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Digital Health

Nick:

Hey everyone, I’m Nick from OSP and welcome to our webinar.

In our last webinar, we spoke about the different digital health tools disrupting the healthcare industry, changing patient experiences, and positively impacting patient outcomes.

Today, we are joined by Matthew Holt, Co-Founder of Health 2.0 and Founder of Smack. Health and The HealthCare Blog will talk on Digital Health: Solving the Health Access-Challenge.

A study conducted in December 2019 shows that 62.93% of Primary Care Health Professional Shortage Areas (HPSAs) were located in rural areas. Let’s find out from Matthew how digital health solutions bridge gaps in patient care and help combat these physician shortages and improve healthcare access. 

Welcome to the webinar, Matthew. Thank you for joining us today.

Matthew:

Thanks, Nick. I like the way you start with the easy question, right? So before we start, let me just say that I’m not, you know, I don’t have, like, the great academic qualifications in rural health care or, but I do know that we have significant imbalances in health care supply. We have used technology very poorly to this point. A lot of things have changed. And the kind of a pandemic to balance the supply. We’veBy the way, we’ve also used technology pretty poorly to make things easier for patients and consumers in areas where there are lots of doctors and hospitals. Right. There are also places in America we know there are massive imbalances in rural areas, the wealthy suburbs, some of the well-supplied cities where there are large academic medical centers, and lots of activity. Last night, the debate was sponsored by Cleveland Clinic. And that’s a great example of where there’s a massive medical complex in the center of a very poor inner-city area, essentially. But I would say we know that we have things like instant connections with specialists and getting people better access to specialty consulting, primary care, and what have you is not great anywhere we have used to. 

But putting that aside, what do you do about the rural areas and a couple of factors has increasingly hit many rural areas. One is the general trend in America over the last few decades to have, you know, essentially money, wealth, and activity to go to the urban and suburban areas that happen anyway. Second has been some of the rural states that have seen the kind of quote-unquote. Being left behind has also not taken the well; I would say pretty obvious that it is taking the Medicaid expansion money of several southern states that didn’t take Medicaid expansion and therefore had less access. When you have a little high, high poverty in that rural areas and you said we’re not taking Medicaid expansion money, you’re essentially condemning the current providers who are there having less money in rural hospital policy problems around that, assuming at some point that gets solved, you still have the underlying issue that you have fewer and fewer and fewer providers will go to those areas. And I haven’t looked into this, but a significant amount of the physicians going to those areas have international medical graduates predominantly coming from India. And I think the joke is in the South that if you see a person looking Indian, you say, hey, doctor, because you, the local doctor, I haven’t looked into what’s happened regarding visa applications, what have you in that area. But I do know that many other areas, the current administration, in its wisdom, has made it very hard for people to come in on those visas. So. I suspect we kind of have a little bit of the perfect storm. So what do you do about it? We’ll continue to be healthy too. Well. The obvious thing is that we’re in we’re moving towards a. We’re not there yet. Welcome to the revolution, we’re moving towards an evolution where you have.

More and more access to technology can transport people, and that might be things like some of the recent legislation around payment for things like stroke. These were all sorts of done remotely to major cost or anything sharp with a stroke instead of somebody at the small critical access hospital in a rural area who’s looking after you; you may have time for attaching devices to you. And they’re getting advice and consent from a big hospital somewhere; I have a tiny company I know well could capture proof, which is doing, you know, using video and photos to do something similar in the intermountain system, where small rural hospitals in Utah are sending information back over to the specialist intermountain and getting advice and back and forth. They can see that’s happening in the hospital. Well, the other areas to take that to the home, you know, and you’ve seen the growth of telehealth as a whole. Telehealth is always paid for with Medicare in rural areas, but private Medicare’s growth for private telehealth companies particularly. Teladoc in America. Well, we’re now public darlings of the stock market, among others, but hundreds of other companies, intel outfits to some extent, remote patient monitoring with the new coach, bankrupt, patient monitoring, helping know, allow access to those areas as well. The one thing I would say is that this all kind of depends on a decent Internet connection. And there are many areas in the US which don’t have you know, the FCC has been putting money into broadband in rural areas, but we’re not a career.

We don’t have a 100 100 gig up and down to many of these places. Yet in many rural areas, there have been a lot of stories, not so much about health care, but about kids trying to do their schoolwork, having to go to sit next to a McDonald’s, and use the Wi-Fi and what have you. So I think there are places to go to. But the goal, I think, should be to figure out how we can use our precious resources of human beings and replace them with and extend them using technology to allow for. The one other thing I’d say, which I’ll stop at this point because this is a way to come back to me and to lead is, of course, using AI and using machines and robots to deliver a lot of front line care. And that’s an interesting work being done. Not so much in rural America, but in rural the world to the rural developing world as a battle now in China. Can you get it? This will be the first line of primary care defense, as it were. So I thought a lot better. But essentially, yeah, there is hope for changing stuff in the rural areas, and we haven’t yet got into things like Wal-Mart’s entry into primary care and that kind of stuff. Nonetheless, it’s a long way to go.

