- Hello everyone, this is Erica Spicer
Mason with Becker's Healthcare.
Thank you so much for tuning into the podcast.
We're thrilled to be joined today by Dr. David Houghton,
the medical director of digital medicine
and the system chair of telemedicine at Oxner Health,
who will talk to us about digital specialty care
for the treatment of cardiometabolic conditions.
Dr. Houghton, thank you so much for joining us today.
- Thank you, Erica. - Thank you.
And before we dive into our conversation, I wanted
to know if you could just share a little bit more about
yourself, your role, your organization,
whatever you'd like to share with our listeners.
- I'm happy to. Thanks so much to, to you
and to Becker's for, for having me.
Um, as part of this podcast today, I'm a neurologist
by training and by trade.
I spend about half my time clinically not only taking care
of, uh, aging neurologic disorders like Parkinson's disease,
but also seeing the ramifications of poor,
poor cardiometabolic health and things like strokes
and heart attacks in the hospital.
I've been at Oxford now for 11 years,
and with the other half of my, my career, I've,
I've enjoyed spending it in the digital health space
initially with telehealth
and the traditional forward facing episodic care models
that we were building even before the Covid to 19 pandemic.
And now over the last three years,
more activity in the chronic disease management space,
taking care of hypertension, diabetes, hyperlipidemia,
and others to try to make our patients in the Gulf South
and actually across the country as healthy as possible.
- Thanks so much, Dr. Den.
It's really helpful to know that background.
Um, congrats on 11 years at oxner.
That's, um, quite a while to see how things,
not just care delivery has shifted in that time,
but you mentioned this, this focus on digital health
and managing chronic conditions,
so I'm sure you've seen a lot
of change there more recently as well. Um,
- Yes, indeed.
- Yeah. So I wanted to start kind of broad here, especially
with your experience, um, in medicine.
You know, we know in the US
that optimal cardiometabolic health rates are declining.
So can you touch a little bit on what are the key factors
contributing to this trend and
how is it affecting not just patients,
but the industry, the healthcare industry more broadly?
- Sure. And in fact, to, to the LI listeners,
they may not be familiar with this term
optimal cardiometabolic health rate
or even what Cardiometabolic health is,
and to level set that it's, it's really a way
of thinking about all of the chronic disease factors
that can impact the outcomes
that more than anything else Americans are trying to avoid,
like heart attacks and strokes, brain bleeds, et cetera.
And most of those are based on blood vessel health,
so things like blood sugar
and to avoid diabetes,
getting your cholesterol under control if you have
hyperlipidemia, getting your blood pressure under control so
that you decrease the stress off the
blood vessels in the body.
And then ultimately,
and what may end up being the most important factor
is weight control.
We recognize that a high BMI
or body mass index is very closely linked.
So that weight, blood sugar, cholesterol, blood pressure,
and the efforts to avoid those downstream late effects like
heart attack and strokes, is really
what we're talking about when we're thinking about
cardiometabolic health.
And the rates are declining.
In fact, some of the most recent data we have was published
last year, but that's a look back to 2018.
And then as, as recently as 2018, less than 7%
of Americans were thought to be
of an optimal cardiome metabolic health.
And that is continued to decline over the previous 20 years.
And here we are five years later.
So I think probably nobody on this podcast would think
that generally the health of Americans with, with regards
to cardiometabolic disease has improved significantly
over the last five years.
And our worry is, is that it's getting worse.
And so we really had to step in as a health system, um,
as a country and think differently about the ways
that we can best tackle things like high blood pressure,
high cholesterol, and diabetes.
- Yeah, absolutely.
And just knowing that I believe the number one killer in the
United States is related to heart health.
Um, so I can see how, you know, just the connection
between these, these risk factors you've mentioned BMI,
blood sugar levels, cholesterol levels,
certainly concerning.
So thank you for kind of painting that picture for us.
So how are you seeing healthcare organizations currently
approaching treatment and
management of conditions like this?
And in your view, are there opportunities
for improvement or innovation?
Um, interested to hear your perspective there.
- Yes, I think we need to do something differently.
And fortunately I'm part of an organization
that's been thinking about this for, for decades in general
as we take care of patients in the Gulf South,
but particularly over the last 10 years, about ways
that we can harness technology
and put a new focus on these cardiometabolic factors.
And the way that we have thought about, um,
this new opportunity is to harness technology in the forms
of smartphones and simple connected Bluetooth devices
and healthcare teams that are able to take care
of two particular portions of somebody's longitudinal care.
One, coaching them on lifestyle choices, diet, exercise,
and really tackling social determinants of health
and the way that those impact people's wellbeing.
And then secondly, following the guidelines that
as primary care physicians
and other specialists we are aware of that take care
of hypertension, diabetes, hyperlipidemia,
using the right drugs at the right time,
and to meet the patients where they are.
