Why Aren’t We Using Telehealth Anymore?  

In this episode of TD Cowen’s FutureHealth Podcast Series, Dr. William Morris, former Executive Medical Director of Cleveland Clinic Innovations and Ventures and current member of the Cleveland Clinic Board of Governors and Google Cloud’s Healthcare and Life Sciences Solutions business, joins Charles Rhyee, TD Cowen’s Health Care Technology Analyst. Together they try and answer the question, what’s going on with telehealth, or more exactly, what’s not going on with telehealth? 

After demonstrating the ability to successfully deliver effective care during the pandemic, with adoption rates in the range of 80-90%, we’ve seen telehealth utilization drop dramatically back to the 10-15% range. While still well above pre-pandemic levels, it’s a far cry from what we saw during the height of the pandemic. So why has this been the case, what can be done about it, and what’s next for virtual care?  

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Transcript

Speaker 1:

Welcome to TD Cowen Insights, a space that brings leading thinkers together to share insights and ideas shaping the world around us. Join us as we converse with the top minds who are influencing our global sectors.

Charles Rhyee:

Hello, my name is Charles Rhyee, Cowen’s healthcare technology analyst, and welcome to the Cowen FutureHealth podcast. Today’s podcast is part of our monthly series that continues Cowen’s efforts to bring together thought leaders, innovators, and investors to discuss how the convergence of healthcare technology and consumerism is changing the way we look at health, healthcare, and the healthcare system. In this episode, we’ll discuss what’s going on with telehealth, or more exactly what’s not going on with telehealth. After demonstrating successfully the ability to deliver effective care during the pandemic with adoption rates in the 80% to 90% range, we’ve seen telehealth usage drop dramatically somewhere in the 10% to 15% range.

While that’s still well above pre-pandemic levels, it’s a far cry from what we saw during the height of the pandemic. So, why has this been the case? What can be done about it, and really, what’s next for virtual care? To discuss the topic, I’m joined by Dr. William Morris. William is the former executive medical director of Cleveland Clinic Innovations and Ventures. He’s a member of the Cleveland Clinic Board of Governors, and currently works at Google Cloud’s healthcare and life sciences Solutions business. Will, thanks for joining us today.

Dr. William Morris:

Absolute pleasure, Charles.

Charles Rhyee:

Well, maybe you can share for us a bit about your background, maybe some of your time at Cleveland Clinic or before, and so how you got involved here.

Dr. William Morris:

It is somewhat of a circuitous story. I refer to myself as the bent arrow. My background was in biomedical engineering, so really, really fascinated around systems, how things are managed and systemness, went to med school, and trained in Boston, and then ultimately came to Cleveland Clinic, because I was really, really fascinated around their idea of care. It centers around a couple three things. One is it was a employed model, meaning clinicians were not incentivized. We never received bonuses or any payment structures to do above and beyond. So as a hospitalist, I didn’t get reimbursed to see more patients, do more procedures, do things.

I was really, really measured on one aperture, which is providing the best quality of care that is the most affordable. One is the practice itself was from a system perspective tuned to that care delivery. I’d say second was one of innovation, so through my background, really interested in systems of care that supports the people in process and obviously technology being one of them, and was lucky enough to be one of the first CMIOs over Cleveland Clinic, and then ultimately the associate CIO over our clinical systems. So while we deployed an enterprise EMR, that was never the single pane of glass that ultimately kept our patients, our mind’s eye towards what’s the best experience for our patients, so really sought smarter, better people than ourselves to bring those experience in.

One around our technology strategy was one of partnerships. How do we actually bring the best and brightest? There’s an embarrassment of riches in technology outside of healthcare, and shame on us if we do not leverage those capabilities. The third aspect from a systemness perspective was a laser focus on, one, your metrics, your goal, your North Star, and that was the patient always. That really… It’s instilled a degree of focus and clarity that I still use today, even while I’m not in specific healthcare delivery at Google. It is my North Star. It’s what keeps me up at night. It’s what wakes me up in the morning.

With that level of clarity and focus, I think you’re able to tackle things that otherwise are “untacklenable,” and really convene people to do great things. During that time, I was blessed to work with an unbelievable aperture of great people, Cowen being one of them, certainly technology company. I was fascinated yet again by what Google was doing and how they were considering these vexing challenges within healthcare in terms of, again, how do we deliver the best care for the lowest cost, and make it affordable and universally accessible?

