Amazon Care and the future of value based care

Ethan Bechtel, OhMD CEO, recently sat down with John Lynn, Founder and Chief Editor at healthcareittoday.com for “The Patient Conversation” to discuss an important shift in healthcare from fee for service to value based care. They also delve into the expected impacts of Amazon Care on the healthcare industry, suggesting ways for smaller scale medical practices to cultivate strong patient relationships to stand up against the tech giant.

Transcript

Ethan Bechtel: [00:00:00] Patients are taking control of their healthcare. Now more than ever, they’re choosing who they receive care from based not just on what they hear about a practice, but also on their own personal experiences. As healthcare continues to shift from fee for service to value based care, patients will continue to expect more.

[00:00:27] They expect that their physician will not just help make them healthy, but also they’ll deliver a better care experience and they’ll get to build a trusted relationship with their care team.

John Lynn is the Founder and Chief Editor at healthcareittoday.com and John has been using his firsthand healthcare experience to create actionable insights and commentary on health care topics while also hoping to answer questions about current healthcare trends, and he does that for his readership around the world, so I’m excited to have John on to chat with me today.

[00:01:05] John, we haven’t talked in a while, but I think you and I originally met on a call like this pre-COVID many years ago with some folks from Dartmouth, talking about some similar stuff. But I’d love it if you introduced yourself as a starting point and we can just have a conversation. 

John Lynn: [00:01:23] Yeah, we were ahead of our time, Ethan, already connecting virtually. No, but it’s, yeah, I appreciate you having me on and you know, as you mentioned, I’m the founder/chief editor at healthcareittoday.com, which we’ve been publishing for 15 years, all health IT content, all day. You know, everything is health IT, you know, interestingly enough for me, that’s my life, I guess.

[00:01:45] So, you know, we’ve published about 14,000 articles. We have 30,000 email subscribers and 10,000 Twitter followers. So just a really good community of health IT professionals that we bring together on our site and events back, you know, and of course now virtual, that back when we could meet in person, we did that as well.

[00:02:03] So, you know, we felt lucky to just be part of the health IT community and everything that’s happening with technology and healthcare. 

Ethan Bechtel: [00:02:10] That’s perfect. Yeah, I’ve, long before I met you, knew your name, followed all of the content for many years and I’m excited to kind of catch up again. And so I guess where I wanted to start, there was this whole like list of questions that that I had for you and I had a starting question that has since changed a little bit.

And it’s not news to you what the plans for Amazon Care were, but we found out yesterday after they announced that they were rolling out across all 50 States to their employees first and have broader plans that I think we’ve known about for a while, but I think the general question to you, and what I’m excited to talk about is what do you think it all means?

I mean, I think it’s exciting at a minimum. There’s a lot of unknowns and variables that we can’t really account for, but at a high level, what are your thoughts on the Amazon Care news?

John Lynn: [00:03:05] Yeah, I think there’s a few things that temper the news a little bit. The first is that they’re really focused on employers. So, you know, what they’re going to provide is likely going to be provided to employers, which, you know, many of us get our healthcare through our employer. So that’s not necessarily a bad thing, but definitely they’re going to have to convince the employers to use this new Amazon Care solution.

[00:03:29] I don’t think, at least it seems from the announcement, that they’re going to go direct to consumer with this solution, at least initially. And so, you know, let’s temper the expectation a little bit there that, hey, if your employer’s on board, then you may really benefit from it. But if they’re not, well, you may be waiting for a little while and you may actually be mad at Amazon that you don’t have access to it.

One exciting potential impact of Amazon Care? An increase in two-way patient texting

John Lynn: [00:03:50] So I think that’s exciting if your employer has it. And the reason it’s exciting is the company that they’ve partnered with to be able to do this Amazon Care, is someone who started out doing care in New York. And they wanted to do care in a really unique way. And they learn what matters and what doesn’t matter.

[00:04:10] And, for example, one of the things that they learned was you don’t have to have a video visit. And so many of us are like, well, I got to go into the doctor so they can listen to my heart or I gotta be on camera so they can see me. And they’re like, yeah, that’s true for some situations, but for many of the things that we need to see a doctor for, all you need to do is talk to them or text them, give them the information and they can help alleviate your fear or, you know, help give you the information you need to treat it.

