Latest / The Strategy Catalyst Dispatch / Virtual Second Opinions with Jarrett Fowler of USCIPP

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Virtual Second Opinions with Jarrett Fowler of USCIPP · The Strategy Catalyst Dispatch

• 0:27
  Jerome: Today we're featuring an interview that Anika Rasheed had back in fall with Jarret Fowler, senior Director of Strategic and International Initiatives at the National Center for Healthcare Leadership, where he leads U ip, the US Cooperative for International Patient Programs.
• 0:43
  Jerome: If you haven't heard of uki, it's a consortium representing over 60 leading US hospitals that are actively involved in international patient programs offering a vantage point for understanding how health systems are building and scaling virtual second opinions across borders.
• 0:57
  Jerome: Hey, Anika, tell us about your interview.
• 1:00
  Anika: So in this episode we're diving into virtual second opinions and international markets.
• 1:07
  Anika: I spoke with Jarret about the biggest questions strategy leaders are asking right now, like which international markets are seeing the most growth.
• 1:15
  Anika: what legal and regulatory challenges should systems be preparing for what's working, especially when it comes to partnership models, peer-to-peer consults, and building sustainable high value virtual second opinion programs that go beyond just being referral systems.
• 1:31
  Anika: So without further ado, let's get into it.
• 1:37
  Anika: So, Jarrett, would you mind, uh, starting by just introducing yourself and telling us a little bit more about your role at USCIP?
• 1:44
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Sure.
• 1:45
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Yeah.
• 1:45
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Thank you so much.
• 1:46
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And thanks for having me on.
• 1:48
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: so I'm Jarrett Fowler.
• 1:50
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I started as a program coordinator for our USCIPP program, U.
• 1:54
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 1:54
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Cooperative for International Patient Programs, which is a consortium of American hospitals and health systems that all have international programs, almost all of the hospitals, in the consortium also, do cross border collaborations, of some sort, education and training, consulting, telemedicine services across borders, et cetera.
• 2:14
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: when I started, we had about 45 hospitals, and we have about 60 now, in the consortium and we have expanded, our services and what we do to support U.
• 2:25
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 2:25
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Hospital.
• 2:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: from, putting on international business development events.
• 2:29
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: to help, bring international partners together with U.
• 2:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 2:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Hospitals benchmarking data collection.
• 2:35
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So understanding where patients are coming from the volumes services that they are looking for or being provided, how international programs are staffed.
• 2:44
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and, more recently, adding, more robust, analytics and data collection and our benchmarking surveys around telemedicine and remote second opinion services, across borders.
• 2:55
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and so now in my current role, I really oversee all of the international Aspects of what we do in particular.
• 3:03
  Anika: so if I were a health system, interested in international work or international second opinions, what are some things that I could expect you skip to help me with?
• 3:12
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I think that one of the things that we have focused on, is making the YouSkip program, a must have for hospitals and health systems in the U.
• 3:22
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 3:22
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: that are interested in this line of work.
• 3:24
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: the data that we collect the vast majority of it is not, distributed publicly.
• 3:29
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: It's proprietary.
• 3:30
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: you have to, give data to see the data, right?
• 3:34
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: really, it helps you understand what the industry standards are.
• 3:39
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: across the, entire, gamut of what it takes to run an international program.
• 3:45
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: we've developed an international patient experience survey, actually, that, we, run with several of our members that, Specifically tailored to the needs and interests of international patients.
• 3:56
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: our benchmarking survey really shows programs that are maybe nascent what kind of data they should be looking at, what they should be collecting.
• 4:05
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: in telemedicine or remote second opinions, we worked with our members to develop very specific definitions.
• 4:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: around what telemedicine is, what is the remote second opinion in order to gather data and have it be an apples to apples comparison, We do a lot of, business intelligence analysis, keeping our members abreast of, what's going on in the market.
• 4:25
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and as it pertains to telemedicine, this is my pet project, my, my baby that I, have shepherded throughout the years and some of our due diligence work there.
• 4:34
  Anika: all sounds extremely valuable to anybody who's interested in, international work.
• 4:39
  Anika: so I kind of want to pivot to ask more about virtual second opinion specifically now.
• 4:43
  Anika: I'm curious in your experience.
• 4:45
  Anika: what trends are you seeing in the demand for virtual second opinions from international markets and which regions are showing the highest potential for growth?
