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?
Newsday – Workforce 2021, CMS Mental Health Telemedicine and Digital Therapeutics
Episode 431: Transcript – August 2, 2021
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] Welcome to This Week in Health IT. It’s Newsday. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.
[00:00:18]Special thanks to Sirius Healthcare, Health Lyrics and World Wide Technology who are Newsday show sponsors for investing in our mission to develop the next generation of health IT leaders. We set a goal for our show. And [00:00:30] one of those goals for this year is to grow our YouTube followers. 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 produced those clips just for you the busy health IT professionals. So go ahead and check that out.
[00:00:55]A common question I get is how do we determine who comes on This Week in Health IT? To be honest, [00:01:00] 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 group larger and larger and it helped us to expand our community of thought leaders and practitioners who could just share their wisdom 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 [email protected] We’ll take a look at it and see if there’s a good fit [00:01:30] to bring their knowledge and wisdom to the community as well. It’s news day. And today we have Dr. Sanaz Cordes on the line. And good morning Sanaz. Welcome to the show.
[00:01:41] Dr. Sanaz Cordes: [00:01:41] Morning. Yes. How are you doing today?
[00:01:44] Bill Russell: [00:01:44] I’m doing pretty well. You’re in a different world than I am. And first of all, you are you’re on the west coast, right?
[00:01:50] Dr. Sanaz Cordes: [00:01:50] That’s right. Central coast of California.
[00:01:54] Bill Russell: [00:01:54] My understanding is that you’re with WWT and the work with clients has really taken off [00:02:00] 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 getting done right now. So you’re probably more busy than I am.
[00:02:20] Dr. Sanaz Cordes: [00:02:20] It is pretty busy. Pent up’s a good term too because I think people have just been. Desire to get back to face to face and white boarding and all the things we’ve had to improvise. [00:02:30] So, yeah, it’s busy but a good shift.
[00:02:33]Bill Russell: [00:02:33] Microsoft released their work trends index for 2021. I think that’s gonna be an interesting conversation. CMS is going to permanently cover audio only telehealth and telemedicine for mental health. And I think we’ll hit on that as well.
[00:02:47] We’re gonna talk about digital therapeutics. I want to start with a short conversation about HIMSS. or You’re going to HIMSS?
[00:02:54] Dr. Sanaz Cordes: [00:02:54] I am. My team is going.
[00:02:56] Bill Russell: [00:02:56] Your team’s going. I am scheduled to be there as [00:03:00] well. I got an email yesterday from their head of marketing, I think for HIMSS. And they said 19 right now, 19,000 people are signed up to be onsite. And to put that into perspective for people, I think the last one I went to was 40 something thousand.
[00:03:18] Dr. Sanaz Cordes: [00:03:18] Yeah, 43,000 was the last one I went to.
[00:03:21] Bill Russell: [00:03:21] Yeah 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 digital and virtual, because they have a, [00:03:30] 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 will you approach 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.
[00:03:56] How is your team going to approach this? Do you have a, like a playbook that you guys [00:04:00] run? Like we’re going to see as much stuff as we can talk to as many clients. I mean, how do you, how do you approach it?
[00:04:05] Dr. Sanaz Cordes: [00:04:05] 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 network that we built the last 20 years. So just reaching out and trying to get some of that scheduled ahead of time, because yeah, there’s a lot of unknowns the digital thing is new. We don’t know how that’s going to play out. So we’re just setting up a lot of chats ahead of time. And we’re actually [00:04:30] going to be in a partner booth demoing one of our kiosks that we did for CDC attestation.
[00:04:35] So hopefully we’ll get some folks there. And I personally it’s positioned plan on attending some of the educational sessions and things like that. So hoping it will be good. And maybe 20,000 folks we’ll make it a little bit more intimate and easier to reach.
[00:04:48] Bill Russell: [00:04:48] Did you, did you just say 20,000 people intimate gathering 20,000 it’s still a, I mean, it’s still a stadium of some kind. That’s pretty big All right. So [00:05:00] I wanted to talk this work trends index. So Microsoft started doing this, I think last year they may have started before that, but last year, it’s the first year. I picked up on it. It’s a pretty extensive study that they do.
