This Week in Health IT
October 7, 2020

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October 7, 2020: How can healthcare leaders make recent gains in digital health long lasting? Dr. Kaveh Safavi and Brian Kalis with Accenture join us to share research they did pre and post COVID, right through the lens of the consumer. What do their findings show? Will digital stick around? We know the pandemic forced a surge of adoption of technology for both clinicians and consumers out of necessity, but what obstructions still remain? Do we have it figured out enough to integrate it as part of future care models? What about the financials? Workflow issues? The digital divide? Are there solutions out there? And who do they think is going to lead the way in terms of digital disruption of healthcare?

Key Points:

  • The 2020 survey was conducted to understand consumers’ wants and needs for using technology to manage their health and healthcare [00:04:05]  
  • What are we hearing about privacy and security across different demographics? [00:15:40] 
  • We need to rethink care models. How do we deliver care differently and how do we finance care differently? [00:35:20] 
  • Telehealth, chatbots, portals, online scheduling, mobile apps and wearables [00:03:25] 
  • How can we solve the digital divide? [00:32:30] 
  • Centene and Samsung to distribute smartphones for free to people of need [00:33:45] 
  • Accenture 2020 Consumer Survey

Making Digital Health Gains Last with Accenture Health

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Making Digital Health Gains Last with Accenture Health

Episode 313: Transcript – October 7, 2020

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

[00:00:00] Bill Russell: [00:00:00] Today I’m really excited to have Dr. Kaveh Safavi and Brian Kalis with Accenture health join us. And they’re going to share some of the research they did around digital health gains, pre and post COVID. And it is a great discussion. I’m looking forward to having that, before we get there, I wanted to share some of the things that’s going on our social media channels.

[00:00:19] So a couple things, one, if you want to follow the show and get the clips that we are sharing, the best way to do that is to follow the show on LinkedIn and on Twitter. And we share [00:00:30] those clips and we share who was on the show this week and those kinds of things. So This Week in Health IT  and this week in HIT.

[00:00:37] So This Week in HIT on Twitter This Week in Health IT on LinkedIn. If you want to follow me, I am. Commenting on the industry. I’m commenting on news stories that are out there and I’m posting a story of day and just starting a conversation. If you want to be a part of that conversation, LinkedIn is really where that’s happening.

[00:00:55] Bill J Russell is the way to follow me and, I would [00:01:00] love to have you participate in the conversation. So any of those posts feel free. to comment and I will do my best to continue the dialogue with you. And then I will probably share, I will absolutely share some of that on Tuesday on our Tuesday news day show.

[00:01:17] Stay posted for that. And the other thing I wanted to make is our YouTube channel is growing significantly. The amount of views, the amount of watch, in terms of hours, is all going up. We’ve organized that a lot [00:01:30] better, and it’s a great resource for you and your team. Great way to stay current. Now, onto the show. 

[00:01:40] This Week in Health IT where we amplify great thinking to propel healthcare forward. My name is Bill Russell, healthcare, CIO, coach, and creator of This Week in Health IT, a set a podcast videos and collaboration events dedicated to developing the next generation of health leaders this episode. And every episode, since we started the COVID-19 series, that’s been sponsored by Sirius healthcare.

[00:01:58] Now we’re exiting in that [00:02:00] series and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show’s efforts during the crisis and beyond. Today we’re going to talk about how healthcare leaders can make the recent gains in digital health last and go forward.

[00:02:18] And we have two gentlemen on the show who have done the research around this. So I’m excited to have the conversation Dr. Kaveh Safavi the Senior Managing Director for Accenture Health and Brian Kalis, [00:02:30] Managing Director for Accenture health. Welcome to the show gentlemen. 

[00:02:34] Kaveh Safavi, M.D.: [00:02:34] Thanks Bill. 

[00:02:36] Bill Russell: [00:02:36] Yeah, I’m looking forward to it and a Kaveh I love the, background. I know I’ve said it before the show, but I have to say it again. It’s such a, that is a fantastic office for someone in your organization. 

[00:02:51] Kaveh Safavi, M.D.: [00:02:51] It’s a real office and I like it. Cause it reminds me of places I used to travel before COVID grounded me. 

[00:02:57] Bill Russell: [00:02:57] Yeah. And you, were one of those, one of [00:03:00] those like platinum players on one of the airlines, 

[00:03:03] Kaveh Safavi, M.D.: [00:03:03] Right? Yeah. They miss me. 

