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Aug 8, 2022: Emily Mischel, CoFounder of FlexTogether joins Bill for the news today. Compelled by consumers who don't always want to schedule a video visit or drive to the doctor's office, health systems are finding new value in asynchronous, or store-and-forward, telehealth. FlexTogether is a comprehensive virtual respiratory care platform to radically expand access to rehabilitation which in turn drastically reduces readmission by 53-73%. Is telehealth moving out of the Post-Covid doldrums? How can we build a business case for asynchronous health? The Market downturn dampens digital health funding M&A in 2022 and three more digital health ‘unicorns’ undergo layoffs.

Key Points:

  • FlexTogether is a comprehensive virtual respiratory care platform to radically expand access to rehabilitation
  • 40% of Medicare beneficiaries don't live within the distance of a pulmonary rehab facility
  • Many health systems took advantage of expanded coverage and access to telehealth during the pandemic to try out asynchronous services
  • FlexTogether
  • Cedars-Sinai Accelerator


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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.

We already have a lot of overburdened burned out healthcare providers. We have to be really. thoughtful and critical about what information we're sending them, how we're sending it to them, not alerting somebody who doesn't need to know at the wrong time. So I think thinking critically around what are those yellow flags? What are those red flags? That's something we think a lot about at flex together is really making that data. A lot of remote systems get a lot of flack for just sending noise, right. And being really thoughtful that we're not part of. That, that noise,

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health leaders.

All right. It's Newsday. And today we are joined by Emily Mischel co-founder and CEO of flex together. Emily, welcome to the show.

Hi, thanks for having me really excited to be here.

Yeah, I'm looking forward to the conversation. So The audience doesn't know you you're like new to my audience. We actually have a sponsor, which is the Cedar Sinai accelerator. And you guys went through the accelerator program. Tell us a little bit about flex together and what you guys did.

Sure. So yeah, of course we went through the exteriors accelerate. It was a wonderful experience. So what we do is we provide respiratory virtual respiratory rehab for C O P D and other pulmonary patients.

So what that means is from the comfort of home, patients can access targeted pulmonary exercise, culturally appropriate health education, and joyous group classes. So a majority of patients who have C O P D are over the age of 65. So we've really taken the time to design the platform specifically for older adults meeting them where they are.

And we're really, really passionate about radically expanding access to underserved populations, especially considering the incredible under utilization of pulmonary rehab.

Wow. No, that's, I mean, that's really exciting. So we're gonna talk about the news. We'll talk about the news in just a minute, but you know, most CEOs have a founder story. Like this is how I got there. How did you get, how did you get to this point? It's very specific area that you decided to focus in on.

Sure. So what, and originally we have started thinking about this idea pre COVID. My grandparents and my co-founder Ben's grandparents both lived far away and we were really confident that we could get them onto video chat. This is before 2020 older adults and video chat was still a new thing.

Are you saying like, like FaceTiming them.

Yeah. Yeah. So that was, that was we're starting small, but we realized that having that interaction and actually being able to help my grandparents with their recovery, they, one of them had a back incident.

So being able to help them with their physical activity over FaceTime really made the experience a lot of fun. It infused a lot of social connection into the experience. And that really jump started. Benji. I thinking like, how do we. Combine social interaction, video chat, and as a way to help people recover and be able to access the care they need, especially if they're older and primarily living at home.

Wow. How big are you guys now? You're just coming out of the accelerator. So you're probably just starting up.

We're growing in a way that makes sense with revenue first, but we're really excited. We have some initial partners and we're excited to see how we continue to grow and continue to help older adults.

Yeah, no, it's, that's really exciting. So we, and actually we're gonna come back to that right now in terms of growth and that kinda stuff. But I wanna start with telehealth. There's a couple articles today, so we're gonna talk telehealth. We're gonna talk some of the health tech funding. And some of the challenges that some of the unicorns have run into. We've seen some layoffs this week and we're gonna talk somewhat about that.