• 4:53
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Yeah, I would say that, in particular, I think obviously COVID had a big impact on, the interest of hospitals in kick starting their, Focus on providing these services and actually, putting resources towards being able to deliver them right?
• 5:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Um, and doing legal due diligence.
• 5:13
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And when people couldn't travel, it became critical to be able to reach patients where they are, and stand up these programs.
• 5:22
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And even, since Covid, We have seen, the volume continue to increase, as far as countries, we actually don't collect data, on a country by country basis in terms of, encounters, yet, but, for telemedicine or remote second opinions, the countries that come to mind immediately would be, the United Arab Emirates, the People's Republic of China, Saudi Arabia, Bermuda, So several Canadian provinces.
• 5:47
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: so each Canadian province, has its own, very complicated, set of regulatory, issues as it relates to the cross border provision of telemedicine and RSOs.
• 5:58
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: let's see, Ecuador, Costa Rica.
• 6:01
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Panama, Mexico, and those are just a few.
• 6:04
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And, these are all, markets that we have had a high demand for, from our members and doing some of our due diligence work.
• 6:12
  Anika: Do you have insight into why there's demand into these regions from your members?
• 6:18
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Yeah.
• 6:18
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I think that, the golf, there are a lot of relationships already built there, patients potentially for travel.
• 6:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: a lot of that is, is with government entities, that, already send a fair amount of patients to the United States for care.
• 6:33
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and, in terms of Mexico and Canada proximity, I think is, it plays a big role as well as Bermuda.
• 6:41
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Um, and to some extent, Ecuador, Costa Rica and Panama as well.
• 6:45
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: there also is in many of those countries that I just listed, several, major U.
• 6:50
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 6:50
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: hospitals have, a strong presence in terms of a partnership or even an in country office where patients can come to the office and, learn about the services, figure out, maybe it makes sense to do a virtual visit before you, you know, travel to the United States.
• 7:06
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: that I think helps a lot in the countries that I listed.
• 7:08
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: A lot of them have those offices as well.
• 7:11
  Anika: Yeah, I'm sure that makes it easier having a partner or an office there in whatever country you're interested in already.
• 7:18
  Anika: On top of that, what do you think are some questions health systems should be asking themselves about their own readiness markets they're before launching
• 7:27
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: great question.
• 7:28
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: You need to have buy in from leadership.
• 7:30
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I think it's probably the most important thing.
• 7:33
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: You need to have buy in from your legal team.
• 7:36
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And you need to have a legal team that is willing to support the international program in this journey.
• 7:42
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: the regulatory environment.
• 7:45
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: on a country by country basis varies considerably, in terms of how permissive they are for various forms of, telemedicine and remote second opinion services.
• 7:56
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and then to be quite frank, you need to have a leadership team in an organization that is willing to take on some degree of risk.
• 8:07
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: currently I do not know of off the top of my head, any sort of litigation that has happened.
• 8:14
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and I will say it may be out there, based on a, cross border, telemedicine or so service.
• 8:21
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: but, the attorneys at the institutions that we work with, they very considerably in their tolerance for risk.
• 8:28
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and let's see.
• 8:29
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I think having, a leadership really seeing this as, An integral part of the overall portfolio of international offerings that the hospital is providing so for example if you Are a hospital and you are thinking you are going to get a ton of patients just by offering this and setting up this program You are probably mistaken the conversion rates, can be quite low, but a lot of hospitals really see offering these programs as a part of a broader package of international offerings that they provide to, their international partner.
• 9:10
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So let's say they work with a hospital in another country.
• 9:12
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: often international telemedicine and RSO services will be part of a consulting agreement or, you know, an affiliation that they have with their international partner.
• 9:23
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: In fact, it's expected, I think in most cases now that would be part of the, collaboration.
• 9:29
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and then also, Being able to do follow up care, with your international patients who have traveled to the United States and then go back to their home country and, having the ability to, connect the physicians with the care team back in the U.
• 9:45
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 9:46
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: After that patient has returned.
• 9:48
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So
• 9:48
  Anika: so that's really interesting.
• 9:50
  Anika: So if you're interested in conversion rates, it's gotta be more than that.
• 9:53
  Anika: It has to be a big picture
• 9:55
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Yeah.