Nick:

Yeah, I think just hang on to this before we get into the questions for you. I think what has accelerated this. Yes. COVID-19 but. Obamacare had rearranged and been bad, good, or indifferent. I’m not being political, but I’ve seen the foreseen the mergers of multiple hospitals and clinics within an area and the closing of several other ones, particularly hospitals in rural counties, say in upstate New York.

So that sort of accelerated the path, I believe, of bringing the need for telehealth. The second item is a lack of resources, skilled resources, too. But there’s another area working in the clinical industry. And I think I mentioned this during our conversation. It was thrust upon many IT organizations within these clinical conglomerates; now, I call them businesses. To have the knowledge and the skills to know what it is. In other words, many of them traditionally were medical personnel just thrust into that role. And so now they have a smorgasbord of legacy systems. That they’re paying contractors to maintain they don’t know what to do. How do we reduce becoming more efficient and no less? Now we have an EHI coming into the picture. Well, how do we leverage it if I don’t understand my infrastructure of content and data because of all these disparate systems?

So it’s like the perfect storm. So I agree, and I actually let me add one more wrinkle, which is the question.

Matthew:

Right. So, Sammy, traditionally, you had provided primary care providers for critical access hospitals and rural providers. Right? And they were. And then you had a lot of them who are poorly qualified health centers and the like. I see subculture. And traditionally, I mean, going back several years now in this MySpace, this was a payer like Medicaid, in particular, were the. What was driving this, and it was kind of the locus of activity within those physician offices and the critical access hospitals, and there’s a lot of concerns about getting access to that if you like to travel away and all that kind of stuff. But, you know, that’s where it was. And then we start talking about connecting them to bigger facilities, to things like stroke and the like. And you got a couple of things going on now. One is that more and more of these Medicaid plans have been put into the private sector, including traditional sort of what used to be moms and kids, AFDC, Medicaid. Still, now the long term support services office, which is, you know, in many states like Iowa and Virginia and elsewhere, it’s become part of them, and companies like Anthem run it. And so that puts it in their systems to manage this. And then you’ve also got the concept of, well, these health plans and they’re no longer just paying for stuff. But most of them, ultimately, this is the biggest or united slash option is the biggest. But many others are getting into this and developing their healthcare provider systems, which are just not just. Primary candidates, they may be buying or other types of providers they’re buying, but they’re also getting more heavily involved into this digital health stuff as well, providing not only telehealth but also Anthem, for example, has got my I got to deal with OK Health, which is an AI chapel.

So it’s not entirely clear who the owner of this function is. That is like the first line of defense for the patient is. So you mentioned. Yes, if you’re a small hospital system or a small hospital or a provider organization in rural areas, you don’t have access to that much technical talent. You’ve got a lot of complexity to deal with, but it’s not entirely clear who’s going to manage those patients. And then, you know, I mentioned it briefly. You’ve got big expansion into health care delivery, per se, by the biggest retailer globally and the biggest retailer, Amazon, which is, well, Amazon, but also Walmart, because it has cost. Walmart is not going to open 35 more centers. And some of these are in suburban areas, of course. But again, a big footprint in the more rural areas. So the question of who is providing care where it gets provided is all in flux. Right. I agree that the strain on the traditional incumbent, you know, rural hospitals, especially with the issue of them merging and being part of the system, etc., and in some cases being taken up with private equity-backed groups. Exactly they were a fraud. There are all kinds of stuff going on. But I think, you know, it’s in flux and, you know, you don’t be political, but you have to say that this is an area of the country which has been massive with the underserved and it’s kind of going its way and probably needs to be. I would say that we need you to know, we need the support of the Tennessee Valley Authority kind of across the country. How can you bring them back and give them broadband and access to the people who live there? You know, some. Exactly. I have not, and not exactly.

Nick:

A matter of fact, the last webinar, sorry, the last webinar, I was talking to a young lady, Robyn, who’s very technically schooled. She works in medicine, and so on. She talked about all the digital technologies, and she must be in her mid 30s or early 30s. But I stopped myself because of my background, this technology, and machine learning, I said, Robyn, with companies like Apple and other companies like Amazon and all these advances. I understand that we will improve our health. That is the way to go, but if we get national health care into the US, and if government bureaucrats run it, they tend to move slower. The two cultures of innovation versus, oh, we must stop the I’s, cross the T’s, it is going to crash. And she said her answer was we would not have national health care for that reason in the US because it will just bring down the incentive for introducing new technology. What is your opinion?

Matthew:

I find it very well, and I think she’s wrong. I don’t think you necessarily have to mean that you look at other countries who have essentially. So this gets complicated because what is national health care? Right. In the UK, in Scandinavia, the government essentially owns the hospitals, essentially employing doctors and nurses. And you can see Finland, for example, extremely low self-care, extremely advanced access to their rural area. They use more technology. They do it somehow. The Germans who don’t have a weird multipage the traditional system, but with a wraparound of some private insurance and some public insurance, but have one fee schedule.

