1 00:00:00,115 --> 00:00:01,025 - Hello everyone. 2 00:00:01,185 --> 00:00:03,705 I am Mariah Mohammed, writer with Becker's Healthcare. 3 00:00:03,795 --> 00:00:05,865 Thank you so much for tuning into the Becker's 4 00:00:05,865 --> 00:00:06,945 Healthcare podcast series. 5 00:00:07,355 --> 00:00:09,705 Today I'm especially pleased to be joined by Dr. 6 00:00:09,705 --> 00:00:12,945 Cynthia Horner, vice President of Amwell Medical Group. 7 00:00:13,165 --> 00:00:15,305 Doctor, thank you so much for talking with us today. 8 00:00:15,305 --> 00:00:16,985 We are very pleased to have you. How are you? 9 00:00:17,645 --> 00:00:18,945 - I'm doing great. Thank you, Mariah. 10 00:00:19,015 --> 00:00:20,145 It's wonderful to be here, 11 00:00:20,245 --> 00:00:22,105 and I appreciate you having me on your podcast. 12 00:00:22,815 --> 00:00:26,105 - Yeah, of course. gl again, so glad to talk to you today. 13 00:00:26,605 --> 00:00:29,665 Um, and with that, let's jump right into our conversation. 14 00:00:30,245 --> 00:00:31,425 So to get us started 15 00:00:31,525 --> 00:00:32,985 and get a good background for 16 00:00:32,985 --> 00:00:34,145 what we'll be discussing today, 17 00:00:34,395 --> 00:00:36,105 could you please just introduce yourself, 18 00:00:36,315 --> 00:00:38,665 share a bit about your role and organization 19 00:00:38,805 --> 00:00:41,305 and what you've currently been working on so far this year? 20 00:00:41,845 --> 00:00:43,905 - So I'm a family physician by profession. 21 00:00:44,375 --> 00:00:47,385 I've been in practice for a little over 25 years, 22 00:00:47,805 --> 00:00:51,265 and my current role is as vice president 23 00:00:51,265 --> 00:00:54,705 of Amwell Medical Group, which, uh, is the medical group 24 00:00:54,705 --> 00:00:57,065 that serves Amwell, the telehealth company. 25 00:00:57,245 --> 00:01:00,705 So in my role as vice president, I lead our medical group 26 00:01:01,125 --> 00:01:03,225 of several thousand clinicians 27 00:01:03,725 --> 00:01:08,225 and provide clinical insights in several different areas in, 28 00:01:08,605 --> 00:01:10,065 in both our software build 29 00:01:10,085 --> 00:01:11,745 and wellbeing, a software telehealth company, 30 00:01:12,485 --> 00:01:15,465 and, uh, working with clients health systems 31 00:01:15,525 --> 00:01:20,385 and health plans in particular as they look to solve some 32 00:01:20,385 --> 00:01:23,705 of their biggest challenges in healthcare delivery 33 00:01:23,965 --> 00:01:27,345 and help to really reinforce 34 00:01:27,345 --> 00:01:30,425 where virtual care can actually help to solve some of the, 35 00:01:30,445 --> 00:01:34,905 the challenges that both providers, patients, 36 00:01:35,125 --> 00:01:36,825 and health plans, the payers 37 00:01:36,845 --> 00:01:39,665 and health systems, uh, find in the delivery of healthcare. 38 00:01:41,045 --> 00:01:42,945 - Got it. Got it. Thank you so much for giving us 39 00:01:42,945 --> 00:01:45,225 that background on you and what you've been working on. 40 00:01:45,645 --> 00:01:48,585 So, to jump right into our conversation today, some research 41 00:01:48,585 --> 00:01:53,465 that I, I found earlier, uh, from last year actually shows 42 00:01:53,465 --> 00:01:56,425 that patients want greater access to digital health tools 43 00:01:56,485 --> 00:01:58,905 to manage their health, which is not surprising at all. 44 00:01:59,365 --> 00:02:02,265 Um, and many organizations are working to meet this demand, 45 00:02:02,785 --> 00:02:05,505 recognizing it's a key opportunity to satisfy patients 46 00:02:05,885 --> 00:02:07,985 and create efficiency and staffing gaps. 47 00:02:08,575 --> 00:02:11,145 What are some key trends you're seeing in this virtual care 48 00:02:11,275 --> 00:02:13,185 space, especially primary care? 49 00:02:13,765 --> 00:02:15,145 Are there any opportunities 50 00:02:15,325 --> 00:02:17,225 and challenges that have emerged? 51 00:02:18,635 --> 00:02:20,195 - Absolutely. So, you know what, 52 00:02:20,585 --> 00:02:22,755 virtual virtual care is really interesting, 53 00:02:22,755 --> 00:02:24,155 particularly virtual primary care, 54 00:02:24,155 --> 00:02:28,235 because it's been a buzzword in the industry for, uh, 55 00:02:28,595 --> 00:02:29,955 probably the last three to four years. 