[00:03:06] Bill Russell: [00:03:06] I would have imagined, I’m looking forward to this conversation. You guys went out and did the research that we’ve all really wanted. It wanted to have happen around this, topic of digital health. And we interviewed like during COVID we interviewed, 40 some odd CIOs.

[00:03:23] And, we heard things like, telehealth, we heard adoption of chatbots. We heard, usage of the [00:03:30] portals and online scheduling just skyrocket, went through the roof. But we have since heard it come back to, not to pre COVID levels, but come back down to earth a little bit. So I wanted to explore that a little bit with you. So talk from your research, talk a little bit about digital health adoption prior to COVID. 

[00:03:51] Kaveh Safavi, M.D.: [00:03:51] Sure. 

[00:03:52] Brian Kalis: [00:03:52] Yeah. And, Hey everyone. So I’ll start by just describing what we did with the survey. So for the past few years, we’ve [00:04:00] conducted a survey to understand consumers, wants and needs for using technology to manage their health and healthcare. Our 2020 survey was conducted prior to COVID-19 community spread. 

[00:04:14] What we found was before COVID-19 digital health was stalling. In our last year survey, we found digital health was reaching mainstream where a majority of people were stating they were using a mobile health [00:04:30] app or a wearable to manage their health or healthcare.

[00:04:33] This in our 2020 survey, we found that had dropped considerably of specifically related to wearables. And ultimately those adoption rates were stalling. Interestingly younger generations were where we saw the biggest dip and older generations were holding stable. 

[00:04:52] Bill Russell: [00:04:52] Okay. Interesting. interesting. So does it really focus in on just wearables? [00:05:00] Are you looking at a lot of different technologies, like, telehealth and other things to that effect? 

[00:05:04] Brian Kalis: [00:05:04] We looked broadly at a set of technology? So we looked at do the use of mobile health apps, wearables, Attitudes and preferences towards the use of chat bots or, clinician assisted machine intelligence, as an example, as well as virtual health as a broader category.

[00:05:23] Kaveh Safavi, M.D.: [00:05:23] And Bill to put it in context, if you look, we do every two years and every two years, the average kept going up. [00:05:30] And what happens in the last two years is that the, the seniors, for example, stayed about one out of five. and the younger people, wear like 60% are drifting down to 50%. And then, in the middle, it’s hanging in the thirties. But in aggregate, what you’re seeing is a leveling off.

[00:05:50] Which is why we call it a plateau and that’s very different than the previous trend. And then we use the survey to really dig into that and figure out why, in fact that [00:06:00] leveling occurred and then COVID occurs. So we had to then reinterpret, what does that plateau mean, given what we’ve discovered in the flattening of this adoption curve, that’s been occurring over half of a decade. So that’s really an interesting thing we should talk about. 

[00:06:14] Bill Russell: [00:06:14] Yeah. So, COVID, does hit and it really does change things pretty significantly. You were mid study. How did you adjust? And, then what did you find as, COVID was progressing? 

[00:06:29] Kaveh Safavi, M.D.: [00:06:29] Sure. Brian, why don’t [00:06:30] you take that?

[00:06:30] Brian Kalis: [00:06:30] Yeah what we found was COVID forced a surge of adoption and the use of technology to help people with their health care. And that was really because of necessity. People needed to shelter in place and stay safe in their homes. As a result, you were seeing clinicians recommending a set of digital technologies as a way to diagnose and treat as well as manage their health and health.

[00:06:56] As an example, if you look at virtual health, [00:07:00] prior to COVID you were saying maybe 200 visits a week, each system was slightly different and that skyrocketed after COVID where, upwards of 10,000 visits a week, we’re coming in per system. 

[00:07:13] Kaveh Safavi, M.D.: [00:07:13] In fact, I’ll recharacterize that a different way. If you look at the total number of visits in the United States, pre COVID, somewhere in the low to mid, single digits was the number of total visits that were done through a virtual kind of a [00:07:30] platform. And in May of this year, when we had the maximum impact of the shutdown and only the COVID cases and emergency cases were being seen in person, the snapshot reports were that we were in the mid fifties of all healthcare being delivered virtually. So that was essentially, going from let’s call it five to 50. Yeah. And then we’re already beginning to see that number settling back down. And one of the big discussions is where will it settle at? [00:08:00] And the, our study actually identified three reasons for why that the rate had been plateauing. One of them had been, if you have a bad experience, you don’t use it again. One of them being because if your doctor doesn’t recommend it, because it doesn’t workday, you don’t use it. And one  being you don’t trust who has trhe data. COVID specifically addressed the second one?