[00:04:40] And then if it gets worse, you can, of course escalate it to them and an office visit or telemedicine visit. So I think that’s what’s exciting is this shift from, ‘I have to be seen by the doctor in the office or on a video’, versus, ‘no, a text message is fine for a lot of the things that we need‘. And in fact, many times we’re too afraid to go to the doctor’s office.

[00:05:03] Cause we know that it’s a miserable experience waiting in the wait room and then, you know, even, right? You know, it’s like, so I avoid it. Whereas if it’s just a text message, “Hey, should I come in for this?” I can get the care that I need, which previously I would’ve just avoided, which might’ve spiraled out of control.

[00:05:21] So I think from that perspective, that’s a shift in mindset. That’s really exciting. 

Ethan Bechtel: [00:05:26] Yeah. So, I think you bring up a really good point around the employer side of things, like what’s the evolution of this thing and what can we expect it to mean short, medium, and long-term?

I think for me, what I’m most interested in is the second and third order effects of this type of thing. Amazon taking advantage of their massive scale, which is what they’ve been successful with in every other thing that they’ve launched, is just larger scale than anyone else has access to.

And the second and third order effects of changing healthcare at scale and what that means for traditional health care in terms of adapting to a changing landscape. And to your point, the realization that not everything has to be in person, not everything can be on video and there’s some sort of place in the middle that we ended up landing based on being forced kind of down this path, understanding of what it all means.

[00:06:26] So, I guess, one follow up question would be thoughts on impact it has on traditional healthcare as it continues down this path to a direct to consumer Amazon Care model in 2022, or whenever that is. 

John Lynn: [00:06:42] Yeah, well, you didn’t even highlight the, you know, Amazon Echo and you know, I, I’m afraid to say Alexa, cause she’s gonna respond, but you know, that’s a powerful tool in their tool belt that they could just enable at any moment that they want to track your blood pressure. All of these other things that would take that whole model another step forward, right?

So I think there’s really exciting things down the road there. As far as the impact to healthcare, I’m really interested to see how it evolves. You know, whether they go to direct to consumer or not.

What’s interesting for me when I look at… and this is true for Amazon, Google, Microsoft, any of these big players… it’s like, are they really going to lower the cost of healthcare or are they just going to profit off the dysfunction of our healthcare system?

[00:07:31] And in many ways, are they just going to eat the low hanging fruit that, you know, every doctor makes their money off of. And, for lack of a better term, screw them over by taking off those profitable patients in a different way. I’m not sure it’s going to fully play out that way, but there’s definitely some risk there for a healthcare organization that doesn’t embrace digital transformation.

With Amazon Care on the horizon, how do I build relationships to retain my patients?

John Lynn: [00:07:55] You know, my friend Ed Marx wrote something… might’ve been his partner, Paddy… he said something like, “if you’re not part of the digital transformation, well, when it rolls by you’re going to get smashed, right?”

And so I thought that was an interesting description, because it’s true, right? If you do not… if you’re not part of this, if you’re not enabling this for your patients, then when the Amazons come rolling through, they’re not going to care. They’re going to roll you over.

But if you already have those services, then your patients will say, well, why would I go to Amazon Care? I already get it from my doctor. So I think that’s the thing doctors should be thinking about is how can I provide these consumer friendly services in order to retain my patients?

Because most patients do want a relationship with their doctor, of some sort. They don’t necessarily want a relationship with Amazon, but what we’ve proven time and time again is that patients will choose convenience over that relationship because they don’t have a good way to measure quality of care.

So if I can’t measure quality, well I can measure convenience. And I’m going to choose that over some sort of relationship that may be more quality, but I don’t really know.

Ethan Bechtel: [00:09:06] Yeah, that’s a really good point. I think. Well, two things. One, I’m pretty sure that was an Ed Marx tweet that I also saw. He dropped some really valuable nuggets pretty frequently around the patient experience that, that I just, I love.

But I think to your point, you know, the convenience thing, certainly the younger demographic… convenience and growing up in the digital world… being digital natives… convenience is baked into everything.

I think healthcare is complicated and as we get older we begin to realize that, that convenience doesn’t necessarily solve for the complexity that is healthcare for your average American, as we continue to get older.

