This Week Health

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August 2, 2021: Dr. Sanaz Cordes, Chief Healthcare Advisor at World Wide Technology joins Bill for the news today. In their 2021 Work Trend Index, Microsoft predicts over 40% of people may quit their jobs this year. Leaders are out of touch and need a reality check. And high productivity is an illusion because the workforce behind it is very tired. CMS proposed permanent Medicare coverage of audio-only mental health telehealth services. What are the requirements? And how promising are digital therapeutics? What’s the value proposition? Why would pharma companies adopt these? Why would physicians prescribe them? Will insurers ever cover them? And what’s the acquisition exit plan for these startups?

Key Points:

  • Productivity has been overdone in this work from home environment [00:07:35]
  • The move to remote work made teams more siloed [00:19:00
  • Physician burnout numbers have always hovered around 50% [00:24:30
  • Mental health providers are one of the lowest paid professions in healthcare [00:31:35]
  • World Wide Technology



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 Welcome to this Week in Health It, it's Newsday. My name is Bill Russell, former healthcare CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping Health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology who are our news day show sponsors for investing in our mission to develop the next generation of health IT leaders.

We set a goal for our show, and one of those goals for this year is to grow our YouTube followers. Uh, we have about 600 plus followers today on our YouTube channel. Why you might ask, because not only do we produce this show in video format, but we also produce four short video clips from each show that we do.

If you subscribe, you'll be notified when they go live. We produce, produce those clips just for you, the busy health IT professional. So go ahead and check that out. Common question I get is how do we determine who comes on this week in health it, to be honest, it started organically, it was just me inviting my peer network and after each show I'd ask them, is there anyone else I should talk to?

The network grew larger and larger, and it helped us to expand our community of thought leaders and practitioners who could just share their, their wisdom and and expertise with the community. But another way is that we receive emails from you saying, Hey, cover this topic. Have this person on the show.

And we really appreciate those submissions as well. You can go ahead and shoot an email to, hello at this week, health We'll take a look at it and, uh, see if there's a good fit to bring their knowledge and wisdom to the community as well. Alright, it's Newsday, and today we have Dr. Sanaz Cortes on the line.

And good morning Sanas. Welcome to the show. Good morning. Yes. How are you doing today? Uh, I'm, you know, I'm doing pretty well. You are in a different world than I am in, first of all, you're on the, you're on the west coast, right? That's right. Central coast of California. And, uh, my understanding is that you're with WWT and the work with clients has really taken off.

Recently I've talked to a bunch of people who are in the consulting world and we're starting to do onsite, again, lots of calls, lots of things just going on around telehealth, lots of things around cybersecurity. There's just a lot of pent up work that is, is getting done right now. So you're probably more busy than I am.

I would imagine. It is pretty busy. Pent ups a good term too. 'cause I think people have just a pent up desire to get back to face-to-face and whiteboarding and all the things we've had to improvise. So yeah, it's busy, but, but a good, good shift. Microsoft released their work trends index for 2021. I think that's gonna be an interesting conversation.

CMS is gonna permanently cover audio only, telehealth and telemedicine for mental health. And I think we'll hit on that as well. We're gonna talk about digital therapeutics. Uh, I wanna start with a short conversation about himss. Are you're going to hims? I am. My team is going. Your team's going. I am scheduled to be there as, as well.

Uh, I got an email yesterday from their . Head of, uh, marketing, I think for hims, and they said 19, right now, 19,000 people are signed up to be on site. And to put that into perspective for people, I think the last one I went to was 40 something thousand. Yep, yep. 43,000 was the last one I went to. Yeah. And I mean, that's, that's a lot of people.

20,000 will be roughly half that. I think they plan to make that up with, with digital and virtual. 'cause they have a, according to the email, they have a robust. Digital solution. And that's one of the things we look forward to, right? It's everyone presenting their solutions. It's a great way to get, to get best practices.

How, how will you approach the, and obviously Nevada just did the mask mandate, so we went from vaccination only to attend, and you're not gonna have to wear a mask to vaccination and you will anywhere indoors, at least you'll be wearing a mask. How, how is your team gonna approach this? Do you have a, like a playbook that you guys run like we're gonna.