• 9:56
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And, and and I think that, I'm just thinking about what some of our hospitals have said, I think that, a lot of the hospitals have used the, telemedicine remote second opinions, for years successfully, for their formal international relationships, for example, as an asynchronous provider to provider tool, to receive advice on specific medical issues, and then they use international telemedicine to, like I said, stay connected with patients who are unable or unwilling, to travel, for whatever reason.
• 10:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: most are seeking tertiary or cautionary care for very complex medical issues.
• 10:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Without having data in front of me, anecdotally, oncology is really, often the biggest, service line that we see,
• 10:39
  Anika: speaking of the specialties, are there other types of cases or specialties that are typically common or most frequently sought by international patients?
• 10:48
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: like I said, oncology, it's interesting.
• 10:50
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: A lot of the hospitals that have participated in our remote second opinion, and telemedicine due diligence and issues have been pediatric hospitals.
• 11:00
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: pediatric subspecialties, are, another big area, neurology is another, big area that we see, digestive health, sometimes as well, there are some service lines that lend themselves quite well, To remote second opinion and telemedicine services.
• 11:17
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: it's if you're looking at, your peds hospitals, rare diseases, right?
• 11:21
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Sort of these one offs that are really uncommon where, in their home country, there might be no physician that has that specialization to be able to treat it.
• 11:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: whatever it is, and there are a lot of people who are, trying to verify to see if the diagnosis of what they've been given in their home country is actually, the case,
• 11:42
  Anika: so we touched on this a little bit earlier, just the regulatory challenges.
• 11:46
  Anika: So I'm sure this is a huge conversation, and I'm sure we won't be able to talk about everything.
• 11:52
  Anika: but what are some primary sort of legal regulatory challenges when providing virtual health care services across borders and does you skip help systems navigate all that?
• 12:02
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Yes.
• 12:03
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: we don't provide the legal advice.
• 12:06
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: We are not attorneys, but, I'm going to give a shout out to our wonderful member, Cleveland Clinic, I got a call from Cleveland Clinic, gosh, in 2018, I think it was, and they said, we are going Doing some of this international telemedicine and RSO due diligence work, on a country by country basis, and it is very expensive, right?
• 12:27
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: to be able to successfully, analyze a market, and they said, why don't we, See if there's interest in having other members pool their resources together to do some of this due diligence work, because I know that we're all interested in a lot of the same countries, and then cost share through the use get program at NCHL.
• 12:47
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And I was like, okay, and then the response was overwhelming everyone was like, oh my goodness Yes, absolutely.
• 12:54
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: These are so expensive, and when i'm say expensive i'm talking 15 to 25 thousand dollars per market And that was in 2019.
• 13:03
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: being able to do, several markets that have high interest and do due diligence on them for a fraction of the price, right?
• 13:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: If you have 10 hospitals cost sharing, and it's a 25, 000 report, that's really very helpful, right?
• 13:17
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: For all of the participants.
• 13:19
  Anika: So how did you do the initial benchmarking?
• 13:22
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: we formed a committee, of our member hospitals and developed a standardized due diligence matrix, that matrix, is something that, we, Put out, to several, legal firms to see, you know, who would be interested in doing this work.
• 13:35
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: The initial body of work was like 10 countries or something.
• 13:39
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So it was like a huge amount of work, And ultimately, we settled on Hogan Levels, I cannot say, enough nice things about Hogan Levels.
• 13:47
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: They are excellent at what they do.
• 13:49
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Top notch work.
• 13:50
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and have been one of our close partners, and together we have, at this point, gosh, analyzed, I think it's like 20, Five or 26 markets now and we've also done updates on a number of those markets like I think we've updated our Saudi Arabia report like three or four times are you a report like three or four times with Hogan levels, working with them to understand where, where things need to be updated.
• 14:16
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and, where the market is shifting, these laws across the different countries are changing very often.
• 14:22
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and there are some markets where I'm shocked at how.
• 14:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Permissive.
• 14:27
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: It is.
• 14:27
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And there are some markets where it's almost impossible, to do it legally.
• 14:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: so having international law firm that is plugged in, has offices all over the world, has international partners, local council in these markets where we're analyzing, has been tremendously helpful, as, we've added a few new markets, and, I think we've done, gosh, probably 15 or 20 updates, or so since we initially started, this process.
• 14:52
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And, this is based on member need and interest, right?