You can’t tell when they show a doctor’s office who they are. It’s like, oh, it’s a Medicaid patient. They don’t think it’s that we have it right. Because they have just, they have just introduced legislation which calls for the footage of this morning. They have recently introduced legislation to essentially pay for what digital therapeutics, a direct payment mechanism for new digital health delivery types. So I don’t know. You can; there’s a lot of stuff back and forth about national health care. Now, we may not get national health insurance the way that some of us would like in the US for many political reasons. You may have noticed last night there was some, I would say discussion, but shouting about shouting and interruptions and whatever passes for debate.

Nick:

Exactly

Matthew:

But I bet I would say that you know, there’s a lot of innovation. And in fact, I would say for the most innovative single health system globally, which has the most digital interaction, is run by three major HMOs is and that Israel. So you can argue that they have nationality and have it. Everyone has national outrage. We’re an outlier polity in many ways. Exactly. Have it. And even within the US, you’ve got this there’s been a decent amount of innovation in the VA, a socialized social provided health care. Exactly. Good point. There is also a decent amount of activity amongst the federal government health centers. They’ve been a lot of technologies being used there, and there have been. So I don’t buy that. You don’t get technology. Yeah, I do agree. Is that? We have yet to figure out if we are going down a market-based path for people like Wal-Mart, Amazon, and others to be prevented and doing health care and innovative ways. We have yet to figure out how that fits our standard Medicare fee schedule, which I would agree is very stultifying.

Nick:

Exactly. That’s why many doctors have dropped it. But it’s interesting because I did work for a national health care service in Great Britain with a customer relationship management system. And I did not see some of the things that have been cited in the debate in the US.

But the specific questions I have for you and again, Matthew, thank you for taking the time today. My first question and which I thought was very interesting, studies have shown that digital sedation could replace the anxiety medicine midazolam in 80 percent of surgeries carried out under local anesthetic. Do you see patients adopting digital sedation? And how effectively can this plan disassociate patients from their symptoms?

Matthew:

So you’re in the wrong guys like Brendan Spiegel at Cedars Sinai, who is the expert on the impact of VR on health? The answer is it’s really on medicine, and it’s early days. But there have been some studies showing that you can disassociate people from pain. And I think in China, they use acupuncture to do that and use energy. So it seems a stretch to imagine that Americans would not take anesthesia, you know, full of surgery. I’ve had a decent amount of these non-surgical knee surgery on the water, and I stumbled into a tree. So I’m on knee surgery and, you know, I was awake for it. You know, they stabbed me a lot. And they give you, they give you a little bit of something to put you out. And they might allow your company to see the surgery. She wants to see what was going on. It seems a bit of a stretch to think that our current culture will leap over that anytime soon.

But I think that the role of things like VR and different types of technologies will come. And suppose you think about the other ways that we’re using things that weren’t really fought off for health care more broadly for everybody. In that case, you know, you are saying things like magic mushrooms, essentially drug magic mushrooms now in advanced trials as a potential cure for all kinds of different mental health issues.

Thank you. And you’re also seeing the same thing happening with the growth of ketamine, which you know, the horse tranquilizer used as a club drug. And now JNJ is a real drug, which is essentially ketamine, which out in the market, you know, a lot of users about things like depression. So I can imagine we will be more accepting as a culture of different ways of treating this. Do I think the anthologist will go out of business and be replaced by VR anytime soon?

Nick:

No, no, no.

Matthew:

It probably would say I would say honestly, let’s see how much he’s written a book about the system and how much trials, and we’ll know much more about this and get it validated one way or the other.

Nick:

And exactly, I know from my own experience in the US military as a consultant for the DOD, they have been doing it sort of sedation, particularly when soldiers are taking this pill. So how can they withstand the pain? 

The second question, what kind of digital health solutions will help uninsured and underinsured Americans get better access to quality health care?

Matthew:

I think it’s very similar to the first question, my right, which is, you know, several decisions are coming which will help them do a combination of self-service and access to to achieve better care. Some of this, you know, some of this is what you can help people deal with, whether it’s that the cell service is looking stuff up, and thoughts of getting better information about the care. That’s one one one area. The other thing would be technology, that is. Designed to help them access better and cheaper care, and we’ve got a great example of that, which is just a component, which is good. All right. So good is a company except now in the specific area of the area of drug pricing. But to help you find the better drug price could help you navigate the maze of drug pricing and drug rebates and coupons or whatever and so on. That walk into any drugstore and get the best price. And, you know, those guys have done very, very well for themselves is now worth more than Cardinal Health.