See as much stuff as we can talk to as many clients. I mean, how do you, how do you approach it? Yeah, and I think this year that's really key sort of planning. We're doing a lot of pre-planning across the three physicians on my team. We've got a pretty good, you know, network that we've built the last 20 years.

So just reaching out and trying to. Get some of that scheduled ahead of time. 'cause yeah, there's a lot of unknowns. The digital thing is new. We don't know how that's gonna play out, so we're just setting up a lot of, um, chats ahead of time and we're actually gonna be in a partner booth demoing one of our kiosk that we did for CDC attestation.

So hopefully we'll get some folks there. And I personally, it's plan on attending some of the . Educational sessions and things like that. So hoping it'll be good and maybe 20,000 folks will make it a little bit more intimate and easier to reach , you know, reach people. So, I'm being optimistic. , did you just say 20,000 people intimate gathering

Yeah. 20,000 still. Uh, I mean, that's still a stadium of some kind. That's, that's pretty big. All right, so I wanted to talk this, this Work Trends index. So Microsoft started doing this I think last year. They may have started before that, but last year's, the first year I, I picked up on it. It's a pretty extensive study that they do.

They take information from teams and from surveys and other things that they do within LinkedIn, office 365 and whatnot. They, it is actually across 31 countries, but this is specifically for the us. And they came back with the seven hybrid work trends every business leader needs to know in 2021. I, I'm going to, I I'm sure you didn't read this 60 page report in its entirety, so I'm gonna, I'm gonna highlight a couple things I think are interesting from this for us to talk about.

And the first I think is pretty obvious, which is flexible work is here to stay. Employees want the best of both worlds. Over 70% of workers want flexible remote work options to continue over 65% are craving more in-person time with their teams. I think those two things are, are very interesting to me.

'cause they, they almost would seem to be at odds with each other, but they're not. They want it to be flexible, but they do want to get back together with their teams. We're craving that in person time, but we're also craving the . There was something exciting about getting into a room with your peers and collaborating and there was an energy that's doesn't really translate as well across these, these video mediums.

I don't think. What, what are you, what are you hearing? What are you seeing with regard to virtual work and where do you think this is gonna go in healthcare? Yeah. And that trend is spot on with what we've seen within our company, within worldwide, because I think both sides of this personality spectrum, if you will, those of us who are extroverts and have wilted a bit just sitting in front of the, the computer and then introverts who it

I had folks tell me, this is great. Like, I, I love being at home. I don't feel like I'm, I'm sheltering in place 'cause this is a better work setup for me. But I think both sides have kind of landed on this, the center of, yeah, whichever end we're on, it is somewhat nice to have the opposite. So that's kind of what we've been hearing.

And so even for myself personally doing. 11 WebEx is a day. I'm happy to be back out on the field, but maybe not five days a week. Right. So, but yeah, that's pretty consistent with what we've been seeing within our organization as well, and with our customers. See, it's gonna be interesting with, from the productivity standpoint, it is really productive.

11 WebExes as opposed to getting on a plane, traveling here, doing this meeting, getting on a plane, traveling here, doing that meeting. It'll be interesting to see how that impacts productivity. But productivity is one of the things that they say we've sort of overdone in this work from home environment.

Their number two thing is that leaders are out of touch with employees that need a wake up call. Some of the stats they give here are 61% of leaders say they, they're thriving right now. And those are people with decision making authority. But that is 23 percentage points higher than those without decision making authority.

So for the people who feel like they're, they're in the know, they're making decisions, they can sort of influence their own world. They're doing pretty well in this environment, but, uh, across, and they break it down. It's really interesting. Married, working moms, gen Z, frontline workers, new employees and single, they, they just ask thriving or surviving and struggling.

And it's interesting when you get down to new employees, as you would imagine, single and gen, gen Z, you know, you're down in the 30% that are thriving, 30 plus percent that are thriving, and over 60% that are just surviving or struggling. Yeah, that's that. That doesn't seem to be a sustainable. Model. How do we get past that?

Is it a matter of engaging employees more? Have we not adapted our management styles to this new, new environment that we're we're working in? Yeah. I think more than ever this last year has really prioritized within the workforce, I mean, within all of our minds, how important the culture is of a company you work with.