And we have a couple other stories. We'll see if we get to them. Here we go. You ready? Yeah. All right. So. Joseph Vidar, who has been on this week health before wrote an article in health system, CIO, one of my favorite places to read articles from moving telehealth out of the post COVID doldrums.

Let me give you a couple of excerpts from this. He says in June of 2020, we were riding the wave of promise, having just experienced mass adoption of telehealth by both patients and providers. At that time, we did not seem to appreciate the lack of competition from face to face interactions.

Doctor's offices were shut down and of course, telehealth flourish starting July, 2021. We began to integrate telehealth and in-person care into the complete healthcare experience. The success of this integration has been spot. And the efforts in most cases, not deliberate over the past year, the percentage of health insurance claims submitted for telehealth visits has remains relatively constant between 4.5 and 5% is, and he asks the question, is this a victory for telehealth or are we indeed in the doldrums?

So let's stop there and start the conversation there. And then we'll get into some of the, some of the bright spots. He talks about behavioral health and Some of the other areas and actually your area is a good area. I assume that falls under the category of telehealth.

Yeah. I mean, so what we're really, the problem we're really trying to solve is thinking about the under utilization of pulmonary rehab.

Because we've done some research only about 2.7% of Medicare beneficiaries who are discharged from the hospital a year out, actually access pulmonary rehab. So that's incredibly, incredibly low. There's been some issues with

Is there funding available for them to get these services? And they're just not utilizing.

Yeah. I mean, so a lot of people, honestly, there's 40% of Medicare beneficiaries don't live within the distance of a pulmonary rehab facility. And honestly, there's actually not enough capacity to be able to serve those moderate to mild C O P D patients that really could benefit from the outcomes of pulmonary rehab, right?

It's lifestyle modifications. It's breathing in physical exercise, it's understanding your triggers and really being able to. At least in the face of flex together, culturally appropriate health education to understand sort of what makes your C O P P act up, how do you create environments in your home that are safe?

It's a matter of not being able to access the service that we know works. And the research has shown reduces remissions increases, quality of life increases outcomes. There is a lot of opportunity to be able to better serve these patients.

But unfortunately, because of all the things that we talked about transportation challenges, you might not be able to access something nearby. These are all contributing to people, not actually receiving pulmonary rehab and those who really, really could need it.

It's it's interesting. I love your story. And I love your story because I think this is how telehealth does move forward. If we keep trying to take the old model of delivering care and trying to morph it and say, okay, instead of this visit, we're going to make it a telehealth visit. I mean, there's some gains there. I mean, clearly we used to be back at about 2% prior to the pandemic.

Now we're at four to 5% of claims. So there has been some growth there, but I think this is the. This is how telehealth is really gonna take off. It's gonna be new and creative models. People looking at areas that are underserved areas that are, that have funding available. I mean, if CMS is willing to pay, if there's codes willing to pay for certain services and people just aren't utilizing, cuz they can't get access.

That's perfect for this kind of this kind of modality, as they say, in our industry and the rest of the world, they would say that this kind of access, but the yeah, I totally agree. Yeah. And behavioral health falls into that category as well. A lot of people, there's a lot of stigma to behavioral health and whatnot.

And I was, I, we interviewed somebody from a telehealth behavioral health company. Actually did a couple of interviews and they talked about the fact that their, their system was so easy to sign up for that when you are. And, they told the story of this woman who was in the bathroom crying and had her phone. And she signed up for the service, saw a behavioral health specialist. And actually it wasn't necessarily a psychologist or whatever. They'd start. They, they tear it and it goes up and they escalate the care as it goes. It is such a great use case for behavioral health. And I think that's what we're exploring right now. What are the use cases that are really gonna drive this forward?