56 00:02:30,495 --> 00:02:34,395 And I think, um, pre covid there was a lot 57 00:02:34,395 --> 00:02:35,715 of churn on 58 00:02:36,025 --> 00:02:38,355 what exactly virtual primary care should look like. 59 00:02:38,355 --> 00:02:40,795 What does it mean? Is it really just, um, 60 00:02:41,145 --> 00:02:44,395 putting a video visit in front of a primary care doctor 61 00:02:44,535 --> 00:02:45,875 and helping them connect 62 00:02:46,065 --> 00:02:47,875 through a video visit with their patient? 63 00:02:47,975 --> 00:02:50,195 Or is there something a little bit more robust 64 00:02:50,455 --> 00:02:52,395 or even sophisticated than that? 65 00:02:52,855 --> 00:02:54,755 Um, obviously it's evolved since 66 00:02:54,785 --> 00:02:58,155 that initial iteration into something quite a bit more. 67 00:02:58,295 --> 00:03:00,405 So what we're hearing now 68 00:03:00,405 --> 00:03:04,805 and what we're seeing now is a lot more focus on how virtual 69 00:03:05,395 --> 00:03:09,085 care can both improve patient 70 00:03:09,585 --> 00:03:12,765 or in the case of a health plan, member satisfaction, 71 00:03:13,295 --> 00:03:15,965 especially improve outcomes in health 72 00:03:16,905 --> 00:03:18,685 and drive down costs. 73 00:03:19,105 --> 00:03:21,885 And, and then finally, you know, it's that it's 74 00:03:21,885 --> 00:03:24,165 that quadruple, triple, quadruple aim, uh, 75 00:03:24,505 --> 00:03:27,525 of improving provider satisfaction and reducing burnout. 76 00:03:27,865 --> 00:03:29,565 So all of those 77 00:03:30,345 --> 00:03:33,805 are areas in which virtual primary care in particular 78 00:03:34,425 --> 00:03:36,085 can help achieve that aim. 79 00:03:36,545 --> 00:03:38,805 And I'm happy to sort of expand on that, 80 00:03:38,945 --> 00:03:42,205 but there are several different elements within that 81 00:03:42,395 --> 00:03:45,685 that we're starting to see it's value-based care is a, 82 00:03:45,805 --> 00:03:47,125 a really hot topic right now, 83 00:03:47,945 --> 00:03:51,725 and, um, how the role of hybrid care. 84 00:03:51,945 --> 00:03:55,805 So, you know, we used to hear about, uh, virtual only, 85 00:03:55,905 --> 00:03:58,285 you know, it's either brick and mortar or a virtual care. 86 00:03:58,905 --> 00:04:00,325 Now we're really, I think, 87 00:04:00,325 --> 00:04:03,325 getting more sophisticated into the concept of, um, 88 00:04:03,545 --> 00:04:07,645 how do you hybridize care across both brick 89 00:04:07,645 --> 00:04:08,765 and mortar virtual 90 00:04:08,945 --> 00:04:11,245 and then even an automated care element, um, 91 00:04:11,265 --> 00:04:13,245 and leveraging remote patient monitoring. 92 00:04:13,245 --> 00:04:15,725 So how do you take all of these different elements to, 93 00:04:16,225 --> 00:04:19,525 to really understand what is happening with a patient 94 00:04:19,825 --> 00:04:22,845 as they walk through their lives to ensure 95 00:04:22,845 --> 00:04:24,125 that they are appropriately 96 00:04:24,475 --> 00:04:26,005 engaged in their healthcare journey. 97 00:04:26,115 --> 00:04:28,125 Give them right sized 98 00:04:28,265 --> 00:04:31,725 and right timed, uh, medical advice, treatment 99 00:04:31,945 --> 00:04:35,965 and intervention, and then ensure that you can, 100 00:04:36,625 --> 00:04:39,245 as always, sort of the gold star is improve those 101 00:04:39,485 --> 00:04:40,605 outcomes in their, in their health. 102 00:04:40,745 --> 00:04:43,285 And by improving outcomes, you should drive down cost. 103 00:04:44,505 --> 00:04:47,075 - Yeah, absolutely. All those things are surely connected. 104 00:04:47,075 --> 00:04:50,555 And to go to another point, um, that, you know, 105 00:04:50,675 --> 00:04:52,675 I care a lot about, and I'm sure millions 106 00:04:52,675 --> 00:04:55,755 of others in America care a lot about mental health. 107 00:04:56,215 --> 00:04:58,435 So as of this year, it's been reported 108 00:04:58,435 --> 00:05:02,515 that 160 million Americans live in areas facing mental 109 00:05:02,515 --> 00:05:03,915 health provider shortages. 