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June 9, 2020: Unlike our previous News Day episodes, where we cover several stories, today is a deep-dive into a single article titled ‘Telehealth: A quarter-trillion-dollar post-COVID-19 reality’. This McKinsey article looks into telehealth research to explore its future — a key theme that we’re looking at closely here at This Week in Health IT. Before diving into the article, Bill gives some context on telehealth missteps over the last decade and why COVID-19 has accelerated the integration of telehealth. Bill discusses why he thinks telehealth funding will continue, possibly into next year, and how the past few months have been an incredible and massive telehealth that’s generated a wellspring of data. Data that will be vital in optimizing telehealth in the future. Bill then dives into the article which predicts that “$250 billion of current US healthcare spend could potentially be virtualized.” After establishing five models of virtual care, the article details five actions for payers, providers, and investors to take to figure out what telehealth means for them. While highlighting each action, Bill provides his take on the situation, as informed by the research generated by his team. Listen to this episode for insights into how McKinsey views the future of virtual care. 

Key Points From This Episode:

  • Bill details the missteps in rolling out telehealth over the last decade.
  • Why it took COVID for providers to embrace telehealth. 
  • How the medical landscape shifted, allowing for telehealth to proliferate. 
  • Bill’s assumption; emergency funding will continue into the year.
  • How the data generated over the last few months can steer the course of telehealth.
  • The predicted rise of virtual urgent care.
  • Learn the five actions that should be taken by telehealth payers, providers, and investors.
  • Why we need to think of telehealth in broader terms. 
  • Kaiser’s success in educating people about their digital front door. 
  • The role of marketing in educating patients about your telehealth services.
  • The challenges of integrating technology into a patient’s home. 
  • Why tele-ICUs are a must-have for CIOs. 
  • The questions that need to be asked before signing with telehealth providers.
Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this week in Health it. It's Tuesday Newsday, where we take a look at the news, which will impact health. It. Today I'm going to give you a little glimpse. We're gonna look at one article. I know last week I tried to get to 10 this week. I'm just gonna do one. And the reason I'm gonna do one is 'cause it's a precursor to a topic that we are looking into very deeply here at this week in health it.

And that is telehealth. What is telehealth, uh, going to do post covid. And, uh, we've done a ton of research. I've, uh, . Uh, we've got some, uh, researchers looking at articles and, uh, I'm gonna share a bunch of that, uh, with you today. But we are only gonna look at one article and really dive deep into some of the themes that we're looking at here at this week in health.

It. My name is Bill Russell Healthcare, CI coach, and creator of this Week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode and every episode since we started the c Ovid 19 series. Has been sponsored by Sirius Healthcare.

It is their commitment to making the content available that has made. The daily episode's possible. Special thanks to Sirius for supporting the show's efforts during the crisis. Uh, I just wanna encourage you to keep the stories coming. If you have a story that you want to want me to cover, please send it to me at bill this week in health it.com.

I love getting the stories and we're gonna incorporate that into future episodes as we get going. Uh, today, as you know, we're gonna do a deep dive into telehealth, really focusing in on this one story. Um, but that's really a, a precursor to what we are doing here at this weekend. Health. It, uh, see what we've done is, uh, I have two researchers right now working who have, uh, collected just about every story we can find on telehealth over the last year.

They are bringing those together and, uh, you know, we're reading them. We're looking for, for themes, for facts, for modalities, successes, failures, growth, future plans, and, uh, all those things which may shape . Your plans in the future. Um, this episode is really part of our process for research. Uh, we're likely gonna prepare a report and a couple PowerPoint decks from this research.

And, uh, and we're gonna do that from a provider standpoint if you wanna be a part of that. I would like some collaborators. So if you wanna be a part of helping me to, uh, put this together, uh, just drop me a note bill at this week in health it.com. I will send you, uh, what we are working on once we get it complete, uh, or, or at least in our draft version.

And then, you know, we, we would love your feedback. We'd love, uh, critique. We'd love additional content, we'd love additional slides. Whatever you're willing to contribute would be great. And, uh, if you participate, you get the research as, uh, as it comes out. So, um, thanks for doing that again, bill at this week in health it.com.

