The COVID19 Telehealth Accelerator

clearly healthcare has been in the news

a lot

this year and healthcare has always been

important

in the united states at 3.6 trillion

dollars

it’s 18 of our gdp the interesting thing

about health care is that it’s different

than most other markets as well though

with all the moving parts that we have

with supply chain

regulatory reimbursement patient rights

it’s very difficult to compare this

market to other markets in the industry

it’s also difficult to draw a straight

line from the patient to the provider

to the payer and in michael

porter’s book in redesigning healthcare

he looks at the fact that health care

itself

is primarily broken around its delivery

system

and that delivery system is challenged

in that innovation moves very slowly

uh through the healthcare market as well

and this is particularly acute in rural

areas where there’s very little

competition

and if there is competition the

prevailing thinking is to keep the

patient within that system

covet 19 has laid bare a lot of the

challenges within our delivery system

and you have to look no further than the

delivery of personal protection

equipment

and ventilators and medication to make

sure that we get to

the right place at the right time

rural healthcare also faces significant

challenges

at most rural hospitals are the

cornerstone

of the community they represent

prosperity they are sometimes the

largest employer in the community

it’s where local families come into and

leave this world

and reimbursement has been a real

challenge for these rural hospitals

in that without the reimbursement being

higher

many hospitals have gone out of business

in fact in the last year

121 hospitals have closed their doors

in these communities regardless of the

reimbursement issues that we face there

are still patients that need to be taken

care of there are homeless

there are addicted there are chronic

patients that need to be taken care of

and these hospital systems have to find

a way to make that happen

another challenge that is facing rural

hospitals is the

facing all of health care and that is

that there is a predicted 120

000 physician shortfall by the year

so there’s a big gap in physicians and

before covet 19

50 of physicians were showing signs of

burnout so there’s a big challenge there

as well so financially there’s a

challenge with rural hospitals

attracting providers as a challenge for

hospitals

rural hospitals also want to make sure

that they’re giving their patients the

best care

irrespective of where when it’s received

ensuring that those patients are taken

care of

this really increases the administrative

cost for the systems

and an additional burden for them they

have no choice

rural hospitals have no choice then to

rethink

how to go forward from here thomas

friedman’s book

the world is flat really elaborates on

how anybody who has a smart device has

access

to world-class services and world-class

support

and hospital systems should look at

these programs

as a way to move forward

telehealth is defined differently in

every state in the country today

every single state looks at telehealth

differently it’s as simple as an

audio phone call between a doctor and a

hospital and a patient at home

two as complicated as multiple

caregivers looking at

data that was received on a wireless

stethoscope

to look at patient progress

we already know that healthcare is a

challenge and that innovation moves

slowly

but let’s look back at what some people

have found relative to

telehealth fast company did an article

on the 1918 spanish flu and

there was uh part of that discussion was

in 1910 so eight years prior to

the spanish flu there was

a uh touting

telephone as the then current technology

to keep people from dissociative

disorder

allowing families to communicate with

each other even though they may be

separated from each other

tuberculosis at that time was a real

challenge and without a vaccine one in

seven families were affected

by tuberculosis so there’s a lot of

separation

and then the spanish flu hit in 1918 and

there was a new york times

article editorial that was pulled out

that was said

please limit the amount of time that you

use a telephone

because of the fact that our operators

are out sick

and a battle creek news article that

said please use the telephone

uh only for essential business so how

much of this is

history repeating itself and how much of

it

is a challenge that we could learn from

did dissociative disorder become

more rampant because of the fact that we

didn’t have that delivery system down

so what’s new what can we do now let’s

say you’re sitting at home you’re

watching television and a message pops

up and it says your physician would like

to talk with you

you accept the call and it’s a video

call with your physician and she says

that she’s concerned about some data

that she’s seeing and that you you show

signs of increased atrial fibrillation

and you say that you feel a little

light-headed but nothing to be bothered

about

and she says you really feel that you

should come in she insists on you coming

in

and asks if you would like your wife to

join the call obviously you let your

wife join the call

and the doctor explains that the

wearable device that you have is showing

increased

uh challenges and that there is a

potential for a catastrophic event for

you

if you don’t seek help right away and

that she’s already called a

trained and certified driver to come

pick you up

and that that driver would deliver you

about the same time that your wife

arrives at the hospital

when you arrive at the hospital your

electronic health record is shared with

all the patients

all the caregivers who are appropriately

allowed to see your

ehr all you have to do is tell them your

name

and birth date and they allow to

progress you through the system

after some tests are done it is

confirmed that

you are indeed having a problem but

with some modifications uh to your diet

and reduce stress that maybe you could

avert

a minimally invasive uh atrial

heart ablation the doctor also

prescribes to you some mobile apps

to focus on reducing stress increasing

sleep

improved exercise and so while you’re

driving home after leaving the doctor’s

office

or the hospital you know that your

medication is going to be delivered by

amazon

within two hours that you’ve got mobile