I gave up my stethoscope so to speak, although I still do virtual care on the side, so we’ll talk about that, but to join an unbelievable team within Google or actually even broadly within Alphabet, to really think about how we can be part of this journey as partners with payers, providers, retail pharmacy, retail health, life science and biotech. I will pause there, because it’s a boring soliloquy, but I guess what gets me going is systems of care, because I think technology is an enablement, and we’re talking about telehealth. It’s great that we can do virtual visits, but it is a piece I think you need to align the people and the processes to achieve the great value.

Charles Rhyee:

That’s really helpful. I think it does set the stage here, because I think we tend to think of telehealth in this vacuum or these single solutions that by the… We don’t think of it in the whole often. Certainly, I think from the investment community side, sometimes we’re looking at just a device or just a single drug, and not thinking how it fits into the broader delivery of care. Focusing here, let’s say… Let’s talk about telehealth a little bit. I thought it was so interesting, because I’ve been covering or following telehealth since nearly the start going back into the early 2010s, and watched companies like Teladoc and Amwell come to the market or getting ready to come to the market, and watching that utilization metrics slowly grow. I think it started at 2%, crept up to low, mid single, upper single digits.

I think everyone was pretty excited that, “Hey look, this seems to be getting some traction here.” Then the pandemic hits, and all of a sudden, the next thing you know we’re at 80%, 90%, and everyone’s scrambling. You’re hearing about it on TV everywhere. By and large, the experience that people had was positive. Everyone lauded the benefits of it. My impression at the time was that, “This is great.” We’re going to come out of it, and we’re going to have discovered a new modality to deliver care in an effective and efficient way. But then and next thing we know, doors open, and everyone reverts back to the status quo.

What was your impression during that time, just a couple years back, and maybe a little bit before that, what you thought of telehealth, and what you saw during the pandemic, and maybe your impression as we were exiting it?

Dr. William Morris:

Pre-COVID, I think that’s going to be a new… Pre-COVID and post-COVID landmarks, but pre-COVID, I think early on in telehealth, it was a solution looking for a problem. I think a lot of that slow uptake and gradual uptake is where people said, “Gosh, you know what, there is value in mental health patients who don’t necessarily want to navigate your lovely parking garage or waiting room, and find solace within the comfort of their own home.” There is value in post-operative patients where actually the provider doesn’t get more revenue, and neither does the facility. It’s part of that global bundle where you can provide exceptional service, exceptional experience, and actually lower cost.

There was exceptional value where you were able to triage patients virtually, and get them to the right care provider, right medication, right intervention all through telehealth. So at the clinic, we were very much not enamored, but saw the opportunities for us to solve one of the more vexing issues that, I think, large systems are facing, which is access. Despite these huge brick and mortar buildings, access is still formidable and difficult. So, we looked at telehealth as a means to do three things. One is to open up access. It’s the right experience for the right patient at the right time at the right cost.

Two, I think it actually opens up growth potential. So, my colleague, Dr. Peter Rasmussen, who led our digital health at Cleveland Clinic, he would see virtually 99.9% of his patients who came to him for neurovascular interventions, because all of the information can be digitized, and he can come up with a plan, and then see them in OR where he really needs to obviously be face-to-face. So, we saw some really, really innovative clinical practices that could grow with this powerful tool. Then I thought then the third opportunity was what are the things that we’re doing today that needs to stop? How can I actually manage a population, and proactively outreach to them as opposed to what is the industry normal?

I will see you in routine followup in three months. Everyone has that knee-jerk, the dot phrase, the phrase in their note, “I’ll see you in three months,” despite that if the patient needs to see you in three days or in three years, because they’re doing well, and yet we have this mentality at least in the face-to-face of one glove fits all. So, we built out the technology at scale, but I still think how do we actually address payment issues? How do I address workflow issues, because you’re still battling a busy clinic, and how do I actually integrate that into a value system that makes sense for a health system, for a payer, and ultimately a patient?

