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Amwell, MDLive, Element Science, Carbon Health, AliveCor, El Camino, ATA, GSR Ventures
This week we had the Future of Virtual Care main event. In the first session, we discussed "Where’s the beef (utilization and effectiveness)?" Archana Dubey (Global Medical Director, HP) and Bambi Francisco Roizen (Founder & CEO, Vator) moderated the panel and Dr. Peter Antall (Chief Medical Officer, Amwell), Priya Abani (CEO, AliveCor), Ann Mond Johnson (CEO, American Telemedicine Association), Sunny Kumar (Partner, GSR Ventures) joined the discussion.
The "Startups disrupting!" session was emceed by Ravi Belani (Managing Partner, Alchemist Accelerator) and Adam Odessky (Co-founder & CEO, Sensely), Chelsea Rowe (Founder, GritWell) and Richard Hanbury (Founder, Sana Health) presented their companies
In the third session, we discussed "What’s the cost (and who’s paying)?" Bambi Francisco Roizen (Founder & CEO, Vator) and Archana Dubey (Global Medical Director, HP) moderated the panel and Eren Bali (Co-founder & CEO, Carbon Health), Uday Kumar (Founder, President & CEO, Element Science), Bruce Harrison (President, El Camino Health Medical Network), Charles Jones (CEO, MDLIVE) joined the discussion.
Here are some takeaways!
15:00 Start of 1st panel and how they define virtual care
Peter: All different modalities, provider types, innovations in how we deliver care.
Ann: I lean towards virtual care as broad a definition as possible: telehealth telemedicine digital health, digital medicine, digital therapeutics, sometimes this is really splicing at a fine level that doesn't lend to the conversation. And so I keep it very, very broad to be as inclusive as possible.
Priya: Covers all manner in which a patient can interact with a patient remotely. Live video, audio, messaging, remote patient devices.
Sunny: Broad definition - any form of substantive care delivered over an electronic communication channel.
28:34 - What were your pre-COVID strategies and how has it shifted?
Priya: Greater use of devices allowing users to check in on their heart without leaving home. Users sending heart data directly to physicians. We aided in-home clinical trials.
33:17 - Peter Amwell - we think of the world as PC and AC; PC - Providers didn't have a compelling reason to use virtual care, now we're experiencing out of necessity. From 5% usage to 80-90% providers started using telehealth every day. When it settles, we expect around 50-60% telehealth. Med-management, behavioral health - they can port well telehealth. April 40k visits a day; we went up 230% volume, up providers went up 10x; utilization of providers not in our network surged 2000%.
42:53 - Ann - variation of cost and quality pre-COVID; iniquities and disparities that occurred that was known pre-COVID, but it took a toll - 14% of Illinois is Black, and 40% of deaths were in the black community. Federal response happened rapidly. Licensure on the state level was exposed as very arcane. Telehealth did OK in a fee-for-service environment but soared in a value-based care environment. Remote monitoring is an unsung hero in all of this.
48:03 - Sunny - massive change in behavior; we are looking for companies that are creating efficiencies for doctors to allow that physician to 2x-10x the number of patients. This will solve underlying access issues.
51:10 - What's possible with virtual care today that will stay virtual and not go back to in-person?
53:46: Peter - we saw the use of chatbots; it helps screen out for certain things. they're also integrated into the provider flow; outside-of-visits nudging; If it's a diabetic, we can interact outside of visits to improve compliance.
55:00: Nudges are good for smoking cessation.
55:55: Sense.ly is already putting a face, personality to chatbots.
58:39: Clinical trials don't stop; from a cardiology point of view, telehealth visits and routine monitoring is essential for cardiology.
1:03: Archana - pre-Covid it was part of the payer to drive utilization; provider and payer weren't incentivized. So COVID made going to ER a risk to the patient
1:04: Peter - the stakeholders (providers, payers, patients) have not been aligned. Payers and patients were adopting earlier; now providers are adopting from 50 visits to 5,000 visits a week. When providers move and adopt as they're doing now.