Alright, let's get to it. Let's kick it off with the, uh, well actually the only story I'm gonna look at today, which is, um, McKinsey article. And, um, so before we go into the McKinsey article, let me tell you where we're at. Decided not to really waste your time with a lot of this. Um, here's the 62nd version of where we are at.

Uh, we meandered for over a decade or more around telehealth because the reimbursement was low, the incentives didn't align right, the reimbursement was low, and the regulations were high. . But not only that, the other thing is the culture wasn't ready for it. We had a lot of missteps in bringing it in. Um, some people did goofy things like thought physicians could see patient here, then do telehealth, then see a patient.

Then they went to block schedule. Then we changed things and it's all good. But at the end of the day, um, we had a lot of missteps, regulations, high reimbursement, low bad recipe. C Ovid 19 hit. So what's the number one thing that happened when C Ovid 19 hit? Safety became the priority in healthcare. During a pandemic, safety becomes the priority.

Go figure. Um, so offices closed. Eds changed their policies. Chronic patients still needed to be cared for, right? Safety required us to do it from a distance. CMS opened up 80 plus codes. Commercial payers followed suit. Security restrictions and regulatory requirements were lessened dramatically, and that was the perfect storm.

right? Safety is the priority. New codes we could get reimbursement for it. Finally, and then the regulatory environment came down, meaning we could stand up the technology in whatever fashion was best for the community and quickest, really, for the community. So at this point, it paid to do telehealth and it was a lot easier to do without getting in trouble.

Visits went up tenfold across the board for healthcare providers and all of that. It's gonna be covered in the report, but what I wanna discuss right now is, is really what's next. And before I go onto what's next, I have a tendency not to celebrate accomplishments enough, uh, because I'm always looking at what's next.

But don't make that same mistake stake. This is a huge accomplishment for healthcare. I. , right? We should celebrate what we've been able to accomplish. Uh, the clinicians coming alongside, training the clinicians, standing up the technology, uh, working with marketing, getting the, uh, patients lined up, redoing the websites.

I mean, we did, we did an awful lot to get this done. Um, and I don't wanna minimize that, but I do wanna start, I do really wanna start talking about what's next, because. You are being pushed for what's next? What's your plan for what's next with telehealth? What do you anticipate is going to be next? Uh, we have a few assumptions here at this week in health.

It, this is what I told the team. My assumption is that the emergency funding that's in place, which will, uh, come to an end in July, it's gonna continue for probably another year. At least another 12 months, I think it's gonna be in place because there is not agreement. There's not general agreement that we are through the, through the thick of this thing yet there's still not agreement whether there will be a second surge or not.

And, uh, it will at least be in place for sure. Between now and the end of the year, but it will likely be in place for at least 12 months. And some people are predicting 18. I think that's a little aggressive, but I think for the next 12 months we are on solid footing to support telehealth and to put the foundation in for the future.

Now, after that, I think we have to look at CMS and we have to look at the payers, uh, the commercial payers and say, what are they going to do? cma, Verma, and that team is giving us every indication that they are all in. . Right. Uh, and I believe they are all in. I think they've, they were all in before, but now they have a funding source that is the sticking point.

The funding source CMS doesn't have access to money unless Congress gives them access to money. Okay. So there has to be, uh, a budget passed. There has to be appropriations of some kind given to CMS to continue this. Now, the good news is we just did a massive experiment. I. , right? Well, over the course of a couple of months, we did a massive experiment.

So we're gonna be able to look at the data and I, and determine where has it been successful? Where has it not been successful? What, uh, clinicians does it work well with? What specialties does it work well with? What patient populations does it work well with? Where have we seen fraud or the appearance of fraud?

Where have we seen people taking advantage of this? They will have a ton of data. To work with, and that data should be just being scoured right now and over the next six months to determine where the, the funds, whatever does, whatever gets appropriated and some will get appropriated, uh, gets allocated.