• 14:55
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So when we realize that a market really needs a refresh, I will go to our members and say, okay, Can we get enough interest to cost share to make it, a viable purchase, to update some of these, analyses that we've done in the past to, to make sure that, the legal teams at the hospitals are equipped with the latest information about, the markets that they may be working in.
• 15:16
  Anika: so I know it sounds like the just, differs environment
• 15:23
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: It is quite different and depending on the market and off the top of my head.
• 15:27
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: there are considerations around, defining the practice of medicine.
• 15:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Defining what constitutes direct patient contact, both in the context of virtual and written interactions, whether that differs between states or provinces in the country, right?
• 15:44
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: looking at, telemedicine, telehealth, confirming whether audio only or email communications constitute telemedicine or telehealth, whether that definition, differs between states or provinces.
• 15:56
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: one of the big ones is, looking at specific laws or regulations concerning remote second opinions and peer to peer, so doctor to doctor consultations.
• 16:05
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: As opposed to live interactive video or audio visits with patients, right?
• 16:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: looking at in the context of peer to peer consultations.
• 16:15
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: describing any differences in how remote second opinions involving interactive video or audio visits are regulated compared to written remote second opinions, and then identifying any, regulatory considerations that might arise should the patient be involved at any point in the peer to peer consultative process.
• 16:34
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So you can see the nuance is very, complicated, I would say These are the things that we have to look at, and maybe, that's really nitty gritty, maybe taking it a step back.
• 16:44
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Other higher level issues, looking at, physician licensure registration requirements, for the practice of, telemedicine remote second opinions, also looking at, whether the jurisdiction has practice requirements that the physician be in the same physical location as the patient at any time.
• 17:02
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: During the health care process, um, and then looking at, specifying the frequency of required in person visits.
• 17:08
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: is it every 12 months, every 24 months, and detailing, any additional, required, conditions or relevant timeframes for in person consultations.
• 17:17
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and then we get into, issues around, registration.
• 17:22
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So looking at healthcare specific registrations in the jurisdiction that might be required for a foreign organization that's looking to provide these services, and then looking at, what are the restrictions or regulations around a foreign organization looking to market, these, services.
• 17:39
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Are there specific criteria or thresholds that would need to be met for marketing activities to trigger the need for licensure and registration, right?
• 17:48
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: things like that.
• 17:49
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and then, finally, I think, one of the, last couple of things that we look at are, and this is the piece that is changing so rapidly and on a country by country basis.
• 17:59
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And it's just, it's probably one of the most challenging is looking at.
• 18:03
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Patient data privacy considerations.
• 18:06
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: required patient consents to participate in telemedicine data storage, and the transfer of protected personal health information.
• 18:13
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So is there official documentation.
• 18:16
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: That's required for patient consent and specific language, that might or must be included in patient consent forms.
• 18:23
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: looking at, just data sovereignty concerns.
• 18:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: whether patient data has to remain within a jurisdiction or if there are specific safeguards needed when patient data are transferred outside, of the jurisdiction internationally, right?
• 18:37
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and then, looking at any other, Potential legal or government imposed obstacles to the provision of telemedicine and RSO services.
• 18:44
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So special requirements around foreign language translation of medical records, uh, things like that.
• 18:51
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and then, part of our analysis and I won't get too deep into this because it's, I would say quite proprietary is, we do an analysis of the likelihood of enforcement, relative to the various areas that I just described.
• 19:02
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So, like, high, medium, low, and then looking at other considerations, that are important to, foreign organizations looking, to potentially enter these markets.
• 19:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: obviously the hospitals, they all have legal teams that, are able to parse through these reports, use them, to understand, can we deliver services into this market legally, right?
• 19:24
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: what is the risk to our organization for doing so?
• 19:27
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Do we need to partner with a local hospital, and provider?
• 19:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: across the board, and this is very general.
• 19:35
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: It is much more permissive in most countries to have a peer to peer.
• 19:38
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So doctor to doctor, sort of relationship, consultation than doing direct to patient.
• 19:43
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: that is the way that a lot of the, hospitals, and you skip, operate when it comes to the provision of these services.
• 19:51
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Now, that's not to say that there aren't, one offs that come from, random countries.
• 19:55
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And, there may be hospitals that, take on that risk, and they might not have a partner there.
• 19:59
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And that's up to them.