Our efforts here have now enrolled more than 30,000 patients
as part of our digital medicine program.
And right now, the way that we are able to change the story
for them is to try to get their blood pressure,
their lipids, and their cholesterol under better control.
- Wow. And that, that is an impressive number,
30,000 patients.
Um, and I just wanted to comment too on something
that you mentioned about harnessing technology like
smartphones and simple Bluetooth connected devices.
I think that simple factor is probably so important, um,
in terms of ensuring that you can get widespread adoption
of, of tools like this.
- That's certainly true. And if, if you're in the bricks
and mortar healthcare business right now,
the number one buzzword is access.
How do we allow access of our patients
to the healthcare system, whether that be for appointments
that they need for their annual visits, whether that be
to get a high level specialist
and hopefully whether that is
to avoid unnecessary ER visits or urgent care visits.
But in the digital health space,
that access is opened up wide by simple,
digestible user-friendly apps.
And then on top of that, the content
that really does meet patients where they are,
and it does sound cliche, this idea of meeting patients
where they are, but it's true.
In fact, we need to find patients
where they are on their healthcare journey.
How can we align our health goals so
that they are better stewards of their own healthcare
with their providers?
How can we address those social determinants?
How can we make sure that the health coaching is
what is they need in their lives at that time?
And so as we have built these focus factories to take care
of hypertension, diabetes, high cholesterol,
we have recognized all the potential overlap
and the benefits that those patients are able
to enjoy quite literally in their pocket.
- Mm-Hmm, . Yeah. So well said.
Thanks so much for kind of building on that
and just going down this road of technology.
I, I wanna get to some more specifics
if you're able to share.
So I know you've talked about the smartphone
and the Bluetooth connected devices,
simple convenient devices that patients can use at home.
Can you share what kind of the key elements are
of a successful approach here digitally
and maybe any case studies
or success stories that come to mind?
- Sure. I think first things first, you need
to lay all preconceived notions
and potential biases at the front door
before you build these programs.
We can't presume, for instance,
that vulnerable patient populations like our seniors
are not able to utilize technology.
We learned during covid, uh, and
before that, in fact, that myth is, is easily debunked.
Similarly, we need to be creative if we have patients
who are, uh, of lower socioeconomic status
or struggling with other, um, ability to,
to access the traditional healthcare systems technology.
We need to work hard to make sure
that there is broadband access.
We need to make sure that we can put technology in
the hands of patients.
So that's number one is, is to remove all your biases and,
and, and think broadly on how we can reach patients.
Then after you determine what you're going to tackle,
you have to recognize that everybody with a certain disease,
everybody with a certain condition may benefit
from the halo effect of a program such as this.
You may have a patient who comes into the program
and their blood pressure's under control,
but they may not be on the optimal regimen
and they may not have addressed the lifestyle factors
that would make it more easy to control in the future.
Or similarly, you may have somebody come into a program
whose diabetes is out of control,
but they really haven't recognized the value of some
of the newer medications yet.
And so the halo effect,
or what they call down in New Orleans, the lanap,
which means a little bit extra, is absolutely
valuable in this program
because it allows the patients now for them
to feel like they are part of a community
that cares about them.
It's important that we don't just educate,
which feels very one-sided in many circumstances,
but we engage and then ultimately we activate the patient so
that they develop their own self-efficacy
and they're the ones who will continue
to drive the improvement.
I think one of the better examples of the ways that we have,
that we have reached our patient populations is
with a Medicaid pilot that we undertook in our state.
Initially, Louisiana has not had the traditional payer
mechanisms for patients with Medicaid
as their insurance product to be able to benefit
from remote patient management products at home remote
patient management programs like our own.
And so with the assistance of some funding from the FCC
that was secured during covid to help d uh, to help, uh,
cover the cost of the connected devices
and with our hospital system, um, fronting the, the,
the cost to take care of, of some of the patients
that are right here in our community, we were able
to enroll not the thousand patients
that we anticipated on the front end,
but now more than 7,500 patients who have Medicaid
as their insurance provider.
And the results that we've seen in that patient population
mimics what we've seen in a commercial payment patient
population, what we've seen through other payers
or employers, what we've seen through Medicare.
So again, we leave our biases at the front door
and we recognize that any patient can benefit from good,
simple, digestible user-friendly technology.
And in fact, it's those patients that have been left
behind in traditional healthcare institutions in some
circumstances that appreciate it the most.
We check our, uh, our, our patient satisfaction rates, um,
on an, on an a regular basis,
and we recognize that
through our net promoter score, which is that simple.
One question of whether you would recommend a service to
a friend or family member.
Our net promoter score rate is 91 really a top
industry number for our patients that were part
of our Medicaid pilot and the fact that we know
that we are benefiting our community in south Louisiana,
but similarly, those patients are appreciating the work
that we're doing with them
and that they then are taking control of their healthcare.
