Why Brad Smith, CareBridge chairman and Nashville resident, is betting on rural health care

Brad Smith is trying to solve one of the most intractable problems in U.S. health care — the dwindling number of providers in rural communities.

He calls it "fun." And he's making a lot of money doing it.

Smith, 40, is chairman of the fastest-growing company in the country, the Nashville-based telehealth services company CareBridge. He launched Russell Street Ventures 2021, a health care-focused business incubator. And, The Tennessean has learned, his Main Street Health rural health care venture stemming from Russell Street just closed a $315 million financing deal and will expand from 18 to 26 U.S. states.

Smith's success has come from finding business opportunities in areas of health care that have been traditionally neglected. And Tennessee, where health care deserts are expanding — particularly in rural areas — is fertile ground for such enterprises.

"I think what we've focused on is populations that were typically needed but also underserved," Smith told The Tennessean. "Whether that was end-of-life care, whether that was hospice or whether that was rural (health care), it turned out nobody was focusing on that and it was a massive market.

"It's this nice combination of being able to help a lot of people but, at the same time, build really big businesses."

Smith isn't exactly a household name.

But his fast-growing East Nashville-based business and his attempt to address shortfalls in rural health is quickly making him one of the biggest names in Tennessee. Quietly, he's already a well-connected player, with ties to former U.S. Sen. Bill Frist of Tennessee, members of the former Trump administration, the Tennessee state government and his mentor, former Tennessee Gov. Bill Haslam.

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Main Street places "health navigators" in more than 900 partner primary care clinics in rural communities to help coordinate patient preventative health screenings, patient scheduling, hospital discharges and related needs. The average partner clinic has two to three navigators and is located in a town of 3,000 to 5,000 people, according to Main Street.

Unlike the more traditional fee-for-service model of health care, Main Street Health uses a "value-based" reimbursement model that rewards providers for health outcomes. Ideally, this improves patients' health and saves on overall medical costs.

Main Street already claims to have produced a 23% reduction in hospitalizations for its clients and a 9% reduction in medical costs.

Smith's supporters talk about him like he's a wunderkind.

"His insatiable need to learn, grow and improve at everything he does has made each company more successful than the last," said Ann Lamont, the co-founder and managing partner of Oak HC/FT, one of Main Street's leading investors, and Connecticut's first lady.

"Yes, they are financially successful, but even more important is their enormous impact on the healthcare system. These are not copycat companies. Each one is solving issues in the healthcare system in a way that no one else has tackled the problem."

Meteoric rise in health care

Smith's meteoric rise in the health care industry seems almost inevitable.

He first made a big name for himself in Nashville when he co-founded Aspire Health with Frist in 2013. The two had collaborated years before on the Tennessee State Collaborative on Reforming Education.

And, as Frist recounts, it was a perfect fit. Smith pitched Aspire Health to him in 2011 as an in-home palliative care company that would be a "house call" service for patients with serious illnesses and/or needed end-of-life care. Frist said, as a physician and a member of Congress, he knew this was a service that was sorely needed.

"Aspire Health is successful because it taps into a real patient need and void in the larger healthcare system," Frist said. "Most individuals don’t know the word 'palliative,' so we described ourselves as a 'house call physician practice' available around the clock for persons who are battling cancer, suffering from multiple hospital readmissions, or living with a debilitating chronic illness."

It was a huge success. Within five years, the company had 750 employees and served more than 100,000 patients in 25 states. It was later acquired by health insurer Anthem for an estimated $440 million.

Smith went on to serve as chief operating officer of Anthem's Diversified Business Group, a multibillion-dollar portfolio of five companies, before he was tapped shortly thereafter to serve in the Trump administration.

There, he moved around quickly, building an impressive resume: deputy director of the White House Domestic Policy Council, senior adviser to the secretary of the U.S. Department of Health and Human Services, deputy administrator at the Centers for Medicare and Medicaid Services and director of the Center for Medicare and Medicaid Innovation.

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During his time in government, he got an inside look at attempts to cut health care costs, so-called "innovation models."