110 00:05:04,165 --> 00:05:06,635 While the demand for these services grow, especially 111 00:05:06,635 --> 00:05:10,555 after COVD, how can virtual care play a role in addressing 112 00:05:10,775 --> 00:05:11,795 access issues here? 113 00:05:12,625 --> 00:05:13,715 - It's critical. Uh, 114 00:05:13,815 --> 00:05:17,515 and frankly with the shortage that you see, uh, both in, uh, 115 00:05:17,515 --> 00:05:21,075 the world of therapy, uh, the shortage of therapists, uh, 116 00:05:21,385 --> 00:05:24,355 with the growth in demand, uh, and, 117 00:05:24,575 --> 00:05:26,755 and the critical shortage of 118 00:05:27,625 --> 00:05:30,355 psychiatrists across the United States, um, 119 00:05:30,585 --> 00:05:31,875 just general psychiatrists 120 00:05:31,875 --> 00:05:33,475 and then of course, pediatric psychiatry 121 00:05:33,475 --> 00:05:37,555 and pediatric therapy, uh, is, uh, 122 00:05:37,615 --> 00:05:39,835 we are facing a crisis in the United States. 123 00:05:40,215 --> 00:05:42,835 So, uh, the ability to actually 124 00:05:44,165 --> 00:05:46,895 improve access from areas 125 00:05:47,025 --> 00:05:51,895 where there is a real paucity of clinical providers 126 00:05:52,635 --> 00:05:56,625 and bring those providers through a telehealth setting 127 00:05:57,235 --> 00:05:58,405 into those regions. 128 00:05:58,985 --> 00:06:03,565 And then in addition to that, um, really expand the type 129 00:06:03,565 --> 00:06:04,925 of care that's being given. 130 00:06:05,345 --> 00:06:06,805 You know, we talk about video visits 131 00:06:06,905 --> 00:06:09,765 and that's one, that's one way to improve access 132 00:06:10,105 --> 00:06:13,565 and ensure that people get the care 133 00:06:13,565 --> 00:06:15,485 that they need when they need it. 134 00:06:16,905 --> 00:06:19,645 But it still begs the question of, um, 135 00:06:19,935 --> 00:06:22,005 individual visits can be very costly 136 00:06:22,345 --> 00:06:25,965 and, uh, how do we ensure that with 137 00:06:26,565 --> 00:06:27,765 a growing understanding 138 00:06:27,945 --> 00:06:30,565 of the mental health needs in it's frankly, global, 139 00:06:30,585 --> 00:06:33,685 but I'll, I'll focus on our country, um, if, 140 00:06:34,345 --> 00:06:37,205 how do we ensure that that cost, that, that the cost 141 00:06:37,205 --> 00:06:40,045 of delivering that care now that we're understanding 142 00:06:40,045 --> 00:06:41,125 that there's a greater need 143 00:06:41,125 --> 00:06:44,085 for care doesn't completely bankrupt, uh, health systems 144 00:06:44,305 --> 00:06:45,885 or health plans, uh, 145 00:06:45,985 --> 00:06:48,245 or individual patients that can't really afford it 146 00:06:48,245 --> 00:06:49,765 because they don't have mental health coverage. 147 00:06:50,705 --> 00:06:54,805 And that's really where some of the augmented AI 148 00:06:55,105 --> 00:06:57,365 and automated care can come into play. 149 00:06:57,465 --> 00:06:59,525 You know, there are several companies out there, um, 150 00:06:59,905 --> 00:07:03,565 as a vice president of aml, I'm particularly familiar 151 00:07:03,595 --> 00:07:06,005 with one of the solutions that Amwell has, uh, 152 00:07:06,005 --> 00:07:07,285 through its Silver Cloud offering. 153 00:07:08,025 --> 00:07:09,725 Silver Cloud is not the only one out there, 154 00:07:09,745 --> 00:07:12,965 but I think they've got really remarkable data, uh, 155 00:07:13,105 --> 00:07:16,885 in delivering cognitive behavioral therapy, uh, to patients 156 00:07:16,885 --> 00:07:18,245 with mild to moderate anxiety 157 00:07:18,265 --> 00:07:23,125 and depression over a, uh, specific period of time monitored 158 00:07:23,125 --> 00:07:25,605 by health coaches that actually showed a dramatic 159 00:07:25,605 --> 00:07:28,445 improvement in symptoms of depression 160 00:07:28,505 --> 00:07:32,685 and anxiety, uh, over the course of that, that therapy, um, 161 00:07:33,305 --> 00:07:37,645 and really outcomes that are equivalent for that 162 00:07:38,445 --> 00:07:41,205 targeted patient population to talk therapy. 163 00:07:41,825 --> 00:07:43,245 So I think that there's a lot 164 00:07:43,245 --> 00:07:46,245 of really interesting opportunity both through, for both 165 00:07:46,245 --> 00:07:50,245 through, um, augmented AI as well as through 166 00:07:50,915 --> 00:07:52,125 traditional telehealth. 