So, we had the building blocks, and then COVID hit. I actually think of this. Your favorite restaurant probably did take out once in a while, but then COVID hit, and all of a sudden became the default mode. Well, COVID became that forcing function that allowed us to decide status quo and, “Oh, well, we can’t do telehealth, and telehealth doesn’t provide exceptional experience. It’s not the same as sitting with a patient in the room in that experience.” I think now that it’s died down, I hope we don’t regress back to the status quo. I feel strongly that is not the right thing to do for our patients. It’s not the right thing to do as healthcare expenses go through the roof.

Now, if you build it, will they come, I think, is a is fool’s errand, and so I think what’s incumbent on all of us is how do we find the right use cases, the right incentive models, the right experiences that make sense? It’s a tool. It’s not the rule. Not everything should be recapitulated in a virtual experience. I think we need to rethink and reimagine the very transactional healthcare experiences. I see you have a followup. I do stuff and use virtual in other ways. Again, I tapped a little bit about chronic disease management, and an ability to engage a member, titrate their meds, make sure that there is no barriers to access preemptively as opposed to what we’re geared towards, which is we wait until the wheels come off, and then you have to use a high-cost, poor experience venue.

Charles Rhyee:

I mean, I totally agree with you. I’d love to touch on that end. You talked about this… It’s an amazing tool, and you hope that people learn to utilize it, and yet we’re not, right? Why do you think that is? Why do you think it has regressed as much as it has?

Dr. William Morris:

I mean, there’s a couple factors at play within the construct of an academic medical center or a hospital. Right now, there are fiscal austerity issues. They need to see patients. They need to support their mission, and so you progress to what works. You regress to things that have always worked, which is get them in fee for service scheduling. It’s okay to have a three-month waiting period. That shows that you’ve got excess demand for your capacity, and you know can imagine that’s revered. I think as we move towards value-based care arrangements, capitation full risk, where we need not just provide care, but we have to provide the right care, and we have to provide proactive care.

We have to provide participatory, meaning that the patient or the member feels engaged. I feel like those alignment strategies will happen. We’re seeing a lot of… Telemedicine is certainly not dead. I think it’s being reimagined and redeployed in different venues. We’re seeing this at least from a Google perspective, and some really, really insightful partnerships, obviously, the acquisitions of either CVS or Walgreens, getting into that space where they don’t want to just provide vaccination clinics and PBM and drug services, but they really want to provide holistic health. Telehealth and access and that consumer experience is exactly those plays.

We’re seeing this definitely within the payer community as they want to participate not only in just an exquisite member experience, but how do they manage these costs? How do they provide a frictionless experience for their members that is pleasurable, and achieves better health outcomes. I think, we are going to see a J point curve up in incentive-aligned uses of telemedicine for patients. I think we see a lot of it even with asynchronous care. We might talk on generative AI and that whole buzz, but I do feel like we’re in this perfect storm where we have unbelievable sensor data. We have unbelievable AI, ML, and insights.

We have an alignment of payment incentives to do the right thing for the patient, and then we have an alignment where the consumer actually demands this experience as they should. I think with those four forces, we’re going to move forward. Those who want to regress to status quo, I think, are going to be in trouble.

Charles Rhyee:

When you talk about these four forces, I mean, the patient one is interesting. You need the patient also to demand the service. Maybe what we’re seeing to a certain extent is that patients, they’re the ones reverting back. I mean, we hear that from some of the hospitals we talked to. When you ask why their telehealth usage is so low, and they say, “Well, there’s no demand for it. Our patients want to come in,” which boggles my mind. I mean, I think I was speaking with one health system, and they’re saying, “The average time, a patient takes an hour and a half drive, wait 30 minutes, 15 minutes visit. Then they’re driving another hour and a half home, so it’s like five hours.”

You would think that that’s not a great patient experience. Yet, it seems that in some cases, patient… Where do you think that lies? How do we educate the patient to be more engaged and see that there’s other ways to receive care?

Dr. William Morris:

Well, I mean, I think at the end of the day, we got to meet the patient where they are. I don’t think it’s our job to create experiences that they don’t want. Now, I question then is it that they don’t want telehealth, or we’re actually not providing the right telehealth experiences. Do I expect a telehealth visit to replace that therapeutic bond between a primary care physician and a patient as the sole entity? Absolutely not because there is such a degree of therapeutic exchange in those physical moments that feels private and privileged, and you’re able to lay hands.