• 20:01
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: But, in general, I would say the, the measured approach and the one that we've seen many hospitals taking is, if you're going to be focusing on it as a sort of pillar of your business, Making sure that your partner's involved, making sure that, the legality part of it is taken care of and is permissive for what you're trying to do in a particular market.
• 20:22
  Anika: I was actually going to ask, like, how concerned in general should health systems be about the enforcement
• 20:27
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: there is a potential for, enforcement mechanisms to come into play should something bad happen.
• 20:35
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: we don't see that.
• 20:36
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I don't know of any, not to say that it hasn't happened, I've not heard of much of that happening, but, there's always the possibility in health care organizations or, U.
• 20:46
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 20:47
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: academic medical centers as, as a whole are quite risk averse organizations, I would say, but we really see a lot of variation in our membership in terms of how willing, some members are to do this type of work.
• 21:00
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Some are really, their legal teams just won't do it, and then some are all in, right?
• 21:04
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Like it's, it really, it's pretty diverse.
• 21:07
  Anika: I was also going to ask you, are health systems typically working with in country And it sounds typically that
• 21:13
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: of
• 21:15
  Anika: like yes
• 21:15
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: of them are.
• 21:16
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and, a model where, off the top of my head, that I can think of, so like Cleveland Clinic Connected, and the Mayo Clinic Care Network, so hospitals will join, as a member of one of their, affiliates internationally, right?
• 21:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Giving them access to the services right by virtue of being an affiliate and we're seeing that model, expand like I think we're going to see a lot more of that, that sort of network affiliate, you know, you are an official affiliate of so and so hospital.
• 21:49
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: giving you access to, remote second opinion telemedicine, tumor boards, you know, multidisciplinary team review of cases, that type of thing.
• 21:59
  Anika: And so by doing this, this gives you access to more of that peer to peer model, then it becomes generally more permissive.
• 22:07
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and and then, there's the upside for, for the U.
• 22:10
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 22:10
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: hospital is, their potential for referrals there as well, right?
• 22:14
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: if your network affiliate has a very complicated case that in whatever country and, they think that the patient would be better cared for back in the U.
• 22:24
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 22:24
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: wherever that might be, like U.
• 22:25
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: C.
• 22:25
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: L.
• 22:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: A.
• 22:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Cedars, Cleveland, Mayo, wherever.
• 22:28
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: that is a direct pathway, right?
• 22:31
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and really helps facilitate, the potential for, referrals, back to, back to the United States.
• 22:37
  Anika: Gotcha.
• 22:39
  Anika: And then we touched on this a little bit earlier, but I kind of want to go back to it.
• 22:42
  Anika: So what are some best practices for marketing to and engaging with international patients?
• 22:49
  Anika: Like how do health systems build the trust and credibility and like transcend culture or language barriers, all these other things that you have to think about when you're working across borders.
• 22:59
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Yeah, so, that's a very interesting question.
• 23:01
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I think that, we do actually collect some data on, like referral sources, and, how patients find out about, the hospital and its services and, Also, we have discussed this internally about building trust and, reputation and everything.
• 23:18
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: It's interesting, if you look at the data, the top, areas where new patients are coming in from, like, how did they find out, right?
• 23:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: self referral is the largest, and this could be people doing research on the internet.
• 23:33
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and word of mouth.
• 23:34
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So friends and family that, have had a good experience at whatever hospital it might be.
• 23:40
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: this varies considerably depending on culture, I would say.
• 23:44
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I think it's significant everywhere.
• 23:46
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: There's some countries and cultures where it plays an even more significant role than others.
• 23:51
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Some of the other, big areas, where we see sort of referrals coming, from and sources, it's like from a payer.
• 23:57
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: So if an embassy or an insurance company, sends the patient, right?
• 24:02
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Okay.
• 24:02
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: to, to whatever, hospital.
• 24:04
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: That's another big area.
• 24:06
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: U.
• 24:06
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 24:06
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: hospitals, you see them doing a lot of activities in certain areas of the world, right?
• 24:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: often those areas of the world are where We have very large patient volumes, right?
• 24:16
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: creating goodwill towards, your partners in particular countries, referral partners, I think that's really important.
• 24:22
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: having, a presence, through an affiliation agreement, right?
• 24:26
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Like having the ex hospital name, on, your hospital in your home country, right?
• 24:32
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: In affiliation with.
• 24:34
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: whatever medical center, whatever clinic.
• 24:36
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: That brings brand recognition.