I think . It's, it's important. We all looked at that as being a key factor of where we are, but this year really put a spotlight on it. And so I think the companies that are large but have a really strong cult, they've responded and within even our organization, they've responded, they've adjusted, they've done the best they can, and maybe

So they are more on the traditional side of that kind of adoption, uh, curve, right? Startups and the world I came from was remote, right? Like this was sort of like, all right, like we're already on Zoom, but we're gonna make some changes. We're not gonna go out to customers. And I think people were further along on that transition, but I think if you were more in that sort of larger corporate setting and you're not a decision maker, it just really rolled up to

Culture, but it's been nice to see companies shift, right? Like, so how is this sustainable in the future? A lot of the customers we talk to have said, boy, like this health system has always had our IT folks come in every day, five days a week. But we're gonna go to fully remote, we're gonna let everybody work fully remote.

And those are sort of the changes that I never thought I'd see, right? Like in my lifetime, so. So I think that's just that it's cultural adoption like anything else and sort of that timeline and curve that people sit on. Have. Have you worked from home a fair amount of time? Yes. I mean, this last year and a half every day,

Oh no. I mean prior. Prior to that. Prior to that. Prior you did? Yeah. Um, yeah. Well, I work from home in the office and then on airplanes. It's interesting when I talk to people about this, when it first started happening, I'm like, I don't think we know what we're getting ourselves into. I've worked from home probably 15 years out of my career.

So far it's, it's hard. It's challenging. Some of these stats sort of lend themselves to this self-assessed Productivity has remained the same or higher for many employees this past year, but at a human cost, close to 20% say their employers don't care about their work-life balance, 54% feel overworked, 39% feel exhausted, and I understand where that work comes from because when your home office is your office.

It's, you're sharing it with your home, and I know for me early on in my career, I couldn't shut it off. I can shut it off. Shut off just fine. Now , but . But back in the day, I remember when we first started getting these cell phones, I felt like I had to respond to every email that came through at whatever hour it came through, and every text.

And I think some people who are used to the office where they could compartmentalize it. I'm going to the office now. Coming home from the office. They weren't used to that. And some of the things that took me 15 years to sort of develop in terms of . Well, I think people are sort of getting buried under that weight of not being able to make that transition that quickly.

And they are responding to emails. Uh, they have some other stats here. Average meeting is 10 minutes. Longer time spent in Microsoft teams has, uh, more than doubled globally. The average team's user is sending 45% more chats per percent more chats per person after hours.

Compared to the same month, last year is up 40.6 billion emails. Wow. Um, I can say 46%. I don't know where that billion put. 6 billion emails. There's been 66% increase in the number of people working on documents in Office 365. And so we're actually giving the company more hours. We're actually giving the company more of our, of our life, and I think people are, are potentially resenting.

It's one, the findings from this. Survey. So as a manager, how do you, how would you approach that? I mean, if, if I put you back in healthcare and you had a team of 20, 20 people or whatever, how would you approach that to, to get in front of that, that challenge that probably just given numbers exists within most teams.

Yeah. No, I mean, , I haven't always been a good manager. Like, like you, I was a workaholic and it, when I was working at home . It. It was roll outta bed, get on the laptop, start pummeling people with emails and messages, and fall, fall asleep 13 hours later from exhaustion. So I've learned just in the last year and a half watching what it's like for people who aren't used to that environment, how to adjust.

And I think one really important thing, and my boss does this, and this is . And I was not good at this, is to tell people I'm not gonna respond to your emails after a certain hour. I want you to have that time with your family and I'm not gonna respond, but to teams and, and he does that sometimes, and I think that's been really important, right?

Like, I think letting people know it's okay not to send it to me because I'm not even gonna be online kind of gives them permission. 'cause I think it's just that fear of if you haven't worked remotely, how do I show that I'm productive? I need to be engaged. And when it's 24 7 and like you said in your in your house, it's hard to kind of turn that off.

So I think that's important. Setting the standard top down, not gonna answer work-life balance is important. Take your weekend time. Words that we should have been saying all along, but really important. Now, I coach CIOs. And one of the lessons I had to learn as ACIO is that the, the position had gravitas, and when you get an email from the CIO, it sort of goes to the top of your inbox.

