An interview about why PERS (Personal Emergency Response System) belongs next to vision and dental, how real-time device data is replacing 90-day-old claims, and what it takes to move from vendor to true healthcare partner.
Key Takeaways
- PERS should be treated as a foundational supplemental benefit on par with vision and dental, not as a secondary add-on competing with flex cards and gym memberships.
- Health plans operate on claims data that’s 90 to 120 days old. Medical Guardian can provide real-time visibility into a member’s health, by the hour or by the day, enabling proactive rather than reactive care.
- The statistics show that 75% of seniors who lie on the floor after a fall without timely help will never live independently again. They’ll go to a nursing home or pass away.
- Medical Guardian’s trusted-device channel achieves up to 75% engagement rates on care gap closures, far higher than cold calls that seniors typically won’t answer.
- The future of healthcare partnerships is value-based. If you’re not doing some sort of risk or value-based arrangement, you’re probably not going to be at the table.
Chaston Thompson is Regional Vice President of Business Development at Medical Guardian. Before joining the company, he held healthcare sales leadership roles at Philips Lifeline, Life Station, and CareCentrics, where he worked on fully risk-based contracts with health plans. He now leads payer partnerships across Medicare Advantage, Medicaid, and MLTSS, and spends more than 100 nights a year on the road at industry conferences building relationships with health plan leaders. In this interview, he talks about why the industry undervalues PERS, how real-time data changes the conversation with payers, and what it takes to become a true healthcare partner instead of just another vendor.
This conversation has been edited for length and clarity.
On why Medical Guardian is different from everywhere else he’s worked
You’ve been in this space for a long time, at Philips Lifeline, Life Station, CareCentrics. What made Medical Guardian different?
It starts with the people. Everybody’s really committed to our mission and our goals, and they’re all aligned. I think that really helps drive everything down to what we do, selling and memorializing this mission to the health plans and the payers.
I had certain elements at Philips of what we do here at Medical Guardian. I got to take a lot of those learnings and apply some of them here. But we were never really able to put it together as a complete package like we have here. We’re really striking on all cylinders.
At CareCentrics, the contracts were 100% risk-based, meaning if you didn’t hit the measures based on the guaranteed dollar amount you could save a plan, we would write them a check for the difference. We told a plan we were going to save them $10 million and we only saved them $8 million, we’re writing them a check for $2 million. Luckily, we never had to do that. But that experience opened up a whole other avenue for me that I didn’t really have before.
When you’re only going to know about what happened to someone within the last three or four months, we can give you that lens into their life in real time. By the hour, by the day, by the week.
On the difference between being a vendor and being a partner
You’ve talked about becoming a true healthcare partner rather than just a vendor. What does that distinction actually mean?
These health plans contract with hundreds of vendors to provide them a service. But when you become a true healthcare partner, you’re actually doing more. You’re providing more value for the same fee, essentially. Maybe detailed reporting. Maybe you’re taking on risk and sharing upside and downside arrangements with those plans. Meaning, if we don’t hit certain metrics, we get paid a lot less. Or in some cases, we don’t get paid at all.
That’s really where the healthcare system is going. If you’re not doing some sort of a risk or value-based arrangement in the future, you’re probably not going to be at the table with a lot of these people that you want to be at the table with.
It’s also about owning that relationship from an enterprise level, not just in PERS. We can do PERS, and we can do gap care closures, but we can also do remote patient monitoring. So we can go across the continuum of the health plans. And those relationships all have to go upstream, because there’s only so much that your ground floor level individuals are ever going to be able to do.
On why 90-day-old data isn’t good enough
You’ve talked about the shift from reactive to proactive care. What does that look like from the payer’s perspective?
Everything in healthcare, and I mean everything, is generally based upon claims and arrears. The problem is you’re only going to get a new claim set every 90 to 120 days. So if someone fell today and their health plan was tracking them through claims, they wouldn’t know about it until June or July.
What we try to do at Medical Guardian is say, look, maybe you don’t think this person needs a device today, but we think it would help them in so many different ways, and we can give you all this data and back-end support. When you’re only going to know about what happened to someone within the last three or four months, we can give you that lens into their life in real time. By the hour, by the day, by the week, whatever you want to see. So it can actually help you take a proactive approach, like, we need to get this person in to see their cardiologist.
On why PERS should be treated like vision and dental
Where does PERS sit in the hierarchy of supplemental benefits for health plans today?
I feel like PERS should be right up there with vision and dental. You should have those, and then you start funneling these other additives. But that’s generally not the way it is. It’s usually vision and dental, and then it’s meals, and it’s transportation, and some plans get really weird with things like acupuncture.
For $14 a month, what are you going to get that’s going to give you insight within the home, which you typically never get, support from your caregiver, the ability to take a proactive approach, and then obviously the main component of a PERS, which is to get the help that you need when you need it the most? I don’t think there is anything that’s going to give you all of those things for a nominal fee. But it’s not flashy. It’s not a flex card offering. I can’t go to Walgreens and spend $50 on whatever I want. So you run into those challenges.