I mean, there is a human connection that I think is an indelible, and so you don’t say that this is a tool that would replace any and all of that. But certainly around chronic disease, when we see there’s the ballooning costs of chronic disease, we know care variation is so large, so we know what these costs are doing to employer plans, and in payers, but also the mortality and morbidity that’s causing patients. So, we’re seeing these new entrants where they’re providing services, not just telehealth service that says, “Hey listen, you have heart failure. Ping me if you feel short of breath.” Instead of going to the emergency room, I think that’s too far down.

It’d, “Hey, we’re going to be monitoring you. We’re going to enable you, and we’re going to do outreach proactively, because we have your care interests at mind.” I do feel like members who have those conditions will opt in, because I think it’s hard-pressed for them to say, “Hey listen, we want to replace your primary care physician or your cardiologist or whoever.” I think that is not their approach, but if it’s, “Hey listen, we want to provide backstop services to prevent you from going into the emergency room, or heaven forbid having a complication, or causing you kidney disease or eye disease because of your diabetes’ poor control,” I think that is good.

Your education point is exactly right. I think we do, and as a physician, a poor job the what. A lot of these chronic diseases are insidious. You don’t feel that your blood sugar’s high, or you don’t feel necessarily that you might be getting a little decompensated if you have heart failure. You don’t feel your high blood pressure. So, I think our job to educate and engage is absolutely essential, and we need to do a better job articulating how these experiences translates to value back to the patient, because otherwise, it just feels like, “Hey listen, we’re just trying to save a dollar by not letting you go to the emergency room.”

That’s not it. We’re trying to keep you the healthiest and in the best condition. We want quality lives and quality life for our patients. I do agree on the education. The engagement and explaining the value story in the eyes of a patient, I think, is a real good opportunity.

Charles Rhyee:

I mean, you bring up a good point, right? I think probably a lot of it is that I want to see my doctor. I don’t want to see a random doctor. So, one of my thoughts was, “Hey, post this pandemic, the next real wave of adoption will be the provider, because their patients want to see them, and then it gives them a new way to do it.” Even here, it seems… That’s where I don’t know whether it’s physician driven, or is that maybe more structural? How much is the fact that we don’t have permanent rules around telehealth, the telehealth flexibilities, and provision of care across state lines, et cetera?

How much of that do you think is impacting the health systems’ decisions on enabling telehealth for physicians? Do you think… Is it that the doctors, they want to do this, but they’re being told, “Hey, we got to be a little careful here, because we don’t know what the rules of the road are right now?”

Dr. William Morris:

I think all of those points are correct. I mean, it is hard, because it’s hard. It’s hard because there are a multitude, back to my original point, of systems challenges that you have to think about. Again, if you build it, they will come is not the right thing. I think you have to understand workflows, get the alignment of the clinicians, get the alignment of the payers, the patient. Otherwise, the other way is what I… change management is really, really tough. I’m going to nibble away on the outside, so lifestyle meds. We’ve seen companies that just, “Listen, we’re going to go after this demographic and this use case. It’s perfect for telehealth, and we’ll carve away.”

That’s fine. I think they’re going to have a hard time then eroding in, if you will, to really tackle what I would say or not the transactional like, “I’ve got an earache. Let me go do this,” but more of the meat of healthcare delivery. I think it’s going to take a village. It’s going to take an alignment with the care team, with the patients, with the payers to all figure out these are all tools in our toolbox, and where is the right tool for the right problem at the right time, at the right cost. So, it was a mediocre answer. It’s complicated, but doing nothing and just going back to, “You know what, I’m going to close out my telehealth, and I’ll just… Here’s my schedule, and I’ll just see you,” I think is not the right thing.

I feel comforted that I don’t see a regression to that point. I think we actually have a new normal. Out of that new normal, I do believe that the winds of change will be at our back.