[00:08:23] Because it forced the doctors to actually have to use it. They had no way other option. And what we [00:08:30] think is that, COVID didn’t really address the user experience because the technology was the same technology and COVID didn’t solve for the problem of who has my data, all it did was it Ray everyone’s awareness of it, but it didn’t address the issue of confidence, but it absolutely did drive it into the workflow.

[00:08:46] And so our sense is that whatever the natural curve, it was a virtual healthcare specifically telemedicine as a component of digital, we definitely brought forward a number of years in terms of how fast it’s going to, to stay. We [00:09:00] think it’ll settle around a third. Some people think it’ll settle it more than that. We’ll see.

[00:09:04] Bill Russell: [00:09:04] That’s what I’m really excited to explore with you guys. So you gave three reasons, one being the, the physicians, one being experience and one being privacy. 

[00:09:16] Kaveh Safavi, M.D.: [00:09:16] Yes, that’s right. Those are the three dominant, reasons. Yes. 

[00:09:20] Bill Russell: [00:09:20] It’s interesting cause I’m wondering, I’ve known this for years, cause I’ve sat in front of physicians trying to have conversations around telehealth.

[00:09:27] And I’ve literally had [00:09:30] physician said over my dead body. And people think, oh, that can’t be true, but those are difficult conversations. You’re asking them to change their practice. There is financial challenges to doing that and, and quite frankly, a digital workflow requires a little different, not only technology, but a different, underlying infrastructure to make that happen. And so I see that, I understand what you’re saying, that they were forced to, so health systems were forced to put that [00:10:00] underlying infrastructure. They’re forced to put the technology in and that really drove it. so if, financial systems stay in place and those things are in place, what’s going to cause it to come back?

[00:10:13] Kaveh Safavi, M.D.: [00:10:13] Yeah so a couple of things happened in some cases, people were being seen virtually. Because that was the only available option, but yeah, the best option. So let’s just say for the example, for the case of, it would be great if I could examine you. Get your vital signs, listen to your heart.

[00:10:30] [00:10:29] Or maybe I could obtain a lab specimen or a culture or something like that. But if that’s just too hard to do or not safe, then I’m going to make my best guess based on history. And maybe some, show me the point, the camera at whatever I you’re, complaining about. Let me try to guess. And we see some percentage of that rolling back, because it was good enough in the absence of no good alternative, but not ideal. And that’s it’s an interesting area for future opportunity, because if people figure out how to [00:11:00] do some things virtually that they haven’t done before, you can maybe close the gap of the ability to examine someone without them being in front of you.

[00:11:08] I think that I want to go back though. And Bill, you made the point about how hard it was to get doctors to adopt. We actually saw. health systems using the same approach they use for the adoption of the electronic health record. That level of personal support around the first days of youth, literally, where do I put my mouse?

[00:11:25] What do I click? How do I turn it on? They had to take that approach. [00:11:30] And, but once the doctors got through the learning curve, just as with electronic health records, they started to see some of the benefits of it. And so we think that once they realize they could use it. They’re going to see some convenience aspects to it. So in some practices, people are going to go wait a second. Now that I know how, and I’ve gone through the pain of learning, how to use it, this is actually an easier way for me to organize my day. 

[00:11:53] Brian Kalis: [00:11:53] Yeah. That’s an interesting point. We found that the forced adoption, both for clinicians and consumers, after they tried [00:12:00] it, many of them were Hey, this actually has a use. This wasn’t that bad. And now it’s figuring out, how do we actually integrate it as part of care models in the future? 

[00:12:10] Bill Russell: [00:12:10] But one of the things about, w you talked about the experience I’ll. Yeah, it wasn’t just a natural expansion. It’s not like we had, we didn’t have Teladoc in place and just expand it.

[00:12:23] And everything was fine. A lot of health systems were, they were using FaceTime. They were using Microsoft Teams. They were using [00:12:30] Skype. They were using, whatever they could throw together, which speaks to that experience. Some people had, there was an uneven experience in terms of an integrated scheduling doctor showing up on time, documentation, follow up because we threw it together. Did you find some of that in your research? 