[00:09:50] And so I think there’s some really smart people. You know, Vinod Khosla talks a lot about the verticalization of healthcare and focusing on specific conditions to really deliver a better patient experience to people with, you know, any sort of conditions. And I’m interested in the evolution of that too, versus looking at, well, let’s have, you know, the primary care doc have to think about all of these things.

[00:10:15] Well, maybe it makes a lot more sense for folks with diabetes or thyroid disease to have someone focused on exactly what that thing is and deliver those services virtually as well to a certain extent. So there’s a lot of directions we could go with this, but, I think, if nothing else, from my perspective, it will improve what we get to experience in terms of our healthcare visit and improvements and kind of streamlining of that visit. 

And we’ll know a little bit more about what we want, what we don’t want. That’ll be fully enabled by the technology that companies like Amazon are putting in front of us to give us the opportunity to use or choose to go to our brick and mortar practice, because we want that experience and we think there’s more value there. 

What will be the role of the care manager in the future of healthcare?

John Lynn: [00:11:04] Well, what’s interesting about what they’re doing because, specialization has already happened, right? I mean, it’s really upon us. It’s been part of healthcare for a long time, but what hasn’t been part of healthcare for many patients is the care coordination between specialists and, in many ways, Amazon Care and what they’re doing is kind of providing a level of care coordination that is needed.

And so, you know, what’s interesting is Amazon care going to really be the doctor? Or is it going to be the care manager? You know, Sunny Tara from CareCognitics wrote an article on our site, Healthcare IT Today, where he said the care manager’s going to be more influential in healthcare than the doctor.

[00:11:46] And that’s not that the doctors becoming less influential, but it’s just the rising influence of the care manager that needs to coordinate the care that you receive across multiple specialists to make sure that the specialists are caring for the entire patient, rather than just the very specific chronic need that you have when you go to that specialist.

So I think the care manager is going to be interested in, especially, in value based care. 

Ethan Bechtel: [00:12:13] Yeah. I mean, that’s a really good point, right? The financial incentive for a primary care doc to quarterback everything doesn’t really exist and they don’t have the bandwidth to do all the things that your average patient needs, and certainly not patients that have chronic conditions that need to see multiple specialists.

[00:12:30] So that would make a lot of sense. There’s definitely a lot of value in the care management role, and, you know, for those of us that have been sick before having someone that acts not just in a  care management role, but as an advocate, is a really hard problem to solve for. But once you found your advocate, as a patient that needs it, it feels like the only way you could have gotten things figured out, right?

[00:12:51] Like I think many of us have been there where it’s just like, you’re at the end of a rope. You haven’t really figured out what the problem is. And you need that advocate to help pushing over the finish line and, and find the care that you need to solve the problem.

John Lynn: [00:13:05] Yeah. And let’s be honest. It’s not a knock on doctors, doctors weren’t trained to do care coordination and the care manager can’t do it without the doctor either. So I mean, you know, healthcare is a team sport. The care manager needs the doctor to create a care plan for the patient. And then, the care manager can ensure that that care plan is being executed and being met and that they’re doing their visits and all those things that you’d want a care manager to do that the doctor certainly doesn’t have time to do.

[00:13:33] So it definitely requires a team approach to it. But in value-based care, we’re going to need this, or you’re not going to be successful. Like a doctor seeing you for 15 minutes is not going to be able to coordinate your care and reduce the costs that value-based care requires. It just isn’t reasonable. So you’re going to need other people assisting with the care plan. 

Ethan Bechtel: [00:13:55] Yep. That makes sense. So I think that’s a good segue. You mentioned Sunny Tara, and I know DocBeat is something that you had been involved with for awhile and thinking about patient experience, even before that. Before we kind of, like, fully shift to patient experience and what things feel like today and where they’re going… when did you start kind of down in the patient experience path and focusing on how technology can help solve for some of these problems?

John Lynn: [00:15:01] Yeah. So it’s interesting when people talk to me and say, you know, do you care about healthcare? And I’m like, yeah, of course. You know, when I first got into healthcare, I was so excited that something I could do could actually impact someone’s health and impact someone’s life.

[00:14:40] I mean, what better mission could you have? You can’t, right? So, I loved that, but at its core, I don’t care so much about “healthcare,” as I care about technology’s ability to transform any process and whether that’s the patient experience or whether that’s the revenue cycle management or those, like, I think technology has the opportunity to transform pretty much anything.