[00:05:10] They take information from Teams and from surveys and other things that they do within LinkedIn office 365 or whatnot. It’s actually across 31 countries, but this is specifically for the US. And they came back with seven hybrid work trends every business leader needs to know in [00:05:30] 2021. I’m going to, I’m sure you didn’t read this 60 page report and it’s entirety.
[00:05:34] So I’m going to, I’m going to highlight a couple of 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.
[00:05:55] I think those two things are very interesting to me cause they, they almost would [00:06:00] 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 that doesn’t really translate as well across these video mediums I don’t think. What do you, what are you hearing? What are you seeing with regard to virtual work and where do you think this is going to go in healthcare?
[00:06:30] [00:06:29] Dr. Sanaz Cordes: [00:06:29] Yeah. And that trend is spot on with what we’ve seen within our company within worldwide, because I think both sides of the personality spectrum, if you will, those of us who are extroverts and have wilted a bit just sitting in front of the computer and then introverts who had I had folks tell me, this is great. Like I love being at home. I don’t feel like I’m I’m sheltering in place because this is a better work set up for me. But I think both sides have kind of landed on the center of yeah, whichever end we’re on at this [00:07:00] somewhat nice to have the opposite. So that’s kind of what we’ve been hearing.
[00:07:02] And so even for myself personally, doing 11 WebEx’s as a day I’m happy to be back out on the field, but maybe not five days a week. Right. So but yeah, that is pretty consistent with what we’ve been seeing within our organization as well. And with our customers.
[00:07:17] Bill Russell: [00:07:17] It’s going to be interesting with the, from the productivity standpoint, it is really productive.
[00:07:23] 11 WebEx’s as opposed to getting on a plane, traveling here, doing this meeting, getting on a plane, traveling here and doing that meeting. [00:07:30] 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.
[00:07:42] Their number two thing is that leaders are out of touch with employees and need a wake up call. Some of the stats that give here are 61% of leaders say they are thriving right now. And those are people with decision-making authority, but that is 23 percentage points higher than those without decision making authority.
[00:07:59] So [00:08:00] 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 across, and they break it down. It’s really interesting. Married, working moms, Gen Z, frontline workers, new employees and single and they just asked them thriving or surviving and struggling. And it’s interesting when you get down to new employees, as you would imagine, single and Gen [00:08:30] Z, you’re down in the 30% that are thriving, 30 plus percent that are thriving and over 60% that are just surviving or struggling.
[00:08:40] 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 environment that we’re working in?
[00:08:54] Dr. Sanaz Cordes: [00:08:54] Yeah. I think more than ever this last year has really prioritized within [00:09:00] 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 culture, they’ve responded and within even our organization, they’ve responded, they’ve adjusted, they’ve done the best they can. And maybe they are more on the traditional side of that kind of adoption curve. Right. Startups and the [00:09:30] world I came from remote, right? Like, this was sort of like, all right, like we’re already on Zoom. But we’re going to make some changes. We’re not going to go out to customers. 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?
[00:09:49] Like, so how is this sustainable in the future? A lot of the customers we talk to have said, boy this health system has always had our IT folks come in every day, five days a week, but we’re going to go to [00:10:00] fully remote. We’re going to 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 in sort of that timeline and curve that people sit on.
[00:10:15] Bill Russell: [00:10:15] Have you worked from home a fair amount of time?
[00:10:18] Dr. Sanaz Cordes: [00:10:18] Yes. I mean this last year and a half, every day.
[00:10:21] Bill Russell: [00:10:21] Prior to that.
[00:10:24] Dr. Sanaz Cordes: [00:10:24] I worked from home in the office and then on airplanes.
[00:10:27]Bill Russell: [00:10:27] It’s interesting when I talk to people about this, [00:10:30] 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 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 in 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 [00:11:00] 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. I can shut it off just fine now, 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 [00:11:30] every text.
[00:11:30] And I think some people who are used to the office where they can compartmentalize it, I’m going to the office. Now I’m 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. I think people are sort of getting buried under that weight of not being able to make that transition that quickly and that they are responding to emails.