[00:12:48] Brian Kalis: [00:12:48] Yeah. On the, prior to COVID, the, area of consumer expectations and just the quality of the experience, was a very important thing before COVID. [00:13:00] Prior to COVID people were stating that a majority of people stated that a bad digital experience with a provider would ruin the entire experience. Now, some of that was relaxed out of necessity, during the COVID environment, but we predict that some of those expectations will come back and there’s going to be a need to really more tightly integrate digital services into existing models and reduce some of the friction that existed out of necessity in COVID times.

[00:13:28] Kaveh Safavi, M.D.: [00:13:28] In fact what’s interesting is about [00:13:30] half the respondents in the survey said that if they had a bad experience, they wouldn’t go back. And about a third said if they had a great experience, they would go back. So this gets into this interesting conundrum of which is more important, not having a bad experience or having a great experience.

[00:13:44] And for some people, each one works, but I think in healthcare, we’ve learned in general that a bad outcome is far more impactful than a good outcome is in terms of changing people’s behaviors. 

[00:13:57] Bill Russell: [00:13:57] That’s a, that’s interesting cause that’s [00:14:00] people are irrational, and I’m not talking to the broad audience. It’s not like I’m Joe Rogan and millions of people are listening to this and they’re going to write me, but just in general, if I have a bad experience at the hospital, if I walk in there and I meet my doctor and it’s a bad experience, you know where I’m going the next time for care, I’m going right back there.

[00:14:18] That’s my primary care doc. That’s my insurance. Most likely I’m not going to change, but if I have a bad digital experience, Oh the heck with this, I’m going to right back to the office. But you wouldn’t have the [00:14:30] other, I had a bad office experience. I’m going to digital.

[00:14:32] Kaveh Safavi, M.D.: [00:14:32] Right. We have some interesting data around who trust from an outcome perspective and patients still trust their clinician.

[00:14:39] 70% place the greatest amount of trust in the healthcare they receive. from a clinician. And whereas from a digital perspective, that’s more like in the thirties, we haven’t gotten to the place where people are comfortable on a equivalent basis between the two. And I think the important thing to think about digital health is it’s really a tool that [00:15:00] expands and augments the formal care system.

[00:15:02] It creates optionality for certain things. It’s not like we’re going to go from one to the other. It’s really that digital is going to become part of the way we do care and allow. People that have options in the way that makes sense for them. 

[00:15:15] Bill Russell: [00:15:15] Yeah. I want to talk about this privacy and security and we focused it in a little bit too much on telehealth cause there, is this remote patient monitoring we’re seeing, we’re seeing Mayo really drive this forward. We’re seeing other systems, especially with chronic conditions during COVID [00:15:30] became very creative in terms of, providing some devices locally. But a lot of that comes back to privacy and security. What are we seeing? What are we hearing across the different demographics about privacy and security?

[00:15:45] Kaveh Safavi, M.D.: [00:15:45] Brian, I’ll let you take that. 

[00:15:47] Brian Kalis: [00:15:47] Yeah as it relates to privacy and security, there is, there’s really a big opportunity to establish trust. And there’s a lot of concern related to who is a trusted source of [00:16:00] your health information.

[00:16:03] As you can imagine the primary, the source of trust that exists is with, clinicians and providers. and there’s more skepticism and less trust when you look at some of the new entrants into the healthcare space whether it’s the large tech platforms or other retailers in general, this kind of signals the need to figure out how do you communicate and how you are being a good steward of people’s data and [00:16:30] how you use that go forward to build trust. 

[00:16:35] Bill Russell: [00:16:35] Let me ask you this. So are so in my local market, the health system is a trusted name, it’s quality it’s and my neighbors work at that health system. They’re trusted. But Apple is also a trusted name. So are you finding people trust Apple with their data more than they trust their local health system? And given this week, we’re, recording this in a week [00:17:00] where UHS has been compromised. Nebraska Medicine has been compromised. The number of. there’s just a number of, systems that are getting hit with ransomware. And those kinds of things. Is that playing a role in how people view their, privacy and security of their data.

[00:17:18] Kaveh Safavi, M.D.: [00:17:18] I think there’s two different dimensions to that statement. One of them is around privacy and one is around security. So on the issue of security, meaning who’s going to protect my data from getting stolen, interestingly [00:17:30] enough, People generally believe that the delivery system is the best at protecting their data from getting stolen.

[00:17:37] And all of our empiric research suggests that they’re the worst at protecting the data from getting stolen. And they generally would place the least amount of trust in the government in protecting their data from getting stolen. But the truth of the matter is that is the best entity to keep your data from getting stolen.