1:06: Sunny - virtual trials go from 1-2% of trials to now every trial to be virtually enabled. As for what can happen with virtual care and will stay, asynchronous communication with the use of chronic conditions and mental health but also with hypertension (now you can get a surrogate measure at home); but now dealing with high cholesterol - it's a condition where you had to be in-person now is one you can do at home.
1:13: What to expect with regulations over the next 6 months?
Getting rid of originating sites; enabling Federally qualified health services post-COVID; make permanent HHS temporary waiver authority during emergencies; Notion that care has to be delivered locally is no longer relevant. States will also be trying to expand virtual care for the Medicaid population.
1:20: Elaboration about nudges and remote care
1:43: Anthony from Avison-Young introduces the break - touches on real estate and healthcare
1:48: Ravi Belani's segment and Startups Disrupting
2:32: Start of the 2nd panel and how they define virtual care
Uday: Virtual care is a misnomer; you're getting care, just remote but it's mostly diagnostic. It's a different modality for diagnostics.
Cindy: Virtual care is being there at the right place at the right time with the right care. It's the total digital care delivery to a patient: synchronous, asynchronous, remote monitoring.
Bruce: Virtual care any delivery of care that is not happening in an in-person encounter; it's phone visits, remote monitoring, etc.
2:43: COVID's impact on your business
Cindy: we have 1500 providers (across behavioral/medical); we had to enhance our recruitment and educate our patients/providers; Tech and EMR enhancement, patient and provider education. In March grew over 140% from the prior year.
Uday: iRythm is a heart-monitoring patch; with COVID, it became clear with cardiologists could just shift massive numbers and service physicians. Having people come back for blood pressure checks or tests were ways hospitals could bill, but COVID exposed the cost/benefit ratio wasn't worth going into the hospital. New gatekeeper could be a virtual tool or virtual visit to increase pre-test probability to determine whether to go in-person. **Do hospitals go back to higher billing models if virtual care volume isn't there.
Eren: Since end of January (patient direct from Wuhan), we put the patient in a virtual ward; there was no testing. Until testing started in March, we used virtual to separate at-risk patients from others. We then tried to get non-COVID service to be virtual and we used our physical footprint for COVID. Now we have specialties that have gone virtual: dermatology, behavioral, nutrition, but things changes every month. Customer expectation of what can be done virtually has skyrocketed. We've tested 60,000 people and some have been positive.
Bruce: Volume declined 75% overnight; how do we balance fixed costs and prepare for possible surge in COVID cases. We set up Zoom immediately; when 1135 waiver was signed, we could get paid virtually. Also with legislation, it didn't matter how secure our system was. Now we could use Zoom, Facetime or whatever. We were setting up a separate respiratory clinic; we didn't have access to great virtual technology so we just did home visits. COVID is the true beginning of telehealth for us.
3:07: Where are we doing this well regarding identifying higher pre-test probability patients using virtual care
Uday: It's easier to see where we're not doing well. This has exposed what we've not done well which is areas where virtual care cannot be delivered. In cardiology, diagnostics rely on good history so for us, we need that historic data. For cardiology and neurology, maybe 70-80% diagnostics can be done by history traditionally; but orthopedics - might be hard without actually seeing someone. It depends on the nature of disease taste (whether history is required or in-person physical interaction is required). Out of hospital sudden cardiac deaths rose; if you look at overall outcomes particularly for those who delayed care.
Cindy: Virtual urgent care, we're lowering the cost of care in aspects of ED avoidance. There's 4 C's in care and the fourth is "contagion avoidance" - people want virtual care to avoid becoming infected.
Bruce: Patience satisfaction has gone up due to the access. Primary care is doing well in virtual care; but orthopedics, ophthalmology - those are specialties haven't been incorporated into virtual care. Our virtual care visits are back down to 10% of visits.
Eren: Is virtual care the new front door, we have to think of total costs. For every visit you have to do virtual, you'd have to ask what should be virtual first. You don't want to pay twice.
3:24: Audience Q&A starts
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