And my team came down on me pretty hard. I, I did a 360 evaluation. They came down on me pretty hard for asking them to work on weekends. I'm like, I never asked. Don't understand emails all weekend. Yeah, but I wasn't, the email to me is like, it's like a, a letter get back to me. Yeah. Right. When you are back at, but that's not how they read it.

They, they Right. They read it very differently. And so we have to have situational awareness and, and position awareness to realize that when someone gets an email from someone of your title, how are they going to respond? And I've, I've told many CIOs, stop sending emails on the weekend. Just don't do it.

Um, but for me, write, write drafts and then hit send on Monday. Exactly. Because sometimes for me it's like I need to get it down on quote unquote paper because I'm gonna forget, or I'm not gonna lose track of it. So maybe put it in a draft folder and shoot it out. Monday I'm, I'm gonna ask you to do, to rewind in your career, and imagine you're a genzer.

This is your first job out of, out of college. You go to work for a health system. So not.

What they're saying here is Gen Z is more likely to be single early in their careers, making them more likely to feel the impacts of isolation, struggle with motivation at work, and lack of financial needs to create proper work space at home. So they're, they're not able to buy the, their ergonomic chair and, and set up an office and those kind of things.

And they might be in an share apartment with like three of their college roommates they graduated with and that kinda stuff makes it very challenging. If I were to rewind back then, I mean, saying to those people.

Because you're trying to learn disciplines

face. Which I would imagine is, is hard as well. I'm trying to empathize with this Gen Z generation who graduated over the last couple years, went into these roles, how can we help them? Yeah, it's, as you were talking, the word empathy was flashing a neon in my, in my brain because that's always key to being a manager.

But I mean. The level that you have to really stretch your empathy skills to make sure you can wrap your head around that, because that's 20 some odd years ago for me and I was in medical school, so still I like, I can't even relate to what it would be like at 22 to enter a position in a corporate environment.

So. It's one of those things that it's so hard to relate to, which makes it that much more important to try to understand it. And I, I just have empathy, I have sympathy for these young people because like you said, I started the day before the lockdown. I've never met any of my coworkers, but I've got 20 some odd years on them.

And so we've developed these skills and we understand, and I, I just can't, I, I, I cannot put myself in that. I, I can't imagine being in that role and so having to be more empathetic and I, I keep coming back to worldwide. We have a great culture, can't help it, but I work with some of the young folks that have come into sales and it's really impressive what that organization has done with these new

Kind of hires where daily they have a lot of like fixed sessions. They're interacting with each other. They have an understanding of like, what's gonna happen this week. They're meeting with different oriented departments. And I was thinking, boy, I, I wanted that. Like, that's great. I'm glad you guys are having that and that, but that's hard, right?

Like not every company has the bandwidth, the resources to be able to do that. So yeah, it's, it's, it's, it's hard. Yeah, so empathy and awareness. I mean, that generation might need more formal, uh, get togethers. Something I, I might have done as ACIO is say, alright, look, we're gonna, we're gonna identify this age group or anyone we've hired over the last two years, and every Friday morning they're gonna meet with a different executive.

It could be the CI this time applications.

Treat it like a, a training session, but it's a way for them to interact, ask questions, learn about, about the company. The, the normal onboarding may have broken down through, through the pandemic. I, yeah, I hope people have really thought about this. There are, number five is shrinking networks are endangering innovation.

The move to remote work made teams more siloed, and the CIOs I've talked to are aware of this. Healthcare leaders are aware of this siloed nature that that tends

around. Definitely one of the things too. Let's see, and even career opportunities, like within your own company, I mean, who of us on our career path the last couple decades haven't had an opportunity because we're face-to-face to raise our hand for project or not position or something that shifts us to a different part of that velocity.

So I it's How do you do that when you're young, you're new and you, you don't even meet the people. In the lunchroom or folks that you, you wanna approach with those kinds of discussions? So it's, it's interesting 'cause somebody asked me the, the question of, Hey, we're going to a hybrid work environment.

How often do you think I should go into the office? And it was a younger person. And I said, as often as you can, if you feel safe, as often as you can. And they're like, well, why would I do that? I'm giving up some of my freedom, my autonomy, I'm like. Would you like to progress in your career? And that was the number one thing.

