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