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September 3, 2023: Adrian Ang, CEO and Co-founder at Aevice Health joins Bill for the news. Adrian opens up about his personal struggle with asthma, which led to the founding of Aevice Health in 2018. He shares insights on their innovative smart wearable stethoscope designed to help patients with asthma or Chronic Obstructive Phenomenal Disease (COPD) manage their conditions at home. This engaging conversation pivots to the efficacy of Remote Patient Monitoring (RPM) in solving many patient and provider problems in rural healthcare. Could these RPM solutions provide an avenue for continuous monitoring, effective disease management, cost efficiency, and accessibility? Or are they creating another barrier with potential hidden costs, particularly for smaller hospitals and clinics? As we navigate the digital health landscape, we also touch on the controversial topic of hospitals charging electronic systems and the pros and cons of these fees. Is this a necessary evil to streamline administrative tasks and reinforce prompt care or does it cripple patient access?

Key Points:

  • Remote Patient Monitoring
  • Cost Efficiency
  • Healthcare Accessibility
  • Electronic Reimbursement Charges

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Transcript

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

Today on This Week Health.

It's a problem that not just U. S., but everywhere in the world is facing. It's just a matter of time someone figure out and, people will start to realize that, Huh, maybe that is what we need and we should work towards that model. 

Welcome to Newsday A this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O for a 16 hospital system and creator of this week health, A set of channels dedicated to keeping health IT staff current and engaged. For five years we've been making podcasts that amplify great thinking to propel healthcare forward.

Special thanks to our Newsday show partners and we have a lot of 'em this year, which I am really excited about. Cedar Sinai Accelerator. Clearsense, CrowdStrike,. Digital scientists, Optimum Healthcare IT, Pure Storage, SureTest, Tausight,, Lumeon and VMware. We appreciate them investing in our mission to develop the next generation of health leaders.

Now onto the show.

All right, it's News Day, man, there's a lot to talk about. Today, we are joined by Adrian Ang with Avis Health, one of the Cedars Sinai accelerator companies. I love talking To founders of company and startups, you are the CEO and co founder of Avis Health. Welcome to the show, by the way. Yeah, thanks for having me.

Yeah, so you are actually in Singapore right now, right?

That's right, that's where we are based right now. Even though do fly to the U. S. quite often.

So, well, tell us about AvisHealth. Let's start there and then we'll get into some of the stories. Right, sure.

Maybe let's start off with saying that I would formally call myself as a patient founder.

A patient myself who suffered from asthma when I was very young, been in and out of the hospital fairly frequent, and saw firsthand the pain and anxiety that my parents went through. So this led me to start my company back in 2018, together with two other co founders of mine. One of them is my classmate, and the other one is my professor in my university, to build the world's smallest smart wearable stethoscope, really to help patients with asthma.

like me, as well as what we call as Chronic Obstructive Phenomenal Disease or COPD in short to manage their conditions at home. And the idea is very simple. Instead of having patients presenting themselves to clinics at several intervals, can be a month or two to see a doctor, we allow a stethoscope to listen to their lungs in real time continuously.

And we notify the patients when an attack is about to occur. So it's pretty much like a preventive healthcare kind of a remote patient monitor that really helps to manage patients conditions so that they can stay at the comfort of their homes. So that's my round about Avis Health. Wow.

So, essentially it's a device that I attach to myself and , I assume I'm looking at it on an iPad or something to that effect.

I'm looking at the readout on that. Or maybe it's. Sending to a physician?

Yes, that's right. So it's actually this little device that you see over here very pretty tiny. You affix onto a silicon patch like this and just stick it on. And we have two other components. One is a mobile app for patient themself related to CD assets.

And if the, let them know wheezing has been detected. And a web app that was designed for healthcare professionals really to see multiple patients all at once to really understand who are the patients who are at risk or who are the patients who had a recent exacerbation just the night before.