You’re giving them mental health to some of them and. Well, they’re going to, and they’re going to hide the fact that I can get the cheap telehealth to consult together. And there are many others in that little area of I mean, that’s a tiny part of the business now. But there are many others in that area of a little bit early stage now. But can we get you cheaper care by doing so? Telehealth access to drugs. So that includes road roary for both boys and girls, I guess. Hinz Lemonade. Yeah. Or New Rexer, I guess. Now I don’t know how to pronounce profit, but can you access that? And I would say that some of this technology access is telehealth, getting you to medication delivered by, you know, in the mail if the mail is still working. Some of that is, to my mind, a, you know, sort of technological replacement for driving expenses. The doctor is going to have a new delivery system, kind of like replacing the taxi. And it’s cheaper for several reasons, but not least because they’re using technology and fewer human beings and they’re putting less onus on the patient. Now, that doesn’t cover everything. That helps them cover some things.

Nick:

Excellent points. The next one has to do with digital therapeutics is a relatively new category, digital health gaining recognition. How is it different from digital wellness applications, and what is the potential and improving population health?

Matthew:

Since the start of the coming digital health system, since 1993, it started where we can get people there? Can we get people that? That data that records right, can you get it, or can you get access to content? I can imagine those that marry those two things together and now it’s can you get the programs that are somehow similar to the ones they would have got from professionals. There’s now been a group of people saying, OK, we can now do a program with a digital-based program that may measure you using your phone but may give you information and give prompts and tell you what to do. That is somewhat similar to how professional we were structured to do. So it’s almost like thinking gives you a book to do more operational measurements, and we’ll put people through these programs, and we’ll say there’s clinical validation that works. And some of them use it. Just the program alone.

Some of them use the program and some use the program as a pill, you know, but the goal of all of these things is to say, can we have you the patient? Take action, take an intervention delivered to my phone on my website, and it may be human, and everybody may have just instructions, it may be measuring you and writing to you. And it’s very, very important to great effect within our mental health. CBT and the other three points in growing and then

increasingly being used known for specific purposes. Some parts of it are conditions like. Schizophrenia or whatever. So I think this is a natural evolution of our health and medicine should go right, because essentially I would agree. Same kind of thing that you came with your doctor, Dr. Do your exercise, change your diet. Call me in the morning, commute to my room, and then talk to a nutritionist or help you talk to a counselor to help you with that. There was this, and it wasn’t applied properly in a broad, systematic program. So I think it’s great to do that, and I think it has great improvements and of course, much of this is self-service and therefore can be achieved over expensive professionals. What I don’t like about digital therapeutics is the approach to settlement several companies in the space have taken, but they are going well; we like what we like about the concept of a therapeutic or a drug is that we can get a patent on the particular thing when we show it works and then we can charge a lot more money than the thing costs that the thing costs us to produce.

Let me make it very profitable. And I’ve seen several digital health companies digital therapeutics companies essentially take a program in some cases, some of which he bought other companies. Programs have turned around, have put them through some kind of trial, or working for FDA validation of the digital therapeutic with the intent of charging more like drug prices than software prices. And that, to me, is the completely wrong way. We shouldn’t be doing that. We should instead be saying, how do you incorporate these kinds of programs delivered by technology? Into the mainstream of health care and, by the way, why we should be looking for the advantages of the software it brings, which is you can do a lot more scalability at a lower price to more people.

Exactly what we shouldn’t say, how can I build this mystical black box, digital health intervention? Call it therapeutic, get some kind of FDA pixie dust foundation, get a patent on it. Exclude other people from doing it and try to make it like trying to make it like a drug, because the way the drug companies price their products with Nopporn does not serve the American public. But if you ask me, people argue about innovation and will have your drugs. But if you ask me, oh, you’re right. Know we shouldn’t be heading down that path. But the influence of money being more or less clear, people will try to do it so strongly. Look, if you want, if you only really name names that pair therapeutics has gone down the list, then they set up when they set up to start doing what they’re doing. They went back, and I tried to find studies that they thought they went to look at all these different intervention studies, and they found the ones they thought they could get through the FDA and get some kind of patent exclusivity. And that was what they were looking to do. And then as a financial game, they wanted to take, they then pursued those studies and built these products off them to have them be defensible, like a drug they will charge for the money. Now, I don’t think in the end payers will pay for that. But that’s the path they’re heading down. And to me, that’s not the way that we’re going to get the full benefit of all of this new kind of technology to the max amount of people. It might be the way those individual companies make a lot more money.

Exactly. But hopefully, they get together. They’re getting to you. But you now have a digital therapeutic alliance that is promoting this and the iPod. And for the most part, it’s just that this stuff doesn’t exist. But that was the right.

Nick:

No, no, Matthew, I couldn’t agree with you more. Many health care providers agree to digital health solutions to enhance patient experiences. One research group reported that the time saved by using mhealth applications could add up to significant ROI for providers, too. Would you find that to be a valid statement?

Matthew:

It depends; I think what you mean by which I got to the study mentioned which applications they were discussing because there’s a lot of them. You know, what is quote-unquote? What is digital health, and what are the health applications? So I think that many of the ones that are now fairly widespread, which are a big increase in efficiency and effectiveness. So I would take a very simple like Fraizer, which I was kicking around forever. I met the CEO when he was like the four of them in an apartment in New York City with a cat and knew they were sitting there fully working the way they built a tool which could, you know, they could give to patients in the waiting room and further enhance that.