167 00:07:52,385 --> 00:07:54,365 Um, funny that I'm using the word traditional 168 00:07:54,365 --> 00:07:56,405 with telehealth, but I think we're in a, in a zone now 169 00:07:56,405 --> 00:07:59,325 where you can, and I think there's room for all sorts 170 00:07:59,325 --> 00:08:00,565 of really creative solutions, 171 00:08:01,025 --> 00:08:03,205 but it's a key part of the solution to the crisis, 172 00:08:03,305 --> 00:08:05,805 the mental health crisis in the United States. Yeah. 173 00:08:06,745 --> 00:08:08,275 - Yeah, absolutely. Thank you so much 174 00:08:08,275 --> 00:08:09,355 for touching on that topic. 175 00:08:09,535 --> 00:08:12,835 And in your view, what are some must have elements 176 00:08:13,095 --> 00:08:15,155 of a virtual primary care strategy? 177 00:08:15,735 --> 00:08:17,475 Are there any examples of tools 178 00:08:17,495 --> 00:08:19,675 and capabilities that you would recommend personally? 179 00:08:20,715 --> 00:08:22,635 - Absolutely, and I would start with the one that is 180 00:08:23,145 --> 00:08:25,515 perhaps obvious, but I think it's really important. 181 00:08:25,535 --> 00:08:28,515 You have to have committed primary care providers that, uh, 182 00:08:28,625 --> 00:08:30,275 believe in longitudinal care. 183 00:08:30,495 --> 00:08:33,555 So it's a, it's a really special group. 184 00:08:33,555 --> 00:08:36,035 Primary care providers are a special group of individuals. 185 00:08:36,035 --> 00:08:40,475 They are not, not better than other types of clinicians, 186 00:08:40,975 --> 00:08:42,955 but they have a longitudinal mindset. 187 00:08:43,375 --> 00:08:45,715 And so you can't take doctors 188 00:08:45,785 --> 00:08:48,835 that are typically doing urgent episodic urgent care visits 189 00:08:49,535 --> 00:08:53,795 and expect to have the same kind of outcomes with, um, 190 00:08:53,995 --> 00:08:55,115 a longitudinal program. 191 00:08:55,385 --> 00:08:56,525 And I will also say that 192 00:08:56,525 --> 00:08:59,605 with longitudinal virtual primary care currently, 193 00:09:00,065 --> 00:09:04,405 and this may change over time as adoption grows, many 194 00:09:04,405 --> 00:09:08,285 of the individuals that sign up for virtual primary care 195 00:09:09,445 --> 00:09:12,205 patients in particular is what I'm referring to, tend 196 00:09:12,205 --> 00:09:13,205 to be more complicated. 197 00:09:13,205 --> 00:09:15,165 Whether it's because they don't have access, 198 00:09:15,185 --> 00:09:16,605 so they haven't been seen in a while, 199 00:09:16,705 --> 00:09:18,445 or they actually have not liked the 200 00:09:18,565 --> 00:09:19,685 providers that they've been seeing. 201 00:09:20,425 --> 00:09:23,205 So our experience has been that many of the people 202 00:09:23,205 --> 00:09:25,925 that actually end up in a virtual primary care setting tend 203 00:09:25,925 --> 00:09:28,405 to actually have a unique set of problems. 204 00:09:28,625 --> 00:09:33,445 So you have to have providers first that are capable of, 205 00:09:34,225 --> 00:09:35,325 um, understanding 206 00:09:35,345 --> 00:09:37,965 and addressing those in the way that, uh, 207 00:09:38,005 --> 00:09:39,645 longitudinal care providers do. 208 00:09:39,865 --> 00:09:42,245 But then of course, to your question, you have 209 00:09:42,245 --> 00:09:45,205 to provide the types of tools that that providers need 210 00:09:45,205 --> 00:09:47,165 because you are doing this virtually . 211 00:09:47,265 --> 00:09:50,685 So, so there's several elements of data that you have to get 212 00:09:50,715 --> 00:09:52,245 that you can't do by putting a 213 00:09:52,245 --> 00:09:53,765 stethoscope on a person's chest. 214 00:09:54,145 --> 00:09:57,485 For example, if a pers if a provider wants to be able 215 00:09:57,485 --> 00:10:00,605 to catch a blood pressure on a patient, um, you know, 216 00:10:00,605 --> 00:10:02,925 when you go into the doctor's office, the first thing 217 00:10:02,925 --> 00:10:04,645 that the, the, uh, nurse 218 00:10:04,645 --> 00:10:07,325 or medical assistant that's rooming, rooming you does, 219 00:10:07,395 --> 00:10:09,565 they put you on a scale, they check your weight 220 00:10:09,585 --> 00:10:10,965 and then they check your blood pressure, 221 00:10:10,965 --> 00:10:12,125 they might check your temperature. 