[00:11:54] And there’s some other stats here. Average meeting is 10 minutes longer time spent in Microsoft teams [00:12:00] as a more than doubled globally. The average Teams user is sending 45% more chats per week, 42% more chats per person after hours. Number of emails delivered to commercial and education customers when compared to the same month last year is up 40.6 billion emails.
[00:12:22] Dr. Sanaz Cordes: [00:12:22] I thought you were going to say 46%. I don’t know where that billion ..
[00:12:25] Bill Russell: [00:12:25] 46 billion emails. There’s been a 66% increase in the number of [00:12:30] people working on documents and Office 365. And so we’re actually giving the company more hours. We’re actually giving the company more of our, of our lives.
[00:12:40] And I think people are potentially resenting this. I think it’s one of the findings from this, 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 people or whatever, how would you approach that to get in front of that challenge that [00:13:00] probably just given numbers exist within most teams.
[00:13:03] Dr. Sanaz Cordes: [00:13:03] Yeah, no, I mean, I haven’t always been a good manager. Like like you, I was a workaholic and it was when I was working at home. It it was roll out of bed, get on laptop, start pummeling people with emails and messages and, fall asleep 13 hours later from exhaustion.
[00:13:21] 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 [00:13:30] 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 going to respond to your emails after a certain hour.
[00:13:40] I want you to have that time with your family and I’m not going to respond to teams. 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 going to be online, kind of gives them permission. Because I think it’s just that fear of, if you haven’t worked remotely, how do I show that I’m [00:14:00] productive?
[00:14:01] I need to be engaged and when it’s 24/7, and like you said, in your house it’s hard to kind of turn that off. So I think that’s important. Setting the standard top down, not going to answer, work-life balance is important. Take your weekend time. Words that we should have been saying all along, but really important now.
[00:14:18]Bill Russell: [00:14:18] I coach CIOs and one of the lessons I had to learn as a CIO is that the position has gravitas. When you get an email from the CIO, [00:14:30] it sort of goes to the top of your inbox. And my team came down on me pretty hard. I did a 360 evaluation. They come down on me pretty hard for asking them to work on weekends.
[00:14:41] And I’m like, I never asked you to work on because I don’t understand what you’re saying. It’s like, you send emails all weekend. I’m like, yeah, but I wasn’t, email to me is like, it’s like a letter. Get back to me when you’re back at work. But that’s not how they read it. They, they, they read it very differently.
[00:14:58] And so we have to have [00:15:00] situational awareness 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 told many CIOs stop sending emails on the weekend. Just don’t.
[00:15:13] Dr. Sanaz Cordes: [00:15:13] Yeah, right. Drafts. And then hit send on Monday. Sometimes for me, it’s like, I need to get it down on quote unquote paper, because I’m going to forget or I’m going to lose track of it. So maybe put it in a draft folder and shoot it out Monday.
[00:15:26] Bill Russell: [00:15:26] I’m going to ask you to do, to rewind in your career and imagine [00:15:30] you’re a Gen Z or this is your first job out of college. You go to work for a health system. And we just went through COVID. So you’ve not met any, this is probably pretty close, you joined WWC at a time where we were in the pandemic.
[00:15:47] 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 means to create proper work space at home. So they’re not able to [00:16:00] buy the ergonomic chair and set up an office and those kinds of things.
[00:16:04] And they might be in a shared apartment with like three of their college roommates and they graduated with, and that kind of stuff. It makes it very challenging. If I were to rewind back then, I mean, what are you saying to those people? That has to be extremely hard. Because you’re trying to learn the disciplines of moving from a college lifestyle to a work lifestyle.
[00:16:23] That transition is harder in and of itself. You’re not meeting your peers face to face, which I would imagine is [00:16:30] hard as well. I’m trying to empathize with this Gen Z generation who graduated over the last couple of years, went into these roles. How can we help them?
[00:16:38] Dr. Sanaz Cordes: [00:16:38] Yeah. As you were talking, the word empathy was flashing in neon in my, in my brain, because that’s always key to being a manager, but I mean, God, 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.
[00:16:58] So still I like, I can’t even [00:17:00] relate to what it would be like at 22 to enter a position in a corporate environment. So it’s one of those things it’s so hard to relate to, which makes it that much more important to try to understand it. And I just have empathy. I have sympathy for these young people, because like you said, I started the day before the lockdown.