Charles Rhyee:

It’s interesting you brought up earlier new ways of deploying telehealth. Maybe it’s not through the traditional provider network. You talked about drug retailers like CVS and Walgreens. Also, it seems like in this vacuum where I would’ve thought traditional providers would’ve stepped up and say, “Hey, we want to provide this service, because it’s a conduit into our system, and we keep our patients.” You’ve seen payers really step into this void. You have UnitedHealth launching a virtual platform, and Aetna as well. What do you see their role? Because right now, that means they’re looking to deliver the clinical care for their members, and provide that experience for their members. What is the role that you think they’ll be playing here?

Dr. William Morris:

I think they’re going to play a formidable role. I mean, they have unbelievable scale. They understand their members’ needs. They have data. They have insights and knowledge. They certainly have capital, but they can do it at scale a lot more judiciously than, say, an individual system, because there isn’t just that… It’s such a fractured market on the care delivery side versus the universe of payers. Even the independents are coming together and thinking about these. I think that’s exciting. I think a coalition of the willing thing. How do we take out non-value experiences? How do we avoid patients going to the emergency room or routine things?

How do we help our members get evidence-based guidelines? The variation of care is you can’t argue against it. You can’t argue that… You can’t look at someone’s eyes, and we’re like, “Oh, in the U.S., we always provide evidence-based care and exceptional care,” because we don’t. I mean, the numbers don’t lie, and some of our outcomes, if you look at fetal mortality, is abysmal. So, doing the same thing is not on the table. I actually applaud the new entrance. I don’t have a horse in this race. I think that those that master data, and those that master the member or the patient experience will really place a challenge to the status quo incumbents.

Charles Rhyee:

Do you think though that the way care is being delivered needs to significantly change? You brought up the example that we can’t go back to doctors having a full schedule, and patients waiting in the waiting room. You talked about this new normal, so maybe pre-pandemic, we were, what, mid, single digit usage. Actually, if you think about, we’re double that today. So if we didn’t have pandemic, maybe we would all looked at this number and said this is great, but we can see where it could be. From this new normal, where do we go now then? How do we drive that further then?

Dr. William Morris:

No, I think we need to continue to experiment, and then when we have something, it’s got to scale, because there’s so many little niche pilots solutions, point solutions, one-offs. I think at the detriment, one of the challenges I think is if you believe this entire universe, you could imagine that a single patient with type two diabetes could have 30 or so little point solutions all gobbling for attention units. So, there has to be a cohesive member experience or patient experience that makes it easy. I’m not saying that we have to solve for all the complexity, but it has to be invisible to the patient.

The patient wants something that feels like it’s coordinated and aligned to their value. They don’t want a phone full of apps and reminders that all have different nuances and different agendas if you will. I think taking things that work, and then bringing to scale is going to be the next journey. We’re seeing that in the startup space. There’s a lot of coalescing of these point solutions, and just something that is holistically aligned to the patient. The other thing I think is… I don’t have a solution for it, but it’s just a reality is that at the end of the day, patients and consumers, it’s an issue of trust.

They trust their provider or health system. There is a inherent brand, if you will, that is really, really special and important. I love the model at Cleveland Clinic, because we weren’t… We’re incentive. I felt like that was the cleanest way that I could look someone in the eye and say, “This is the right thing to do,” and I’m not getting a dollar or saved or earned on that, but it’s not. Certainly, it’s not the only model, and I do feel like the physicians, the nurse practitioners, the caregivers out there do have an unbelievable leg up, which is the relationship.

So, how these new entrants think about the member, and think about the engagement, they have to take in consideration, “How do I capture that ethos, if you will, and bring it?” I don’t think a faceless app will ever replace that kind of therapeutic alliance between a patient and their provider. How do we enable that and make it better I think is the real opportunity.

Charles Rhyee:

Even bring it together, right? I mean, it’s a… Which is why, because to your point, I think that relationship really is important, and you see it. I know from my own experience, I’ve used both telehealth, seeing somebody just quickly and then still go to my own doctor. It’s funny when I talk to him, “Do you offer telehealth?” He is like, “Well, I did it for a bit.” It’s like, “Ah, okay.” I’m still with him.

Dr. William Morris:

Just text me if you need something, and then when you text them, they’re like, “Great. Come in tomorrow. I’ll see you tomorrow,” so I get it.