And we want to make sure that it gets allocated in the areas that have the most return for healthcare and for the population. Alright. That's the background. That's what's going on. Funding is the, it's the million dollar question. I think you're on solid ground for 12 months. Uh, starting today, June 1st to June 1st, I think you're gonna be at solid ground.

CMS is gonna continue to fund. You're gonna have some rumblings from commercial payers of pulling back from this. But generally, I think there's gonna be an awful lot of backlash if they do pull away from this. Uh, so I think you're, you're on solid ground for about a year, and I think there will be money appropriated and then it will be strategically placed.

In those areas that the data tells us it had the best impact. Alright, let me get to the story and the story. The reason I chose this story, first of all, is it's, it's recent, and second of all, it gives me a good platform to talk about a lot of the things that are showing up in our, uh, research as well.

Okay, so this story is Telehealth a quarter trillion dollar post C Ovid 19 reality, and it's a McKinsey, um, article. Is that the best way to say this? It's, it's sort of like, uh, it's an article that talks about the research that they've done. So think about that. Quarter trillion dollar post C Ovid 19 reality, $250 billion.

Uh, where are they saying that's gonna come from? Well, they really give us, uh, five key areas. Five, yes. Five key areas where they believe that's gonna come from, uh, on demand. Virtual urgent care is one of the areas they believe that this is gonna come from, uh, which is no surprise. Virtual office visits is a majority of it, which is no surprise either.

Uh, near virtual office visits, this is what we saw during Covid, right? I. So it is, uh, they combine virtual access to physician consults of some kind. So it's seeing a telehealth provider, but there's still some physical access to it. Like in Covid, in a case of Covid, they would have to go somewhere to get tested and they would have to go somewhere for, uh, care.

And so there's physical that follows the virtual, so it's near virtual office visits. Uh, I'm not sure I like that terminology. I'm sure there'll be. Something better that comes up for that, uh, virtual home health services. . Um, I think it's gonna be, well anyway, is one of the areas that they believe that this quarter trillion dollar, uh, opportunity exists.

Virtual home health services is, uh, one of those areas. I think it's gonna really, um, grow significantly. It may not be as big as virtual offices. It's an on-demand, virtual, urgent care. But it is gonna grow . Probably the, uh, percentage wise, it's gonna grow the most. And then tech enabled, home medication administration, uh, this is a holy grail kind of thing.

I, you know, I hope we have a lot more ways to do this and technology is definitely, uh, playing a part in making this much more of a reality. Um. , but again, I think we're still in the infancy of this and hopefully see some, uh, some movement. So that's where they think the quarter trillion is actually, uh, coming, coming from.

They talk a little bit about the money. Oh, actually, they actually do say in here, scaling Telehealth does more than alleviate patient and provider concerns over the next 12 to 18 months, and Covid 19 vaccine is available. So they're also also talking and, well, they don't really say that Telehealth funding will continue.

Now they don't say telehealth. Funding's gonna continue for that timeframe, but they're saying, uh, until we get a vaccine, that likely there will be a, a ground or a basis to continue the funding of telehealth. Um, so that we don't exacerbate the, uh, pandemic problem as it exists. So, what do I want to get to with this?

What I wanna get to is they list out five actions for, um, uh, five actions for payers, five actions for, uh, for providers, and five actions for investors. Three groups of people that they think should be, uh, considering what telehealth means to them. I'm gonna start with. To payers, even though the show is primarily for providers, what telehealth means.

Siri trying to help me with the show. Sorry about that. Um, even though the show is primarily for, uh, providers, um, there's an awful lot of information that they give around the payers, which I think will inform what we do moving forward. Okay, so let's take a look at the five things that they give for the payers as, uh, next steps.

Okay, so the first thing to define a value backed virtual health roadmap, okay, so what they're saying is huge experiment. Lots of data. Go through that data. Figure out where the value can be created and create those, those, uh, care journeys, the end-to-end care journeys, if you will, and drop virtual health in there where it makes sense to do so.