There's no better feeling than that.
- Absolutely. That patient satisfaction score is definitely
impressive, and I know that patient satisfaction is top
of mind for so many healthcare organizations right now
as they're trying to keep patients on board and,
and also recruit new ones.
So, um, congrats on that metric. That's exciting.
- Thank you. - Yeah.
So considering everything we've discussed, you know,
as you look to the near future,
how do you really see digital care for the treatment
of conditions like cardiometabolic conditions evolving,
and also how do you see them down the line
benefiting payer organizations?
I know you mentioned the Medicaid pilot
and then also just, you know, other healthcare organizations
as well, hospitals and health
systems. What excites you? Yeah,
- That's a, that's a terrific question.
We're, you know, always have our eye on the future,
particularly being able to work, um, across this landscape
of, of digital care.
At Oxford, we've reorganized underneath our,
our chief digital officer, Dr.
Denise Bazo, um, who really is a visionary as it relates
to connected health.
And so telehealth products, digital products as it relates
to chronic disease management, other management products
that you can imagine for long-term cancer care
or long-term neurologic care.
All of these are on our roadmap as a healthcare organization
and, and, um,
selfishly we feel like it's healthcare organizations
that ought to be at the tip of the, of, of the spear for,
for this hard work.
And so it's a really, uh, I would suggest enviable position
for, for us to be in.
If you look in the near term future, I think the
realization by payers, by large employers, um, by CMS,
um, about the value of remote patient management, um,
is really on the rise.
We have been successful, um, in
building per member per month payment models and,
and being able to share our quality metrics
and our reduction in high dollar utilization
and the ability to really demonstrate a return on investment
for any of those groups that may be on the hook for the cost
of their employers or the cost of their beneficiaries.
And similarly, we've shown the same return on health
investment to individual patients who now realize
that their future is brighter without the risks
of cardiometabolic disasters like strokes and attacks.
If we a little further out, I think that's
where advances in technology are gonna be
quite exciting, right?
We have fairly low price point,
digitally connected Bluetooth enabled, um,
blood pressure cuffs and weight scales
and blood glucometers.
But we are on the cusp of, uh, much of
that technology really being on the smartphone itself.
There are technology companies out there
that are on the cusp of being able
to measure things like blood pressure just
by looking into the, into the screen of a cell phone.
And the technologies for us to be able
to do biometric measurements on patients are only getting
simpler and easier.
And if in fact, that is a rate limiting step for utilization
for these, and now we know how often we find smartphones,
not even with just an individual,
but in multi-generational households.
I think that only opens up the ease of use of this program.
I mentioned that we have 30,000 people in the program today.
We've taken care of 40,000 people over the life
of it over the last decade.
I feel like those numbers skyrocket when the technology gets
even simpler and cheaper for patients to appreciate.
- Absolutely. And just thinking about the potential of some
of those tools, like the blood pressure monitoring
being enabled on the smartphone,
that would really skyrocket access.
It seems like it's really exciting.
Thank you so much for, for sharing your future outlooks, Dr.
Den. It's really exciting to learn about, you know,
what opportunities there are on the business end of things,
but then of course on the patient end
and improving those risk factors and improving outcomes.
So before we hop off today, is there anything else
that you wanted listeners to take away
that we might not have touched on yet?
- Well, I think the primary call to action for any work
that's being done in the digital medicine realm
or in the remote patient management space is
for the patients, for the providers, the physicians,
and the other groups across the country who are
so interested in this is that it's never
too late to take care of your health.
And in fact, whether you're 40 or 50 or 60 or
or a hundred years old, we see so much benefit
in getting blood pressure under control,
getting blood sugar under control,
getting weight under control, exercising,
eating the right foods.
And while that drum beat has been heard
for decades, I finally believe now
that using technology the same, the way that we use it
for our streaming television
and video services in the same way that we've used it
to deliver groceries or, or, or grab a, a ride share.
I truly believe that the ability for patients,
for people to be able to take care of their health
with the same degree of convenience that we've all come
to expect in other aspects of our life is,
is now at a moment where we, hopefully,
hopefully the next time they,
they publish those cardiometabolic health rates, we'll start
to see a bottom out and a rise.
And, and similarly we'll be able to, to thank the ability
of technology to really help facilitate the work
that our patients can do.
- Thanks, Dr. Houghton.
I really appreciate that message that you've ended on.
It's never too late to take care of your health.
It's so important and it's certainly speaking to my roots
as a health educator .
So thank you so much again for your time
and for all the insights today.
- Well, thank you very much.
It's my pleasure to be here
and, um, it's been an honor to be able to,
to greet your audience
- .
Wonderful. Now we'd also like to thank our sponsor
for today's episode, Oxner Health.
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