Charles Rhyee:

Exactly. It’s a start though, right? At least he’s texting. I mean, it’s one of those things where it feels like… You look at all this universe of digital health, and a lot of what they’re offering seems quite interesting, but it sits apart from this traditional healthcare infrastructure. Is the answer then the ones that can integrate themselves, and help connect maybe in a more efficient way or a more engaging way the provider to their patient? Is that the path that we should look at?

Dr. William Morris:

I certainly feel that. I think that’s why I came to Google is Google in cloud. We’re not going to get into the provision of care, because that’s not our core book of business, but what our core book of business is managing the world’s data, and making it universally accessible and useful and secure. I look at our opportunity to enable those things we talked about through the lens of platforms that can capture these disparate data sources, harmonize them, and make them secure, but then make them accessible to those care systems, care providers who are doing that last mile.

So, from our Google health strategy, we view our job to enable those men and women who are providing those exceptional care experiences, or payers who are trying to create the next generation of care experiences, or new or existing retail health solutions where they’re trying to ensure that if they provide unbelievable diabetic care for that patient, that local primary care is getting that right information, and they are well informed and part of this community. The exciting thing is this stitching together this data fabric that allows the patient to be in control of their data, and then also allows them to have a frictionless experience as they, I don’t want to say, bounce, but navigate around these new experiences.

Charles Rhyee:

Maybe just following up on that, I mean, are you saying… The mission that you guys are looking at right now, where are we in terms of this open data fabric? Because healthcare has been born and raised on these proprietary systems that were used to be closed, and we’ve been fighting for years to interoperability, is it a made-up word just to try to connect all these things together? I guess the question really is how close are we to what you guys are… what you’re talking about here?

Dr. William Morris:

We are closer. I mean, I think it’s… This is a marathon, not a sprint. Interoperability is buzzword bingo. It’s a lot of work. There’s policy. There’s a belief in open standards that a rising tide raises all boats. We come from a position where we think exceptional and secure experiences controlled by the patient and the systems or customers needs to operate in a transparent fashion that is secure, that it meets all of the security compliance, but also is not one to be locked into a proprietary schema, because it’s not the right thing to do. If we think about this new world of an ecosystem, where who knows who’s inventing the next experience or the next sensor, the next drug discovery, our job is to level the playing field, and ensure that we don’t create silos or blocks to that type of innovation and work.

Are we there yet? No. I mean, I don’t think there’s ever going to be the mission accomplice sign, if you want to go back into history. I think it is a relentless forward progress event that just requires constant working with the government, working with software companies, working with even our competitors. We are all striving for this. It’s hard work, but I think, again, going back to my principles, if the patient’s at the center, the duty and the obligation become clear, and we just need to continue to do that.

We’re seeing… We’re beginning to see cracks and opportunities. We’re seeing unbelievable collaborations and data collaborations between payers and the providers in ways that they’re leveraging open standards that can de-risk and bring in exceptional and unbelievable experiences. I am beyond optimistic, and it’s a marathon, but totally in it.

Charles Rhyee:

I hear you on the marathon part. It is… The question is like, “Are we at mile five, or are we at mile 15?” It feels like we’re still quite ways from the finish line.

Dr. William Morris:

No, I think we’re on our way. We’re certainly not 24. We’re not… Some days, it feels like we’re on Heartbreak Hill if your listeners are Bostonians, but I think we are more than halfway. I believe we have standards. We have policies in place. It’s getting them disseminated and deployed. I think that last part of the race or races is how are we creating value for the patient or the payer or the provider, and how do we actually leverage? It’s great. If you build it, they will come. You have to start thinking how do you stitch all of these things together to ultimately drive value? I think that’s the exciting part.

Charles Rhyee:

You touched on before, and I always fall to that as well. I think about it a lot, which is the way our healthcare system is set up, you can think of as reactive. You come in… I go in because I don’t feel well, and then I’m diagnosed with something. Then there’s a treatment plan to try to fix that. Whereas it is… To your point earlier, we have the technologies, it seems, to be more proactive so that you as a provider, we can intervene earlier, and maybe prevent really the most costliest outcomes. Maybe talk a little bit about that. You touched on it a little earlier. The role of AI in this to be able to maybe triage earlier, where are we with that?