The second thing they have is optimize provider networks and accelerate value-based contracting to incentivize telehealth. Okay, listen to that and that, that's gonna go with the next one pretty closely. So, optimize provider networks and accelerate value-based contracting to incentivize telehealth. So.

What they're looking at is look at again, look at that continuum of care. Look at your networks, look at your products, and create ways that you can really optimize the value that's being created from those networks. Not only that, I think the next one is even more telling. Build virtual health into new product designs.

Think about this, what they're telling, what they're telling payers, and when McKinsey speaks. People generally listen, um, build virtual health into new product designs. If you can imagine. They're, what they're saying is build, build your product designs that incentivizes telehealth from, from beginning to end, right?

So before you go to see your primary care physician, see a virtual physician first and determine if you even need to go there. Um, you know, before for certain types of follow-up visits. Uh, it's virtual. It's virtual care first. It's use the digital front door features first. Uh, instead of our knee jerk reaction is to go into the, uh, the facility.

I heard someone the other day on a, um, on a webinar telling the story of, uh, they had a friend who, who is uh, is a Kaiser patient and something happened to their daughter and they immediately went to, well, we've, we've gotta find . Um, we've gotta find a video console so I can see a physician. And he was struck 'cause he worked for a traditional health system and he was struck that the mindset of a Kaiser patient is virtual first.

And that's what they're saying for the, uh, carriers, for the payers to start thinking virtual first drive, virtual first. If the healthcare providers were unable to build it, we will start to build it this way essentially. And what you're gonna see is a whole new set of products that dictate to a certain extent that virtual health needs to be inserted at certain points, uh, with regard to their products, and they'll be able to drive down the cost of those products.

And, uh, and still deliver a pretty high level of care. Alright, so the fourth thing, integrate virtual health into the care delivery approach. And the fifth thing, reinfor, reinforce the technology and analytics foundation for this. And by the way, I think that's true across the board, the, uh, technology foundation.

that we put in temporarily, that should be one of your highest priorities right now, is to figure out what the, uh, what the long-term solution is going to be for your telehealth. Um, but think of the different modalities. It's not just virtual visits, it's virtual consults. It's, uh, remote patient monitoring.

It's tele ICU. It's um, it's, uh, nurses stations going into rooms, I mean. The, the, the, the, uh, telehealth is a broad category and it is a holdover. I get it from when Alexander Ram Bell said, come in here Watson. I'm, I'm, you know, whatever. Um, so yes, that was the first instance of telehealth, but at the end of the day, it's, it's a broad category and you need to think in that broad category and then put the technologies in place.

That provide for the ability to, uh, deliver in a, in a broad way, broad range of areas. And we're gonna talk about that in a minute. Let's talk about health systems, right? So McKinsey comes up with five things that health systems should consider, need a drink. Hold on.

All right, so the first one, accelerate development of an overall consumer integrated front door. And, uh, you know, this is something we've been working on for a while, but I think we have the wrong mindset when we go into this. A lot of health system technology, people that I talk to, when they think of the digital front door, they think of portal.

They think of a singular app, and they're like, well, my, my, my, uh, my EHR provider gives me this digital front door. Or, uh, or we have, uh, we have an app. I hear that all the time. The reality is it's not just an app. It is a series of technologies that form the foundation for interacting, uh, with your patients in a virtual setting.

Right? And so that can be, that can be an app, it can be a set top box, it can be a phone, it can be, uh, information that's being collected by a, a device that doesn't even have a screen and sending it back to the EHR or some sort of set of clinic, uh, clinicians who are looking at that data and responding via telephone.

right? There's, so there's a whole host of, there's a foundational set of technologies that we should be thinking about and putting in place that's gonna enable us to do all sorts of modalities, uh, uh, for delivering virtual care. And now the digital front door is, you know, if when we say app, it's so limiting.

because it could be multiple apps. It could be apps based on your condition. It could be apps, uh, based on the, uh, you know, the types of, of data that we're actually interacting with. Uh, but people have to self select. So it has to be easier than that. But at the end of the day, you're gonna need to be able to put, uh, home monitoring in place.

