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TownHall: Exploring the Growth, Challenges, and Future of At-Home Care with Christopher McGhee

December 5: Today on TownHall, Brett Oliver, Family Physician and Chief Medical Information Officer at Baptist Health talks with Christopher McGhee, CEO at Current Health. Post pandemic, how has the at-home market evolved and what are its current challenges? The conversation raises thought-provoking questions: As health systems' financial situations are challenged, are we seeing a cooling of interest in care at home or is it a transition period to a better, more efficient future? How can healthcare organizations adapt to these shifts, preparing for the future without compromising the present? Are bricks-and-mortar health systems ready to offer more consumer-centric services?

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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.

I hear clinician hesitancy over artificial intelligence. It's the same thing, like it's happening. It doesn't, you either choose to be part of this or it's going to happen to you.

There's no control over this. And you therefore are either part of it or you're just going to get swept up in it. And I for one would much rather be part of it and be able to at least try and influence the direction in which it goes.

Welcome to Town Hall, a show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels and events dedicated to keeping health IT staff current and engaged.

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Now, on to our show.

All right. Hello and welcome. My name is Brett Oliver. I'm the Chief Medical Information Officer and a family physician for Baptist Health in Kentucky and Indiana. And I am once again pleased to have joined me, Chris McGee. Chris is the CEO for Current Health, a Best Buy health company, and we're here to talk RPM, remote patient monitoring, anything else that's on Chris's mind today.

So welcome, Chris.

Good to have you. Hey, Brad, thanks so much for the invite. Absolutely.

We'll just jump right in. I wanted to talk first sort of post COVID, or at least post the public health emergency. COVID's still around, but where have you seen the at home market? I mean, that's where you are you know, acutely aware and acutely involved in this at home market of RPM.

Where have you seen it grow and where has it stalled a bit post the public health emergency?

Yeah, so I think during COVID, the immediate need, the immediate problem was Managing capacity within our inpatient facilities and ensuring that we could deliver. hEalthcare services out in the community and in the home.

So there was, you know, massive increase in interest in at home solutions just to try and manage capacity and most of the time the buyers at that point were CIOs, CMIOs who, you know, the problem of we want to do more in the home had already been established and it was go find solutions, applications, technology that can help us do this in the home.

I think that world shifted a little bit and now the problem isn't necessarily.

How do we deliver more care in the home? The problem is... You know, how do we increase capacity in our ER? How do we increase capacity in our primary care? How do we get more throughput of, within our surgical departments? How do we deal with the fact that we've got all these new entrants into the market, like the CVSEs and Amazons who are just by virtue of the type of businesses, they are more consumerized from the outset.

So how do I, as a traditional bricks and mortar health system offer more? Consumer centric services our job is moving from simply saying, Hey, here's this technology to Hey, here's how care at home and here's how our technology and services and knowledge can be used to help solve some of those problems that I just mentioned.

Like here's how we can make you more consumer accessible. Here's how we can expand primary care. Here's how we can do more direct consumer. Actually, one of the interesting things I've seen over the last year is More and more interest from what I'm gonna call traditional bricks and mortar health systems, indirect consumer offerings.

And our job is shifting much more to, to educate on how care at home can help solve some of those near term problems. I think the other thing that I needs to be said is that the financial situation within health systems right now is. You know, way better than me is super, super challenging.

You know, I honestly can't imagine anything more difficult right now than being a health system CEO or senior executive, you know, the combined impact of inflation, rising labor costs, punitive contract negotiations with MA and payers, you know, has all led to this really difficult situation. And I think that's at least causing a slight.

Cooling of the kind of rapid interest we saw in care at home during COVID and in some places people saying, Hey, I'm going to retreat to my core, which is heads in beds. Like, you know, that's my core business.

Yeah, unfortunately, that's tends to be our response as a healthcare organization, right? So, which is, I mean, you spoke a lot of truth about the current sort of financial state, but let's say I recognize that and there are some things I can't do right now from a purchasing standpoint or expanding a service.

With what you said, that shift in thinking and maybe more long term, how could a healthcare organization, you know, shift their thinking or prepare? And change their strategy around and maybe because maybe over the horizon, another 18 months or so, okay, the finances ease up a little bit and we're able to do some things.

Well, I don't want to be starting then as a healthcare. What, where's that strategy or shifting that strategy to align with what you're saying now? Well,

and I think there are some organizations and Baptist is certainly one of them who, who see it that way and who think that, who recognize that the strategic future is not just, heads in beds like that, you know, in five or ten years, that's probably not going to be the way that their businesses are going to necessarily be orientated.

And They are saying, hey, how can we start to build in more direct to consumer, more care at home, more virtual care now into our offerings? But I would say that they are absolutely laser focused on how those do one of two things. Either they generate new revenue or two, they're, you know, in an organization that already has significant risk or is at least trying to take on more risk in a I hesitate to say because I feel like we've been talking for 10 more risk, but it seems certainly that organizations are starting maybe tentatively, famous last words, to embrace more risk.