Dr. William Morris:

Well, let’s accept a couple realities even with the data that we have today. I mean, you have to… I’m a pragmatist like, “Have we mastered even the data in front of you?” The answer is no, right? I’ll play out a scenario. Like you said, you don’t feel well. You show up. At that point, the clock begins. But if he or she clinician were to look at that chart, or understand that, there’s probably signals in that record that they would say, “Hey, you know what, Charles, what you’re telling me makes sense, because look at this. You’ve been slowly gaining weight, and your creatinine’s been creeping, and so there’s a lot of the signal and the noise.”

The question I always have is do we need more hay? Do we need more sensor data, or do we actually need insights and AI to actually find the needle in the haystack? It’s a little bit of both. I think we have an opportunity to master the data that we have in front of us. It’s not just the EHR, social determinants of health. We can identify patients in socially, economically challenging areas or health disparity areas that have food deserts, and we can play out the scenario. We know what will happen in terms of health equity outcomes or access to care, and yet we don’t do anything. We wait until something happens and then we react.

One is it’s great that we can… We have to create insights in AI, but if the AI is just sitting there, it’s got to activate someone. It’s got to activate a system of care to proactively do something. These alerts in the electronic health record are great when you open up the chart, but it doesn’t fire, or it doesn’t fire to anyone in particular if the data had come in three hours or two, three days before. It’s a very time temporal challenge. So, we’ve got to think about, “Yes, it’s important to get data into insights, insights into actual insights, but then what you also need is the people in the process to take that football, and run it down the field.”

Otherwise, what we just do is we create alerts, and we automate our broken process, which just gets us broken faster.

Charles Rhyee:

Is that an incentives issue? I mean-

Dr. William Morris:

It’s an incentive, and it’s a workflow issue. I mean your busy primary care physician, God bless, is working at 120% just for who’s in front of me right now in transaction. They’re not asking questions. It’s difficult to say, “Of my 2,500 patients, who’s at risk and who should come in?” That’s a real challenge, and so I think these opportunities to think about population health and predictive analytics that are so unbelievable care coordinators and nursing, I think pharmacists and clinical pharmacists are another complete untapped rockstar clinician that can be leveraged to help us with complex med titration, med management, med titrations.

I do… A long-winded answer, I think AI is a piece or finding the signal and the noise. I think there’s also of who in the care team needs to be activated? Then in the incentive, if I did that, what’s the value? How do I cover that cost of care? How do I recoup that effort, because it is resource. So, these risk model agreements where there’s incentives to do the right thing and do it proactively, I think, are key pieces.

Charles Rhyee:

Have you seen anyone try that, remodel the workflow where we’re only calling in the patients where we’re seeing signals? So, it’s not like we’re setting up routine. Obviously, people will come in because they have a problem, but to track and reshuffle the way we run an office.

Dr. William Morris:

Well, I think we’ve definitely seen a lot of examples of these, and some of these exciting companies and MA plans are doing a lot where they’re engaging the member, and trying to keep them off the curve, if you will. I think, again, this model of, “Well, I have one solution. Everyone should have it,” is wrong, right? Healthy 20 something doesn’t need that horsepower behind them. If they’re doing all right, then routine followup is just fine, but perhaps that 20 something has a chronic disease and needs that. So, I think it’s the right solutions for the right patient. I think that matching game needs to happen too.

It’s not just a model of care or a solution. It’s the right solution for the right problem at the right time, at the right cost. You need to have all of that consolation. Again, yes, there are examples of these and unbelievable examples in terms of outcome, how they then stitch together with all of the other care delivery aspects, because people are varied. How do you do that at scale, I think, is the exciting next chapters.

Charles Rhyee:

You talked about generating insight. It’s got to lead to action to someone to actually do something. Obviously, a lot of buzz around AI and ChatGPT where… I mean, do you see a world where an AI can be trained to provide that first level of triage like that urgent care visit like, “I have a rash, and I can take a picture, and I can send it?” Is there a future where we don’t even need the clinician to deal with that minor issue, and really save that resource for something more complicated?