It's like you can't, especially with your career, you can't replace serendipity. You can't replace that. Just running into somebody saying, Hey, let's go to launch. Let's have a conversation. Even you, you think, well, that's within my own company. But you might meet a vendor partner, you might meet a consultant, you might meet somebody who changes the, the trajectory of your career.

And that stuff doesn't happen. It almost has to be planned if you are working the way we're working right now. Yeah, it doesn't happen on Zoom , right? Like that's 100%. There's no way to walk down the hall and see who's, who's in every Zoom meeting. That would be an interesting feature though, wouldn't it?

anyway, uh, number six was authenticity will spur productivity and well workplace become more human. And they talk about that more people have each other's. More coworkers have cried with each other during the, uh, pandemic, which is an interesting statistic, I guess, that has to, you have to get that stat through a survey.

I don't think Microsoft Teams is tracking that. And then talent is everywhere in a hybrid world. So there is this. Of the big statistics outta this thing is that as we sort of shared earlier, that 40% of people may quit their jobs this year and 60 some odd percent are looking alright. So from a talent perspective, healthcare system within the technology realm or, or even clinical informatics realm.

I mean, just sheer numbers, 40% might quit their jobs. 60% are looking e even if you feel like you have the best environment in the world, let's take those numbers down a bit. 30% of your people are gonna leave this year and 40% are looking. Mm-Hmm, . That's almost half your workforce is considering a job change.

That's a significant amount of, of institutional knowledge. You're gonna lose significant amount of training. You're gonna have to do ramping up into a timeframe when healthcare is really trying to accelerate. This is gonna be this, I would think this is one of those things that's top of mind. This is why we're spending so much time on this topic.

People, you, you can't do the job without people and you need a great team in order to be successful. Well, and we're talking about it, but if we do look at healthcare, . 43% of nurses, that was the last stat I read, are considering leaving the profession up from 17% in 2019, leaving the profession completely of nursing.

Wow. So Matt, let's look at that number. And then a third of healthcare workforce in general. Doctors, technicians, folks that work in the hospital are unhappy and thinking about leaving, and we were talking about Gen Z. When you look at that number, the breakdown of, you know, . Dinosaurs, like myself, like the percentage is smaller, like it's closer to 10%, 15%.

But as you move down to that under 30 age, it's north of like 60% of the healthcare workforce are thinking about leaving. So that's a scary number too, right? Like we've gotta do something, we've gotta make some changes. 'cause you talk about not sustainable. Interest. This is anecdotal, but I was, I go to this thing called Stretch Labs where they, they do resistance stretching because I am very not flexible after sitting in this chair for as many hours as I do, and I was talking yoga, I was talking to the lady who was yoga.

Well, yeah, I, I recommend it. I was talking to the lady yesterday and she said, I said, so how'd you get, how'd you get to doing this? She goes, well, I'm a, I'm an RN by training. And one of the things is during the pandemic, she had four kids and it really didn't work for her to be an rn and she left and she started doing this.

I said, do you plan to go back? She goes, oh, no, never . It's like, wow. I mean, you just didn't like, she goes, it's, it's a really hard job. It takes its toll on you over, yeah. Over a period of time I. And physician burnout numbers have always hovered around 50%. I'm scared to see what the numbers look like on the next time we get these like national surveys, and then what do we do there?

We all read the AMA projections of like, oh, we're gonna have a hundred thousand doctor shortage. And then the next few years marrying that with these stats that we're talking about. I think, yeah, I think it's really, we gotta do something. So we're gonna compare our, our answers to the Microsoft answers, then we'll go on to the next story.

They have five strategies for the way forward. One is create a plan to empower people for extreme flexibility. And they have, and by the way, I'm just gonna recommend people download this. This is a really good study. It's the, it's the Microsoft. What do they actually title the thing? Microsoft Next Generation Disruption is hybrid work.

Are we ready? It's the Work Trend Index for 2021. It's loaded with great information. Uh, so that's number one. Number two, invest in space and technology to bridge the physical and digital worlds. They say UP is upwards of like 50 to 60% of organizations are redesigning their workspace based on what's going on in the virtual world.

That's combat digital exhaustion from the top. So leaders have to be a part of, of really addressing that digital exhaustion, prioritize rebuilding social capital and culture, reframe network building and team bonding from a passive effort to a proactive one. And then rethink employees experience to compete for best and most diverse talent.