222 00:10:12,635 --> 00:10:14,765 Well, those are all important pieces of data. 223 00:10:15,185 --> 00:10:17,405 Now, one could argue that they're not important 224 00:10:17,425 --> 00:10:20,525 for every single visit, uh, for every single condition, 225 00:10:20,945 --> 00:10:22,765 but they're, all of those pieces 226 00:10:22,765 --> 00:10:24,605 of data are important enough 227 00:10:24,835 --> 00:10:27,005 that remote patient monitoring is critical. 228 00:10:27,665 --> 00:10:30,205 And digitize remote patient monitoring, which is, 229 00:10:30,265 --> 00:10:33,765 for example, maybe a person with a, um, history 230 00:10:33,765 --> 00:10:36,365 of hypertension or high blood pressure can, 231 00:10:36,915 --> 00:10:39,285 will have a blood pressure cuff delivered to them 232 00:10:39,435 --> 00:10:41,565 that is not just let the doctor 233 00:10:41,625 --> 00:10:43,805 and the video visit watch you take your blood pressure. 234 00:10:43,805 --> 00:10:45,525 That's one level that you could get. 235 00:10:45,785 --> 00:10:48,005 But the other level is to actually have it integrated 236 00:10:48,645 --> 00:10:51,205 directly into the software system. 237 00:10:51,305 --> 00:10:54,605 So the provider actually, not only checks, has access 238 00:10:54,665 --> 00:10:57,965 to the blood pressure in that visit and can check it, 239 00:10:57,965 --> 00:10:59,725 but they have access every time you 240 00:10:59,725 --> 00:11:01,005 check your blood pressure at home. 241 00:11:01,625 --> 00:11:04,765 And then let's add another level to this of automated care. 242 00:11:04,985 --> 00:11:06,725 You're checking your blood pressure at home. 243 00:11:07,395 --> 00:11:11,205 What if that connects to your automated care, um, component 244 00:11:11,225 --> 00:11:14,285 of your visit that then says, interesting. 245 00:11:14,345 --> 00:11:15,605 We just noticed, um, 246 00:11:15,795 --> 00:11:17,485 that when you checked your blood pressure, 247 00:11:17,995 --> 00:11:19,405 it's seeming a little high. 248 00:11:19,585 --> 00:11:22,245 Did you wanna talk about it? Or it's seeming very high. 249 00:11:22,865 --> 00:11:24,845 Um, we recommend that you connect 250 00:11:24,845 --> 00:11:28,405 with your primary care provider, uh, in the next 24 hours, 251 00:11:28,825 --> 00:11:31,725 or it's seeming at emergency levels, we're really concerned, 252 00:11:31,725 --> 00:11:33,925 we want you to actually connect for an urgent care visit. 253 00:11:33,985 --> 00:11:35,805 Or would you like me to call 9 1 1? 254 00:11:35,905 --> 00:11:37,365 All, all of those different scenarios. 255 00:11:37,945 --> 00:11:42,005 So, so you noticed in that story that I built, 256 00:11:42,605 --> 00:11:44,525 I pulled in remote patient monitoring. 257 00:11:44,885 --> 00:11:47,445 I pulled in automated care to assist with 258 00:11:47,445 --> 00:11:51,605 that patient engagement between visits, which is so critical 259 00:11:51,605 --> 00:11:55,485 because you get 15 minutes maybe if you're lucky in a visit 260 00:11:55,485 --> 00:11:57,965 with a, with a clinical provider in a, in a visit, 261 00:11:58,255 --> 00:12:00,485 maybe 30 minutes if it's a really long visit, 262 00:12:00,605 --> 00:12:03,005 a wellness visit, or frankly, if it's for behavioral health, 263 00:12:03,025 --> 00:12:04,245 it might even be 50 minutes. 264 00:12:04,905 --> 00:12:07,165 But then the next time you see your provider is gonna be 265 00:12:07,775 --> 00:12:10,165 maybe, maybe a month if you know, 266 00:12:10,165 --> 00:12:11,725 if it's a really acute issue 267 00:12:11,825 --> 00:12:14,525 or maybe more likely four to six months down the road. 268 00:12:14,865 --> 00:12:17,565 And there's all sorts of decision making that's happening 269 00:12:18,225 --> 00:12:20,085 during that period of time between visits 270 00:12:20,115 --> 00:12:23,485 that we really need to actually be able to capture the data 271 00:12:23,485 --> 00:12:25,845 that people are gathering on themselves, their weights, 272 00:12:25,845 --> 00:12:27,645 their blood pressure, their symptoms, 273 00:12:28,265 --> 00:12:32,005 and surface it to the care team that can then respond 274 00:12:32,065 --> 00:12:34,405 and engage people when they're all out 275 00:12:34,405 --> 00:12:35,485 and about living their life. 276 00:12:36,365 --> 00:12:40,445 I think other less sort of sexy things would be there, 277 00:12:40,825 --> 00:12:42,005 we talk about data capture. 