That's fantastic. Well that sets up our first story pretty well because I, much has been talked about of remote patient monitoring and the ability to care for patients outside the four walls of the hospital. And, you know, the first story we're going to look at is how RPM can solve many patient and provider problems in rural healthcare.

This is in Healthcare IT News, and they did an interview of Kimberly O'Laughlin, CEO of Health Recovery Solutions. And it was interesting. Here's, you know, just some of the things. That she pulled out. She said, for example, the Mayo Clinic has shown that 72. 5% of remote patient monitoring patients comply with care plan tasks, including taking meds and monitoring vitals.

Further, only 9. 4% were readmitted within 30 days versus 20% of patients not using RPM, especially in rural healthcare. I would assume that this is a primary strategy for how we're going to deliver care, especially to these areas that that are potentially underserved or there's just large geography.

That that separates them from their care provider. What are your thoughts from this article and your experience?

you know, I think that this is very close to heart. Again, our solution is pretty much a remote patient monitors. That's where we are positioned. And you know, I'm just going to probably talk more about respiratory health because that's where I'm familiar with much more than diabetes, strokes and cardio for that matter.

So I do think that RPM is a good solution that could you know, benefit patients especially in the rural areas. I would just name probably about three. You know, main benefits that I see in RPM solutions in the market today. I think the first one is the ability to do continuous monitoring of patients.

And for us, what we do is we monitor important parameters, such as their breath rate, heart rate, but the most important thing is actually the occurrence of wheezing. Because of the ability to do continuous monitoring. It allows us to actually detect potential attacks early, and in that sense, it enables us to notify the patients to take early interventions before the conditions even deteriorates even further.

So in that sense, we think that RPM is invited work towards effective disease management leading to better health outcomes in patients. The second one is actually more on what we think is how we can actually help in terms of achieving cost efficiency and resource allocation in the event that we are able to help identify health issues early on in patients, we can pretty much you know, reduce the need of patients having to be admitted to the EDs and this is a significant cost savings as well as burdens on healthcare professionals in the ED setting.

One of the things that I would like to share as well is that in the space that we are at, In the US, approximately 25% of all ED visits are attributed to asthma and COPD conditions. So again, if you have... And the reason of 25% is because you have cases where people are really severe, they go into the ED. Or you can have parents like me, where my child is suffering from asthma, I get very anxious in the middle of the night, I just rush down to the ED because I just want a doctor to look after my child. With the idea of RPM, Potentially, we could help the triage patients by really assessing who are the serious one and who are those that, you know, continuity or inhaler, we observed, and we let you know if you need to go down to the ED.

And the idea is really to help to alleviate the stress on the ED environment and better allocate resources. And the last one is what we have mentioned and what we are talking about, accessibility. I think that with population living in rural places, this will be a good way for us to monitor this group of patients, rather than having them to travel one or two hours just to go to the clearest hospitals or clinics to seek care.

So, let me ask you, as a CEO, co founder, is the best way to get this into the hands of the people who need it the most, through a business to business relationship, where you're partnering with the health systems the physicians are prescribing? This kind of solution, or is it direct to consumer where they're they're essentially getting the device because they're looking after their child or even themselves?

What's the best way to get it into the hands of the most people?

You know, that's really an interesting and good question, to be honest, and I have spent a lot of time thinking about that, actually, when we first started the company, and I could share with you as well, being very transparent, was that when we first started AetherSelf, we had the idea that this could be a direct to consumer play.

I mean, asthma is a very common disease, people know about it. Oh, why not we just put on to Walmart, we put on to CVS and let people just buy off the shelves. And of course we work on reimbursement. And then I quickly came and realized one issue is that It depends on the maturity of the technology as well as the clinical workflow.

If you are introducing something like a continuous glucose monitor, people are aware of the benefits, people are aware of how it actually works, what are the interventions that they need if their sugar level is beyond a certain level. I think that you could go for a D2C play, put it out onto the shelves, you know, sell directly to consumers.