[00:15:04] Not that technology is always the answer. Sometimes it’s a mix of technology and other processes, but technology can enable so many workflows that we couldn’t have even thought about previously. So, I guess at the core, that’s what interests me most.

Has it fallen short in healthcare? Absolutely. Right? Like, every one of us looks at the EHR and we’d be like, man, it could have been so much more. Right? And all it is is this big billing system, which in many ways is the bane of a doctor’s existence because who likes billing, no one likes billing. Right? And yet that’s what they have to live with every day.

Using technology to transform the patient experience

John Lynn: [00:15:43] So, you know, to me, you know, I saw all of that and I saw that technology has this opportunity to really transform what we’re doing and transform the experience a patient has in the office. And so this is what gets me excited.

So, you know, whenever I have opportunities writing on Healthcare IT Today, I get to see firsthand a lot of really cool things, you know? Obviously we met a number of years ago and loved what you were doing to enable the communication between patient and doctor.

[00:16:13] And to me, the thing that’s probably most exciting there, is how many doctors were afraid of it. They’re afraid of enabling the communication with a patient. And we saw that with Sunny and docBeat as well. It’s like doctors were scared. They’re like, “Wait, they’re going to have access to me? They’re probably going to abuse it.”

[00:16:32] Right? You know? And you’re just like, “Do they abuse your phone?” You know? Like… so it’s like, you know, I think helping to overcome those misconceptions with people is one of the most exciting things that I get to do. 

Ethan Bechtel: [00:16:46] Yeah, I think, you know, you just rattled off a bunch of things that like I’ve said, you know, thousands of times probably at this point. You know, to your point…

[00:16:55] Yeah, I think one of the things that’s come up a lot of our time in talking about messaging versus the telephone and certain patients taking advantage of technology to, I guess, add to the workload of a doctor and the staff. What I think is the most important part of all of that, and it’s not just in healthcare, it’s everywhere, is  you can’t design for the 1%.

[00:17:19] You have to design for the 99%. So don’t stop delivering an amazing experience to 99% of your patients, because you’ve got that 1% that may use it in a way that you don’t really prefer. Instead build tools or use tools that give you the flexibility and control over that conversation to an extent where that’s not a problem.

[00:17:39] That’s what technology gives us the ability to do where other mediums don’t, right? I mean, the phone call, if the phone’s ringing the phone’s ringing and there is, there’s nothing you’re going to do about that. You’re going to answer it or you’re not, but the phone is ringing and it’s ringing for you and you are the bottleneck as that one person that it’s ringing for.

When you talk about texts and you talk about being able to manage these conversations with a team of people and, you know, delegate these conversations to people as they come in and respond in an asynchronous way. You’re giving yourself a lot of control over that situation.

[00:18:12] And, those 99% of patients are going to be really grateful that you’ve changed the experience and focused on giving them the convenience and kind of access that everyone hopes for as a patient. Not a lot of us get it., but it’s what we all want, right? So anyway, you’ve lived through a lot of the same things, a lot of the same conversations 

John Lynn: [00:18:31] And what’s fascinating and ironic about this, is that patients don’t want to reach out to you. Right? Like, you know, none of us want to go to the doctor. None of us want to reach out to the doctor cause it’s just fun, you know? Like let’s focus on our health, right? Like, that’s not what we want to do.

In fact, when you look at value-based care, we actually have to try to convince them to get care. Right? So it’s ironic that, you know, we want to like somehow stop them from doing it. But now if we’re moving into value based care, “Oh no, can you please communicate with me so that I can care for you the right way?” And so it’s like, we almost have to flip that paradigm for the new reimbursement models, right?

[00:19:15] Where you need to have a relationship with them and you need their engagement. And guess what, everyone that’s been trying to do this, whether it’s an ACO or some chronic care management effort, they’ve had challenges getting the patient to respond. It’s not the problem that they’re actually abusing it because none of us want to consume healthcare.

[00:19:34] That’s not fun. You know? We don’t want to do that. Instead, they’re trying everything they can to get you to actually engage with your healthcare so that they can lower costs. So, you know, it’s just really ironic how, you know, as you described, the 1% kind of hurts us everywhere else we’re trying to convince them to actually engage with us.