And they had payment features on the tools and information. So they added the interaction with the physician’s office. And pretty much what they were doing was having the checking function and informational function, the payment function, a bunch of other stuff taking on. Four out of the receptionist’s hands, the clock, and give you to the patient, which enabled them to build those interfaces, enabled people to get checked in more quickly. I’ve seen the reverse that was happening. So, for example, I don’t have to study. But the recent bump up in you, Satel, out from the COVID, there’ve been several anecdotes instead of in the. Physical with it when it comes to the exam room, the doctor, the nurse pops out of the system pops, and that’s the way in the blood pressure, is that the other? And the doctor pops into the information ready to go and can do that pretty quickly and effectively. Just talk to a patient and set the data. Whereas in telehealth. Even though he’s a patient, he couldn’t go in kind of danger of infection in telehealth, they don’t have that information they might have discovered, and maybe the patient’s going to get pressure, blood pressure cuff from the lab. You know, they have to like that is part of the vision that extends the neck of the with it. So we’ve got some way to go into proof of this. However, more and more people are going to find that they have our remote monitoring tools. A couple of companies are building some of that front end Swiss Army knife tool for telehealth title characters in a local med one who built that kind of thing more often.

We can have these things, and you can have more this technology for sensing in the home. And that probably will kind of go away. But I understand how you bring in a new system, and it doesn’t necessarily save time. The biggest one of the lot here has been the introduction, which people call digital health. But what it does is not what I would call digital health, but the introduction of EMR, which, as we know in general, flows doctors down to more to do. They spend more time, as much time with a smile as they do with the patient, whereas many of them have gotten very, very good at doing paper note shorthand. So there are lots of volunteers to EMR, but I think it probably delayed the interface that the doctor, the patient, is in a big way. You have a series of companies and of course. The reflection that you had, the growth of this new professional, describes a simple premed student wandering around, you know, writing down everything in the background, and there’s a lot of that going on. You’ve got several companies that are now building solutions. You got people. Oh, like Suki and Robin are doing kind of a new way to try and try to take the verbal conversation and make sense out of it, that electronic medical record and get the interface of the emotion out of the way.

And you’ve got a company called. On Blikre, they have the Google Glass, which has the scribe sitting in Pakistan over the system. It’s not Animatrix. What is the name of it? I’m blanking in the name of remembering it when we think of the next question, but they have Google Glass, and it’s being used. They raised about a million bucks, and they’ve allowed the information related to the doctor and that Google Glass, but also the desktop in the background able to uplift and write up the writing of what’s going on. And that’s where that seems to, again, take a lot of the clunky interface out of the way and improve the experience. So I think it’s all over the map. Somebody said all medic’s in the chat. Thank you very much. It is all mixed. There are two medics. There’s one called the medics with a system, which is the Hillcroft Scribe company. That’s what medics with an axe, an Israeli company with a weird view into the augmented reality of surgery. I’ve talked to both of them, and they both said the other wants to change their name.

Nick:

I so COVID-19 has made it crystal clear that understanding the social determinants of health is an integral part of health care delivery. How can digital technologies help capture and analyze social determinants of health data better than the traditional approaches? For analyzing this data.

Matthew:

Whoa. Well, I mean, that does a lot of look, with no additional health regarding such evidence of health, both on the side and the actual of getting stuff done on site. So I think if you go back, there’s been a lot of discussion for years in the Alzheimer’s research community about how the zip code is helped with the zip code. And we know the impact of education and housing in this than the other one on health and obviously the impact of drugs and then things like substance abuse etcetera, etcetera. So we know, we can do a lot more tracking people’s health as a consequence of that. Life, basically the life circumstances, and we can start to do stuff about their life circumstances, but I think the obvious things that we can do there are companies like Unite US aU.S. others who are essential. Plugged into the email in a healthcare provider, physician, clinician organization has somebody with a particular problem in front of them. They can now prescribe solutions that are not just medical solutions, and it might be housing. It might be for reference to social work. It might be a reference to the food banks and all that kind of stuff. In fact, in upstate New York, Jacob Writer, who used to be RNC deputy national director for a long time, is running to put together an IPA independent press organization, which is not a doctor, but of all these social service agencies, and they’re using Unite US, U.S.e technology is the backbone for his for those so that you can actually if you appear in any one of those, you know, you might appear at a housing shelter or a food bank or whatever it is, they can refer you back into medical care and medical care, refer back to July one referring system.

So I think there’s a lot that can be done on the analysis side. They said, we’re getting very good at figuring out what works and what doesn’t work and who is who, who needs what intervention, what, we have a lot of tools being delivered that across the board, even plenty of attorneys going these days with involved in this at one point looking at things like, oh, infections and destroying disease in the spread of things like which are not such themselves health, things like salmonella outbreaks and food because they can track across multiple factors in a way that probably wasn’t done before. I don’t know if there is such a thing as a solution for this because you’ve had companies like Asseri which did, you know, geographic information systems for years looking at the access to providers and access to all sorts of foods and all the rest of it. At some point, you’ve got to have this. Like we said before, we have got some kind of policy intervention, right? At some point, you decide that we’re not going to spend money and spend money.