Yeah, I think it's important thinking about telehealth there's, it's definitely not replacing in person visits, right? Especially thinking about pulmonary care. There is a lot of very, very severe cases that truly do need to be seen by pulmon. In a healthcare and hospital setting. That's not necessarily the place for telehealth, but I think thinking about hybrid care, right. And thinking about those times that maybe it's easier for people who live in a rural area or people who don't have transportation consistently to be able to get to their doctor's appointment.

Really thinking about those historically underserved populations who might not live near. A lot of good options for them. Telehealth can be a really great way to be able to access that specialty care in a way that makes sense. And really thinking critically about what's inside that camera, right?

If you have the camera on a patient, what other information can you get? So it's not, we're not attempting at least at flex together. We're not attempting to. Strictly replicate an in person visit, right? We're trying to contribute something new. I imagine that other telehealth companies are doing this as well, is what other information can we provide?

Because there are things that we cannot provide because we are not in person, but there are also things we can provide because we're not in person. Right. Thinking about R PPG and being able to measure. Blood pressure and all sorts of good stuff from the face, looking at it through the webcam, or thinking about in that article, they talked about using digital ways to be able to see voice tone, right.

And how that can be able to. Tell you information about that patient's condition, right? If it's for us, if they're raspy or if they're horse and being able to utilize AI to actually augment what the providers are doing on that call. So just thinking about different things for different patients at different times

and Dr. Kavita goes on and talks about ways, but again, he's approaching this from how can we do more of the services that we do in the traditional healthcare? Outbound. And he's saying, Hey, we need more home devices digital biomarkers, home testing, and that kind of stuff.

And , he's not wrong. I hear a lot of health systems going to hospital at home to different devices. And I was talking to somebody they have a innovation center set up for lack of a better term. That's not what they call it, but essentially they have like a, a room of the future and what it might look like.

And one of the rooms they have set up is a home. And they have these devices that they're saying, Hey, look, here's the home person sitting over here. Here's the the call center or whatever. And then here's the physician and they show the whole workflow. And one of the devices I found really fascinating was essentially with cameras, not with pressure, cuffs and whatnot with cameras, it's picking up. All sorts of metrics. It's watching your breathing pattern, the depth of your breathing and all that stuff. And I'm, I'm sitting there going, are we getting to the point at some point in our future where we stand in front of the mirror. I mean, we've seen this in, Movies, right. You stand in front of the mirror and it goes shallow breathing today, da, da, da, and then all of a sudden, some readout pops up and it says, would you like to talk to your primary care physician?

And then you say yes. And then all of a sudden, the screen changes to your primary care physician. It seems like we're closer to that. That today then we were even two years ago and our trajectory is a lot quicker than it was prior to the pandemic.

Yeah, I definitely agree. I mean, I still think we're far, far way off from that sort of sci-fi reality, but we're definitely,

man, you're bringing me down. Come on. No,

but I do think we're, we're close and I think it's really thinking about how do we engage with providers? That's the one, when I hear that neuro story, think about what includes a red flag for those providers. We already have a lot of overburdened burned out healthcare providers.

We have to be really. CRI thoughtful and critical about what information we're sending them, how we're sending it to them, not alerting somebody who doesn't need to know at the wrong time. So I think thinking critically around what are those yellow flags? What are those red flags? That's something we think a lot about at flex together is really making that data.

A lot of remote systems get a lot of flack for just sending noise, right. And being really thoughtful that we're not part of. That, that noise, that we're sending things that pulmonary patients need to keep under track and being like, Hey, this seems like something that's important in helping better decide when that information is shared and how it's shared in a way that makes sense.

But to your point, I mean, there's some really interesting stuff, even with radio waves around fault prevention, right. That you can put a box in your home and it can know if you're up or you're down. So we're definitely. Close that be would think to that reality 📍

📍 We'll get back to our show in just a minute, we have a couple of webinars coming up and I don't like webinars. I think they are oversaturated at this point. And I think a lot of them are not all that good. And so that's why I think I'm the perfect person to put together webinars for you. I make sure that we have great topics.