[00:17:21] 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 just can’t, [00:17:30] I cannot put myself in that. I can’t imagine being in that role and so having to be more empathetic and. I I keep coming back to World Wide. 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 with 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.
[00:17:56] They have an understanding of like, what’s going to happen this week. [00:18:00] They’re meeting with different or departments. And I was thinking of blah, I wanted that. Like, that’s great. I’m glad you guys are having that. 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.
[00:18:16] Bill Russell: [00:18:16] Empathy and awareness. I mean, that generation might need more formal get togethers something I might’ve done as a CIO is say, all right, look, we’re gonna, we’re gonna identify this age group or anyone we’ve hired over the last [00:18:30] two years. And every Friday morning, they’re going to meet with a different executive.
[00:18:34] It could be the CIO this time. It could be the VP of applications. It could be the CMIO. It could be the Chief Security Officer. We’re going to treat it like a training session, but it’s a way for them to interact,ask questions, learn about the company. That’s the normal onboarding may have broken down through the pandemic.
[00:18:55] I hope people have really thought about this. There are a number five is shrinking networks [00:19:00] are endangering innovation. The move to remote work made teams more siloed. And the CIO is I’ve talked to, are aware of this. The health care leaders are aware of this siloed nature that tends to pop up. And I I think we’re trying to be creative around it, but that’s definitely one of the things too lLet’s see.
[00:19:24] Dr. Sanaz Cordes: [00:19:24] And even career opportunities like within your own company. I mean, who of us [00:19:30] on our career path, the last couple of decades, haven’t had an opportunity because we’re face to face to raise our hand for a project or not a position or something that shifts us to a different part of that velocity, so it’s, how do you do that when you’re young, you’re new and you don’t even meet the people in the lunch room or folks that you, you want to approach with those kinds of discussions.
[00:19:54] Bill Russell: [00:19:54] It’s interesting cause somebody asked me that the question of, Hey, we’re going to a hybrid work environment. How often do you [00:20:00] 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.
[00:20:15] 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 lunch. Let’s have a conversation. Even you think, well, that’s within my own company, but you might [00:20:30] meet a vendor partner. You might meet a consultant. You might be somebody who changes the trajectory of your career and that stuff doesn’t happen. It almost has to be planned if you’re working the way we’re working.
[00:20:44] Dr. Sanaz Cordes: [00:20:44] Yeah. It doesn’t happen on Zoom. Like that’s 100%.
[00:20:50] Bill Russell: [00:20:50] No way to walk down the hall and see who’s in every Zoom meeting. That would be an interesting feature. Number six was authenticity will [00:21:00] spur productivity and wellbeing. The workplace has become more human and they talk about the fact that more people have met each other’s pets through Zoom, I guess. And more coworkers have cried with each other during the pandemic, which is an interesting statistic, I guess, that has you have to get that stat through a survey.
[00:21:18] I don’t think Microsoft Teams is tracking that. And then talent is everywhere in a hybrid world. So there is this belief, and one of the big statistics out of this [00:21:30] 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. All right.
[00:21:41] So from a talent perspective, healthcare system within the technology realm or even clinical informatics from I mean just sheer numbers. 40% might quit their jobs. 60% are looking. Even if you feel like you have the [00:22:00] best environment in the world, let’s take those numbers down a bit 30% of your people are going to leave this year. And 40% are looking that’s almost half of your workforce is considering a job change.
[00:22:13] That’s a significant amount of institutional knowledge. You’re going to lose significant amount of training. You’re going to have to do ramping up into a timeframe when healthcare is really trying to accelerate, this is going to be this. I would think this is one of those [00:22:30] things. That’s top of mind, this is why we’re spending so much time on this topic. People you can’t do the job without people, and you need a great team in order to be successful.
[00:22:39]Dr. Sanaz Cordes: [00:22:39] 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. Completely of nurses. So let’s look at that number and then [00:23:00] a third of healthcare workforce in general doctors, technicians, folks that work in the hospital are unhappy and thinking about leaving.
[00:23:10] And we were talking about Gen Z. When you look at that number, the breakdown of 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% [00:23:30] of the healthcare workforce are thinking about leaving. So that’s a scary number too, right?