You know, in housing, you have even seen organizations like UnitedHealth Group and Kaiser Permanente spend money directly on housing for people who could suffer. If you are homeless, who consistently show up in emergency rooms, costing a lot of money, it’s not entirely clear that this kind of approach is. Evil is the right thing. The health care system, we don’t rather a more general government approach or whether this is as effective as people going to be that the hospital is trying in Camden, New Jersey, actually showed it wasn’t that effective in terms of saving money made in the getting away from using the social. Services to try and stop the people coming to the rescue weren’t that effective. Reduced injuries, hospitalizations, not that much, although people go back and forth about whether it’s the way that was set up or whether it’s been set up in other areas, et cetera. But, you know, this is part of a bigger realization that coming to the healthcare system is part of society, the whole thing to each other. And we’ve got a way to go out. As we mentioned, there are bacteria. There are a bunch of political reasons. We don’t connect to much of the health care system, let alone to the wider society.

Nick:

Exactly. So let me ask you a question concerning the Veterans Administration. About 80 percent of the medications, including muscle, critical medications like blood pressure, diabetes, and heart disease, are still sent to veterans by the US. Is this because of provider or patient reluctance or any other reason, like a government report instead of as opposed instead of being administered to veterans by mail? It’s being administered on-site.

Matthew:

So I’m not being sent by now. Yes. Yes. OK, yes. Sorry. I mean, I think it’s a good idea to send someone to try it or not.

Yeah, well, I mean, ignoring for the moment the fact that the mail service is going to work or not. Ignoring the fact that the post office might be for political reasons may or may not be working as well as it was, and we’ll know that. But that’s irrelevant. It is not caused by health care. Over the last few decades, you’ve seen a tremendous growth of the mail and mail order being used for. Being used for. Routine drugs and the other thing you’re saying are much more recent, but the growth of both male mice and other forms, Danbury based drugs. So you’re saying you’ve seen coming out of the pharmacy, which is now supposedly starting in San Francisco, which is actually working, is now delivering bike messenger bikes or whatever it is. Bye-bye. FedEx or whatever else. There are medications that way to get. So even that I’ll be prescribed the same day, the same day, having to wait for it to go through a PBM system or what have you with mail order. So I don’t know why I didn’t realize I wasn’t taking this. I’ll take it as much. I don’t know if there was an issue with whether problems tracking the people involved or what have you. But it seems to me that the prices were going in that area. If you just saw Amazon talk about fighting for Wal-Mart again, talk about using drones for drug delivery, using some of the technologies that have been quite successful in a place like Africa, in Rwanda, which have been doing drone-based delivery of medications. And I think we mentioned Amazon before. They’re likely to do so. They’re very likely that they already have Killpack, deliberate delivery of a drug delivery system with the drugs included in the heart.

So I think that that’s a. An option, you might see more of that, so I don’t know why the VA iV.A.where the VA iV.A. not specifically, but it seems to me that. A combination of getting the stuff you need to people at home and the tools and the coaching that they need to show you how to do it will grow dramatically. One of the things that I’ve seen is the increase in the hospital. The Mayo Clinic will deal with a company called Medically Home, which is doing exactly that. And. You know, they bring a ton of stuff into the home, oxygen supplies, technology for medications, whatever or whatever is needed. Right. And they found it cheaper doing that than spending the money or having hospital admissions because there’s so much capital intensity. And hospitals also have to charge so much, and they can get some of that out due to the budget. So. The general trend is towards more widespread distribution. Then if you go down the path, I mean, this is fiction, but, you know, with the spread of 3D printing, printing a lot more, these things at home deliver much, they’ll be much more distribution of the supplies, the way that you start to see energy. Right. People without producing energy on fire with solar panels and that kind of stuff rather than the central generation. This is going to be the trend of the next few decades. Exactly how it is in health care. Marshall.

Nick:

No, that’s I agree with you, Matthew. So what steps should health care organizations take to digitally engage patients to better and in a less transactional manner in the post-pandemic era?

Matthew:

So I have a show up in the show. I want to hear the short answer is the. You know, they need the help, organizations are getting better. However, they’re still rooted in the plans and the customer service technology, the nineteen nineties, nineteen eighty-eight, the need to sort of start thinking about. Allowing more multichannel, social media sites that we mentioned using Chappells can be for having customer service and remote camping, remote patient care. We’ve got some companies and people like us to help, which is something you know well. And you’re out of the way by bye by UCSF and Cisco, where they’ve been doing kind of. Symptom checking uses a bot, but a very good conversational rhythm and message interface, which works very well and can put you up to the level. So you have Kobie symptoms? Well, the machine can decide about that. I told you I could put you up into a channel of a human being and then maybe give you that. So that kind of level of customer service is going to come. The long answer is something I’ve been pimping for a while, which is cool, but we’ve got to do that.