But the plans that really get it are the ones that have seen the value and seen the data. It’s not really a device sell. It’s what we can do for you that you’re not getting today with any of your other vendors.
On the stigma that’s still holding adoption back
There’s still a stigma around PERS. How is that changing?
Sometimes I have conversations and I feel like, man, we’re on the right path, it’s turning a corner. And then I have other conversations and it takes me down a different road. But realistically, people think that you don’t need a PERS device until you can’t get out of bed or can’t walk to your mailbox anymore. It’s really the complete opposite.
Especially now where we’ve reinvented the wearables. It used to be like a brick around someone’s neck. But now they’re really lightweight, and we’ve actually converted mostly to wrist wearables. Your watches, your Fitbit-looking type devices. It’s discreet. People don’t even know you’re wearing it. And we can still give the plan all the back-end data they need to take a proactive approach.
On what happens when someone doesn’t get help in time
What does the data show about what happens after a fall when there’s no intervention?
The statistics show, and this is older data, but the longer you lie on the floor from a fall without help getting up, 75% of those people will never live independently again. They’re going to go to a nursing home or they’re going to pass away. And if I’m an insurer, that’s the last thing I want to happen, because if they go to a nursing home, they lose their Medicare. If they pass away, they obviously lose their benefit altogether. Even just getting people off the floor in a timely way, even if it wasn’t a traumatic injury, matters. I’ve seen so many times in the data, just since I’ve been in the industry, where the reason someone passed away is because they fell and they were on the floor for 48 hours. Couldn’t get any help. But if they had the device, we would have automatically picked up that they fell and already started the process to get them off the floor and into the hospital within 10 minutes.
On why a trusted device closes more care gaps than a phone call
How does the PERS device itself become a tool for closing care gaps?
Everybody’s spammed. We all get calls that we’re not going to answer because we don’t recognize the number. That’s even amplified for seniors because they’re usually financially taken advantage of. But when we come through on a trusted device that they recognize as Medical Guardian, and we have empathetic people on the line, we can close gaps at a significantly higher rate than if you’re just calling and texting someone. Up to 75% engagement rate, which is really some of the highest in the industry for that.
So we’ve had plans where PERS wasn’t even on their radar, but now it is because we’re going to help use the device as a layer to go after these care gaps. That’s included in our basic offering. So again, it goes back to that nominal fee. Why aren’t we looked at like vision and dental? Because really, we’re pretty much right up there as far as necessities go.
On the utilization challenge that holds plans back
What’s the biggest obstacle you encounter with payers?
Health plans are a business first. They look at how they can make a splash. Is a PERS device going to gain them new members during Annual Enrollment Period (AEP)? Most of the time, the answer is probably no. So you’re competing against flex card offerings and gym memberships and all these other things that are flashier.
Plans only have a certain number of benefits they’re going to add new each year. And when you do get PERS in the door, a lot of times it’s run by a case management team, and they’re going to require two or three comorbidities before someone can qualify. So you’re limiting the population before you even start.
And then utilization gets tracked on top of that. If someone gets the device and just puts it in a drawer and never does anything with it, the health plan doesn’t like that either because now they’re paying for something no one’s using. So we’re able to give reports to show they’re wearing it. We ping these devices to make sure they’re charged. But that’s the reality of how it works.
On how star ratings drive everything
How do star ratings and quality measures factor into these conversations?
Plans are judged basically purely off their star ratings, and there’s a lot that goes into that. But a big risk is the triple-weighted metrics. This year it’s controlling high blood pressure. Before that it’s been CAHPS surveys. There’s usually one big weighted metric that’s really going to determine whether you’re an optimal four-star or better plan or below.
You don’t really want to be below four stars for a lot of reasons. If you get into two or three stars, you may not even have a plan. So when you talk to those people, it’s, I need to close more gaps in care. We need to get more mammograms. We need to get hypertension under control. Our CAHPS surveys suck. Can you help us with that? And for all of those, the answer is yes.
On what actually differentiates Medical Guardian
What makes Medical Guardian different from competitors in this space?
Obviously I’m going to say we have the best people first, because I know those competitors, and I know what we are and who they are. But outside of that, we have the best technology. We have some of the best partnerships already aligned.
The biggest thing is that we really do live to keep these adults living independently and at home for as long as possible, and we invest in that every day to make sure we’re delivering on that message. A lot of competitors just want to sell you a device and that’s really it. The device probably isn’t great, and the customer service is even worse.
We come in with the mindset of, hey, you want to be a partner, you need this, you need that. If we don’t have it today, we’re going to go build it for you and come back with it. Most of the time we do have it. But we are a PERS-first company. Some of our competitors kind of shy away from PERS. They want to become like they think they’re Apple or Google. They’re not. We’re a healthcare technology company, but we’re a PERS-first company.
On what keeps him going
You’re on 100 planes a year, staying in a lot of hotel rooms. What keeps you motivated?
I’ll never meet any of these people in most cases. But in a small way, I get to help people’s lives for the better. That’s what motivates me in the morning. That’s why I get out of bed and do this. We all need to work, but there’s a bigger mission to that. And I think you see that with a lot of people here. That’s what’s refreshing about it.