Ethan Bechtel: [00:19:53] Yeah, absolutely. I think there’s so much that we can learn from consumer experiences and others in other spaces. Looking to how we live our normal lives. We don’t want to spend time dealing with healthcare. It’s not a good feeling. It’s rarely ever fun.

And there’s better experiences that I think we can hope for as patients and in healthcare, the challenge is always where’s the alignment? Where’s the financial alignment so that practices can keep the lights on? What can they and can’t they do in the eight hours they have every day? And that’s really where the biggest challenge is. I think every doctor wants to provide the best possible care to their patients.

[00:20:35] They want their patients to be healthy. There are just these constraints of the system that make it really hard to do that. And so, you know, I think using technology in the right way to optimize care, to really deliver better care in the time that you have, it’s kind of the best that, that we can hope for now.

Will the release of Amazon Care in a post-pandemic world mean an acceleration in value based care?

[00:20:54] I guess that’s kind of a good segue. I skipped around a little bit on questions, but I guess as we think about value based reimbursement and finding that financial alignment, we’ve been talking about value based reimbursement for a really long time. And we’ve been slowly moving there. Does that speed up?

[00:21:14] I was having this conversation with someone else today. Does that speed up because of the last year and COVID? Is there any change in the pace at which value-based reimbursement will continue? Or what are your thoughts on that? 

John Lynn: [00:21:29] Yeah. I mean, trying to predict value based reimbursement means you have to predict the government and payers, which I think is, it’s always a challenging thing to do, right? Because they work so slowly. I think that’s the problem.

You know, has COVID impacted it? Well, we saw the explosion of telehealth, which I think will enable a lot of the value-based reimbursement models to be more effective, right? It gave an understanding that patients are willing to do this.

[00:22:01] And it also educated a bunch of doctors that, “Hey, this isn’t so bad. I could do this. And I can care for a large number of conditions that my patients have through telehealth.” Now, have the reimbursement models caught up with it? Not fully. I mean, they did pretty good during COVID in that regard, but there’s still a ways to go.

[00:22:23] So, you know, it’s a tough question to ask. Right? And to know the answer, too, because we have to predict what government will do, but that said, like, I think now we’re going to have the data. Around telehealth visits and things like that, that’s going to help them better understand, “Oh, you know what these models actually do work. And they did lower costs.”

And, you know, we can do that analysis, which will then lead to the legislation, which will lead to the regulation and reimbursement that will allow for value-based care to come. So I’m hopeful that we, this data will help to drive that forward and that the data will be good. I mean, I think we still, you know, it’s an open question.

[00:23:03] What was the impact of all these telehealth visits and did more people come in than would have previously, because it was so easy to do a telehealth visit and, and what was the impact of that? Did it avoid some downstream effects and all that, right? 

[00:23:15] So, we have a really interesting test case over the last year and they’re going to dive into the data. Some really smart researchers and the people at the payers are going to say, what does this mean? And I think we’re going to find out. And hopefully that data comes out really positive and says, “yeah, these models are incredible. Let’s do more and more.” 

[00:23:34] But what’s interesting is there was this effort going on before COVID, right? I mean, this shift was happening and we’ve been talking to him about it for a while, but every organization pretty much, at least a reasonable size, has some sort of value based effort going on. And, you know, even if it goes back to something as simple as a wellness visit, right?

[00:23:56] Yeah. They’re already doing that and doing reminders for that. So, you know, I don’t have my crystal ball ready for you, but if it were me, I would say, we need to create the relationship and what you do now can work really effectively even in the fee for service world, because if you build the relationship with the patient and you build some trust with the patient, well, then they’re going to want to come to you for a fee for service as well.

[00:24:23] But then it also positions you to be able to perform effectively and be successful in value-based care where not only do you have to tell them, “Hey, come in for a regular visit”, but now I need to tell you, “come in for your second dose of vaccine”, and all sorts of things like that. 

A move away from the transactional patient engagement to a patient relationship

Ethan Bechtel: [00:24:38] Yeah. And you’ve said that you’ve used the phrase patient relationship a few times, and that’s something we talk about a lot, right?