You know, how can care at home, how can RPM, how can more direct consumer offerings, how can they actually enable risk to be taken on? Because if you're going to go into like full cap risk arrangements, you really care deeply about the life of your member, patient, consumer, you know, in a more long term way than you do if, your financial model orientates around them coming into the clinic or coming into the hospital.

And RPM gives you that visibility into the home and a way to manage that risk. So I think, you know, the forward thinking organizations know that the future is more consumer orientated, and it's more at home orientated than it is today. And they are trying to explore ways that they can do that as long as those ways can either generate meaningful new revenue or allow them to reduce total cost of care and manage risk that they're taking on or want to take on.

Yeah, that

makes a lot of sense. So, kind of along those lines, Is it simply financial at this point, but is there a pivot point of sorts that, that you can envision care at home that would sort of permanently change the industry or this approach to care? You know, we've got a lot of hopefully forward thinking organizations saying, listen, this has got to be where we go.

It's safer. It's cheaper. Patients love it. Or maybe asked another way. What other hurdles are there to more broad adoption of this approach?

sO I think that there's four. The first one's financial, and you know, there has been work done on that, like the acute care at home waiver, which has allowed hospital at home to flourish, was extended by President Biden in January, and hopefully we will see it extended again.

There's been a lot of work done to try and solidify and improve reimbursement models, so there's a lot more to do on that. I think the second one is infrastructure, like You know, if we think about the hospital today, we spent 50 years optimizing hospital workflows to get to the point where you can, with one click, basically admit someone from the ER to the floor and just loads of things just happen to make that work and make it work fairly seamlessly.

the home, that's not true right now. You know, if I look at a hospital home model, just as an example, more often than not, it can take The hospitalists six or seven phone calls to arrange for someone to go into a hospital at home program. If I'm a busy ER attending and I've got, you know, 20 patients waiting in the waiting room, if it's a choice between one click or seven phone calls, I'm taking the one click and I don't really care about anything else.

So we have to build up that infrastructure and that's where, companies like Best Buy that's, many ways up to us to try and bring services and solutions into the market that help improve that. I think the third one is, around regulation particularly as it relates to hospital at home, it's interesting to look at the UK versus the US I get this unique opportunity to see across both, and in the UK, we call it virtual wards, we don't call it hospital at home, but the big difference is that there isn't the same centralized regulatory Requirements as there is in the us.

So in hospital, at home, in the us, you need two or three visits per day. You need, you know, like 24/7 asynchronous emergency contacts. You need to have them within certain geographic range of the hospital and so on. In the UK it's very much delegated to clinical judgment and risk assessment. What's allowed.

So that means the programs in the UK are much, much larger and they're taken in. In many cases, lower risk patients than would be possible within a U. S. hospital home program. It's just not, it's not cost effective otherwise. So I think giving more flexibility and regulation will also help. It's putting too much burden and I think it should be left up to clinical judgment and risk assessment.

And then the fourth one I think is education and evidence. I think that the evidence of how care at home brings down cost and improves outcomes is too woolly it's too unclear. You know, even if you ask right now, does hospital at home reduce cost? There's not really a great answer to that at the moment.

You know, some programs will say definitely. Some people don't want to say definitely because they worry that means they will have to take a different DLG payment for the home than the hospital. It's just unclear. The same is true for things like chronic disease management. I mean, I saw an interesting one the other day where a population health or chronic disease management program it drove up near term utilization.

Didn't bring it down. Now, I actually don't think that's unexpected because you're getting more involved with these patients and you're finding things and that's driving near term utilisation and the real question is, does that bring down costs over you know, the next 36 months? But in a world where people might change insurance plan every year or change employer every couple of years, like that makes that financial case really murky.

And again, I think we need more evidence around it. And we need to use that evidence to educate. Physicians and nurses around why this is a good thing, like when I was in medical school, no one talked about the home as a possible site of care, you know, that wasn't a thing. We need to educate the clinical workforce that the home is a viable site of care, that it's as safe, if not safer than the hospital, that it's something they should think about when they're thinking about how patients receive care and that they should be really comfortable with that.

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Yeah, and I really like what you said about making it easier on the folks that entered the order for it, or that are responsible for making that decision, because you're right. If I have to make seven calls to make sure the meals are taken care of, all the ancillary services, you're right. That's part of my order set.

And I don't even know how all the details are in the hospital. It's just well vetted already. I think that's really well said. sHifting gears just a little bit with you, you know, you and I have talked several occasions about patient generated data that is outside of something that I've ordered as a physician.

How do, and it's becoming more and more important to those. Patients, like I want to get this to my doctor and sometimes it's a thousand data points that as their doctor I really don't want all thousand data points. I can't look at all those. How do we get that meaningfully to clinicians whether it's in an actionable state or just something that's more meaningful?

What are your thoughts just on the current state of the market? In that regard and challenges to that.

So a couple of different things. I think the first thing is that I hear from physicians a lot, you know, Do we even want the consumer to be able to do this? And my answer is it doesn't really matter.