• 24:38
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Having that on your website, I'm a random person in a random country, I'm going on the website, and I see that, the hospital that I'm thinking about going to locally has a partnership with a, a well, known, renowned U.
• 24:51
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: S.
• 24:52
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: institution that, I think helps a lot
• 24:55
  Anika: Yeah.
• 24:56
  Anika: definitely.
• 24:57
  Anika: I want to pick up on what you said a little bit earlier and kind of segue.
• 25:01
  Anika: so you mentioned international payers.
• 25:03
  Anika: what's the typical financial model for these programs?
• 25:06
  Anika: are most health systems interacting with international payers or I would imagine not really.
• 25:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I would say that, A lot of them are interacting with pay, because a lot of payers have their own virtual platforms that, that either homegrown or, they're using, some of the big commercial ones, and, a virtual visit internationally, could be part of the package that is offered through, An insurance company, it could be something that, a, embassy payer, we call them one of the, Gulf countries may be willing to pay for, you know, I think that, a lot of engagement with payers when I say payers, I mean insurance companies, governments that are covering, these types of things, or individuals like patients who are doing self pay.
• 25:52
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: That a lot of the hospitals offer, remote second opinion service for, whatever, 1500, 2, 000.
• 25:58
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: and they're the pair, right?
• 26:00
  Anika: how would you say in, in what you've heard and just in your experience, how would you say health systems are typically measuring ROI for these kinds of programs that they're putting up?
• 26:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Yeah.
• 26:11
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: the return on investment is, it depends on the hospital, but you're really building a lot of cachet, I think, with your international partners by offering remote second opinions and telemedicine services as part of your agreements with them.
• 26:27
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And it really also helps build rapport with the country, with your partners, the government in the country, if you are willing to do this, right?
• 26:39
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: even though it may not, ultimately result in a referral, it's still something that a lot of the hospitals consider to be valuable, because sometimes it does result in a referral, and it helps maintain a good relationship with your partners, with the country, with the population of the countries that you're working in.
• 27:00
  Anika: and you've already sort of covered this a little bit, but just again, once more, you know, tell us more about how YouSkip membership works and what members, what member systems can expect.
• 27:08
  Anika: And then if they want to learn more about you, skip how they can you and, get more information
• 27:14
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: Yeah, so we have, a few levels of membership, available on our website and chl.
• 27:19
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: org slash uskip, and, members, can generally join on a calendar year annual basis and, I'd encourage folks to go look at our membership benefits perspective, and, talk to other members about, the value that they've gotten from their membership.
• 27:35
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I am very passionate about this work.
• 27:37
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: I think we've made tremendous strides, I would say, in, Really taking a loose, network affiliation of folks who did this work back in the day and have really developed it into, A professional business consortium that does a lot of work that members find quite valuable, and I would encourage folks to go on our website and learn more about that.
• 28:01
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And all of the work that we do.
• 28:02
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: And, if you'd like to join, please email you to get that NCHL.
• 28:06
  Jarrett Fowlerjarrett-fowler_1_10-24-2024_133443jarrett-fowler_1_10-24-2024_133443: org.
• 28:08
  Anika: so a huge thank you to Jared for joining us and sharing his deep expertise on this subject.
• 28:15
  Jerome: It's really fascinating to hear about how international virtual second opinions are a strategic lever for some health systems.
• 28:22
  Jerome: high growth markets to focus on were UAE, China, Saudi Arabia, Canada, Mexico, and Latin America, The other thing I heard were that proximity government sponsored programs and existing US hospital partnerships are market enablers.
• 28:36
  Anika: It's really important to identify which markets align with your health system's global strategy.
• 28:42
  Anika: So telemedicine and second opinions are often entry points.
• 28:46
  Anika: And these services allow hospitals to bring brand awareness and relationships with international partners.
• 28:54
  Anika: So word of mouth.
• 28:56
  Anika: Local presence and trusted in-country partnerships are really key to success, and we wanna focus on developing those long-term, scalable international partnerships.
• 29:06
  Jerome: There's a certain amount of legal ambiguity, that institutions have to navigate in order to be successful in this space.
• 29:13
  Jerome: But it sounds like the partnerships really lessen that risk.
• 29:16
  Jerome: And U Skip also has help with cost effective legal due diligence for expansion efforts So there's a certain amount of management of expectations when it comes to direct revenue.