[00:24:46] It’s not, it’s just that relationships matter. They matter in our social lives and they matter in business and healthcare is no different. Establishing trust and building on a relationship and you know, giving people access to you, these are all kind of parts of this holistic idea of a relationship and healthcare. And the constraints, again, are just like the reimbursement model, the hours in a day.

But I do think that everybody that got into healthcare, for the most part, got into healthcare because they want to help people. They want to be well patient relationships and they’ll do everything they can to get to a point where that’s what they’re delivering as a part of their care.

[00:25:29] And you know, that’s kind of our hope, too, is just what we do in focusing on the patient conversation is only a piece of that relationship, but it’s an important piece. And I think that’s the future of healthcare that I want is one where there is a real relationship between people.

I think there’s some, this is a on a few different directions here, but there’s a lot of talk and there has been for years about AI chat bots. And I think there’s some value that can be delivered there to a certain extent, but ultimately, you know, healthcare is… it’s a lot about personal connections and humans interacting with each other because healthcare is emotional, right? 

[00:26:09] When you’re sick… it’s not the same thing as, as buying something on Amazon or going to CVS and picking up a prescription necessarily. It comes down to humans taking care of humans. So that’s where we want things to go, I think. 

John Lynn: [00:26:26] Yeah, well, much of the relationships in healthcare are transactional relationships.

[00:26:31] I have a chief complaint. You give me a visit. I pay you for the visit. I feel better. I’m done. That’s the end of our transactional relationship. And the doctor outside of that 15 minutes in the room is not going to think about me again. And, and that’s how much of healthcare is. There’s some exceptions though, right?

[00:26:50] Chronic patients often have a deep relationship with their provider. That’s very different. I mean, I think about my wife’s OBGYN. Like, you know, when we miscarried and she showed such tenderness and kindness to us, that changed it from a transactional relationship to a personal relationship where I care about her and I appreciate her.

[00:27:12] And so, you know, it’s tough to change my mentality, although every single person I’ve talked to that works in value-based care and whether they’ve started their own company and they’re a former doctor or former nurse, that’s decided, “Hey, this value based care, this chronic care management is where it’s at,” and they’re doing it right.

Or, whether they’re doing something in their own practice. Whenever I talk to them, they always say the same phrase and that’s, “this is how I always wanted it.” And then they usually follow it up with “and how could I go back to that other way of practicing medicine?” So, you know, to your point, everyone wants to do that that way. 

The potential role of AI in healthcare’s future

[00:27:49] Now your conversation around AI is super fascinating because it’s coming, whether we want it or not. And interestingly enough, the question is, how will it come.

And I like what one of my radiologist friends said about AI in radiology. He says, if we’re involved in it, it will be a tool that makes our work better. And if we’re not involved with it, it’ll be a tool that replaces us. And I think that’s exactly what AI could do, right?

If the doctors embraced it, it’s going to take away all the useless stuff that’s repetitive. And it’s not useless, I guess it’s probably the wrong term. But the repetitive, mundane things that they hate doing. And AI is going to take that all off their plate and just focus them on the hard things, the meaningful things that they actually would love to do.

[00:28:39] So, you know, but if they don’t, then AI will take over for them and it won’t be a tool for them. So I think that’s where we’re at is trying to figure out are doctors going to embrace it as a tool that enhances what they do or are they going to say, “Oh no, it can never do what I do.” 

Ethan Bechtel: [00:28:55] Yeah. I mean, we’ve seen some really cool companies that are really solving some of those burdensome tasks with machine learning, right?

The idea of a doctor spending, you know, 50 plus percent of their time documenting visits, well, okay. Let’s use machine learning for that. That’s not something that anyone, you know, a physician or anybody else along the care spectrum should be spending their time doing.

[00:29:20] And… we can use the data and the machine learning to help us be better diagnosticians to give us access to information that otherwise would have landed in the EMR and not necessarily analyzed in any way further than just documented for storage in the chart. So I think there’s some really exciting opportunities to use AI, to create efficiencies.

[00:29:42] I think, you know, one word that hasn’t come up yet, but we both kind of like skirt around it is, it’s just the word empathy, right? The role of empathy in healthcare is an important one. And I don’t think that’s going away.