"It turned out that only four of the 54 (models) had saved money," he said. "None of them had demonstrably improved quality. But the reasons that it happened were very technical and very specific. The hard part of making technical changes is, they aren't always very popular."

Ultimately, he said, government work wasn't for him. Long hours kept him from his wife and three children. He decided to resign from his post, return to Nashville and build a business close to home.

Early beginnings as an up-and-comer

Smith was noticed early.

Haslam remembers meeting Smith when he was a high school senior at Webb School in Knoxville, Haslam's alma mater.

During a school event, Smith asked him his advice about where he should go to college. (He settled on Harvard.)

Smith later came back to work on Haslam's successful run for mayor of Knoxville, volunteer work that began a lifelong friendship between the two.

"I was immediately struck by his curiosity and eagerness to learn," Haslam said. "He has a good combination of being friendly, obviously, and being very intensely motivated. You don't accomplish much in life without being that way."

That relationship led him to more. Smith, at the urging of Haslam, went to work with former Sen. Bob Corker (who had been roommates with Haslam's brother in college), serving as his personal driver as he campaigned throughout the state.

Smith eventually graduated summa cum laude from Harvard, where he studied government, and later became a Rhodes Scholar, where he received a master's degree in philosophy.

Why health care?

Smith has really only been serious about the health care industry for the last decade.

He studied government in college and took a White House job as an executive assistant in the Bush administration after Corker won his senate bid in 2006 — shortly before heading off to Oxford.

Smith eventually landed back in Nashville and found a post with Haslam's Department of Economic and Community Development, where he served as chief of staff. He later served as interim president and CEO of the Tennessee Technology Development Corp.

He left shortly thereafter to work on the Tennessee State Collaborative on Reforming Education, a Nashville non-profit he co-founded with Frist.

Smith said that it was a personal experience with the health care system's failings that led him to get into the industry.

Specifically, his grandmother's final days in a hospital.

"I don't know if she was getting good care or not, but it didn't feel like she was getting good care," Smith said. "She was living by herself after my granddad died. She had a bad hip after falling down some stairs and went in and out of the hospital probably three times. And she ended up dying in the hospital."

Smith said that led him to research best practices in hospice care. That led to Aspire.

Meeting a need

Main Street contracts with health care clinics largely in rural communities where there is a shortage of health care providers.

One of those communities is Whitefish, Montana, population 8,500. This community at the edge of Glacier National Park is home to a booming tourism trade that has made the cost of living increasingly too high for the local population, said Dr. Jennie Eckstrom, a partner at Glacier Medical Associates.

Her clinic has three Main Street navigators.

While they do traditional navigator work, like helping with patient scheduling and medication checks, they also help with making sure patients are getting their other needs met, she said.

One patient, a disabled veteran, needed help finding wood to heat his home for the winter, she said. Another navigator helped a patient make sure they could get a ride to and from the clinic, she said. In one case, a navigator helped a patient find economic assistance while that person was in between jobs, she said.

"A lot of the things that we know have to do with patient outcomes, things that have to do with how they're doing with their diabetes or hypertension are not just related to just to they're coming to see me and me prescribing a medication," Eckstrom said. "It's can they afford that medication. Can they afford to come to their follow-up (appointment)? Do they have transportation? Do they have money to keep the lights on? Do they have wood to heat their house?"

Tennessee has the second-highest rate of hospital closures in the nation. Many of its rural communities also suffer from a shortage of health care providers. Meanwhile, Main Street navigators are already in more than 70 practices in 52 Tennessee counties, Smith said.

"I think it just speaks to the need that we're meeting," Smith said. "We think we'll be able to grow from 900 to 1,300. There's not really anybody else focused on the kinds of towns and communities we're focused on. And so it's really just kind of taken off in ways that are way beyond what we expected."

Frank Gluck is the health care reporter for The Tennessean. He can be reached at fgluck@tennessean.com. Follow him on Twitter at @FrankGluck.

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This article originally appeared on Nashville Tennessean: Meet Brad Smith. This Nashville leader is rethinking rural health care