[00:17:53] The different issue on trust is. Who’s going to do the right thing with my data who is going to use my data for a good purpose. [00:18:00] That’s where we get into complicated issues about is someone going to sell my data to someone else that’s going to try to make money off of it or market things back to me, that’s where we start to get into trouble. When third party companies who are not providers have my data, because I don’t actually know what their business intent is. And we’re not talking about stealing, we’re talking about purposefully using it in some fashion. And that’s where I think the big tech companies have some work to do. 

[00:18:30] [00:18:29] Brian Kalis: [00:18:29] And interestingly, when we looked at that younger generations did have greater trust in tech companies and retailers than older generations to provide health services. However, an interesting thing I think in our data is. Gen Z, has an interesting pattern where it isn’t as strong of trust relative to Millennials and Gen X. So that’s something we’re going to be watching in the future. 

[00:18:56] Bill Russell: [00:18:56] Yeah. Talk, expand on the demographics a little bit. [00:19:00] So I want to look at the demographics in two directions. I want to look at the demographics of people using it. I also want to talk about the clinicians. How are, are we seeing adoption? I don’t know if you break it down in this perspective, but adoption for, older physicians and younger, physicians and those kinds of things. Let’s, start with just the general population. Digital health adoption. You touched on this earlier, but yeah. what are we seeing in terms of just broadly across the [00:19:30] board is, you talk about gen X and you’re talking, w when we talked about it and we talked about the young invincible and then the chronic patients, these are two very different categories. Is it better to look at it that way, or is it better to look at it based on, the traditional demographic breakdowns? 

[00:19:50] Kaveh Safavi, M.D.: [00:19:50] The way, I think about it right now, the cohorts that are the most natural are the baby boomers and older, so call them 56 years old and older. and then you see [00:20:00] the Gen Xers that sit between there they’re 40 in mid fifties, and then you start and then you see the younger cohort, which Brian made the point that very young, the people, the people under the age of 25 are actually different than the people between 25 and 40.

[00:20:15] What, so what we see for example is if you’re a baby boomer, and this is actually, I used to talk about this where the older people, where the post baby boomer. And then I realized I’m a baby boomer. I’m in the older generation. Now in every data set, I’m considered [00:20:30] older because baby boomers are older.

[00:20:32] They’re sitting in that kind of one out of five range for using these kinds of technologies. And then if you go to the Gen X or so, the people in their thirties, in their forties and early fifties, they’re sitting more in the mid thirties, 30 to 40% range. And then when you go under the age of 30, and this is all technologies put together, it just, think about it as digital and totality, wearables apps, virtual healthcare. When you get to the younger [00:21:00] than 30 that’s where you start to see, 50%, 50% plus using something for digital. And then what Brian’s point is, that the issue of who do you trust with your data is interesting because in that young group, the very young, they’re just as skeptical as the middle aged people as to whether the data is going to be used and monetize in some fashion. So they still use it, but they have a much keener awareness of the fact that they’re trading their data for something. And they’re not [00:21:30] exactly sure how it’s going to get used.

[00:21:31] Bill Russell: [00:21:31] Is there a breakdown by doctor by type of practice or complexity of the of their practice or by age, in terms of their adoption of digital health? 

[00:21:42] Kaveh Safavi, M.D.: [00:21:42] Yeah. Our studies didn’t take on the doctors. It was strictly through the lens of the consumer, but I will tell you that it’s, when you look at the doctor’s side of the equation, it is more complicated than you think because the workflow issue confounds the discussion.

[00:21:58] So if you were to look at doctors as [00:22:00] users of digital technologies, not technologies for work. Doctors are actually some of the fastest adopters of digital tools and toys in their life. look at, for example, the introduction of an iPad as an example, or an iPhone, they used it, they were one of the fastest classes to use even for just their daily life.

[00:22:19] I think the challenge has been that digital health technologies don’t fit into the workflow and because they don’t fit into the workflow, you get very different kinds of adoption. So if you’re [00:22:30] primarily a hospital based doctor, you might get one experience. If you’re an office space doctor, you might get another experience. The act of having to type data in has been such a drag on productivity that it’s really, cause a lot of doctors would just hold off on using technology in their, workflow until they can solve for that problem. 

[00:22:49] Bill Russell: [00:22:49] All right. I want to get to what will make digital health stick. one of the reasons I think a video visit makes the most sense is I can sit here and be typing right now.