I think it’s just what tools can we leverage in some of those cumbersome tasks that don’t really require a physician to be sitting there doing, so that they have time and bandwidth to be the type of physician that they want, to deliver care through empathy and in as many situations as it warrants.

So anyway, I think there’s a lot of potential. And I think the convergence of the human touch and and machine learning is, it’s going to be exciting to kind of see how it all unfolds, but it should make doctors more powerful, better at their jobs and better diagnosticians.

Making room for empathy in healthcare

John Lynn: [00:30:35] Well, in the way healthcare is structured today, there’s no room for empathy. I mean, how are they supposed to show empathy when they’re too busy you know, charting all of this information to your point, right? You know, if the AI, the ambient clinical voice, it takes that documentation burden off of them.

[00:30:53] Now they have time and space for empathy, the same as with a text messages with a doctor. If the doctor’s trying to just text you to get the information he needs so that he can give you the, the treatment plan and the information you need. Well, if he’s so busy doing that, that he, you know, where’s his room for empathy?

[00:31:12] Whereas if the AI had already taken care of that and collected all the information from the patient, so that then the information was all there. Now the doctor has time to give you the care plan and show you some empathy.

So, you know, obviously that’s a, that’s a pretty rosy look and, you know, there’s going to be bumps along the way that’s going to definitely burn doctors out when the AI does it wrong. And so then they’re actually frustrated rather than showing empathy, but you know, that’s going to be part of the process of where we need to get to. 

What percentage of telehealth usage might we expect going forward?

Ethan Bechtel: [00:31:41] Sure. Well, okay, so I’m interested in, you know, this has been obviously a crazy year. What we saw with, you know, kind of back to telehealth, what we saw was this immediate surge in telehealth visits where, you know, larger organizations were doing upwards of 50 plus percent of their visits that were going to be in person or now telehealth we’ve, we’ve been, kind of, seeing those subside back to… not levels that they were at before, still exponentially higher than they were before…

[00:32:15] In a post, you know, fully post- COVID world. Again, this is kind of a crystal ball question. You know,  we get out of this and vaccinations are abundant and everybody’s doing good, and out and about. Where does the telehealth number land? And again, I don’t have an answer to this. You may not either.

I’m just curious about where we as patients… will actually want an in person experience again, versus doing the app thing that we’re all kind of a little bit exhausted of. 

John Lynn: [00:32:45] Yeah. So I’ll pull out my crystal ball for this one. This is one I’ve thought a lot about, and the only caveat is where will telehealth reimbursement go because that could really change it. I think it could change it five to ten percent either way, right? So if it doesn’t come through, it could be five to ten percent less than what I’m about to predict. And if it comes through, it could be five to ten percent more.

But, you know, if you look at it and say, “okay, yeah, we got up to 50, 60% you know, of telehealth visits.” My feeling is that homeostasis for telehealth is going to be somewhere in the 15% range. And those that are, you know, maybe less into it, maybe down to the 10%, right we’ll have a few get up to 20.

But I think, you know, on average it’s going to be about 15% of visits are going to be telehealth. And then we’re going to see a slow increase, right, over time, where patients are more comfortable with it, doctors find ways to incorporate it better, health systems force doctors to do it. We’ll see a bunch of those things. So then it will be a nice linear growth path from there. But I think 15% is right about where we’re going to be as far as how many telehealth visits are going to be long-term.

Ethan Bechtel: [00:33:57] OK! Well, the prediction’s on the books. We’ll have to circle back to this. That’s great. I’m glad you had thought about that because, having a hard number, I thought a lot about it as well. I’m not bold enough to make a prediction quite yet. I don’t have enough inputs and I’m so unsure about where everything goes in the next year.

[00:34:16] I mean, if have these moments, like probably everyone else, where I’m sitting there and I’m like, “Wow. If you would’ve told me 12 months ago that I would be, you know, insert thing here, like I would be, you know, on a website looking up how to get a vaccination… like refreshing this website on how to get a vaccination as soon as possible,” I never would have believed it. So anyway, it’ll be interesting to see how that plays out.

What is the future for telehealth?

John Lynn: [00:34:42] I think the problem is that patients really loved it. I think for the most part, patients loved it. But what’s interesting is we always knew patients loved it, because telehealth transforms the patient’s experience, but telehealth, doesn’t transform the doctor’s experience at all.

