years, where as a new physician coming in, you know, trying to practice medicine in the hospital as a hospitalist, I thought I could do everything. I thought no one else knows what I know. And I can actually provide the best care to the patients only by myself.

And that actually got debunked very quickly in my first four months of actually practicing. I crashed. I crashed because I wasn’t able to accomplish anything by myself. Literally, I felt like I failed my patients.

I couldn’t do it. And to me, that was the juncture where team is the way to go. I got to work with the team, even though it’s not my own team, to give you an example in the hospital. As a hospitalist, you go in, you could go in incognito, go in, see your patient, come out, write your note, your orders leave.

What I found it to be more helpful after that incident is like, you know, I got to get this. There’s a lot more people. The nurses spend more time with the patients than I do. They know them probably more than I do.

I could spend 30, 40 minutes an hour, but they’re like had them for the full day. There must be some insights in there that I could learn to help with the patient care. So I actually started going.

I go on the floor. Some nurses, most nurses loved it. Some actually called me out on it. It’s like, guys, could you run with me? I’m going to go see the patient. Can we go together? Can we do this? And then they will say, okay, I’m distributing meds. I’ll wait.

I’ll wait till they do it. So the biggest learning for me was that by myself, I can’t accomplish anything, but by the numbers and by having the team, there’s a lot more that could be accomplished and learned from. And that’s kind of early on, and I took it. I’ve been doing it all along here is you really got to rely on your team, delegate, but also, you know, you can delegate and check, right? But you got to delegate to your team, give them that trust. And like I said, a smart team will outsmart you in a very beautiful way. And that brings me tons of comfort to have the folks actually, you know, accomplishing also their goals and what they want to do in their career. So team is the theme here.

AnthonyCodispoti : Yeah, are there any books or podcasts that have been particularly helpful for you in kind of learning some of these lessons that our audience might be interested in checking out?

Dr. Iyad Houshan : No podcasts come to mind now, even though in our team meetings, we actually share a lot of podcasts and we have like learning shares. So they come in with different podcasts. There’s several. But there’s a book that I read, which is actually, it’s a leadership book. Some folks by Reddit now the title evades me, but I can see it in my library here. It talks about all of the seven little stories, leadership stories. One of them talk about, you know, Marie Currie. The other one about NASA story. And other like seven little stories of leadership that every time I go back to that book, you know, every few years, like read a story or two, because there was a lot of learnings from it. And it’s called like leadership in stories.

I can send you the full name later for the audience or for the listeners if they need to. But that’s one of the books that’s always, you know, top of mind for me. There’s, I’m currently reading my fourth book on emotional intelligence. It seems to be a topic that I’m interested in just learning more, more and more, because if we apply more emotional intelligence with our patients, I think we’ll learn more and be more effective.

AnthonyCodispoti : That’s interesting. The fourth book currently on emotional intelligence. And so are you able to sort of synthesize some of these lessons and then implement them or help teach them to the rest of your team?

Dr. Iyad Houshan : Yeah, I try to kind of, you know, have those learnings and share two or three things that I learned. And then to me, it’s up to the team of adopting or not, but I’ll continue to remind them of those. The big stories here is, again, sitting across from a patient is also another intimidating thing, because you’re like sitting with a person who has a lot of issues and you don’t know what to expect, especially when they have family around. I don’t know if you’ve ever been in a room where there’s like probably 16 family members and a patient. This is real intimidating, because you got all these people on stage and find out what they’re thinking, right?

And they’re looking up to you, so you got to respect that and you have to provide that value. Knowing when to say, I really don’t know. You shouldn’t have an answer for everything. Saying, I don’t know is good.

Actually, it brings more confidence like, oh, okay, they don’t know this, but I’ll follow. I’ll come back with an answer. I’ll find out what the answer is and I’ll come back to you with it. But, you know, Emotional Intelligence, I think we don’t have, we don’t do a lot of it with our patients. And the more and more we do it, we can actually glean a lot more from the patient stories to be effective in their care.

AnthonyCodispoti : Dr, I’ve just got one more question for you. But before I ask it, I want to do a couple of things. First of all, for everyone listening today, there’s probably somebody in your life that would get a lot of value out of this podcast.

Go ahead and hit the share button. Send that to somebody you know that’s in the medical field, somebody who’s in senior care, home care. I think they would probably get a lot of value out of what the doctor has shared today.

I’m also going to let people know how to get in touch with you, doctor. We’ve got your website, which is wellbe. Wellbe.com. We’ve got your LinkedIn page, which will share the link in the show notes, but folks can just search for you. Your first name is spelled I-Y-A-D. Easy for me to say I-Y-A-D. And then the last name, Hushan, is H-O-U-S-H-A-N. Any other way that you want to direct people to either follow you or get in touch with you?

Dr. Iyad Houshan : Yeah, eod.hushan .wellbe.com. They could send me an email. More than happy to respond to those, LinkedIn in another way of actually trying to communicate. And we also have on our website a Wellbe that we can offer after the call for you to the listeners to be able to reach out if they have any questions on Wellbe in general.

AnthonyCodispoti : That’s terrific. So last question for you, doctor. As you look to the future, whether you think specifically about Wellbe or the larger senior home care industry in general, what are some of the changes coming that you’re most excited about?

Dr. Iyad Houshan : The changes, I think, you know, there’s a lot of industry changes in general. What I’m excited about is actually, so this is more of a, if you look at the Medicare Advantage world, there’s a lot of challenges in the world of Medicare Advantage.

And, you know, we could go through, there’s probably, you know, multiple things that you, if you look at MA in general. So we know that, for example, Medicare Advantage plans will decrease by 2.8% national. So that’s going to be, you know, less care for some of these patients who really love to be with MA. And individuals joining MA is like less by 6.5%, right? A lot of the beneficiaries today, you know, they have only about 34 MA plans to choose from in 2025.

It was a lot higher before work. So I’d say, you know, things that were excited about is partnering with Medicare Advantage health plans, helping Medicare Advantage health plans really deliver the best benefits to their patients by applying those care and services. The comfort of patients’ homes. That’s very exciting to me because the industry having a lot of changes and we can go in details. There’s the IRA, Inflation Reduction Act, a lot of out-of-pocket expense for the patients.

So having, you know, aiding and helping Medicare Advantage beef up those, let’s call it the benefits to the patients to make sure that the patients stay in the care of Medicare Advantage and be able to deliver better care at the end of the day to give those patients better days. I think that would be super exciting for me because somebody has to do something here. Like we can’t really have a lot of control. We have a voice.

We have a lot of control of regulatory changes that are taking place, but we can react to them by easing, let’s call it the pain on the patient end, and also helping and aiding Medicare Advantage health plans, you know, provide better benefits to the patients at the point of care in their home.

AnthonyCodispoti : Dr. Yad Hushan, I want to be the first one to thank you for sharing both your time and your story with us today. I really appreciate it. Absolutely.

Dr. Iyad Houshan : Thank you very much, Anthony. I appreciate the opportunity again and hope to come and talk to you soon at some point.

AnthonyCodispoti : I’d love that. Folks, that’s a wrap on another episode of the Inspired Stories podcast. Thanks for learning with us today.