But when you're introducing something that is fairly new, like our stethoscope for asthma and COPD care, I guess the only way to go forward is to really work with providers, work with physicians, to really introduce this care to patients and tell them how it can benefit them over time. Only show them when the markets actually understand the benefit of it.

The solutions very much like continuous glucose monitor. And I think that is where we are ready to actually say that we could go to direct to consumer. But for now it will be a strictly a

B2B.

And so if I'm a physician who's looking at the potential or a system with the potential for this, if I'm a system, so I used to be a CIO for a 16 hospital system, and I'm looking at this going, hey, you know what?

We're in Southern California. Southern California used to have a reputation for smog. Now we have a lot of electric cars, so we have less smog, but we still have a, we still have a smog problem from LA down to down to Orange County. And and so that exacerbates some breathing challenges that, that people have.

So if I'm looking at that as a system and going, hey, look, This is something that could really help us to care for this market. Maybe Chicago falls into that category and some other places fall into that category. And I'm going to bring this in. What does a partnership look like? Is it one in which, you know, we essentially have to stand it up in our call center and integrate it into our EHR and those kinds of things?

Or could you go to an individual doctor and that individual doctor looks at it and goes, yeah, this is something we can do at the clinic level or at the individual level?

That's a good question as well. So again, at least for us at Aevice Health, again, we are fairly early stage company in the market. We are honestly just trying to figure out exactly what is the best clinical workflow going forward. But we do have an idea of how we want to implement this.

We do think that if we were to implement with health systems and we are fortunate to have two partners, one in New York and one in LA that we are currently working with. What we really wanted to build is to go on with a small pilot. We have manpower to actually help doctors to make sense of this information, this data.

And we also invest in terms of the software to flag out high risk patients automatically. So as to reduce the burden of having manpower on my platform to monitor this data. And my clinicians don't have to have someone literally looking at the screen every single morning to screen every single patient.

And in the event that we flag out that patients are of high risk, what we do is that we will then you know, send this information to the clinicians so that they know that, hey, you might want to follow up with this group of patients. One of the other ways that we are working as well is how can we leverage on our partnerships, logistic partners, distributors, to be part of this entire process.

We're also looking into whether are we able to bring them in to have a manpower, you know, like a call center to help to schedule appointments. between the patients as well as the health providers if there's a need to. So I think this is something that we are currently working with our pilot partners progressively over the next 18 months and hopefully by then I'll have something interesting to share with you.

No, that's fantastic. Well, I look forward to hearing about your progress as you move forward.

 We'll get back to our show in just a moment. I'm gonna read this just as it is. My team is doing more and more to help me be more efficient and effective. And they wrote this ad for me, and I'm just gonna go ahead and read it the way it is. If you're keen on the intersection of healthcare and technology, you won't want to miss our upcoming webinar, our AI journey in healthcare.

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m. Eastern time and 10 a. m. Pacific time. So if you are interested in this webinar, we would love to have you sign up. You can put your question in there ahead of time. And we take that group of questions, we give it to our panelists and we discuss it and it's going to be a great panel. I don't have them confirmed yet, but I really am excited about the people who I've been talking to about this.

So join us as we navigate the future of health care. Trust me, you don't want to be left behind. Register now at thisweekhealth. com. Now, back to our show.

Let's hit on two other stories real quick. This one caught my attention and it, there's been a couple of these type of stories recently where they are sort of extracting health care and finding the middlemen and the people who are hanging on but they're extracting significant money from the system and So this is a Becker's article.

It's ridiculous why hospitals pay millions to get paid electronically. And to set it up, hospitals and physicians are paying millions of dollars for a hidden fee to receive reimbursements from payers. Electronically, ProPublica reported on August 15th, payers and middlemen... Charge healthcare providers as much as 5% to process to process electronic payments.