• 29:27
  Jerome: That was part of what I was hearing.
• 29:29
  Jerome: and then when it comes to payment structures, it sounds like models include self-pay, some government sponsorship and insurance-based coverages, and that some health systems are embedding second opinions within larger consulting agreements.
• 29:41
  Anika: exactly.
• 29:42
  Anika: like Jarret said, and we've heard this as well in our conversations with our system cohort, conversion rates to in-person care.
• 29:50
  Anika: Maybe low, but the relationship building and brand expansion and network efforts are what provide the strategic value here.
• 29:58
  Jerome: So it sounds like there's a lot to talk about here, both from an international's perspective and then how this translate to a domestic virtual second opinion program.
• 30:06
  Anika: Absolutely.
• 30:07
  Anika: international virtual second opinions offer this really exciting market opportunity, but they require a thoughtful and measured approach.
• 30:15
  Anika: There are legal, cultural, and operational hurdles, and this goes for domestic, virtual second opinions as well.
• 30:23
  Anika: In general, there's no reason to reinvent the wheel here.
• 30:26
  Anika: Start small, go slow and work closely with your legal.
• 30:30
  Jerome: Yeah, especially with a privacy piece.
• 30:32
  Jerome: Just because a record is sitting in the cloud doesn't mean it's exempt from international data laws Patient consent has to be crystal clear when you're moving records across jurisdictions.
• 30:42
  Anika: And then there's also licensure to think about.
• 30:45
  Anika: A lot of countries require physicians to be locally licensed to provide any sort of medical advice, but the workaround, like we heard in Jared's interview, is partnering with a local treating physician.
• 30:56
  Anika: And that is legally much safer.
• 30:59
  Anika: It also sets the foundation for better continuity of care.
• 31:02
  Anika: The patient receives your advice under the care of their treating physician, and And that sets them up better if a patient ends up traveling to the US for treatment and then needs any type of post-care monitoring once they're back home.
• 31:14
  Anika: What we don't want is for things to get lost in translation, and we wanna reduce the risk of medical errors as much as possible.
• 31:22
  Anika: So strong.
• 31:22
  Anika: Local partnerships help make this possible and ensure that the advice can be clearly communicated back to the patient.
• 31:28
  Anika: And as long as US healthcare continues to be highly respected, there's going to be a demand for specialty expertise, especially in the areas that we discuss, like oncology, neurology, peds.
• 31:40
  Anika: That kind of deep knowledge just isn't distributed evenly across the world as we know.
• 31:45
  Anika: So if your system has that kind of expertise.
• 31:47
  Anika: Sharing it through virtual second opinions can be both a mission driven and strategic opportunity.
• 31:53
  Anika: And like we said, you can't overlook the brand building opportunity even if international virtual second opinions don't convert immediately to in-person treatment.
• 32:02
  Anika: They expand your institution's reach and reputation.
• 32:05
  Jerome: All right, let's.
• 32:06
  Jerome: Shift gears and talk about domestic virtual second opinions.
• 32:09
  Jerome: 'cause a lot of what we just discussed applies here too, but it has its own set of operational challenges.
• 32:15
  Anika: one of the biggest is physician participation.
• 32:18
  Anika: Some clinicians really hesitate to offer a second opinion unless they can examine the patient in person.
• 32:23
  Anika: Other physicians are just stretched already.
• 32:27
  Jerome: Some second opinion reviews happen asynchronously, and that can be a major benefit over telemedicine.
• 32:32
  Jerome: Physician doesn't have to squeeze in another appointment.
• 32:35
  Jerome: They can review those cases when it works for them.
• 32:38
  Jerome: And so we've seen some systems get creative here and offer moonlighting rates.
• 32:42
  Jerome: I.
• 32:42
  Anika: And it helps when the cases are highly aligned with the physician subspecialty, like not just oncology, but a specific cancer type that they may specialize in that makes it.
• 32:54
  Anika: More worth their time because they're practicing top of license.
• 32:58
  Anika: And so some systems are even starting to screen for virtual second opinion champions when they're hiring physicians who really see second opinions as part of their personal mission or brand.
• 33:09
  Jerome: Oh, I see.
• 33:10
  Jerome: So some systems that are really leaning into virtual second opinions, It sounds like this is actually a recruitment asset, a way for physicians to broaden their reputations and reach patients outside of the traditional footprint.