I validate them with CIOs. I make sure we have great guests and I make sure. We actually plan ahead and we actually spend time together before the actual webinar. So it's not just spur of the moment stuff, but we make sure we identify the things that we should talk about in those webinars. And we even collect questions from you ahead of the webinar so that we can make sure to talk about the things that you want to talk about.

So let me tell you a little bit about the two webinars we have coming up. There's a global survey. That we talked about on the today show a thousand cybersecurity professionals found that 30% plan to change professions within two or more years, and cybersecurity threats are growing. And, you know, quite frankly, we need to make sure that we recruit, retain and optimize our staff so that they can be our frontline.

And so the first webinar we're doing is how's your frontline recruit. Retain and optimize your cybersecurity team. And we're gonna talk to experts from Christiana care and Seattle children's and Seuss about their thoughts on this exit of security professionals and what you can do to stay ahead of that.

You can join us August 11th. At, 1:00 PM Eastern time and you can register right on our homepage this week, on the top right hand side, you're gonna have the two upcoming webinars. You go ahead and click on those again. That is August 11th at 1:00 PM Eastern time. The next one, we're going to talk about ransomware, but I've seen a lot of different ransomware, webinars.

I love this one. The topic we came up with is Don. Pay the ransom and rubric is bringing together some great leaders from Thomas Jefferson university in St. Luke's university health system and and rubric themselves. And we're gonna discuss solutions around protecting all of your healthcare data, especially as you're moving to the cloud.

And specifically, we're also gonna talk about epic. Backup in Azure. And what rubric gets doing around that, that webinar is going to be on Thursday, August 18th at 1:00 PM. You can register for both of them. Just go to our homepage this week, upper right hand corner. You're gonna see both of the graphics for those click on the one you wanna attend, fill out the form. And we will see you then now back to our show. 📍


well, let me, let me take you through the next story, which takes us to the next level, which is building business case for asynchronous telehealth. And this is in health leaders' magazine, and I'm not gonna read much of this cuz we talked about telehealth here bunch, but this is interesting cuz it's compelled by consumer. Who don't always wanna schedule a video visit or a drive to the doctor's office or ER, health systems are finding new value in asynchronous or stored forward.

So people who aren't familiar with asynchronous that's technology nerds talk asynchronous all the time, but essentially it is. Think of it, like note passing, essentially. Here's, here's how I'm doing. And then they get the note and they look at it and go here's whatever. So it's not real time.

It's not it is sort of that store and forward here. Here you go. Here's some of the takeaways a hit for this story. Many health systems took advantage of expanded coverage and access to telehealth during the pandemic To try out asynchronous services, which give consumers the ability to access care without the hassle of driving to a doctor's office or ER, or scheduling a video visit asynchronous telehealth platforms typically allow people to fill out an automated questionnaire on their health concerns.

Which is then screened by the health system and sent to a care provider who can review the data and send it back send back a diagnosis and a care plan. The platform is designed to easily treat non-acute concerns quickly, such as infections, colds, and viruses, and allows providers to ask for more information, including images or shift the encounter to video visit or in person care when necessary.

So the thing I found interesting about this in conjunction with the telehealth visit is there's, there's sort of this progression of visits and progression of modalities that we can can consider. And one of the things that we've talked about on the show of fair amount is increasing the touch points and the rise of consumerism within healthcare.

And we want to have a trusted partner on the other side. Of the equation. And people have talked about Hey, my car has all these sensors and somebody's on the other side. And they see all these sensors and they get back to me. that's where we increase the number of touch points.

But the important thing is who's gonna be established on the other end of that touchpoint as the trusted partner for my health. I guess that's my question for you. As you go out with your model, is it to empower health systems to say, Hey, utilize us to do this. And then you can be the trusted partner, or are you gonna be the trusted partner for pulmonary health?