According to the story, the ACA required payers to offer electronic funds, transfers, and nudge physicians to take them. CMS at one time prohibited the processing fees before reversing course. And it goes on to talk about the people who are upset about it. One, one person said, it's ridiculous. That's where the title came from.

It's ridiculous. Karen Jackson, a retired. Senior CMS official told the news outlet. So, you know, when you're reading that story, you're hearing that story, what are some things that, that jump out at you?

Well, I think, it's an interesting story when I saw this article and I can understand and relate to what providers are thinking, what physicians are thinking.

If I could just list down some of the pros and cons in terms of what, you know, again, it's my own personal opinion. Of course, standing on the physician side, I think that if we talk about all this, costing. All these extra fees can quickly add up and significantly affect the hospital bottom line.

And if you look at the hospital different hospitals will have different impact. If you're looking at smaller hospitals, they will definitely struggle much more than the bigger ones who are able to bear this cost better. And this will just exacerbate the entire healthcare inequalities in the US.

And I think that the last one, maybe one more point, is that if we were to be over reliant on third party payment processes over time, this will actually lead to problems if the service experiences and increases its fee, or in the worst case, if the company goes down. And that will be some of the big issues that we have to face.

However, I do also understand from a service provider perspective you know, that there may be some pros on it, is that if these electronic payments are able to deliver what they are supposed to do, so for example, they are able to make things faster, more reliable than traditional payment methods it can also help to actually increase, improve the cash flow and financing planning for all these hospitals.

The other thing is actually most important, I felt, is are they able to automate systems with the goal of helping hospitals to reduce workload, free up their administrative staff and for other tasks. I have been talking to quite a number of, you know, smaller clinics, doctors run private practices in the US.

One of the issues that they bring up to me is that whenever patients call them up, They have to literally track what time they call, as well as what time they put down the phone. And they have to get someone to actually be an external auditor to audit this amount of time that they're spending with the patients before they actually send the billing.

And this is actually very time consuming. So many of times, doctors end up... Just providing pre consultations and over time they just get demotivated. So I do understand why, we might have this system happening in the U. S. for now.

Yeah, I love your approach to that story. I mean, the pros and cons, because there are some benefits.

There's value in the fees if it does reduce your internal load and provide services and offload some of the work. I mean, there's value in that. And it's interesting, as we're talking about value, we'll close on these stories, or this concept in these stories, and it's Mayo Clinic to charge for MyChart messages.

They're not the first. In fact this is a Becker story, and you can go back. Becker's on August 9th of 2023 has another story where they list all the different health systems and what they're doing around messaging. This is becoming a much more common occurrence. I just got back from Epic UGM and there was a lot of talk around automating inbox responses and that kind of stuff.

But, you know, what do you do, you know, what do you do to slow down the onslaught of in box messages? Because you have patients now who have a direct link or what is perceived to be a direct link to their physician. And it's one thing to do a follow up to say, Hey, I'm running out of this prescription. Can you do something?

In which case, most providers will not charge for that. But it's another thing to say, Oh, and by the way, now I have chest pain, which is a completely different visit. And that's the kind of stuff they're trying to say, Look, that's a new, that's a new visit. That's like not a, that's not, you can't like just start a text string and it's the same.

Like every time you switch a topic that's a different visit, and so it needs to be categorized differently. Otherwise, the physician and the health system can't get paid for it, and I think that's the intention here, but more and more health systems are looking at this whole idea of you know, for certain types of messages, there's a fee, and some of the fees being talked about are 50.

So, any thoughts on this?

Yeah, I think that is a pretty interesting article as well. So what we feel is that it, it does make sense to certain, you know, to a certain degree of charging patients for this kind of services. And I'll talk more about what is FHIR later on in that sense.

Because you don't want a case where patients, just send a lot of very unfiltered information and ask tons of questions at the expense of the providers. You want them to be as direct as they can, to be as concrete as they can, what are the issues that they face. So I think that having a charging component does help to limit and discourage misuse and overuse of the platform for very non urgent or trivial questions.