And that's gonna be the interesting thing. Have some opportunities to recruit really from anywhere. Yeah. Uh, depending on, on the work environment we set up, but we.

We only used to have to worry about them being recruited away from the hospital system down the street. Now we have to worry about them being recruited from any hospital in the country. Yeah. Well, and I mean, I, I don't wanna change the course of this, this report, but if you combine that with. All the disruption, right?

Because now, yeah, you're competing with workforce from the hospital down the street. You're also now competing with all these disruptors, like these big tech disruptors and these new models that have popped up Amazon Care, where, uh, all of those patient surveys show that that convenience trumps loyalty to your health system.

So it is, it is a, like, we're at a critical point of. Really needing to shift the whole way that we think about healthcare, our workforce, how we deliver it. 'cause these industry drivers just didn't exist a few years ago. And it's, uh, it's an interesting time. Two more stories real quick. We'll only do three stories this week.

We have the, let's do the CMS stories. So CMS to permanently cover audio, telemedicine for mental health. And so CMS has proposed making it a permanent change to Medicare coverage. In the 2022 physician fee schedule, proposed rule. And so here's in, in plain English what they're saying services are limited to.

And so this is the, the caveats around it. So they're always worried that when they do something like this, it will increase usage significantly. But I guess they looked at this and they said, that's not a. To, to, to increase usage for this area, and they have seven rules around it. Services are limited to diagnosis, evaluation, or treatment of mental illness disorders available to establish patients only.

So you have to, they have to be one of your patients already. The distance site practitioner must have furnished the patient with an in-person visit in the last six months. The patient must be located at his or her home as the originating site, not another location. That's an odd one to me. I mean, we're talking telehealth here.

I mean, yeah, but okay. So they have to be in their home for whatever reason. I'm sure I can't come up with a reason, but, uh, the distance site practitioner must have the technical capability at the home of the service to use interactive audio video modality with the patient. The patient is o So essentially what.

If the patient is not capable, then they will reimburse audio only. That's number six. Right? Right. And then number seven, the distance site practitioner appends the claim of service level modifier to identify the service as audio only and to certify compliance with these requirements. Wow. You know, I'm glad they're doing this.

They are worried a little bit about where, where it goes in terms of usage, if there's spike in. Preliminary phase so people can actually provide their input to CMS at this point. They can. They can give their feedback. Specifically what they're looking is, should all mental health telehealth services codes be allowed to be used audio only?

What if any additional documentation should be required in the patient's medical records to support the clinical appropriateness of providing audio telehealth services? Should CMS audio only for certain higher level services, such as level four or five EM visit codes when furnished alongside. So with you, what I'd like to do is talk about this in the broader scheme of things.

This probably makes sense to everybody, right? They're looking at this going, absolutely, you, you can do, you can do a mental health visit via phone because.

Video. Video. I guess they wanna add that added level of connectivity, but I'm seeing a lot of discussion in healthcare just in general, that people want a significant uptick in what CMS will reimburse post the public health emergency. And I think they're gonna take this approach. I think it's gonna be targeted along the way.

I don't think there's of.

We're gonna build out and how we build it out. I would assume, are you hearing a lot of discussion around how health systems are thinking about, uh, telehealth at this point, specifically to mental health? They're thinking we need help, we need more providers. Right. I mean, I. I'm involved with a couple teletherapy companies from my past, still very active with them, and they can't keep up with the demand, right?

Like they're, they, these health systems have been so understaffed as it is with these wait lists of like months in some cases, to have their patient population see providers. And so now. The last year and a half, and based on these proposals and where we land in the future, it's like not even not slowing down, it's like floodgates.

So health systems have, they're just struggling. Like, how do we get more folks to provide these, these services? And obviously that's gonna roll up to far beyond the health systems, right? How do we change training? How do we recruit more folks? How do we pay them better? Mental health providers are one of the lowest paid.

Professions in healthcare, so just kind of looking, education costs, loans, all these things roll into it. So, but yeah, health systems that what they're focused on is how do I get more bodies to, to meet these needs. Yeah. This has gotta be a boom though for some of those, some of those mental health digital startups, I would think.