Well, I’m going to continue with the clinic, and I started calling it the chemo, and my wife and my friend and colleague, just an assistant, told me that that’s a stupid name for me.

But I’ve discovered this interesting patient location, independent clinic care integration management organization. Right. So what does that mean? That means all the stuff we’ve been talking about, all the remote monitoring, the sensing devices, the delivery of the stuff, whether it be pills or whatever, to the home to manage patients, the tracking of the tracking and the coaching and the telehealth back and forth with the patient regarding the. Let’s say that Konbit and they are one of the devices in the blocks and dips; you need to immediately, you know, ping them on their devices and get through them automatically. And there are some technical tricks in that as well. And then you need an infrastructure around that which is measuring all the stuff that’s coming back to measuring all the data that’s coming. We talk about measuring data from individual patients because, in general, most patients take a look that comes like a little longer, which is working on doing, you know, managing people’s diabetes. And they’re taking the data for three days. And then a coach will give somebody a call or somebody blood glucose is way out of whack and say, OK, looks like you’re out of whack.

You need to, you know, take advantage of food or whatever the solution is or, you know, can we help with this and that. The combination of coaching in the minute and then more general behavior change coaching. Right. Based on the flow up and down of the blood glucose is doing. Now, if you take that and go across the board, say one of the other things that blood pressure, blood glucose, pulse, temperature, etc., etc., all this stuff, some relatively healthy people don’t have any problems, you know, we should be checking in on.

Things like waiting forever over time, but it’s not. There is some intensive monitoring, whether we get in the hospital or the ICU level. This is a sort of medical home concept. And what we need is a system where we take all data, and instead of everyone being monitored for everything because, you know, the average, I could do my blood pressure five times a day. It’s not very helpful for primary care at all. But for the people who do need a way out of range, you need help. We need to have intelligent care pathways and diet algorithms to figure out.

Yet we’ve got to intervene with this person that doesn’t get it right. We need a staff that we just an old tech augmented staff who can then say, yeah, I’m going to do a telehealth visit now, or I’m going to intervene here with some coaching or I’m going to send a human being to their house because they need it right now or the center of the health hospital. If we have that in place for Kobe, we can manage without getting some people in the hospital. And we have had less infection. And we could have happily been sent home from the ER if they weren’t admitted for that reason exactly why we can save a lot of lives that way. So I think you can argue I would argue that if you want to do patient engagement, you’ve got to be able to do patient real patient engagement outside the facility. And this goes back to the question of who runs this, right? Is this the role of the hospital? Is this role the health funds? The new organization’s role, the continuous clinic, I call it, does not exist now. And that’s a question. Does Amazon do this? That’s the question. No question. We haven’t. We have not yet right now.

Nick:

And people still like I mean, with telehealth, that has its advantages. But like I said before, it’s bringing back an old fashion where the doctor used to make a visit to your house going back to the 50s and 60s. The next question is going to be multipart with digital solutions. It seems that during COVID-19, the largest segment of the American population there have been very hard hit, has been Hispanic and African-American communities; we could talk about socioeconomic issues, et cetera, lack of health care, particularly in the cities. So. What is your perspective, particularly when we’re looking in today’s technology and telehealth and machine learning to accelerate preventative medicine, being proactive, and can this technology address the challenges faced by not just Hispanic and African-American communities, but also what about the baby boomers that are becoming probably the largest health care population to address in terms of their needs?

Matthew:

Wow, OK, a lot of that. So I think yeah, there are some obvious things to say. We have an unequal society which reflects in our system. I have my daughter, Thawne, a pediatrician. Amazing pictures. Nadine Burke Harris was the surgeon general of California, first of all. And she ran a clinic in the Bayview on this point area of San Francisco, which is the small part of San Francisco that isn’t wealthy. And that’s a lot of Hispanic and African-American populations. And she is very sure she ended up running a center before she ran for the governor-general. Her main thought was that was with the ACS study, which Kaisei back in San Diego back then, which was the year I remember which is the study looking at adverse clinical factors that, you know, and these tend to be heavy amounts of we’re all subject to some of them, but these tend to be worse. These factors include not having a parent in the house, having a parent, the child, and having an alcoholic drunk with family composition. And of the more of these you have, the more likely it is that you have various health conditions from a young age, you know, including things that you would think of, like heart disease and stuff. It’s based on a lot of this history with stuff that we know about in terms of stress and the impact of stress on health as a whole is going to be the reason that Dean Ornish, when he had the whole heart rebuilt, his heart disease practice of reversing heart disease without surgery was implying that meditation and diet that helps you realize there was a reason that

we had that.

Well, exactly, because this stuff is bad for, you know, excessive stress and that you and we know the impact of things like financial problems, divorce, living in unsafe areas, et cetera, etcetera. So, some of this is going to historical racism, but, you know, dive into it. But it’s been a big part of America since 16, 19, if not before I read all the way to last night with exactly the conversation. Right. So all these things come together. And then a lot of it is the way that people, people of what community is now, has been historically treated in hospitals and medical professionals have been different in the whole issue of the concept.

