Mike McSherry, CEO of Xealth, met with host Bill Russell to talk about the digital health startup, digital tools, payers and providers, changes in consumer needs, and the future of health systems.
Xealth is a platform that clinicians use to prescribe digital health tools. Digitally, they can track when patients utilize tools and remotely monitor them. The platform has integrated over 40 vendors for various educational resources, device integrations, and other generic services.
"Our platform is pretty broad in that whatever the clinicians think can be digitally facilitated to improve that patient care or ease of experience, we can put it into our prescribing and then engagement workflow," he said.
Comparing Xealth to Surescripts, a mandated program that now handles more than 90% of prescriptions electronically, McSherry describes the platform as the clinical decision support, the Surescripts of digital health.
The platform operates in real-time and checks patients vitals, clinical diagnoses, insurance eligibility, age, and gender. According to McSherry, the data filters applicable digital tools for individual patients, which a clinician can access with the click a button.
Patient enrollment can also be automated. For example, there is an automated enrollment in their maternity care app for patients over 18 years of age.
There is flexibility on the patient side of operations, McSherry explained. One way is in communication, as there are automated emails and SMS messages sent from doctors.
By monitoring patient app and device usage, clinicians have real-time data for making care assessments, according to McSherry.
McSherry discussed how Xealth wants to be ubiquitous when their customers prescribe digital tools, apps, and devices. Teaming with Cerner, the company has invested in them and marketed them to their provider base. Additionally, it is now the default digital enablement platform for 13 of the largest Epic systems.
According to McSherry, the pandemic brought exponential growth in the digital health space.
"When all patient care essentially stopped, you went from maybe 3% of patients having done some telehealth experience to reaching 80% in some targeted timelines," he explained.
These high levels have declined, but there is a reported new normal of between with 60% going back to in-person care and 40% remaining in telehealth, according to McSherry.
Another area of growth amid the pandemic is virtual care for specific disease states like diabetes, hypertension, behavioral health, and remote patient monitoring.
McSherry explained this was due to the $18 million Teladoc-Livongo merger. It is a sign of the rise of digital health and app-based care management.
He believes the merged companies will expand into more chronic disease states, viewing the decision to move towards an oligopoly-type structure.
"It was a shock to the industry and a real wake-up call; [as to] how the industry is responding, as measured in different increments, depending upon which sector payer-provider, employer, pharma, as to how aggressively they're playing in this digital health game," he said.
According to McSherry, he believes there will be a hybrid model for primary care.
Companies like Optum, Amazon, Walgreens, Express Scripts, and others are trying to attain asset-light infrastructure for virtual referrals, and commercially insured patients.
"You want to close the loop in as much as possible on that virtual experience if it's satisfactory and achieves the need of resolving that patient issue. And only then, if you can't solve it virtually, do you refer them to the expensive hospital system infrastructure," he said.
For Xealth, digital health includes patient education, shared decision-making tools, management apps, and prep and recovery facilities.
The demands of the consumer have changed in the last year, which is primarily the desire for digital transactions, according to McSherry, .
"They can so easily transact in their consumer life against every other element of life digitally, but in healthcare, it sort of hits this analog experience level," he said.
However, this is changing through booking appointments, telehealth, and the resulting care protocol.
Comparing it with Uber, McSherry explained that consumers love the “press of a button” experience. In healthcare, people have to book an appointment, travel to the appointment, wait for it, and receive papers and directions for the next steps.
"What healthcare needs to do is solve that magical middle and the bookend to create a seamless consumer-friendly experience to that patient care," he said.
Even things like parking affects convenience, which spans various activities and interactions, according to McSherry.
Regarding the differentiation of health systems, it is not as much as systems do this against one another than new competitors. Systems need to consider how to remain viable and nonviable.
According to McSherry, he advises hospital systems to look at the neighbor across town as their competition.
"I'd be thinking, five, ten years down the line, how am I more effectively competing against these payers and new entrances to have skin in the game and maintain that patient relationship?" he explained.
With promising statistics for a hybrid healthcare model, it's vital to implement a seamlessly bridged telehealth and in-person experience. According to McSherry, without that intermingling of ease for consumer and patient convenience, hospitals will risk losing everything.
In the sales process, there is a pre- and post-COVID reality, according to McSherry. There is a classic innovator's dilemma because health systems are retreating against their financial impact and trying to out-compete new entrants.
Health systems have to decide if they can invest in digital health features, which will affect the future’s competitive dynamics.
As time goes on, hospital systems will be unable to ignore the digital, according to McSherry.
"Most of those solutions in chronic care have been targeted payer and employer, and that valuation escalation has been focused on those distribution channels, not provider distribution channels. And providers need to step up their game and both capitation exposure and risk, as well as digital enablement of convenience and options. Otherwise, they're going to risk losing that new front door strategy," he said.
Looking at the future of consumer experiences in 2025, McSherry anticipates more proactive care delivered. He also believes in-home sensors and RPM kits will rise in use to provide additional intervention.
He anticipates financial models, business models, and incentives for Americans willing to be monitored for interventive care, which would be more cost-effective. Overall, he believes many consumers will give-up a degree of privacy for their financial savings.
According to McSherry, hospitals need to become bedfellows to better compete against the verticalization of services like Optum, CVS, and Amazon. He foresees partnerships, entities, and collaborations amongst hospital systems to be successful for high acuity care and surgeries.
However, hospitals will have a hard time competing with a digital platform for things that can be done virtually.
"At the end of the day, convenience always wins," he said.
According to McSherry, not everyone has equal access to healthcare. For example, digital tools and convenience options are not yet reimbursed for Medicare and Medicaid patients, often challenged by traveling to face-to-face appointments.
"There's a health inequality that has kind of reached a level here that's been exposed, and I think needs to get addressed. And CMS needs to look long and hard at the efficacy and engagement and results of these digital solutions," he said.
According to McSherry, the economic incentives for the commercially insured are because of the reimbursement rates obtained. However, for CMS to have an increased cap, hospital systems would have to bring prices down, which would force them into more digital automation.
"The hospital system has, and they continue to, add more bodies, more resources, more face-to-face exposure, which in itself is good for employment numbers, but bad for the total economy and the cost of healthcare. And it gets distributed unequally out to the patient population trying to manage their care against the costs," he said.
To learn more about this episode of This Week in Health IT, watch the full interview at www.thisweekhealth.com.
Tess Kellogg – Editor-in-Chief
Katie Talpos – Staff Writer