278 00:12:42,145 --> 00:12:44,365 You have to have an electronic medical record that can 279 00:12:45,075 --> 00:12:48,605 literally capture these different discrete data points 280 00:12:49,265 --> 00:12:53,605 and aggregate them so that a provider 281 00:12:53,825 --> 00:12:58,405 or even a health plan can understand a population, 282 00:12:58,665 --> 00:13:00,685 how the health of a population of people are doing. 283 00:13:00,745 --> 00:13:03,245 So providers like to understand your individual health, 284 00:13:03,425 --> 00:13:04,965 but they also wanna understand, for example, 285 00:13:05,505 --> 00:13:07,965 how are all my hypertensive patients doing? 286 00:13:08,305 --> 00:13:11,885 Am I really treating them in a way that from, um, 287 00:13:11,915 --> 00:13:15,485 January 1st of, of the year through December 30th 288 00:13:15,485 --> 00:13:19,245 of the year, I can see that all of my hypertensive patients, 289 00:13:19,315 --> 00:13:20,885 well better put 60% 290 00:13:20,885 --> 00:13:23,005 of my hypertensive patients have actually improved their 291 00:13:23,005 --> 00:13:24,405 blood pressures down to normal. 292 00:13:25,185 --> 00:13:28,885 And I can see that without just having sort as an aggregate 293 00:13:28,885 --> 00:13:31,405 and it's reported on a dashboard in a database. 294 00:13:32,305 --> 00:13:34,445 And there's all sorts of people that would love to see that. 295 00:13:34,625 --> 00:13:37,125 And frankly, that gets us into value-based care, 296 00:13:37,125 --> 00:13:38,565 which is a completely separate subject, 297 00:13:38,585 --> 00:13:41,365 but what if providers are, uh, incentivized 298 00:13:42,025 --> 00:13:43,165 by those good outcomes 299 00:13:43,425 --> 00:13:47,605 and they get paid for the additional value that they are 300 00:13:48,445 --> 00:13:50,485 creating for the outcomes for their patients. 301 00:13:50,545 --> 00:13:53,575 So a lot of different pieces in their data tracking 302 00:13:53,635 --> 00:13:56,335 and captured the, uh, ability 303 00:13:56,395 --> 00:13:57,895 to take remote patient monitoring 304 00:13:57,895 --> 00:14:00,495 and integrate it into an EMR that can track that data 305 00:14:00,635 --> 00:14:03,775 and aggregate it and report on it, automated care 306 00:14:03,835 --> 00:14:05,015 for time between the visits. 307 00:14:05,395 --> 00:14:08,415 So in a summary that would be, those would be the key pieces 308 00:14:08,445 --> 00:14:10,655 that I would say are critical to virtual primary care. 309 00:14:11,935 --> 00:14:14,075 - Got it. Got it. Yeah, thank you so much for sharing all of 310 00:14:14,075 --> 00:14:16,315 that insight and kind of a add-on 311 00:14:16,335 --> 00:14:18,715 to everything we've discussed so far, especially, um, 312 00:14:18,715 --> 00:14:19,755 my previous question, 313 00:14:20,415 --> 00:14:23,795 but how can the type of strategy we've discussed contribute 314 00:14:23,935 --> 00:14:26,715 to overall improvements in patient outcomes, 315 00:14:27,225 --> 00:14:28,635 care delivery and costs? 316 00:14:29,095 --> 00:14:30,635 Are there any success stories 317 00:14:30,735 --> 00:14:32,275 or case studies that come to mind? 318 00:14:32,935 --> 00:14:34,955 - You bet there are several different case stories 319 00:14:35,015 --> 00:14:38,555 and I think, um, I'm gonna focus on, uh, a case 320 00:14:38,555 --> 00:14:42,515 that actually came to amwell from one of our partners, 321 00:14:42,515 --> 00:14:46,035 Northwell Health, who leveraged our automated care strategy 322 00:14:46,655 --> 00:14:50,675 to ensure that they had improved maternity outcomes 323 00:14:50,695 --> 00:14:53,325 and maternity engagement for their patients. 324 00:14:53,665 --> 00:14:56,965 So they were looking to ensure that they had, 325 00:14:57,105 --> 00:14:58,885 and they had several different programs, uh, 326 00:14:58,885 --> 00:15:00,125 so I may mention a couple of them, 327 00:15:00,145 --> 00:15:01,925 but particularly with their maternity program, 328 00:15:02,715 --> 00:15:05,005 they actually had, um, a, 329 00:15:05,005 --> 00:15:09,685 an automated care feature in which they reached out to all 330 00:15:09,685 --> 00:15:10,805 of their patients 331 00:15:10,805 --> 00:15:12,645 that were engaged in their prenatal program 332 00:15:13,465 --> 00:15:16,165 and made sure that they were checking, I believe these were, 333 00:15:16,225 --> 00:15:17,685 um, preeclamptic patients. 