apps that you’re downloading on the

drive home

and you also open a email with your

final bill

which is correct and in line with what

your expectations were

we are closer now to these kinds of

scenarios than we ever have been

because of covid19 the acceleration that

covet 19

provided in the last couple months is

amazing

uh they’ve done we’ve done more in the

last six weeks than was done in the

previous 10 years previous 10 years

relative to telehealth

the patient can be seen across state

lines

and reverse reimbursement is done this

is through the help of

medicare and medicaid so prior to covet

19

you were restricted in how you could be

seen and how you could be reimbursed

with telehealth

obviously the government has done a good

job of allowing us to

provide care where care is needed and

this was done by

eliminating the licensure issue across

state lines and allowing

reimbursement to be done at exact the

same exactly the same rate whether it

was in person

or a virtual visit during this time

henry ford went from 150 visits per week

to over 6 000. bcbs and happ

along with priority health waived

co-pays

as well as guaranteeing reimbursement

for the payers

upmc also saw an increase of 250 virtual

visits per day

to over 9 000 a 3 700

increase in virtual visits in that short

amount of time

and what we’ve learned by that is that

many of the visits that we’re seeing

are for patients who really should stay

out of the hospital those patients who

are on chemotherapy

those patients who have heart disease or

diabetes

so should we be concerned about what’s

going on with kovid should we be

concerned about the

healthcare marketplace and the current

environment is

potentially catastrophic for a certain

part of our community

not to downplay the significant and

horrible cost of suicide but

on an annual basis we have a one

trillion dollar cost globally to

depression

and in the month of march there was a 34

increase in prescribed

anti-anxiety medication our providers

our caregivers

are doing everything they can to help us

out and our caregivers

need help as well a company called

talkspace

has provided uh free of charge to our

caregivers

anytime anyplace care for them to

seek help about their own uh be

their own mental health during this

challenging time

and what they’ve seen is that they’ve

had conversations with these

uh these service providers that say

we’re all in this

together uh you know the thoughts that

you have

are global everyone has very similar

thoughts

and that these thoughts are bad for your

immune system so you’re unable to

continue

to do your job if you don’t pay

attention to your own health

and that the irrational or destructive

thoughts should be

mitigated so talkspace has done a good

job of helping out our caregivers at the

same time

headspace and calm have also provided

their

applications for patients and patients

are able to download this content

and use that offline so if they don’t

have access

to the internet while they’re there

in times of uncertainty what people

really need is simple

we need clear accurate data and we need

to be

kept away from misinformation and that

may sound simple but

in this age of the internet where the

democratization of data has become

so prevalent there’s so much information

about health care

it needs to be curated every day in fact

there’s a book that’s out by near eol

called hooked and what he talks about in

his book is

how software programmers are actually

designing mobile apps that are addictive

to people who use them we all know what

it’s like to go back and check

and do likes and make sure that you’ve

got updates

on your social media that’s by design

the software programmers are doing that

by design

and that’s fine if it’s for good but if

it’s for nefarious reasons

that’s a big challenge and you can’t

treat a gamer the same way you treat

a patient patients need to be treated

differently

and so when you when you look at the way

things are programmed and when you look

at the applications patients

and providers need to be very careful

what applications

those patients are using

interestingly enough nereo published a

separate book later on which is called

indistractible which shows people how

not to be

addicted by these applications that are

designed

but these apps when used appropriately

and when

under the guidance of a physician are

really important and very impactful

there’s promise and a bright future for

our

rural hospital systems so where can we

go

rahm emanuel quoted uh instant winston

churchill or paraphrased him

and said never let a serious crisis go

to waste

and what he means by this is while

you’re in the midst of a crisis there

are things that you would do that you

never thought of doing before

and that’s kind of where we are with

health care in this country today

what if we were to reduce the amount of

time physicians spend on their screen

and increase the amount of time that

they spend with their patients

what would that do to offset the

potential shortfall of physicians that

we’re going to have

in the year 2030 what if we were to find

a way to get

to the last 25 to 30 percent of patients

broadband so that they can access

telehealth which by the way

primary care 80 of primary care can be

delivered via telehealth

so what if we were able to provide that

what if we were

able to provide patients the seamless

type of approach that we talked about in

our scenario

that drives out costs by from the time

the appointment is scheduled

until the time they receive their final

bill everything is seamless to the

patient

i think we need to immediately embrace

one of the most important

challenges that are going to precipitate

out of covet 19 which is

our mental health issues anxiety and

depression

hopefully not suicide but it’s going to

be a challenge and let’s not let

history repeat itself let’s allow the

delivery system

to make sure that it’s as efficient as

possible and as

accessible as possible yes healthcare is

complicated

there’s a lot of different things going

on within healthcare and yes

rural hospitals have their own

significant challenges

but telehealth is working we’ve proven

that it can work

providers are using it patients are

using it let’s not miss that

opportunity to use this modality and i

would say

why not let our rural hospitals lead the

way

in this endeavor thank you very much