There are organizations out there. That much like you would outsource your emergency room or outsource portions of your physician practices and those kind of things. There are mental health companies that will outsource these kinds of services to, to health systems and make them available. And if you have the digital.

Tools around it. They can either use their own or they can, they can come into yours. So there's a lot of different ways, ways to do this. But this is one of the areas, I think we talked about this, I talked to this this last week on the show. We had to do psych evals for our emergency departments in Southern California.

We couldn't really put a, a psychiatrist at each one of our locations. It would make no sense, but that's, that was one of the cases for telehealth here we're talking about. We're really talking about broad access to telehealth amongst a well, cms, so that Medicare Medicaid population, which has. Really suffered through the pandemic with isolation, loneliness, disconnecting disconnectedness and, and those kind of things.

Um, and, and not everybody has access to high-speed internet, right? I mean, the rural populations, I think this is so important to, to keep, push this proposal through and, and make this happen because they, they can't just hop on a Zoom and have a video chat. So when we look at, I think . There was maybe like a 30% increase of people seeking mental health services over the last year.

Just new access requests. Yeah.

And audio only was a very large chunk. So if you look at who did audio only, it was majority, right? Like for mental health. And I mean, look, we talk about costs and over usage. This is one area that I, I don't wanna cut costs, right? Like, I mean, and you're not cutting costs because if you take away access for people to get help when they're reaching crisis, I mean, what's the financial and human cost to that?

So I think this just makes. So much sense. Right. I just think that this has to, has to happen in my opinion. Yeah. I'm just worried about the, we, we generalize the argument and so we say CMS should, you know, do this massive funding of all telehealth. And I think what CMS is doing is they're. They now have a year and a half worth of data and they're looking through it and saying, mm-hmm, , Hey look, this is preventative.

This is helpful, this is good. We're gonna, we're gonna recommend that this gets funded. And they're looking at these other areas. But when we have things like the American Hospital Association saying, oh no, there should just be this broad whatever. I'm like, we're not making a good argument. We should have data as well at this point.

And. Here. Here are the five to 10 areas where we think telehealth should absolutely get funded follow up visits for fill in the blank. This should get funded at in office visit. And the reason it should is because, and we're gonna make 'em come into the office anyway, and it's just a lot more, it's a lot more productive for everyone if they don't come into the office.

I. Um, so, or if they don't crash into the ER as a physician who practiced for many years, and then now switching over to supporting health systems. I mean, just the cost of that one ER visit versus two or three tele or audio only sessions. I'm no math major, but it's an astronomical advantage. Yep.

Absolutely. Alright, this, so this last one, digital Therapeutics. Why are you high on digital therapeutics? . Why do, why do you think there's, I mean, because you picked this story, so I'm, I'm curious why you, why you picked this story and, and, and why Digital Therapeutics has an appealed I'm more, I'm more fascinated by digital therapeutics than anything because I think it's, it's kind of an unknown

Space, it's unknown, you know, frontier in terms of, of its space. Like where is it gonna go? The business model's weird, right? Like it's not clear cut. The exit strategy's not clear. And yet we're seeing investors put so much money in this space. Like with the prescription digital therapeutics. I mean, we're looking at a hundred million dollars.

Went to Pair Therapeutics, which was like the first therapeutic company by the way, that did AFDA approval for a prescription drug, uh, prescription digital like four or five years ago, 160 million to another one recently. So we're seeing so much investment in this space, but the business model is. Unclear, right?

I mean, very few physicians are prescribing this like less than 5%. It's very limited treatment areas that lend themselves to software only treatment, behavioral health, some pain management, diabetes. I. It's not covered by payers, right? They wanna see data showing that this is clinically and financially valuable to them.

So that in and of itself is fascinating to me. All this money going in, but we don't know the biz model. What's pharma gonna do with this? We've all been watching what Big Pharma is gonna do. So they've partnered with some broken up with some digital therapeutics, tried to invest and do it themselves.

Very few are doing that, by the way. So when we think about that, is it a digital companion? Like do they wanna increase drug revenue and use a digital therapeutic to give away for free? I. To increase their drug or is it truly a prescription digital therapeutic that would be a standalone product? Does that cannibalize revenue?