[00:23:35] Like we’ve got to do something. We’ve got to make some changes because you talk about not sustainable.
[00:23:40]Bill Russell: [00:23:40] Interesting. And 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.
[00:23:52] And I was talking to, I was talking to the lady who was … yoga. Well, yeah, yesterday. And she said, [00:24:00] 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 that was during the pandemic, she had four kids and it really didn’t work for her to be an RN.
[00:24:14] And she left and she started doing this. I said, do you plan to go back? She goes, oh, no, never. I was like, wow. I mean, you just didn’t like, and she goes, it’s a really hard job. It takes its toll on you over a period of time. I’m like, yeah.
[00:24:30] [00:24:30] Dr. Sanaz Cordes: [00:24:30] Well, 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 going to have a hundred thousand doctors 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 got to do something.
[00:24:57] Bill Russell: [00:24:57] All right. So we’re going to compare our answers to the [00:25:00] Microsoft answers. Then we’ll go onto 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 going to 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. So that’s number one. Number two, invest in space and technology and to bridge the [00:25:30] 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 interesting. Combat digital exhaustion from the top so leaders have to be a part of really addressing that digital exhaustion. Prioritize, rebuilding social capital and culture, reframed network building and team bonding from a passive effort to a proactive one, and then resync employees experience to compete for [00:26:00] best and most diverse talent.
[00:26:02] And that’s going to be an interesting thing. We have some opportunities to recruit really from anywhere, depending on the work environment we set up. But we also have to be aware of that. Used to, 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.
[00:26:22] Dr. Sanaz Cordes: [00:26:22] Yeah. Well, and I mean, I don’t want to change the course of this report but if you combine that with [00:26:30] 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 all of those patients surveys show that that convenience trumps loyalty to your health system. So it is, it is a cru like we’re at a critical point. Really needing to shift the whole way that we think about healthcare, our workforce, how we deliver it. [00:27:00] Cause these industry drivers just didn’t exist a few years ago and it’s a, it’s an interesting time.
[00:27:06]Bill Russell: [00:27:06] Two more stories real quick. We’ll only do three stories this week. We have the let’s do the CMS stories and CMS to permanently cover of 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 plain English what they’re saying [00:27:30] services are limited to.
[00:27:31] 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 bad thing to increase usage for this year. And they have seven rules around that services are limited to diagnosis, evaluation, or treatment of mental illness disorders available to establish patients only.
[00:27:55] So you have to, they have to be one of your patients are already the [00:28:00] 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.
[00:28:14] 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 the distance site practitioner must have the technical capability at the home of the service to use interactive audio, video modality [00:28:30] with the patient. The patient is, oh, so essentially what they’re saying is you have to use video if you can.
[00:28:37] If The patient is not capable, then they will reimburse audio only. That’s number six. And 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. No, I’m glad they’re doing this.
[00:28:56] They are worried a little bit about where [00:29:00] it goes in terms of usage. If there’s a big spike, obviously there’s more money. This is in the 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.
[00:29:23] What, if any additional documentation should be required in the patient’s medical records to support the clinical appropriateness [00:29:30] of providing audio only tele-health services. For mental health, should CMS disallow, audio only, or certain higher level services, such as level four or five EM visit codes when furnished alongside.
[00:29:43] 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 could do, you can do a mental health visit via phone because a majority of it is discussion anyway. [00:30:00] For the most part, it’s interesting that they want the video, I guess they want to 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 reimbursed post the public health emergency. And I think they’re going to take this approach. I think it’s going to be targeted along the way.
[00:30:26] I don’t think there’s just going to be this broad, huge amount of money that’s [00:30:30] thrown towards. And if that’s the case, then it’s also some, we have to determine what we’re going to 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 telehealth at this point?
[00:30:43] Dr. Sanaz Cordes: [00:30:43] Specifically to mental health. They’re thinking we need help. We need more providers, right? I mean, I’m involved with a couple teletherapy companies for my past still very active with them and they can’t keep up with the demand. Right? Like [00:31:00] 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 flood gates. So health systems, they’re just struggling. Like how do we get more folks to provide these services? And obviously that’s going to roll up to far [00:31:30] beyond the health systems, right?
