- Hello everyone.
I am Mariah Mohammed, writer with Becker's Healthcare.
Thank you so much for tuning into the Becker's
Healthcare podcast series.
Today I'm especially pleased to be joined by Dr.
Cynthia Horner, vice President of Amwell Medical Group.
Doctor, thank you so much for talking with us today.
We are very pleased to have you. How are you?
- I'm doing great. Thank you, Mariah.
It's wonderful to be here,
and I appreciate you having me on your podcast.
- Yeah, of course. gl again, so glad to talk to you today.
Um, and with that, let's jump right into our conversation.
So to get us started
and get a good background for
what we'll be discussing today,
could you please just introduce yourself,
share a bit about your role and organization
and what you've currently been working on so far this year?
- So I'm a family physician by profession.
I've been in practice for a little over 25 years,
and my current role is as vice president
of Amwell Medical Group, which, uh, is the medical group
that serves Amwell, the telehealth company.
So in my role as vice president, I lead our medical group
of several thousand clinicians
and provide clinical insights in several different areas in,
in both our software build
and wellbeing, a software telehealth company,
and, uh, working with clients health systems
and health plans in particular as they look to solve some
of their biggest challenges in healthcare delivery
and help to really reinforce
where virtual care can actually help to solve some of the,
the challenges that both providers, patients,
and health plans, the payers
and health systems, uh, find in the delivery of healthcare.
- Got it. Got it. Thank you so much for giving us
that background on you and what you've been working on.
So, to jump right into our conversation today, some research
that I, I found earlier, uh, from last year actually shows
that patients want greater access to digital health tools
to manage their health, which is not surprising at all.
Um, and many organizations are working to meet this demand,
recognizing it's a key opportunity to satisfy patients
and create efficiency and staffing gaps.
What are some key trends you're seeing in this virtual care
space, especially primary care?
Are there any opportunities
and challenges that have emerged?
- Absolutely. So, you know what,
virtual virtual care is really interesting,
particularly virtual primary care,
because it's been a buzzword in the industry for, uh,
probably the last three to four years.
And I think, um, pre covid there was a lot
of churn on
what exactly virtual primary care should look like.
What does it mean? Is it really just, um,
putting a video visit in front of a primary care doctor
and helping them connect
through a video visit with their patient?
Or is there something a little bit more robust
or even sophisticated than that?
Um, obviously it's evolved since
that initial iteration into something quite a bit more.
So what we're hearing now
and what we're seeing now is a lot more focus on how virtual
care can both improve patient
or in the case of a health plan, member satisfaction,
especially improve outcomes in health
and drive down costs.
And, and then finally, you know, it's that it's
that quadruple, triple, quadruple aim, uh,
of improving provider satisfaction and reducing burnout.
So all of those
are areas in which virtual primary care in particular
can help achieve that aim.
And I'm happy to sort of expand on that,
but there are several different elements within that
that we're starting to see it's value-based care is a,
a really hot topic right now,
and, um, how the role of hybrid care.
So, you know, we used to hear about, uh, virtual only,
you know, it's either brick and mortar or a virtual care.
Now we're really, I think,
getting more sophisticated into the concept of, um,
how do you hybridize care across both brick
and mortar virtual
and then even an automated care element, um,
and leveraging remote patient monitoring.
So how do you take all of these different elements to,
to really understand what is happening with a patient
as they walk through their lives to ensure
that they are appropriately
engaged in their healthcare journey.
Give them right sized
and right timed, uh, medical advice, treatment
and intervention, and then ensure that you can,
as always, sort of the gold star is improve those
outcomes in their, in their health.
And by improving outcomes, you should drive down cost.
- Yeah, absolutely. All those things are surely connected.
And to go to another point, um, that, you know,
I care a lot about, and I'm sure millions
of others in America care a lot about mental health.
So as of this year, it's been reported
that 160 million Americans live in areas facing mental
health provider shortages.