Like the consumer is doing it whether you want it or not. You can't control this. Like this is happening. The second thing then I think is how do we evolve the products and services that are out there? to help the consumer do that in an effective way and join that up to their physician. And what I mean by that is, I think there's more scope for health systems to explore direct to consumer products themselves, where they are going much more proactive and saying, hey, we want, you know, we recommend this for you to monitor and track and engage your health.

At the appropriate time when you know you have some health care event or where we want to check in on you we're able to come in and get access to that information, but it's not all coming back to us 24 seven and its primary purpose is to empower you to manage your own health and educate you on your own health and all that kind of thing.

And then the next part of it is personally think that the. development of LLMs over the last year. We've seen what has happened with while there's a lot of hype around that, I honestly think that some of that is as transformational as the advent of the steam engine.

It is truly incredible technology. We have to use that incredible technology to parse and generate for the physician insight that they can use to take action. Like data for me on the physician is not useful.

What's useful is how do we apply machine learning to that data to surface for the physician, who they need to see who they need to take action on it and what action maybe is most appropriate and, you know, unless we start training thousands more doctors and thousands more nurses, which it does not appear that we are doing, I don't think we have any other choice than that because we need to be able to then scale the resource, scale the capacity of that individual physician.

And that means using machine learning much more effectively than we do today. So

using an LLM, The patient generated data is just one data set. I'm going to, the LLM is going to marry that up with their medication list, their problem list, maybe a nursing note and all that, and then bring that insight to the clinician.

Or other appropriate machine learning model. I mean, you know, LLM is one example, although it's the most transformational that's come out over the last

Yeah. No that's fair. I just, I think that concept is very helpful because when you're trying to think of, let's use blood pressure as an example, if my patient's, getting this data on their own, what do I want out of those 100 blood pressure values?

Do I want an average? No, probably not. And then certainly the range of what I'm expecting is going to differ by patient. I don't want to know every time it's high, but maybe I want to know every time it's this high. Okay. And so to be able to curate that and know what else the person's, on to know that we just stopped the blood pressure medicine, so we do want to pay a closer attention to it.

I think that's very insightful and I hope we can make some advances there with some of these new models because it's going to be needed.

I think the key is how much signal can we really get? I mean, to use the blood pressures example, someone's blood pressure is continuing to go up.

Is that because they're on the wrong anti hypertensives, that they need another anti hypertensive, or is it they're just not taking their anti hypertensive? right now some of that is only able to be answered through a conversation between that clinician and the patient. Like, and even then sometimes it's not necessarily known.

so I think marrying up multiple different signals like, you know, can we not just get blood pressures, but can we understand how often they're filling at the pharmacy? You know, bring that together. It, you know, gives a suggested picture.

Yeah, no, that makes a lot of sense. when I talk to my colleagues, my clinician colleagues, that's the concern is like, I don't have another minute in the day. And that's their hesitation to, I don't want that. And that's the question you're getting where you're saying it doesn't matter if you want it or not, it's coming at you.

So how do we help them from a technology standpoint? I think you make a really good point.

I mean, I honestly think it's the same as like I hear clinician hesitancy over artificial intelligence. It's the same thing, like it's happening. It doesn't, you either choose to be part of this or it's going to happen to you.

Like you will not, there's no control over this. And you therefore are either part of it or you're just going to get swept up in it. And I for one would much rather be part of it and be able to at least try and influence the direction in which it goes.

Yeah, a hundred percent. The common axiom of, you know, AI won't replace physicians, but it will replace physicians that don't use AI.

Yeah, absolutely.

Exactly. All right, well, let's wrap up with sort of a two parter here. What, where do you think this next stage of care at home is likely to look like maybe most immediately? And then maybe a little more esoteric. If you did have a magic wand and you could wave it at the U. S.

healthcare system, what's the one thing that you would change immediately?

sO I think in the near term The most adoption will be focused on use cases that expand most of our health systems are still fee for service. And in that model the most adoption will be in areas that increase capacity and throughput, so, you know, ability to do more.

surgery ability to do more or see more cancer patients. That is where I think most adoption of care at home will be and go. I think in the medium term, and hopefully regulatory change and reimbursement change will help enable this, that's where hopefully you'll start to see more direct to consumer and more, like, long term Care at home solutions that go hand in hand with more risk.

I think if I had a magic wand, I would actually change two things. Like, one is I would love the money to follow the consumer. You know, right now we have this system that the money is very, siloed. I would love the money to follow the consumer. And I think that helps enable a whole bunch of different things.

And I think the second thing is I would just like to improve general education of how healthcare is paid for in this country. You know, most people I don't think really understand, even most, candidly, most physicians. I don't think necessarily fully understand how healthcare is paid for in this country.

And I think that is an obstacle to change because people don't really know what they're arguing for or against. So money follow the consumer, more education of how healthcare is actually paid for. Those

are actually pretty practical. Like that's not something that's would need a magic wand necessarily.

No, it's just not saying it's easy, but uh, well, Chris, man great insights. Thank you so much for taking the time to be with us today. It's always a pleasure.

So thanks. Thanks so much for having me, Brett. Absolutely.

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