[00:31:31] 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, what they’re focused on is how do I get more bodies to, to meet these needs?
[00:31:52] Bill Russell: [00:31:52] Yeah. This has gotta be a boom though, for some of those, some of those mental health, digital startups, I would think. I mean, [00:32:00] as these reimbursement models come into place. If I were a health system, there are organizations out there. That much like you would outsource your emergency room or outsource portions of your physician practices and those kinds of things.
[00:32:13] There are mental health companies that will outsource these kinds of services to health systems and make them available. And if you have the digital tools are out at, they can either use their own or they can come into yours. So there’s a lot of [00:32:30] different ways to do this, but this is one of the areas, I think we’ve talked about this. I talked about this last week on the show. We had to do psyche evals for our emergency departments in Southern California. We couldn’t really put a psychiatrist at each one of our locations that would make no sense. But that’s, that was one of the use cases for telehealth. Here we’re talking about we’re really talking about broad access to telehealth amongst a lot of CMS. So it’s amongst [00:33:00] medicare Medicaid population, which has really suffered through the pandemic with isolation, loneliness, disconnecting disconnected, and those kinds of things.
[00:33:12] Dr. Sanaz Cordes: [00:33:12] And, and not everybody has access to high-speed internet. Right. And I mean the rural populations, I think this is so important to, to keep push this proposal through and make this happen because. They, they can’t just hop on a zoom and have a video chat. So when we look [00:33:30] at, I think there was maybe like a 30% increase of people seeking mental health services over the last year. Just new access requests.
[00:33:39]Bill Russell: [00:33:39] It’s the biggest use of telehealth is mental health.
[00:33:43] Dr. Sanaz Cordes: [00:33:43] 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 don’t want to cut costs, right?
[00:33:57] Like, I mean, and you’re not cutting costs because if you [00:34:00] 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 happen in my opinion.
[00:34:12] Bill Russell: [00:34:12] Yeah. I’m just worried about the, we generalize the argument and so we say CMS should do this massive funding of all telehealth. And I think what CMS is doing is. They now have a year and a half worth of data and they’re looking through it and saying, Hey, look, this is [00:34:30] preventative. This is helpful. This is good. We’re going to, we’re going to 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 shouldn’t just be this broad, whatever.
[00:34:41] I’m like, we’re not making a good argument. We should have data as well at this point and be looking at it and go, yeah. Here are these five to 10 areas where we think tele-health should absolutely get funded, follow up visits for fill in the blank. This should get funded at, in [00:35:00] office visit. And the reason it should is because we’re going to make them 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 mean.
[00:35:08] Dr. Sanaz Cordes: [00:35:08] 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.
[00:35:29] Bill Russell: [00:35:29] Yep. [00:35:30] Absolutely. All right. So this last one, digital therapeutics. Why are you high on digital therapy? Why do you think there’s, I mean, cause you pick this story, so I’m, I’m curious why, why you pick this story and why digital therapeutics has an appeal?
[00:35:44] Dr. Sanaz Cordes: [00:35:44] I’m more, I’m more fascinated by digital therapeutics than anything cause I think it’s kind of an unknown space. It’s unknown frontier in terms of its space, like where is it going to go? The business models. Right. Like, it’s not clear cut the exit [00:36:00] strategies, not clear. And yet we’re seeing investors put so much money in this space, like with the prescription digital therapeutics.
[00:36:08] I mean, we’re looking at a hundred million dollars went to Pear Therapeutics, which was like the first therapeutic company, by the way, that did a FDA approval for a prescription drug prescription digital like four or five years ago. 160 million to another one recently so we’re seeing so much investment in the space, but the [00:36:30] 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. It’s not covered by payers, right. They want to see data showing that this is clinically and financially valuable to them.
[00:36:54] So that in and of itself is fascinating to me all this money going in, but we don’t know that this [00:37:00] model. What’s pharma going to do with this. We’ve all been watching what big pharma is going to 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 want to increase drug revenue and use a digital therapeutic to give away for free to increase their drug or is it truly a prescription digital therapeutic that would be a standalone product? Does that cannibalize revenue?
