Andro Herrera-Mendoza says PAM Well being absolutely acknowledges that the way in which healthcare is utilized by sufferers is evolving. As senior vp and chief innovation officer (his seventh promotion upon coming to PAM in 2018), Herrera-Mendoza is driving innovation on the group that’s centered, firmly, within the perception that generally tech is the reply and generally it isn’t, however what issues most is the right way to enhance care and entry PAM sufferers, significantly these sufferers who want longer-term care and monitoring.
“We’re speaking about people with situations which have been constructing for years,” he says. “The query is how can we keep related to them throughout that complete journey, not only for just a few days in a hospital mattress?”
PAM Well being operates within the post-acute care area, one which most individuals by no means take into consideration till they or a beloved one land there. These are sufferers who usually blow previous the common 4.5‑day hospital keep after which want weeks of ongoing, excessive‑acuity help.
“As soon as somebody’s been in a hospital, there’s a major likelihood they’ll go to some form of publish‑acute setting,” Herrera‑Mendoza explains. “That may very well be a protracted‑time period acute care hospital, inpatient rehab, a talented nursing facility, residence well being, and even hospice. It’s a continuum, not a single cease.”
The scientific image is getting more durable. Growing older People with two or extra persistent situations are colliding with a youthful inhabitants—millennials and Gen Z—who’re growing critical well being points sooner than earlier generations. The result’s a gradual stream of sufferers with neuro‑associated issues, musculoskeletal issues, autoimmune situations, and motion issues arriving sicker and staying longer.
Hospitals are responding by constructing for complexity, fewer low‑acuity instances, and extra excessive‑acuity sufferers who want longer stays and thoroughly managed discharges. That solely works if there are dependable companions downstream.
“If you happen to don’t have robust publish‑acute choices, you don’t have beds,” he says. “You possibly can’t preserve admitting advanced sufferers if you happen to can’t safely transfer them to the subsequent acceptable degree of care.”
When Protection Isn’t Entry
The scientific aspect is just half the issue. The opposite half is who pays.
In Herrera‑Mendoza’s world, authorities applications, employers, and sufferers themselves are all searching for care within the acceptable setting. The stark actuality is that always means sourcing choices inexpensive than a hospital. That stress performs out most visibly in prior authorization and community negotiations.
The SVP is blunt about how that may really feel on the bottom.
“Think about your kitchen pipe bursts and also you want a plumber,” he says. “Now think about somebody has to ‘pre‑authorize’ the restore earlier than the plumber may even present up. That’s what healthcare seems to be like at occasions.”
Right this moment, well being plans usually depend on algorithms and AI to approve or deny companies in seconds. The reviewer could not share the scientific experience of the specialist requesting the process. Many denials are later overturned on enchantment, however by then therapy has been delayed.
“It’s possible you’ll catch just a few unhealthy actors, however you’re additionally holding up lots of essential care,” Herrera‑Mendoza explains. “The delay alone could make a situation worse, and dearer to deal with.”
“We’re thrilled to companion with Andro and PAM Well being, a corporation that shares our dedication to innovation and patient-centered care.” Says Brit Pim, President & CEO at Healix Infusion Remedy, LLC. “By combining Healix’s infusion experience with their patient-focused care, we goal to set a brand new customary for delivering specialised care that actually meets sufferers the place they’re.”
The Alternative to Innovate
Given his title, individuals assume Herrera‑Mendoza sits in a lab testing the newest and biggest tech advances. That’s not how he sees the job anymore.
“After I first moved into innovation, the query was, ‘What tech are you engaged on?’” chief innovation officer says. “Now the query is, ‘Can individuals really use their protection once they want care?’ Protection isn’t the identical as entry.”
For PAM Well being, innovation means redesigning how and the place sufferers transfer by means of the system. That features shifting companies like infusions out of hospitals and into residence or close to‑residence settings when it’s protected to take action.
“Let’s be trustworthy eople need to be in their very own houses,” he says. “You’re extra snug, you’re feeling extra in management. Our problem is to deliver a excessive degree of care into that atmosphere.”
Doing that at scale is the problem. The group should rethink all the things from staffing to logistics. How does PAM route clinicians and gear by means of a number of communities in twenty-three states with out letting prices spiral?
The Inspiration for Care
Herrera‑Mendoza’s perspective is especially necessary as he’s made the leap from caregiving himself.
As an adolescent in San Antonio, he volunteered on the state chest hospital in the course of the period of tuberculosis wards. He remembers a toddler in a crib, alone for lengthy stretches whereas nurses and workers moved out and in. Sooner or later he introduced her a stuffed bear as a result of she had no toys in sight. The picture stayed with him.
“Trying again, which will have been the primary second I actually understood what it means to wish care and never have a lot round you,” he says.
The evening he graduated highschool, he joined the US Navy and skilled as a respiratory technician, finally working as a respiratory therapist in ICUs, pediatrics, and neonatal models. After his service, he moved right into a Stage I trauma heart with a youngsters’s hospital, nonetheless on the bedside however quietly including enterprise and finance programs to his workload.
Right this moment, at PAM Well being, Herrera‑Mendoza continues to be attempting to bridge worlds, sufferers and payers, hospitals and houses, clinicians and executives. The stakes are increased, the system extra advanced, however the throughline stays the identical because it was in that San Antonio ward. The SVP desires to make sure that individuals don’t need to face critical sickness alone and that the constructions round them really work when it issues most.
Healix is a number one supplier of infusion companies, specializing in physician-owned and ambulatory infusion facilities nationwide. With over 35 years of experience, Healix delivers patient-focused care, providing superior therapies throughout specialties like infectious illness, neurology, and gastroenterology. Headquartered in Sugar Land, Texas, Healix delivers high-quality, protected, and seamless healthcare options.