While the demand for these services grow, especially
after COVD, how can virtual care play a role in addressing
access issues here?
- It's critical. Uh,
and frankly with the shortage that you see, uh, both in, uh,
the world of therapy, uh, the shortage of therapists, uh,
with the growth in demand, uh, and,
and the critical shortage of
psychiatrists across the United States, um,
just general psychiatrists
and then of course, pediatric psychiatry
and pediatric therapy, uh, is, uh,
we are facing a crisis in the United States.
So, uh, the ability to actually
improve access from areas
where there is a real paucity of clinical providers
and bring those providers through a telehealth setting
into those regions.
And then in addition to that, um, really expand the type
of care that's being given.
You know, we talk about video visits
and that's one, that's one way to improve access
and ensure that people get the care
that they need when they need it.
But it still begs the question of, um,
individual visits can be very costly
and, uh, how do we ensure that with
a growing understanding
of the mental health needs in it's frankly, global,
but I'll, I'll focus on our country, um, if,
how do we ensure that that cost, that, that the cost
of delivering that care now that we're understanding
that there's a greater need
for care doesn't completely bankrupt, uh, health systems
or health plans, uh,
or individual patients that can't really afford it
because they don't have mental health coverage.
And that's really where some of the augmented AI
and automated care can come into play.
You know, there are several companies out there, um,
as a vice president of aml, I'm particularly familiar
with one of the solutions that Amwell has, uh,
through its Silver Cloud offering.
Silver Cloud is not the only one out there,
but I think they've got really remarkable data, uh,
in delivering cognitive behavioral therapy, uh, to patients
with mild to moderate anxiety
and depression over a, uh, specific period of time monitored
by health coaches that actually showed a dramatic
improvement in symptoms of depression
and anxiety, uh, over the course of that, that therapy, um,
and really outcomes that are equivalent for that
targeted patient population to talk therapy.
So I think that there's a lot
of really interesting opportunity both through, for both
through, um, augmented AI as well as through
traditional telehealth.
Um, funny that I'm using the word traditional
with telehealth, but I think we're in a, in a zone now
where you can, and I think there's room for all sorts
of really creative solutions,
but it's a key part of the solution to the crisis,
the mental health crisis in the United States. Yeah.
- Yeah, absolutely. Thank you so much
for touching on that topic.
And in your view, what are some must have elements
of a virtual primary care strategy?
Are there any examples of tools
and capabilities that you would recommend personally?
- Absolutely, and I would start with the one that is
perhaps obvious, but I think it's really important.
You have to have committed primary care providers that, uh,
believe in longitudinal care.
So it's a, it's a really special group.
Primary care providers are a special group of individuals.
They are not, not better than other types of clinicians,
but they have a longitudinal mindset.
And so you can't take doctors
that are typically doing urgent episodic urgent care visits
and expect to have the same kind of outcomes with, um,
a longitudinal program.
And I will also say that
with longitudinal virtual primary care currently,
and this may change over time as adoption grows, many
of the individuals that sign up for virtual primary care
patients in particular is what I'm referring to, tend
to be more complicated.
Whether it's because they don't have access,
so they haven't been seen in a while,
or they actually have not liked the
providers that they've been seeing.
So our experience has been that many of the people
that actually end up in a virtual primary care setting tend
to actually have a unique set of problems.
So you have to have providers first that are capable of,
um, understanding
and addressing those in the way that, uh,
longitudinal care providers do.
But then of course, to your question, you have
to provide the types of tools that that providers need
because you are doing this virtually .
So, so there's several elements of data that you have to get
that you can't do by putting a
stethoscope on a person's chest.
For example, if a pers if a provider wants to be able
to catch a blood pressure on a patient, um, you know,
when you go into the doctor's office, the first thing
that the, the, uh, nurse
or medical assistant that's rooming, rooming you does,
they put you on a scale, they check your weight
and then they check your blood pressure,
they might check your temperature.
Well, those are all important pieces of data.