[00:37:28] So they pharma [00:37:30] sort of like, we’re not really sure how we’re going to do this and we’re not really investing a lot of effort. So yeah, I’m fascinated by this market where it is, how it’s rapidly progressing and in funding, but you know, where is it? Where’s it gonna go?
[00:37:43]Bill Russell: [00:37:43] Digital therapeutics startups are getting their fair share of investment dollars flowing into the healthcare industry. The amount of venture capital investment in digital therapeutics grew from 134 million in 2015 to 1.2 billion in 2019. And according to PitchBook, another [00:38:00] 709 million was invested in the first nine months of 2020.
[00:38:03] So you have a fair amount of money heading in that direction, but along the lines of what you said, Pear 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 raised eyebrows. Pear sells three apps designed to treat opioid abuse, substance abuse, and chronic insomnia, but it’s only expected to make $4 million in revenue. So at $1.6 billion a year [00:38:30] deal 4 million in revenue. And they do go into some of the partnerships insurance carriers. And pharma that might make sense in terms of partnerships here. They also talked about the challenge with getting those kinds of longitudinal studies.
[00:38:51]Those studies that sometimes take 5, 6, 7 years and whatnot. Digital therapeutics don’t have 5, [00:39:00] 6, 7 years of time, really revenue and whatnot to exist. But they almost need that in order to have that kind of credibility around, are they actually making. A clinical difference in what they are trying to treat. And so,
[00:39:18] Dr. Sanaz Cordes: [00:39:18] Yeah. And, and then even after that discovery to distribution phase, like you said, it could be many years for the FDA and regulatory process, it’s not easy getting approval for these. That’s why there’s [00:39:30] 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.
[00:39:40] So this is quicker, faster, better, but we come back again too, but for whom, right. And who who’s going to support this, who’s the buyer, who’s the business model. For example, working with some of these companies at World Wide, we’re working with a handful of these and these are questions that we are all asking internally and with the customer.
[00:39:58] And I think the [00:40:00] answer is kind of unknown all around, right? Like even these companies are trying to figure out who they’re going to 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 of startups and I remember just asking for like, $5 million and the scrutiny of what’s your exit strategy.
[00:40:19] We don’t believe that such and so is going to buy you and they ultimately did. But it’s just crazy to see $160 million being thrown at an industry where we [00:40:30] don’t, we don’t know, we don’t know what that exit strategy is.
[00:40:33] Bill Russell: [00:40:33] It is really interesting and it has two problems. One problem is insurance carriers won’t pay for it yet. And 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 see the value and start to prescribe it. But why would they prescribe it if nobody’s going to be paying for it? That would put it, yeah, that would [00:41:00] put it right in the consumers hands.
[00:41:03] I t 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 approved or whatever approval you’re going for you think the technology is going to change five to seven years?
[00:41:14] Dr. Sanaz Cordes: [00:41:14] Absolutely. And that’s part of the problem too, is that yeah 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 going to change the machine [00:41:30] learning is going to get smarter. And there’s a lot of unknown 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.
[00:41:50] There’s like a fourth player in the unknown equation, which is the regulatory bodies and how they’ll keep up with these technology.
[00:41:58] Bill Russell: [00:41:58] It is an exciting space. It [00:42:00] will take off at some point. It’ll be interesting if it folds into the insurance carriers are using it as a way to keep people healthy and to drive their costs down or pharma who’s looking to somehow monetize it.
[00:42:13] Or even the healthcare providers who are looking to augment something that they’re. There’s as as we’re talking, you can almost here we are at the we’re at the, how gonna ensure we’re at the starting gate, but we’re close to the starting gate either [00:42:30] on the Olympic time.
[00:42:32] 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, to see what. Thank you very much for your time, your valuable time at this point, with the, with all of the stuff that you guys are doing. And I look forward to catching up with you at HIMSS should be fun.
[00:42:51] Dr. Sanaz Cordes: [00:42:51] Yeah. Thank you so much. It was pleasure. And yeah. Looking forward to seeing you.
[00:42:55]Bill Russell: [00:42:55] What a great discussion. If you know someone that might benefit from our channel, from these kinds of [00:43:00] discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our [00:43:30] mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.