So actually we have two different ways that we work with health systems. So we work with them as a, either supplemental or post have experience for their pulmonary rehab patients. Right. So if they can't necessarily come in every day, we can be. Remote option or we can extend the duration of care. I think, you know what you were saying, this is a promise, I think, of remote patient monitoring or what we're really interested in remote therapeutic monitoring that we can be able to extend that duration of care, be able to monitor somebody over time and be able to have our own providers looking at that data, making sense of it and making suggestions that actually lead to activities for that patient. I think that's the promise of all the remote monitoring, but we also soon are gonna be able to have our own providers to be able to take on our own patients, be an affiliate provider and actually take referrals from health systems who might not have the capacity to be able to see all the pulmonary patients they would like to see, or their patients are really far away from their health system. And so a remote option would work better for them. So we work with health systems. To those two different ways.

Interesting. When I'm talking to health systems about how they're delivering care, they are looking at all these different again, modalities for delivering care and really rethinking how they how they engage with the consumer, where they direct the consumer. There's a convenience aspect. There's a, there's a safety aspect, quite frankly, there's a cost aspect. There's access obviously aspect to it. And they're not only looking at it from all that, all of those things.

They're also looking at it from a From a, an equity standpoint as well. So there's just an awful lot to take into account. As we try to rework this a hundred year old system in in the way we deliver care.

And I think asynchronous care is really, I think what you were saying before makes a ton of sense. I mean, I think when we work with our patients at flex together, being able to combine visits with. Providers and be able to also have our at home program, right. They're doing their pulmonary exercise. They can even record their movements and be able to have that reviewed. And these things are working together.

It's not, you have an asynchronous event and that's happening over here and you're having your provider and your appointment. And that's happening over here. I think the future of asynchronous health is really making those things work together. Right? You have those synchronous events when you need that immediate feedback, but then having those in between those appointments, being able to have that data in.

So by the time you see that provider, you're not coming in with no information, they can say, Hey I've been looking at your data. This is what I've been seeing, but let's start with you. Let's talk to you. So I think thinking about equity in the future of care, I think what you were bringing up about that age synchronous care, working with traditional telehealth, I think is the way of the future.

So let me ask you, how did you fund flex together? Is it food strapped? Is it PE based? Is it venture based? How did you fund.

Sure. I mean, we of course got some funding for the Cedar Sinai accelerated and we've been boots dropping it up to this point. I think we're looking to the future. We're hoping to do some fundraising soon because we are social enterprise. We really care about that mission of being to serve unserved patients who. At this point, really underserved by a lot of pulmonary care, but not being able to access it.

Right. If you're not male, if you're not of high socioeconomic status, you don't have high health literacy good chances. You're not being able to access pulmonary rehab. So keeping that mission front and center has been important to us, but we also realize this. The scope of this problem is so enormous that we are gonna need some partners to be able to truly tackle this problem and be able to deliver world class respiratory care for all the patients that need it.

All right. So I, then I'm sorry for covering this story.

no, I think it's a great story. It's important. It's something we've been thinking a lot about, and it's, it's been reflected in sort of how we've gone forward. I mean, we were, we were watching 2021 with everyone else being like, oh, what's happen.

Oh, I know. Yeah. Well I all right. So the stories from fierce healthcare market downturn, dampens digital health funding, M and a in 2022, these sectors raked in the most cash. So it covers three different things. Heather Landy writes this article. I like her writing. It's very easy to read after reaching a fever pitch in 2021 digital health funding cooled down in 2022, raising 10.3 billion across 329 deals in the first six months.

That's down from 14.7 billion raised during the same period last year, according to first half 2022 funding report from rock health. So that's the source rock health but it should be noted 10 billion. It's still a hefty amount of cash. And you would accept just a little portion of that 10 billion and just be fine. I would assume. Yeah,

that would work for us.

that would work. Yeah. Still have the amount of cash pouring into digital health. And this year's funding is on tracked outpace funding in 2020. This year's overall funding is now pacing to land around 21 billion, significantly less than 2020 ones, total 29 billion.