[00:34:59] If anything, they might actually get paid to less doing telehealth than if they did an in-person. So many people say, “Oh, the genie is not going back in the bottle”. I was like, yeah. Don’t underestimate the power of how it was previously, because the only reason many of those doctors went to telehealth is because the value equation changed for them.

[00:35:18] Their choice was see no one or do telehealth. And that’s a very different value equation than what we have today. Which, okay, you can go into the office and you’re going to wear a mask and we’re going to have to do some digital check-in and some things like that.

But it’s doable. So, you know, if they can get reimbursed properly, then there will be a decent number that say, “okay, let’s do it because it’s right for the patient, because it transforms the patient’s experience”, but it does nothing for the doctor.

[00:35:44] And that’s what I think many people are like… I mean, we said this even before COVID. “Why isn’t, telehealth adopted?” It doesn’t help the doctor. It may actually hurt them. So, you think doctors should do this? 

Ethan Bechtel: [00:35:56] Yeah. Yeah, no, that’s a really good point. I mean, because you’ve thought a lot about this you might have some insight into this as well, but I’ve realized that the more I talk to physicians about their telehealth experience and what they like and don’t like about it, I hear the same thing over and over, and that is:

[00:36:13] There are observations that you can make in person that absolutely, today, do not translate digitally. And that could be anything from, you have a patient in your office that, you know, maybe had dealt with alcoholism, and there are senses you no longer have access to, to help you figure out what’s going on.

[00:36:38] Is this person, you know, is this person a smoker? You know, what else can’t I learn from being on video that I used to be able to observe in person?

And so I think the opportunity there is as the technology evolves, and obviously there’s a regulatory component of this to make it worth doing, but as the technology evolves and we start talking about internet- connected devices that can provide readings to kind of augment some of what would have been an in-person experience, but all through the phone, right? How can I do everything from getting temperature to, you know, anything else because of, of connected devices?

[00:37:21] You know, I think maybe those things start to help. And I also think to help doctors think kind of real-time about what’s going on. Are there things that I’m missing? That are in conversation right there for us to learn from. I think there’s an opportunity there too. 

John Lynn: [00:37:36] Yeah. You know, I think it was a decade ago, I was talking to a doctor about his visits and he went through his whole schedule and he said, “okay, how many of these did I need to see the patient?”

[00:37:48] And, you know, his estimate looking at his schedule, which is, you know, this is anecdotal. He’s like 60 to 70% of them I didn’t have any need to actually see them. I could’ve just talked them through, heard their symptoms and been able to do the diagnosis. So there’s a large number of things where you don’t need it.

[00:38:04] And the counter to your point, as far as you know, “Oh, could I smell their breath? And, you know, I understand something about them?” Certainly that’s a negative and there’s certain situations where that’s true.

But we’re actually hearing many stories from doctors that are doing telehealth that are like, “Hey, we got insight by seeing their living situation that let us understand how to diagnose them better and how to give them an effective treatment plan”.

“Oh, you’ve got ten beer bottles behind you. Hmm? I wonder?” Right? You know, so it’s the same message,  but the other direction. So, you know, there’s pros and cons to in-person versus telehealth. There’s pros and cons to text messaging versus telehealth.

[00:38:41] I might even be more open with you if I’m texting you than if I’m on video and I see you face to face. So I think that there’s differences in all of them. And we’re going to have to figure out where is it most effective to text? When is it most effective to hop on video? And when is it most effective to get yourself into the office and let’s see each other in person?

Ethan Bechtel: [00:39:02] Yeah, I think we’re going to learn a lot about when, to your point, when we dig into the data and we start thinking about what it means from the past year, what are the takeaways? And we’re gonna be able to apply those learnings to future direction, hopefully that means more leveraging of technology to provide care and access like this to more people.

[00:39:24] So anyway, it’ll be an exciting next 12 months. Hopefully we’ll go in a more positive direction and come out on the other end, feeling good about all of it.

[00:39:33] John, I’m sure I missed some questions, but this has been a great conversation. I’ve actually been excited to talk to you for a little while now. So much has changed since we last spoke, but I’m excited to do it again sometime. This has been great. 

John Lynn: [00:39:46] Definitely. Thanks for having me. I really enjoyed the discussion.