For instance, black women have much worse, much worse maternal mortality rates. Somebody is, you know, wealthy and successful from the Serena Williams family died due to lack of money, but it’s an example of that. So all this stuff wraps up. I don’t know if digital technology in itself can do much other than it can spotlight, you know, and communicate these issues and be used to be used as a way to get more access to more people. I think originally we talked, and this is kind of and also for the baby boomers. Still, the greatest generation was the reluctance of those folks to use and maybe get people to get access to this technology with the generation before them. But I think with smartphones and the adoption of smartphones by folks like Greg Coleman, Best Buy to. Yes, to people to be developed to help people and the fact that the smartphone is now cheaper, generic, and can you find them for 50 bucks, 30 bucks on Street India, and 100 bucks at Best Buy. Now enough to buy a thousand Verizon? To my mind, a lot of this access to digital technology is going to improve, and it’s not going to get rid of the other big structural problems in society. But it’s something we can use to help.

Nick:

Exactly. And to me, it’s needed. But besides, digital has all the capabilities to leverage machine learning even at a distance, deep learning. So, yes. Yeah. So, Matthew, it was great speaking with you. What I would like to do is open it up to a couple of questions. We may go over by five minutes.

And so let me go to the Q&A session, and we have a question that says this. This gentleman’s name is ACoNs Aimo. He says, My organization will be very grateful to have a detailed conversation with LWP to develop a software system for an impending project.

Matthew:

You’ve got to lead out of the. Yeah. So I can. Thank you. I’ll take my 10 percent on that.

Nick:

OK. OK, but the next one is from Vanessa McCarthy. The healthcare industry is shifting to the value-based health care model. That is true. I’ve heard that term used many times. You think digital health platforms will benefit providers or result in revenue losses as patients may not feel an emotional connection through these platforms. What do you think?

Matthew:

I have my own opinion, but I think that’s a good question. It is a little less. I think as it ripples through, it’s slowed up. What happens in most other industries is that you end up with different players profiting when you change the technology delivery system. The Amazon effect, and if you look at what happened to Sears and Macy’s stock price and other companies like Amazon, you see different people. Probably the whole thing goes up, and it’s different people. And I think the emotional connection is largely gone anyway. Now, people, I think, can be replaced. But if you talk to Marc Saltzman at Walmart, he’ll say that they survey consumers. Why did Wal-Mart think it could develop primary care without a brand, without a personal connection, without a branded cat? The reason is that the survey that population and a 30 something working go had no primary care doctor. No emotional connection with a primary care doctor does the number then. Half of the other 60 or so, 50 percent, are well for them, so couldn’t say they had a primary care doctor but couldn’t name him or her. You hadn’t seen him in three. So now 60 percent of the dinner now. So most people go to Wal-Mart, FICTIONALISE, don’t have an emotional connection. I would also say that you can enhance the emotional connection with your integrated connection. I mean, I’m a member of the medical staff. They charge you 150 bucks a year to sign up in the mornings. You get it if you get an email and kind of when you want

it.

And I get my doctor, who I know perfectly well, emails me back. Both have an emotional connection with him. He happens to be their medical director as well, which is random. And so we spend most of our time talking about technology, not enough to talk about my health and blame. I don’t blame him for my health. But the point is, you know, we go back and forth and he’ll send an email saying, I didn’t see it recently. Have you been eating those cookies and going running? And so I think, and he does that without me seeing him in person. But I see him out socially awkward, which is more than I see him in his office. So I guess that it will be different people and overall the money flows with the same change. Exactly.

Nick:

This is the last question, a major challenge in health care access. This is by Jeff Henderson. Rather. A major challenge in health care access, even in urban areas, is the lack of services and skilled specialists. Can technology address this issue?

Matthew:

Well, I think we’ve been discussing that it’s the whole basis of digital health. So. So what’s your opinion?

I think this is one that will be cracked because I think there’s access to specialist care specialists’ opinions. There are companies like Rubicon, MDA, and others who just do that, that with a store and forward technology, which does spread pretty fast. And I think pretty much every right to be standard now to go to a primary care doctor saying you should be getting a special referral. This should be done right then, and that when the lab tests come back in 24 hours, the doctor should be telling these results on video. Rather a patient driving to a doctor across the town to get the results. The concept of waiting and trying to get a specialist’s appointment would go away because the digital health access through telehealth is especially across the state lines. 

Nick:

Exactly, there has been talking about health access, especially in rural areas. Something like the peace corps that president Kennedy started to domestically administer and, in the meantime to help ease the medical learning costs to help students to get to medical school. So the more physicians that we raised, particularly the specialists, were great. 

Thank you for sharing your point of view, Matthew, and thank you all for joining in. I hope you found this webinar useful. Be sure to visit osplabs.com to learn more about the healthcare industry and discover our helpful bonus content.

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Originally published October 1, 2020 2:13 pm

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