You're gonna need to, need to be able to put, um, . , you know, uh, patient generated data in place as well. So accelerate the development of the overall consumer integrated front door. With that being said, I think the other thing they are touching on is. You have to be able to tell your populations how to interact with you from a digital standpoint.

This is what Kaiser has done. Kaiser has educated their entire population on this is how you, uh, interact with us. So this isn't just a technology project if it's far from just a technology project. This is a technology project. It's an operations project. It's a clinical operations project. It is a marketing project.

Right. Your marketing team has to get the word out there. This is how you interact with us. We are now a digital company. We learned through Covid to do these things effectively and we're gonna continue to do them for the good of our community and for the good of our population. And I would, you know, create campaigns and get the word out there.

You do not want people to, to think, oh, that was just a covid thing, and then snap back to the old. Um, types of behaviors, if you will, especially once we start to integrate the virtual care. And we're gonna get to that. So that's number one. Digital front door. Number two, segment the patient populations, for example, with specific chronic diseases and specialties.

Uh, whose remote interactions could be scaled with home-based diagnostics and equipment? , right? I think that's one of the things that's changed pretty dramatically is that people, um, want to interact with the health system differently. I'm gonna give you a short story on this, which is we had dinner last night with neighbors.

First time, we've done that in months, and we just moved to a new, new place, new neighborhood. Uh, haven't really met our neighbors. Our next door neighbor set up a dinner with multiple neighbors. And, uh, we were, we were scheduled to go over there. We went over there. It was just them. The other neighbors did not come over because they're at varying degrees of comfort with social interaction still as they should be.

Right? And everybody has to sort of step back into the world at their own pace. Well, that's gonna be true for our health system as well. And we have to take into account that there are some people that we're gonna have to care for in a home setting. Alright, what technologies do you need? We learned so much the first time we did this back in 2000 and.

11, I believe it was. Now, we put devices into people's homes. We had to learn how to go into people's homes, uh, which is not easy in and of itself, right? So you're now going into their homes. You need permission to go into their homes. We had to set up technology in their homes, something that we were not adept at.

At that point. We had to set up technology that they couldn't. mess up, right? . Um, at first we gave them some technologies and they'd move it around and it would lose wifi connection and the, the diagnostics we were trying to get back didn't get back. Um, we have to think through this. Think through the populations, think through the continuum of care and what technologies you're gonna use, and then think through solutions that are really bulletproof, uh, for use in the home.

Third thing, build the capabilities and incentives of the provider workforce to support virtual care. All right. If you don't align incentives, there's no reason to do anything. Incentives. The financial incentives have to align. You need your clinicians to be excited about, uh, delivering virtual care in all of its forms.

So figure out how to align those incentives and, uh, and make sure that the workforce is, uh, aligned with block scheduling. Whatever else needs to happen in order for them to feel comfortable doing it. Uh, the fourth thing, measure the value of virtual care by quantifying clinical outcomes. This gets back to that metrics and analytics foundation that we need to have in place.

We need to be so good at the numbers if we're gonna rely on CMS to say, Hey, here's what's effective and here's what's not effective. We're missing the boat. We should be able to. To generate those kinds, same kinds of numbers around telehealth, that CMS is gonna be required to do that. The commercial payers, I'm guarantee you are already doing.

We should be able to look at, uh, how effective have we been? How, you know, what level of outcomes are we seeing? Uh, what kind of follow-ups are we seeing? Uh, you know, let's, you know, this will, this will fundamentally change. How we look at risk, how we look at care, how we look at cost. And so we need the analytics and the tools around it.

And then the fifth thing they say is, consider strategies and rationale to go beyond telehealth. Um, and they talk about clinic visit replacement that is, uh, to drive growth and new markets and populations and scale other applications. For example, tele ICU, post-acute care integration. Now, with that being said.

If you're gonna stand up at tele ICU and start offering it, uh, out in the community. Someone recently talked to me about this and I said, look, there's a handful of companies that are doing this, uh, but their, their income on it really requires them to get a sales force and sell it to other health systems.