All right, so that's what they're saying. And they're saying this would establish 20, 21 as the anomaly, not the norm that this, they feel like this is more in line with 2020. And the, the numbers and the natural growth rate in the market, it's still a fair amount of money. They, they do note that let's see investors are putting their money in, looks like digital health startups, catalyzing, R and D in biopharma and MedTech digital mental health.

And we talked about that earlier and digital health solutions monitoring disease brought in 1.4 billion and then things that address. High staff burnout rates and and probably wage inflation if I thought about it. So those are the areas where money is at how I'm seeing this play out.

To be honest with I'm talking to a bunch of startup. And by the way, the follow on story to this is not too fun. But it has digital health. This is the modern healthcare magazine, three more digital health unicorns undergo layoffs, and they talk about Cedar letting go of 24% of its 500 plus person organization let's get checked reduced to some of their people and forward reduced some of their people. And then just today we saw all of AI let go of about 400 People as well, there's, there's a couple others cerebral carbon health, Q health.

So just suffice it to say, I think the the investors are getting together with their portfolio companies and saying, Hey, you know what? Cash is going to be a little tighter over the next year and a half to two years. So make sure you have your house in order and you have a good run rate to keep going. I assume you're hearing the same.

Yeah. I mean, I think we, we heard that the evaluations were very sky high in 2021 and thinking about obviously good products for getting funded, but maybe not products that we're thinking revenue first. I think moving forward, we've definitely seen start be, have to really focus in on what are their value propositions?

And I think what are they innovating on? I think healthcare is a unique market. We've definitely seen this. It's really hard to innovate your revenue model and innovate delivery of care. So if you're a smaller startup it might make sense to kick one of those, right? You can deliver care in a way that's maybe more traditional, but the way that you get paid could be really cool and innovative or vice versa.

Because of all there's a lot of government involved in healthcare and there's a lot of regulation, so it can be tricky to innovate everything all at once and have people accept that and be interested in upending the whole system. As you said, you can't change a 100 year old system in a day. As much as maybe I. So us want to.

I love your optimism. One of the things I, when I come across people that are a little too sour on things, is I remind them that in downturns, in the economy, there's always winners, there's winners in every type of market. But your focus has to be a little different.

In fact it's probably better for some startups in a down market because people are looking for different solutions. Their lens has changed a little bit, so they might be looking at things a little differently. And there's opportunities that didn't exist before. Plus. People get more discerning with their money.

And if your value proposition, as you talked about, which is so key if your value proposition is solid and your story is solid, you're still gonna be able to get funding and you're still be gonna be able to get clients because quite frankly, that it's harder in a. Fer the market to get heard, because there's just so much stuff going on.

And you almost want some, we don't want anyone to hurt, but you almost want some of that stuff to go away that doesn't have solid value propositions and good business model behind it. when that goes away, then some of the other things can get some more attention. That's actually delivering value.

That's my 2 cents on that. I do think there's an opportunity in a down market. And so I don't think, I don't think that's necessarily all a bad story, to be honest with you.

Yeah. I mean, we're definitely hoping, so cuz we know we're charging ahead. So in these, at least in our case and in a lot of healthcare startups case, like there're patients that need your service, so you gotta figure it out so you can get it to them.

Well, Emily, it was great having you on the show. I appreciate the conversation I learned a few things and I love the business model. I love where you're going with it and wish you the best moving forward.

Well, thank you so much and thank you for having me really appreciate it.

What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to show just like this one. It's conference level value every week. They can subscribe on our website They can also subscribe wherever they listen to podcasts. Apple, Google, Overcast. You get the picture. We are everywhere. Go ahead. Subscribe today. We want to thank our news day sponsors who are investing in our mission to develop the next generation of health leaders. Those are CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst. Thanks for listening. That's all for now.


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