A Fierce Healthcare Podnosis Interview With Jeff Smith, CEO of Bamboo Health
Fast Facts:
- Adults with five or more chronic conditions see an average of 14 physicians and have 37 annual appointments (CDC)
- Individuals with behavioral and physical health conditions cost up to 3.5 times more than those without (Milliman)
- The top 5% of high-cost patients account for nearly 50% of all U.S. healthcare expenditures (Kaiser Family Foundation)
- One in five adults in the U.S. live with a behavioral health condition (National Institute of Mental Health)
In today’s fragmented healthcare system, high-need, high-cost patients, especially those with behavioral health challenges, too often fall through the cracks. On a recent episode of Podnosis, Jeff Smith, Chief Executive Officer of Bamboo Health, joined Fierce Healthcare to discuss how real-time care navigation, interoperability and artificial intelligence (AI) are reshaping the future of complex care.
Q: Why are high-need, high-cost patients such a priority for health systems?
A: Roughly 20% of patients drive 60% of healthcare costs. What’s striking is how frequently behavioral health is a factor. One in 20 U.S. adults are diagnosed with serious mental illness each year, and even more, one in six U.S. youth aged 6 to 17 are diagnosed. Proactive, coordinated care addressing physical and behavioral health is essential to improve outcomes and reduce costs.
Key takeaway: Addressing behavioral and physical health is essential to improving care and controlling costs.
Q: What happens when behavioral and physical health are not integrated?
A: I recently visited a behavioral health clinic, and the director told me her biggest challenge is coordinating care for patients’ physical health needs. Without integration, patients face fragmented care, missed follow-ups and unnecessary emergency department (ED) visits. Integrated care models reduce ED visits and hospitalizations, improving outcomes during pivotal care moments.
Key takeaway: Integrated care improves quality of life and reduces overutilization of the ED and hospital.
Q: What role does care navigation play in closing these gaps?
A: A patient with five or more chronic conditions sees an average of 14 physicians in one year and uses a larger number of medications, lab tests and imaging studies than other Medicare patients while suffering more adverse events. For this group, real-time care navigation is essential. It bridges communication across providers, guides patients to the appropriate level of care and prevents unnecessary readmissions. The ability to respond during pivotal care moments, such as post-discharge or following a new diagnosis, is vital to improving adherence and outcomes.
Key takeaway: Real-time care navigation reduces redundancy, improves continuity and supports adherence.
Q: How can health plans, providers and community organizations collaborate more effectively?
A: First, we need shared data and insights. When everyone aligns around the same patient information, decision-making becomes streamlined. Second, we must build high-performing networks across all care sites, including community organizations, to support social determinants of health. These networks allow us to match individuals with the right provider or providers for their needs.
Key takeaway: Collaboration requires shared data, integrated care networks and attention to social factors.
Q: How does real-time data support value-based care?
A: Real-time data drives early identification of risks and enables timely interventions. It supports the closure of quality care gaps and accurate documentation for risk adjustment, especially under models like Medicare Advantage v28. The new model improves the accuracy of how Medicare Advantage plans are paid, particularly for managing complex patients with chronic conditions. Giving physicians prospective insights helps them manage conditions proactively and sustain the care infrastructure required under value-based care.
Key takeaway: Real-time data underpins better quality, risk management and reimbursement alignment.
Q: What innovations are you most excited about?
A: Two key innovations are transforming care delivery. Real-time, interoperable data empowers care teams to coordinate and respond more effectively. In parallel, AI unlocks predictive analytics, early warning signals and personalized support, available 24/7 and enhanced by human oversight.
Key takeaway: AI and real-time data unlock proactive, personalized and scalable care delivery.
Listen to the full episode on Fierce Healthcare’s Podnosis: Tech-Driven Care Navigation: Transforming Outcomes for Complex Patients