Dr. William Morris:

Listen, I think anything is possible in the future. Is it here today? No, and I think we need to buttress reality, and crawl, walk, run. I just came back from HIMSS, which is a very, very large health conference around technology, and large language models or generative AI has certainly captured the zeitgeist of the moment. It’s fascinating because it’s creative. It’s interactive. It’s a huge leap of faith to say then, “Hey listen, this magical foundational models is going to supplant the clinician.” Someone a lot smarter than I had said, “AI or these capabilities won’t replace the physician, but the physicians who use AI, and use these tools will certainly replace those who don’t.”

I think there’s a subtle degree of truth to that. I think these are, again, powerful tools and experiences that I’m optimistic for. I also have a degree of trepidation in terms of really the groundfulness and truthfulness responsible AI that needs to happen. I mean, these are patient’s lives. Even something as benign as, hey, having a generative AI give me a physical therapy routine can impact a patient in a way that we don’t know the unattended consequence. I think that’s incumbent on us to be in this space optimistic, but not complicit and stupid. So, we’re very much… Again, this isn’t just a Google thing, but we published this in 2017 before we wrote the transformer paper that it is incumbent on all of us to think about these responsible AIs particularly with healthcare.

We have agnostic AI principles, but respecting science literature always with the human in mind, making sure we capture issues like bias, really, really understanding regulatory compliance, security, privacy. These are things that are just top of mind and have to be solved. Again, I’m excited, but I think it requires a lot of smarter people than myself, a whole community, and not just within the tech space to really think thoughtfully and carefully around this. So at the end of the day, technology enables exceptional clinical care for patients, because we all know it’s not perfect now. It’s in fact pretty broken if you think about your own experience, but we don’t want to cause harm. Absolutely not.

We have to do the right thing, and so I think this’ll be a brave new chapter as the hype around this and in the imagination. It’s great that you can write a limerick. We could turn this entire chat into iambic pentameter, and Bard could do that. That’s great, but this is about patient care, and this really requires the respect and rigor that we would do any drug touching a patient or any procedure.

Charles Rhyee:

Well, hey, this has all been great. Maybe just to throw one last question to you, you talked about you think we’re more than halfway there, and obviously very optimistic about the future. Where do you see then maybe the next five, 10 years? How do you envision what the future patient encounter will look like?

Dr. William Morris:

I love it. Well, so let’s focus on the patient encounter, because it’s a ubiquitous pain point not just from a clinician, but from a patient perspective. You sit down with a provider, even sit down with a nurse. I guarantee you, I’m not looking in your eye. I’m looking to try to… Again, this is not a hit to the EHRs. There’s a lot of data in there. It’s data dense information poor, meaning there’s a lot of pieces of data, but I have to use my cognitive workflow to paint a picture, and read all of these data MOs to get an idea of what is going on with you and what do I need to do next, as opposed to having that information synthesized and presented and packaged that is relevant to the issue at hand.

I do feel like in the next couple years, we are going to have the ability to at least enable a nurse or the provider or even the pharmacist who today may just see that one med, but may not see the entire 360 picture. They might have access to the data, but they don’t have the time. So, how do we leverage technology to surface the right information in the right format to the provider? I think things like ambient voice and huge leaps and bounds around speech but then summarization is really exciting. I think that’s awesome, because it’s less time than I’m typing, and more time I’m listening, and going back to the original hypothesis, “Will telehealth replace all?”

No. We love the physical encounter. Great. Can we make the physical encounter even better, not just the telehealth? I think the answer is yes. So, I want to give back time to the provider. I want to give back time to the patient actually as they navigate that experience. Then the last one, I think, is all of the Byzantine games that happen on the backend between payer and provider are beginning to dissolve. We’re seeing some tremendous partnerships around, “Hey listen, if we have this information, and we can auto adjudicate a payment, a claim, or that patient will know what it’s going to cost, and have transparency.”

I am really, really optimistic of the coalescence of the players, and at the end of the day, making the patient’s life better, but their experience and ergo, those who are providing the care, their experience better too.

Charles Rhyee:

Well, this was fantastic and, I think, a great way to end it here, and really the focus on the patient. I want to thank you for joining us on this podcast, and really sharing your thoughts. I want to thank everyone for joining us for this episode. I hope you tune in for future ones. Thank you, everyone.

Speaker 1:

Thanks for joining us. Stay tuned for the next episode of TD Cowen Insights.

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