Now, one could argue that they're not important
for every single visit, uh, for every single condition,
but they're, all of those pieces
of data are important enough
that remote patient monitoring is critical.
And digitize remote patient monitoring, which is,
for example, maybe a person with a, um, history
of hypertension or high blood pressure can,
will have a blood pressure cuff delivered to them
that is not just let the doctor
and the video visit watch you take your blood pressure.
That's one level that you could get.
But the other level is to actually have it integrated
directly into the software system.
So the provider actually, not only checks, has access
to the blood pressure in that visit and can check it,
but they have access every time you
check your blood pressure at home.
And then let's add another level to this of automated care.
You're checking your blood pressure at home.
What if that connects to your automated care, um, component
of your visit that then says, interesting.
We just noticed, um,
that when you checked your blood pressure,
it's seeming a little high.
Did you wanna talk about it? Or it's seeming very high.
Um, we recommend that you connect
with your primary care provider, uh, in the next 24 hours,
or it's seeming at emergency levels, we're really concerned,
we want you to actually connect for an urgent care visit.
Or would you like me to call 9 1 1?
All, all of those different scenarios.
So, so you noticed in that story that I built,
I pulled in remote patient monitoring.
I pulled in automated care to assist with
that patient engagement between visits, which is so critical
because you get 15 minutes maybe if you're lucky in a visit
with a, with a clinical provider in a, in a visit,
maybe 30 minutes if it's a really long visit,
a wellness visit, or frankly, if it's for behavioral health,
it might even be 50 minutes.
But then the next time you see your provider is gonna be
maybe, maybe a month if you know,
if it's a really acute issue
or maybe more likely four to six months down the road.
And there's all sorts of decision making that's happening
during that period of time between visits
that we really need to actually be able to capture the data
that people are gathering on themselves, their weights,
their blood pressure, their symptoms,
and surface it to the care team that can then respond
and engage people when they're all out
and about living their life.
I think other less sort of sexy things would be there,
we talk about data capture.
You have to have an electronic medical record that can
literally capture these different discrete data points
and aggregate them so that a provider
or even a health plan can understand a population,
how the health of a population of people are doing.
So providers like to understand your individual health,
but they also wanna understand, for example,
how are all my hypertensive patients doing?
Am I really treating them in a way that from, um,
January 1st of, of the year through December 30th
of the year, I can see that all of my hypertensive patients,
well better put 60%
of my hypertensive patients have actually improved their
blood pressures down to normal.
And I can see that without just having sort as an aggregate
and it's reported on a dashboard in a database.
And there's all sorts of people that would love to see that.
And frankly, that gets us into value-based care,
which is a completely separate subject,
but what if providers are, uh, incentivized
by those good outcomes
and they get paid for the additional value that they are
creating for the outcomes for their patients.
So a lot of different pieces in their data tracking
and captured the, uh, ability
to take remote patient monitoring
and integrate it into an EMR that can track that data
and aggregate it and report on it, automated care
for time between the visits.
So in a summary that would be, those would be the key pieces
that I would say are critical to virtual primary care.
- Got it. Got it. Yeah, thank you so much for sharing all of
that insight and kind of a add-on
to everything we've discussed so far, especially, um,
my previous question,
but how can the type of strategy we've discussed contribute
to overall improvements in patient outcomes,
care delivery and costs?
Are there any success stories
or case studies that come to mind?
- You bet there are several different case stories
and I think, um, I'm gonna focus on, uh, a case
that actually came to amwell from one of our partners,
Northwell Health, who leveraged our automated care strategy
to ensure that they had improved maternity outcomes
and maternity engagement for their patients.
So they were looking to ensure that they had,
and they had several different programs, uh,
so I may mention a couple of them,
but particularly with their maternity program,
they actually had, um, a,
an automated care feature in which they reached out to all
of their patients
that were engaged in their prenatal program
and made sure that they were checking, I believe these were,
um, preeclamptic patients.