334 00:15:17,785 --> 00:15:19,445 And so they were checking their blood pressures 335 00:15:19,445 --> 00:15:21,605 and made sure that they were accessing the blood pressures, 336 00:15:21,985 --> 00:15:23,205 uh, in an appropriate way, 337 00:15:23,305 --> 00:15:28,165 and that they were checking for symptoms for, um, worsening 338 00:15:28,465 --> 00:15:30,805 of their preeclampsia toxemia. 339 00:15:30,985 --> 00:15:32,845 And so they would check for headache, they would check 340 00:15:32,845 --> 00:15:35,725 for blurred vision, they would check for unusual kinds 341 00:15:35,725 --> 00:15:37,445 of swelling, and they, they found 342 00:15:37,445 --> 00:15:40,645 that they were actually able to significantly improve the 343 00:15:41,285 --> 00:15:43,925 outcomes and bring patients in earlier than they might 344 00:15:43,925 --> 00:15:45,325 otherwise have without this. 345 00:15:45,355 --> 00:15:48,245 They had, I believe it was a 76% engagement, 346 00:15:48,705 --> 00:15:49,805 uh, from patients. 347 00:15:49,985 --> 00:15:52,525 And they found that they actually had significant improved 348 00:15:53,025 --> 00:15:56,445 or reduced, uh, uh, preterm births from 349 00:15:56,445 --> 00:15:57,445 that particular program. 350 00:15:58,305 --> 00:16:01,805 So they, Northwell Health had another program, uh, which was 351 00:16:02,455 --> 00:16:05,725 monitoring gaps in care in, in primary care. 352 00:16:05,785 --> 00:16:07,525 And again, this, to use the automated care 353 00:16:07,525 --> 00:16:08,765 component of what we were talking about. 354 00:16:09,585 --> 00:16:13,005 And, uh, prior to instituting this automated care 355 00:16:13,005 --> 00:16:16,325 where they would reach out to patients to say, 356 00:16:16,325 --> 00:16:17,845 when was your last colonoscopy? 357 00:16:17,845 --> 00:16:19,005 It looks like you're due for this. 358 00:16:19,025 --> 00:16:20,525 And they actually were able to integrate 359 00:16:20,635 --> 00:16:23,565 with the electronic medical record to pull that data 360 00:16:24,385 --> 00:16:26,925 and, uh, to identify that somebody was not up 361 00:16:26,925 --> 00:16:29,285 to date on their colonoscopy or their mammogram 362 00:16:29,545 --> 00:16:32,045 or, um, you know, any of the gaps in care 363 00:16:32,045 --> 00:16:34,805 that are preventative measures that are typically monitored. 364 00:16:35,545 --> 00:16:39,965 And they had, um, an 89% satisfaction rate 365 00:16:40,585 --> 00:16:43,285 on the gaps in care automated care program, 366 00:16:43,625 --> 00:16:48,405 and they were able to close almost 70% of the gaps in care 367 00:16:48,475 --> 00:16:50,925 with which, you know, any of your, uh, 368 00:16:50,925 --> 00:16:53,605 health plan executives , that might be listening 369 00:16:53,605 --> 00:16:55,925 to this podcast, will immediately recognize. 370 00:16:55,925 --> 00:16:58,365 That's a really remarkable, uh, statistics. 371 00:16:58,365 --> 00:17:01,805 So they also had an issue with, uh, 372 00:17:02,195 --> 00:17:03,445 colonoscopy no-shows. 373 00:17:03,625 --> 00:17:05,205 And so patients would, um, 374 00:17:05,805 --> 00:17:07,365 schedule their colonoscopy appointment 375 00:17:07,785 --> 00:17:10,805 and, um, they had a really significant rate. 376 00:17:10,865 --> 00:17:13,885 Almost 50% of patients, uh, actually were no showing 377 00:17:13,905 --> 00:17:16,125 for the colonoscopy, which as you can imagine, that's a lot 378 00:17:16,125 --> 00:17:17,445 of, you know, you have to book, you have 379 00:17:17,445 --> 00:17:20,605 to book the colonoscopy room, you book the anesthetist, uh, 380 00:17:20,665 --> 00:17:22,765 you book the doctor who's doing the colonoscopy. 381 00:17:22,765 --> 00:17:24,925 That's a lot of lost, uh, revenue 382 00:17:25,505 --> 00:17:27,885 and frankly lost opportunity for patients 383 00:17:28,585 --> 00:17:29,725 in this colonoscopy. 384 00:17:30,245 --> 00:17:31,565 Reminder. Automated care, 385 00:17:31,795 --> 00:17:34,165 they had a 48% percent reduction in their 386 00:17:34,165 --> 00:17:35,445 no-show in cancellation rates. 