The other thing is that I feel that when hospitals does charge patients or They are payers for services like this. The good side of things is that it does also create a new revenue stream for the healthcare providers and the most important is what do they do with that new revenue stream.

If they are reinvesting that to essential services, for example, to maintain and improve the platform increase staffing or other digital services that they offer to the patients, I think that is not necessarily a bad thing as well. So that's what we feel in terms of you know, what I feel in terms of charging patients for the use of these services.

However, I think one of the most important thing that we have to recognize also is the importance of you know, inclusion. What happens to those patients who fall below a certain poverty line or are facing financial hardships? And they should not fall through the crack. We should be able to provide a framework that we can actually create for them to ensure that nobody left behind.

This could include, for example, sliding scale fees, subsidies, or other forms of financial assistance that we can offer to them so that we can make sure that, you know, they are not worried to ask questions because they are afraid of being charged for that.

Right. And that is the biggest argument against this is access, right?

We want people to see their physician. We want them to go to their primary care doc. We want them to... to follow up and we want to have more interactions with them to try to keep people healthy. Because health is really what we're after here. That's what the reason so many health systems have renamed to fill in the blank health.

They used to be healthcare or hospitals, but now they are, you know, Advent Health, they are Providence Health, they are, you know, Stanford Health. They all have health after their name. And so we want people, we want more interactions, we want them to seek care and we want them to get their information through through their primary care provider and not Dr.

Google or WebMD. But when we put up these kinds of barriers the immediate pushback is, well, wait a minute, we want them to seek care. We want them to come to us. You know, is there a way around that? Is there a way? Where, you know, they send the message, but the response back is still as high touch, but is it necessarily a you know, we talk about practicing at the top of your license, isn't necessarily an MD responding to them, but maybe it's somebody else.

I'm not sure what the answer is, and I think if the answer was obvious, we'd already know it.

Yeah, I don't have an answer to this. The only thing I think is a policy level, I think. Well, I mean, if it's a common question, I think we could easily look at generative AI, but of course with enough safeguards to make sure that the questions that they ask does not fall into something that the generative AI are advising wrongly.

And of course, if you're talking about more complex questions, you get clinicians and physicians to come in. We could even get nurses to come in to advise on all these patients. I think it all boils back to one thing is how do we implement a fair and, you know, well designed billing system for people all across different kind of income level or, different income group.

I do believe that eventually we will figure out that piece and how do we move towards a healthcare system that is efficient and equitable. I know it takes time. It's a problem that not just U. S., but everywhere in the world is facing. It's just a matter of time someone figure out and, people will start to realize that, Huh, maybe that is what we need and we should work towards that model.

Fantastic. Hey, I want to thank you for your time. For those who are interested, Adrian Ang, CEO, co founder of Aevice Health. And when you hear me say that in the United States, you think I'm saying A V I S. I'm not. It's A E V I C E, Aevice Health. So, I think it's, you know, it's a solution I think health systems could look at.

I think it's really interesting to I think we do want to increase the number of touchpoint we have as health systems with patients, especially those that are struggling with chronic conditions. And you know, provide them the feedback and the peace of mind. It's the kind of thing that you could link into a nurse call center or those kinds of things where they have.

or a call center with nurses or even physicians in it. And I would assume that, you know, one person could probably monitor hundreds, essentially, across the city and really increase the quality of life for people in that city. So, I commend you for what you're doing and if people want to know more about it, it's AEVICE.

com. And they can reach out to you through LinkedIn or from the website. So that would be great. Thank you again.

Well, thanks for having me, Bill. It was fun. I'll be on this call.

And that is the news. If I were a CIO today, I think what I would do is I'd have every team member listening to a show just like this one, and trying to have conversations with them after the show about what they've learned.

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