[00:22:56] I can be taking notes on this and it would appear to you that I’m looking [00:23:00] at you. Whereas that was one of the biggest drawbacks in going to an office that they were staring at a computer while you’re sitting over here. And we’ve done a lot of things to enhance that, we have nuance and we have other types of technologies for a voice and whatnot, but still there’s that impersonal aspect of it.

[00:23:18] Whereas with this, I could be looking at it. But let’s, I think the thing everybody wants to, what does your findings show in terms of making digital stick, moving forward? What do we need to do, to, to, really see [00:23:30] those gains at a higher level? 

[00:23:33] Brian Kalis: [00:23:33] One key thing we need to do to make a digital adoption stick is really leverage the trust of clinicians to get those recommended and trusted recommendations to consumers. What we found prior to COVID is. A majority of people really wanted their clinician to recommend quality solutions. Like over 50% were like, I really would like, that trusted recommendation of what’s good versus not good. It helped me manage [00:24:00] my health, but only 11% of people were receiving that type of recommendation from their clinician.

[00:24:06] Now what COVID did is now you have out of necessity, recommendations were coming for, clinicians to use a collection of digital tools to help people stay safe and healthy, in the safety of their homes. So the question is, how can we continue that momentum of that trusted recommendation and referral from clinicians to consumers?

[00:24:31] [00:24:30] Bill Russell: [00:24:31] Interesting and I think we knew this. The physicians are an extremely important piece of this puzzle. They are trusted. WHen your physician tells you, Hey, here’s your prescription. Go to the pharmacy. You do that. And one of the things I’ve, said a couple of times is, very few people have seen me naked. My doctor has seen me naked. it’s it’s that level of trust. We have a close bond. So when they say, Hey, I’m going to [00:25:00] use it for this visit. Don’t worry about it. It’s pretty common. It’s just a follow up. I’m going to trust that, recommendation. That is, probably the leading indicator of people’s use isn’t it. it’s the, physician’s recommendation. 

[00:25:14] Brian Kalis: [00:25:14] Yep. Agreed. It’s also important to think of the other side of the equation as Kevin was alluding to earlier. Kaveh, do you want to talk about just the workflow integration and how to make that work? 

[00:25:24] Kaveh Safavi, M.D.: [00:25:24] Yeah, because, and you made this point Bill, if you, if, there’s no natural way to fit it into the day, [00:25:30] for example, then, it becomes a distraction to the way the doctors are working and, everything from do I go between, do I have all physical visits and virtual visits, or do I go between, and what happens if I decide in the middle that I have to order a test or I need to examine you?

[00:25:48] And so the more that we can, Address those, the more likely it is that they’re going to use it without it being a distraction to the way they do their workday. there is a lot [00:26:00] of bad side and then the other side, and we saw this with the forced adoption of virtual health. Is it the, technology on the patient’s end isn’t perfect and seamless. And if you talk to clinicians, they’ll tell you what percentage of their, essentially, a telemedicine visit with video bombs out and becomes nothing more than a phone call because the patient’s side they just can’t figure out how to make it work or they can’t get connected.

[00:26:24] So you’ve got, let’s call it workflow issues on both sides of this [00:26:30] equation in order for everything to try to work. And I think that, to Brian’s point, people were forced to use it. They saw some of the benefits, but they also see some of the warts and the ability to get it to stick is directly related to now going in and trying to make those things better.

[00:26:49] In order to take advantage of it. And I think what you’re going to see, he is a split. You’re going to, I see a group of physicians and providers who recognize that actually a physical digital blend is a more [00:27:00] optimal way of providing care. I can allocate my resources better. My doctors can actually see more people without adding more doctors. THey’ll make the investment than we’ll look at it and say, you know what I’ve got an office. I’ve already paid for it. I’ve got staff. I don’t really need to go to the effort of trying to sort all that stuff out, just come back in. And so you’ll see some percent slide back because they don’t, they’re not ready to make the additional investment. And then others will see the return on investment in the future and continue down [00:27:30] that path.

[00:27:30] They’ll take advantage of the accelerant. So I expect to see separation of behaviors post COVID in terms of who makes the investment to persist and who basically rolls back. 