387 00:17:36,185 --> 00:17:39,765 And they were also interestingly able to identify 388 00:17:40,275 --> 00:17:43,205 that they had a barrier to care in 20% of those people. 389 00:17:43,745 --> 00:17:45,405 And so they were able to then go through 390 00:17:45,505 --> 00:17:48,005 and identify some of the social determinants of health 391 00:17:48,105 --> 00:17:50,605 and address SDUH in ways 392 00:17:50,605 --> 00:17:52,805 that they hadn't even anticipated in, 393 00:17:53,025 --> 00:17:54,205 in starting this program. 394 00:17:54,665 --> 00:17:56,285 So those are a couple of examples 395 00:17:56,285 --> 00:17:57,965 that I could, that I could share. 396 00:17:57,965 --> 00:18:01,885 There's several others, uh, that I could riff on if, uh, uh, 397 00:18:01,885 --> 00:18:04,285 you know, time depending, but, um, I'll just leave it. 398 00:18:04,285 --> 00:18:05,285 I'll start with those. 399 00:18:06,375 --> 00:18:08,465 - Yeah, yeah, no amazing examples. 400 00:18:08,465 --> 00:18:09,905 Thank you so much for sharing those. 401 00:18:10,005 --> 00:18:12,985 And overall, you've given such good intel, 402 00:18:13,125 --> 00:18:14,665 you know, about this topic. 403 00:18:15,245 --> 00:18:16,665 Um, before I let you go, 404 00:18:16,725 --> 00:18:18,625 is there anything our listeners should know? 405 00:18:19,785 --> 00:18:22,645 - You know, I think as it, when we talk about virtual care 406 00:18:22,985 --> 00:18:27,805 and particularly virtual primary care, the real key 407 00:18:27,825 --> 00:18:28,885 to understanding how 408 00:18:28,885 --> 00:18:31,405 to deliver an effective virtual primary care 409 00:18:31,425 --> 00:18:34,645 and virtual care offering is to not simply assume 410 00:18:35,115 --> 00:18:38,925 that you're taking brick and mortar models of care 411 00:18:39,065 --> 00:18:42,285 and workflow and putting them into a video visit. 412 00:18:42,795 --> 00:18:44,805 What we have found is you really need 413 00:18:45,165 --> 00:18:48,845 to deconstruct the workflow, deconstruct the visit, 414 00:18:49,025 --> 00:18:52,525 and identify what is it that you can do 415 00:18:52,525 --> 00:18:53,645 through a virtual setting. 416 00:18:54,115 --> 00:18:56,525 What is it that really you should leverage some other 417 00:18:56,525 --> 00:18:59,645 technologies, whether it's an automated care chat, uh, 418 00:18:59,645 --> 00:19:04,045 whether it's, uh, a CBT program, um, 419 00:19:04,235 --> 00:19:07,245 whether it's frankly leveraging, um, uh, 420 00:19:07,315 --> 00:19:11,045 some health coaches, uh, to engage in some 421 00:19:11,045 --> 00:19:13,805 of the care management, but break down the workflows 422 00:19:13,985 --> 00:19:15,845 and figure out what can be done virtually, 423 00:19:15,845 --> 00:19:17,885 and then figure out what the technology is out there. 424 00:19:18,735 --> 00:19:20,725 Telehealth and particular virtual, 425 00:19:20,835 --> 00:19:24,965 virtual primary care is not just, it's not, it, it, 426 00:19:25,225 --> 00:19:27,885 almost every piece of it is gonna need to be a hybrid care, 427 00:19:28,265 --> 00:19:31,045 but what that means, what part is brick 428 00:19:31,045 --> 00:19:33,965 and mortar, what part is automated, what part it comes 429 00:19:33,965 --> 00:19:37,205 through virtual and who does those specific components? 430 00:19:37,635 --> 00:19:39,645 There's so much amazing opportunity, 431 00:19:40,105 --> 00:19:41,285 but you've gotta be smart. 432 00:19:43,005 --> 00:19:45,175 - Yeah, absolutely. Thank you so much, Dr. 433 00:19:45,455 --> 00:19:46,455 Horner, for your time 434 00:19:46,915 --> 00:19:49,735 and thought-provoking response to, to responses today. 435 00:19:49,735 --> 00:19:50,895 We really do appreciate it. 436 00:19:51,155 --> 00:19:54,135 Uh, we'll also like to thank our podcast sponsor am well, 437 00:19:54,595 --> 00:19:56,695 uh, thank you all for joining us for another episode 438 00:19:56,715 --> 00:19:58,015 of Becker's Healthcare Podcast. 439 00:19:58,635 --> 00:20:01,255 You can tune into more podcasts from Becker's Healthcare 440 00:20:01,355 --> 00:20:03,535 by visiting our podcast page at 441 00:20:03,695 --> 00:20:05,815 becker's hospital review.com. Thank you again, doctor. 442 00:20:06,435 --> 00:20:07,815 - You bet. Thank you. Bye.