And so they were checking their blood pressures
and made sure that they were accessing the blood pressures,
uh, in an appropriate way,
and that they were checking for symptoms for, um, worsening
of their preeclampsia toxemia.
And so they would check for headache, they would check
for blurred vision, they would check for unusual kinds
of swelling, and they, they found
that they were actually able to significantly improve the
outcomes and bring patients in earlier than they might
otherwise have without this.
They had, I believe it was a 76% engagement,
uh, from patients.
And they found that they actually had significant improved
or reduced, uh, uh, preterm births from
that particular program.
So they, Northwell Health had another program, uh, which was
monitoring gaps in care in, in primary care.
And again, this, to use the automated care
component of what we were talking about.
And, uh, prior to instituting this automated care
where they would reach out to patients to say,
when was your last colonoscopy?
It looks like you're due for this.
And they actually were able to integrate
with the electronic medical record to pull that data
and, uh, to identify that somebody was not up
to date on their colonoscopy or their mammogram
or, um, you know, any of the gaps in care
that are preventative measures that are typically monitored.
And they had, um, an 89% satisfaction rate
on the gaps in care automated care program,
and they were able to close almost 70% of the gaps in care
with which, you know, any of your, uh,
health plan executives , that might be listening
to this podcast, will immediately recognize.
That's a really remarkable, uh, statistics.
So they also had an issue with, uh,
colonoscopy no-shows.
And so patients would, um,
schedule their colonoscopy appointment
and, um, they had a really significant rate.
Almost 50% of patients, uh, actually were no showing
for the colonoscopy, which as you can imagine, that's a lot
of, you know, you have to book, you have
to book the colonoscopy room, you book the anesthetist, uh,
you book the doctor who's doing the colonoscopy.
That's a lot of lost, uh, revenue
and frankly lost opportunity for patients
in this colonoscopy.
Reminder. Automated care,
they had a 48% percent reduction in their
no-show in cancellation rates.
And they were also interestingly able to identify
that they had a barrier to care in 20% of those people.
And so they were able to then go through
and identify some of the social determinants of health
and address SDUH in ways
that they hadn't even anticipated in,
in starting this program.
So those are a couple of examples
that I could, that I could share.
There's several others, uh, that I could riff on if, uh, uh,
you know, time depending, but, um, I'll just leave it.
I'll start with those.
- Yeah, yeah, no amazing examples.
Thank you so much for sharing those.
And overall, you've given such good intel,
you know, about this topic.
Um, before I let you go,
is there anything our listeners should know?
- You know, I think as it, when we talk about virtual care
and particularly virtual primary care, the real key
to understanding how
to deliver an effective virtual primary care
and virtual care offering is to not simply assume
that you're taking brick and mortar models of care
and workflow and putting them into a video visit.
What we have found is you really need
to deconstruct the workflow, deconstruct the visit,
and identify what is it that you can do
through a virtual setting.
What is it that really you should leverage some other
technologies, whether it's an automated care chat, uh,
whether it's, uh, a CBT program, um,
whether it's frankly leveraging, um, uh,
some health coaches, uh, to engage in some
of the care management, but break down the workflows
and figure out what can be done virtually,
and then figure out what the technology is out there.
Telehealth and particular virtual,
virtual primary care is not just, it's not, it, it,
almost every piece of it is gonna need to be a hybrid care,
but what that means, what part is brick
and mortar, what part is automated, what part it comes
through virtual and who does those specific components?
There's so much amazing opportunity,
but you've gotta be smart.
- Yeah, absolutely. Thank you so much, Dr.
Horner, for your time
and thought-provoking response to, to responses today.
We really do appreciate it.
Uh, we'll also like to thank our podcast sponsor am well,
uh, thank you all for joining us for another episode
of Becker's Healthcare Podcast.
You can tune into more podcasts from Becker's Healthcare
by visiting our podcast page at
becker's hospital review.com. Thank you again, doctor.
- You bet. Thank you. Bye.