• 33:21
  Jerome: So that's a bit of a strategic HR angle here too.
• 33:25
  Anika: it definitely can be.
• 33:26
  Anika: And from a brand and equity standpoint, if you are the leading system in your state, why not give patients outside your geography access to your expertise?
• 33:35
  Jerome: Yeah, and I have to imagine now a lot of patients are coming to expect it.
• 33:39
  Jerome: Telehealth has sort of normalized the idea that care can be delivered virtually, and second opinions are often less about real-time interaction and more about thoughtful analysis of existing records, labs, imaging, and physician notes.
• 33:51
  Anika: Yeah, for sure.
• 33:53
  Anika: That being said, there are definitely.
• 33:55
  Anika: Reasons this type of program might not be for your system.
• 33:59
  Anika: For example, if your system's legal department is unwilling to navigate the gray areas, if your clinicians are uncomfortable rendering opinions without seeing patients in person, or they don't want the extra workload and you don't have a strategy to recruit and support physicians who do value virtual second opinions or to compensate them.
• 34:17
  Anika: If leadership expects quick revenue instead of long-term brand expansion, patient access, or downstream referrals, the program may be misaligned with the actual returns.
• 34:28
  Anika: Also, if the system doesn't have the infrastructure or a third party partnership to support these kinds of asynchronous consults, record review, or secure file sharing, the implementation will be difficult.
• 34:41
  Anika: so if key stakeholders at your system, like strategy, legal, innovation, clinical marketing, if, if these folks aren't all aligned and if the system lacks nationally recognized specialties or doesn't have some kind of strong brand presence beyond its region, the strategic value of such a program may be limited.
• 34:59
  Anika: But I will say the trend line looks good.
• 35:01
  Anika: More and more remote consults are being reimbursed.
• 35:05
  Jerome: And that suggests that we really have a green light for expansion.
• 35:08
  Jerome: Of virtual second opinion programs.
• 35:11
  Jerome: on the licensure front, the good news is that most states don't prohibit out of state opinions as long as they're issued in consultation with a local provider.
• 35:18
  Jerome: Some states have even introduced simplified or lightweight telemedicine licenses that are easier and cheaper to obtain than the full license.
• 35:25
  Jerome: Plus the Interstate Medical licensure compact, which now I think has 39 states and territories, makes it easier for physicians to apply once and get licensed in multiple states.
• 35:34
  Jerome: My understanding, though, is that the process isn't less expensive.
• 35:38
  Anika: some systems are also sidestepping that complexity by framing virtual second opinions as educational consults or clinical collaboration rather than formal.
• 35:48
  Anika: Diagnoses.
• 35:49
  Anika: Um, it isn't perfect, but it works within the bounds of most current regulations.
• 35:55
  Jerome: and while we would wanna see longer term support from the political side to really scale these efforts, Congress did just pass a cr, which kicked the can of Telehealth down the road at least until September.
• 36:05
  Jerome: The lack of long-term legislation can make it hard for CSOs to justify deeper investment.
• 36:11
  Jerome: and I know it's frustrating to have these sort of short-term extensions, even though telehealth does have broad bipartisan support, it's really hard to get behind an initiative and scale it What you're looking at is a three to six month legislative cycle.
• 36:26
  Anika: Despite that, there's definitely still momentum.
• 36:29
  Anika: Second opinions are more and more being seen as a natural sort of extension of telemedicine and in areas.
• 36:35
  Anika: Like oncology where subspecialty knowledge is evolving fast and access is uneven.
• 36:40
  Anika: They're a really important part of access.
• 36:43
  Jerome: And it is still true that Medicare encourages second opinions before major procedures.
• 36:47
  Jerome: so for our members, whether your goals are access, equity, revenue, or broad expansion, virtual second opinions can play a role.
• 36:53
  Jerome: as we heard.
• 36:54
  Jerome: Just start intentionally, don't overextend and align with what your system already does well and build from there.
• 37:00
  Anika: And organizations like UKI can help with benchmarking, regulatory guidance and partnerships, especially internationally.
• 37:07
  Anika: So another shout out to Jarret for joining us today and sharing his insights.
• 37:10
  Anika: You can reach out to U Skipp and NCL for more information about their program at U skipp@nnc.org, and on their website nnc.org
• 37:20
  Jerome: Thanks, Anika.
• 37:21
  Jerome: We appreciate that interview.