It's, uh, it's one thing to stand it up for yourself. It's another thing to actually take it to market. Um, . You know, doing tele ICU for yourself is almost a must have. I'm not sure why you're not doing that today. It's, it's more efficient, more effective. But if you're going to really think of it as a another source of revenue, you're gonna have to sell it to a bunch.

That's a different business model altogether. Just understand what you're stepping into and then, um. I, what was the other thing I was gonna say? That, uh, clinic replacement drive growth into new mar new markets. So this has been effective in for some health systems in going in new markets now because of the state barriers that we used to have for clinicians, uh, practicing across state lines.

It was tricky. It's always been tricky because of that. Uh, but within state we've seen some effective, uh, programs and I talked a little bit about, uh, Baylor Scott and White going into, uh, Austin, Texas. So, uh, investors, I'll, I'll cover these just because they're here and, uh, worth looking at 'em a little over anyway.

Uh, investors in health systems, uh, and health services and technology firms should consider, uh, number one, develop scenarios on how health virtual health will evolve and when. Assess impact across virtual health solutions. Service types, develop potential options. Identify the assets and capabilities to implement these options.

And number five, execute, execute, execute. The next normal will rapidly take hold. And those who can best anticipate its impact will create disproportionate value. Don't underestimate the potential of the network effect. Um, I'll say as I read that, one of the things I am reminded of so many health systems, uh.

You know, just sort of look at it and say, well, we're gonna go out and sign up with fill in the blank, uh, provider. Um, I would be really careful. I remember when we were looking at these, a handful of, uh, a handful of solutions came to us. I sort of looked at it and read the contracts and I was new to healthcare.

So I had that sort of clean perspective. And I'm looking at it going, Hey, what's gonna keep this company from competing with us for patients in the future? You know, what are we doing around the data to make sure that they're not utilizing the data, uh, for a future endeavor that will compete with us. I mean, there're just a whole host of questions that need to be asked before you just say, well, our telehealth provider is telehealth's, are us.

Uh, read that contract closely. Understand what their, um, what their rights are with your patients, uh, because at, at the start of the contract, they are your patients and you potentially could be . Handing access over to them. So just something to keep, consider, uh, keep in, keep in mind, or to consider. Um, I'm not gonna make a new word.

Uh, that's all for the news for this week. Again, if you wanna participate in the research and the reports that we're creating around telehealth, love to have you do that. Uh, we are generating the reports right now and, uh, just drop me an a line bill at this weekend, health it.com. I'm really looking for health system providers, people who work for health system providers who want to be a part of, uh, seeing that.

Data and, uh, providing some feedback. Special thanks to our sponsors, VMware Starbridge advisors, Galen Healthcare health leaders, serious healthcare and pro talent advisors for choosing to invest in developing the gen next generation of health leaders. This show is a production of this week in Health it.

For more great content, check out the website this week, health.com, or our YouTube channel if you want to support the show, best way to do that, share with pr. Second best way, sign up on our YouTube channel. I wanna make you aware of the fact that, uh, we are actually pulling back a little bit from the daily shows so that we can do a couple of other things.

Uh, we're getting back to our mission. Uh, I thought it was important to do the daily shows during the, uh, covid crisis, but now I think it's, uh, equally as important for us to research. Like the research we're doing on the, the telehealth, get back to some of the collaboration events we were doing, uh, between, uh, health systems and providers.

Uh, uh, between health systems, uh, executives and other executives and, um, and some of the things around insights and staff meeting that you guys have, uh, have signed up for in droves. So, uh, I wanna get back to, uh, producing some of those and getting some of those out. So we're not gonna be putting out as many shows on a weekly basis on a daily basis, but we are gonna be producing great content for you as we move along.

So, uh, please check back off and we'll keep dropping shows probably on a schedule of Tuesday. . Tuesday and Friday, definitely probably one on Wednesday or Thursday as well. We'll, we'll continue to drop three a week, um, and then scale back to our normal schedule of, uh, Tuesday and Friday. Thanks for listening.

That's all for now.

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