[00:27:42] Bill Russell: [00:27:42] Yeah. this, whole concept of care to distance, I think is going to be something we look at as a COVID generated thing. We’ve, talked to health systems where, even within the hospital, they’re limiting the number of touch points, not only with infectious, but with other patients as well. And they’re [00:28:00] finding ways I would assume. so that would be one aspect. We’re making the case to physicians that would be one aspect of, it’s safer and in some cases to do care to distance. And then the second I would make is, look, we’ve been talking about quality of life and getting you home by five clock for a long time. How about we get you home by noon? You have office hours during the week that are 8:00 AM to 12, and the rest of your visits are telehealth from home because there’s no, viable reason for you to be.

[00:28:30] [00:28:29] We could really. Make a if, again, a lot of this depends on the financials, the reimbursements, and a lot of it depends on the tools and technologies and the workflows we talk about. But if we can, solve those problems, we can actually, do rounding this way. We can do.

[00:28:46] There’s a lot of things we can do with these technologies as we’ve proven during COVID I think, 

[00:28:51] Kaveh Safavi, M.D.: [00:28:51] Yeah, we’ve written, specifically about the fact that physical distance as a requirement. [00:29:00] And a benefit is now in the calculus for virtual. It used to be that you thought about virtual healthcare and you have to do a return on investment and it was strictly either access, preference or financial. Now safety is a new return on investment calculus because I think our society is now accustomed to the concept because of this pandemic. That infection spread and separation is one way to control it. And the longer we deal with this [00:29:30] pandemic, the more that will get burned into our psyche as a way of doing work, just like physical security became part of our mentality after 9 11.

[00:29:40] Even though we don’t have continuous acts of terrorism, no one would expect physical security to be absent in any, in a number of settings. It’s just taken for granted. The distance and disease contagion gets baked into the way we think about healthcare. Maybe the way we think about travel, the way we [00:30:00] think about hotels, all these kinds of things suddenly have to deal with physical distance and contagion as just a normal part of doing business. And that gives doctors the opportunity to do this. Waiting rooms. We’re seeing, we’re seeing health systems now say, I eliminate the waiting room for COVID, but if I really think about it, who needs a waiting room and they’re actually redesigning. The office experience to eliminate the waiting room for everybody forever into the future.

[00:30:26] Brian Kalis: [00:30:26] And Kaveh is really pointing out the opportunity. And this is [00:30:30] an opportunity that we call out in the report and that’s, this really creates an opportunity for healthcare enterprises to not just think of, am I adding digital or adding a virtual channel to connect. It’s really how do we rethink the care model?

[00:30:45] How do we rethink the care model to blend digital and physical, to change the nature of, different roles being incorporated in that to address many of the items caught in. 

[00:30:56] Bill Russell: [00:30:56] What are some other things that we need to take into account in order for these central games to [00:31:00] stick? I don’t know which, one of you wants to answer that?

[00:31:03] Brian Kalis: [00:31:03] Yeah. One important thing we need to consider as digital increasingly becomes part of care models is the digital divide and that’s because consumers are not benefiting evenly from digital health. we need to think through, who has access to broadband access, other forms of technology and how do we ensure equity and equitable access to the technologies, to enable digital care models?

[00:31:30] [00:31:30] Bill Russell: [00:31:30] It’s interesting. I had that conversation on social media just this week. Cause one of the things I’ve been I’ve now said twice on social media is if the government wants to fund something, one of the things they might want to consider funding is getting everyone a cell phone. Because that’s and a data plan because to a certain extent, I don’t know how people function anymore. That’s how we look for jobs. It’s how we get directions to things. It’s how we find a doctor. It’s how we visit with the doctor. There, really is. And, [00:32:00] broadband access is one of those, one of those really challenging topics to talk about everyone feels like the government should solve this.

[00:32:07] But, it feels to me like space X is going to solve this. they’re going to, there, are some commercial as well as government ways that we can get everyone broadband access. But at the end of the day, if I don’t have that device. That gives me that is the end point for that it is, you’re, seeing, those [00:32:30] divides. Are there solutions out there? Are there, are people talking about how that is going to be solved? 

[00:32:35] Kaveh Safavi, M.D.: [00:32:35] Yeah, I think it’s interesting because on one hand, digital actually solves an access problem that existed before digital technology.

[00:32:41] It makes it possible to reach distances that you couldn’t reach or spread out resources in ways that you couldn’t spread out or maybe break the link of time to two people, can’t be in the same room at the same time, but they can have a conversation. So arguably digital has improved access, but it doesn’t guarantee access [00:33:00] because at the end of the day, you still need the technical ability to interact.