So they, pharma is sort of like, we're not really sure how we're gonna do this and we're not really investing a lot of effort. So, yeah, I'm fascinated, you know, by this market where it is, how it's rapidly progressing in, in funding. But you know, where is it? Where's it gonna go? Digital, therapeutic startups are getting their fair share of investment dollars flow.

Investment in digital therapeutics grew from 134 million in 2015 to 1.2 billion in 2019. And according to PitchBook, another 709 million was invested in the first nine months of 2020. So you have a fair amount of money heading in that direction. But along the lines of what you said, pair therapeutics is a leader in the field, but the announcement last month that it would go public in a $1.6 billion deal with a spac.

Raise eyebrows, hair cells. Three apps designed to treat opioid abuse, substance abuse, and chronic insomnia. But it's only expected to make $4 million in revenue . So $1.6 billion a year deal, 4 million in revenue. And they do go into some of the partnerships, insurance carriers and pharma might make.

Here they also talk about the, the challenge with, with getting those kinds of longitudinal studies, those studies that sometimes take 5, 6, 7 years and whatnot. Digital therapeutics don't have 5, 6, 7 years of time, really revenue and whatnot to exist, but they almost need that in order to have that, that kind of credibility around are they making.

A clinical difference in what they're trying to, to treat. And so, yeah, and, and then even after that discovery to distribution phase that, like you said, could be many years of the FDA and regulatory process, it's not easy getting approval for these. That's why there's only like a handful of prescription therapeutics that have received that.

And some will say, well, pharma, it's three to five years, $2 billion for a drug. So this is quicker, faster, better, but . We back again to but for whom? Right? And who, who's gonna support this? Who's the buyer? Who's the business model? And we're working with some of these companies at Worldwide. We're, we're working with a handful of these and, and these are questions that we are all asking internally and with the customer.

And I think the answer is kind of unknown all around, right? Like even these companies are trying to figure out who they're gonna be when they grow up. And it's also funny, I mean, to hear these like a hundred million, I mean, I've launched a couple startups and I remember just asking for like . $5 million and the scrutiny of what's your exit strategy?

We don't believe that such and so is gonna buy you. And they ultimately did, but it's just crazy to see $160 million being thrown at an industry where we don't, we don't know. We don't know what that exit strategy is. And it is really interesting and, and it has two problems. And the one problem is insurance carriers won't pay for it yet.

The second is, as you mentioned, only 5% of physicians will prescribe or recommend them at this point. So we have a significant curve to get physicians to, to see the value and start to prescribe it. But why would they prescribe it if nobody's going to be paying for Exactly. That would put it, yeah, that would put it right in the, the, uh, consumers.

It is. It is an interesting space. It's definitely something to keep an eye on. The other thing is if it takes five to seven years to get FDA a approved or, or whatever approval you're going for, you think the technology's gonna change in five to seven years? Absolutely. And that's part of the problem too, is that in order to get these things created and pushed out, it has to be a faster timeline on the FDA side because that's exactly to your point.

The technology will change. A lot of these are AI powered, the model's gonna change. The machine learning is gonna get smarter and . There's a lot of unknowns on the FDA side of how do we even handle this? We're not equipped to necessarily handle this type of solution, and so they're kind of struggling and scratching their heads and talking about putting in place these accelerated approval tracks for things like this.

But yeah, you bring up a good point. There's like a fourth player in the unknown equation, which is the regulatory bodies and how they'll keep up with these technology. It, it is an exciting space. It will take off at some point. It'll be interesting if it folds into the insurance carriers who are using it as a way to keep people healthy and to drive their costs down, or, or pharma who's looking to somehow monetize it.

Or even the healthcare providers who are looking to augment something that they, they're. Yeah, there's, but as, as, as we're talking, you can almost hear we are at the, we're at the, I'm not even sure we're at the starting gate, but we're close to the starting gate either on this, the Olympic time right now.

We're either getting into the blocks or we're just out of the blocks in this, and it'll be fun to, to keep an eye on this. Thank you very much for your time, your valuable time at this point with, uh, with all the stuff that you guys are doing, and I, I look forward to catching up with you at hims. Should be fun.

Yeah. Thank you so much. It was a pleasure and yeah, looking forward to seeing you. What a great discussion. If you know of 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 ACIO today, I would have every one of my team members listening to this show.

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