[00:33:03] And for example, in some developing countries where there is no broadband connectivity for that very last mile, we’re seeing interesting models where you take a, a lay person train them a little bit and then give them a smart device. And then they can physically go into a setting. In fact, it’s even being used in some, low income communities in the United States where a local healthcare worker with a smart device essentially closes that last one [00:33:30] digital access for some people.

[00:33:33] Brian Kalis: [00:33:33] We also see this as a unique room for collaborations, and we’re starting to see some of these materialize in the market today. So recently Centene has announced a collaboration with Samsung to distribute phones for free to people of need. And we’re seeing things like that and different ways of trying to address the gap.

[00:33:53] Bill Russell: [00:33:53] Yeah, that’d be good. So let me close on it. This has been a great discussion. I really appreciate you guys coming on. [00:34:00] And, at the end, I’m going to provide some information on how to access the report. And I think it’s a must read. Who is, I’m looking at things and I’m constantly talking to healthcare systems about being disintermediate, right?

[00:34:17] Allowing people to come between you and your customers. Now there’s a lot of things in terms of, networks and whatnot require people to keep coming back, but we keeps seeing these moves by [00:34:30] players of acquisitions and just little pieces that organizations keep getting in between health providers and their customers.

[00:34:41] Providers, payers, retail, tech companies. There’s a lot of movement here. digital is probably one of those ways that people can really disrupt. We know that they can disrupt the market. Who’s gonna lead the way in terms of digital disruption of healthcare do you think? This [00:35:00] may not be in the report, this might just be an opinion.

[00:35:02] Kaveh Safavi, M.D.: [00:35:02] Yeah. Brian, you want to give your thoughts and then I’ll give mine. 

[00:35:07] Brian Kalis: [00:35:07] Yeah, I yeah, I think there’s the opportunity to lead the way as coming from incumbent health organizations and really those that are seeing this, seeing the current learning as a way to rethink care models and how do we both deliver care differently and finance care differently? [00:35:30] In many cases that will come also through collaboration with many of the non traditional entrants that are entering in to the market as a way to compliment to create a new ecosystem. 

[00:35:42] Kaveh Safavi, M.D.: [00:35:42] And Bill, the way I think about it to add to that is I think you have to separate out the technology from the sponsor of the technology. And when you ask that question clearly, technology companies will build capabilities, but the question as to who’s going to own and use that technology is I think wide open right now. And it’s honestly, [00:36:00] it’s the delivery system to lose because what we’re seeing more and more of is just like when we wake up in the morning and we have a question about anything in life, often times we start with a search of some sort and the majority of those searches are done on Google. Health actually inquiry start the same way. And the simple question is. Where’s the first place. I start on my journey. That doesn’t necessarily mean that I don’t, I’m not going to go to my doctor, but let me set, figure out what my options are. And the sponsor of that can be [00:36:30] a health provider organization. It could be an insurance company, it could be a government, it could be a third party company, a brand we’d never heard of. It could be anybody, but if people don’t recognize the fact that if you just, the journey, there’s an opportunity to use a digital platform to be the first thing people think about to start their journey, then you lose the opportunity to be in that flow. And, I would say right now to the provider, organization’s listing here, if you take it for [00:37:00] granted that people are going to come to you as the first stop, you’ll find out that there’s a stop before you and someone, anyone, other than you could step into that. If you don’t step into it. 

[00:37:12] Bill Russell: [00:37:12] Fantastic gentlemen, this is a this has been a great conversation and I really appreciate you, doing this research and, coming on the show. It’s really been fantastic. Thanks. And thanks again for your time. 

[00:37:25] Kaveh Safavi, M.D.: [00:37:25] Thanks Bill. Take care. Bye bye. 

[00:37:29] Bill Russell: [00:37:29] That’s all for [00:37:30] this week. I want to thank our guests for sharing their research. If you want access to the report, easiest way to get it is, no spaces. So 2020 consumer survey. Special thanks to our sponsors, VMware, StarBridge Advisors, Galen Healthcare, Health Lyrics, Sirius Healthcare, Pro Talent Advisors HealthNXT and McAfee for choosing to invest in developing the next generation of health leaders. If you made it this far, you’re a fan of this show. You can do one of two things for us.

[00:37:59] It [00:38:00] would be greatly appreciated. One, share it with a peer, just let them know that you’re getting value out of the show. The second thing is go up to iTunes and leave a review on the show, and that helps us as well. Please check back on Tuesday for news, Wednesday for solutions and Friday for interviews with industry influencers. Thanks for listening. That’s all for now.

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