Latest / Becker’s Healthcare - Clinical Leadership Podcast / Kenny Cole, MD, System Vice President of Clinical Improvement at Ochsner Health System

Transcript

Kenny Cole, MD, System Vice President of Clinical Improvement at Ochsner Health System · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  This is Laura Dierda with the Becker's Healthcare
• 0:02
  podcast. I'm thrilled today to be joined by
• 0:04
  doctor Kenny Cole, system vice president of clinical
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  improvement and medical director of digital medicine at
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  Ochsner Health. Doctor Cole, it's a pleasure to
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  have you on the podcast today.
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  Thank you. It's a pleasure to be here.
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  Absolutely. Now I'm excited for our conversation. I
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  know we're gonna be talking about digital medicine,
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  primary care, and the future of how both
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  are growing and becoming more and more interconnected
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  as time goes on. But before we dive
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  into that discussion, can you tell us just
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  a little bit more about yourself and your
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  background?
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  Sure. I'm a I'm an internist and a
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  primary care physician at heart.
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  I have spent about the last decade of
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  my career in various administrative roles,
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  really attempting to facilitate the same mission, which
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  is the,
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  transformation
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  of primary care.
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  And,
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  you know, my title, system vice president of
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  clinical improvement, kind of indicates my philosophy, which
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  is that I I think that there's nothing
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  in health care that, can't be
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  improved. And, I'm a strong proponent of the
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  role of technology in being able to facilitate
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  those improvements.
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  I love that. I think that's an especially
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  open and important,
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  mindset and,
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  you know, really tactic to take into the
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  future. Now from your perspective as a practicing
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  internal medicine physician, how would you describe the
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  current state of primary care today?
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  Mission impossible.
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  I think that,
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  and that and that's not just,
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  hyperbole.
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  You know, the,
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  there was a study that was done,
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  back in 2022,
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  which really just expanded on on multiple other
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  studies over the past twenty years.
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  But this particular study in 2022
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  was done in Chicago. It was published in,
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  the American Journal
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  of Internal Medicine and
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  and basically attempted to quantify the workday of
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  a primary care physician. And so what it,
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  postulated was okay. Like, if if a primary
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  care physician managing a panel of about 2,500
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  patients
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  actually,
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  attempted
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  to execute all of the guideline recommended therapy,
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  all of the evidence based recommendations
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  as it relates to preventive health,
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  as it relates to chronic conditions management,
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  documentation and inbox management,
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  and then managing acute conditions,
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  how many hours would it take that primary
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  care physician to do all of that? And
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  the answer came back, right at twenty seven
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  hours per day. And, again, that's not even
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  the first time that a study has demonstrated
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  that. That just built on the earlier work
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  of of OSPI and Yornau, which,
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  basically came up with, similar,
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  almost impossible type workloads
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  on primary care if they actually were able
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  to do everything that they're supposed to do.
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  Wow. That's incredible. I mean, to really think
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  about how long it takes and what really
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  goes into each primary care visit and the
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  patients that primary care physicians are taking on,
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  it's mind boggling. So
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  what are some of the pressures, clinical, operational,
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  and workforce related that you're seeing most acutely
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  right now for these primary care physicians and
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  in the field in general?
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  Yeah. So so, you know, the the way
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  that health system financing works or health care
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  financing works is, you know, procedural
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  interventions, surgical interventions,
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  you know,
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  imaging services
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  have have traditionally
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  been rewarded with the highest level of compensation,
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  actually, like sitting and thinking and listening to
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  patients,
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  is not,
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  it is not as financially,
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  lucrative, shall we say, as more procedurally oriented
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  care. And so the tendency has been that
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  for for primary care to generate, you know,
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  levels of income for themselves as well as
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  a financial contribution
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  to whether it's a health system or to
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  their practice or whatever it may be,
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  they typically have to see, you know, 25
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  or 30 people a day,
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  which unfortunately just doesn't lend itself to, you
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  know, being able to do all of the
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  things that you need to do, you know,
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  for a given panel. And and so,
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  it it it does lead to high levels
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  of burnout within the field of primary care
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  where where I know I know personally
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  not only did I probably burn out myself,
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  but I I just I I have also
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  said that, you know, in the years that
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  I was practicing full time,
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  I
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  I know that I never left a work
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  day and all the work was actually done.
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  And I think, the the three words I
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  I said more than any other three words
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  in all the years I practiced were I'm
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  so sorry, and and that was because, I'm
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  so sorry I'm running late. I'm so sorry
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  I couldn't get you in to see you
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  the other day. I'm so sorry I haven't
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  called you back with your lab results yet.
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  You know, things like that.
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  Got it. And that, you know, it is
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  such a helpful picture to paint, especially when
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  you think about all the responsibilities that you
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  have to,
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  go through with the different patients, and then,
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  to understand, you know, how you're approaching these
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  conversations and always feeling like you're behind is
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  not great. And so, to your point, it
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  leads to a lot of burnout and lots
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  of challenges,
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  in practicing medicine. And so,
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  I I wanna ask a little bit more
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  about how you're defining digital medicine in primary
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  care and how that's,
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  becoming more of the conversation and more of
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  a solution.
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  When we talk about digital medicine in primary
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  care, how do you define its role alongside
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  that traditional physician patient relationship? Where does it
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  fit and how is it working, to solve
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  some of the challenges that you are have
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  been discussing?
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  Yeah. So when you think about, you know,
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  all the all of the
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  tasks that a primary care physician has to
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  do,
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  you know, part of that is is the
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  task of solving problems and the application of
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  knowledge to that problem solving process.
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  And then you sort of think about the
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  evolution of knowledge. And and when it comes
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  to the management of chronic conditions,
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  quite a bit of the knowledge has evolved
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  to such an extent
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  that the knowledge is is nearly explicit. Not
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  quite, but but when I say explicit, I
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  mean that
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  when the knowledge of a given
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  condition or area is so evolved and so
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  complete,
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  typically, what you can do is you can
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  protocolize
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  that knowledge or capture it into an evidence
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  based care pathway
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  where the reliability
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  of the outcome is more dependent
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  on adherence to the evidence based pathway
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  than it is on a given
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  primary clinician's individual
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  knowledge and skill,
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  or or more tacit knowledge application to complex,
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  unstructured problem solving.
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  And and so, you know, primary care physicians
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  have to do both. Right? They have to
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  solve the complex problem of the patient that
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  comes in with fever and rash after having
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  traveled outside of the country,
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  but they also have to apply evidence based
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  pathways to the management of chronic conditions.
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  And so then when you think about the
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  best use of time for, you know, a
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  physician who's worked so hard to build out,
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  you know, tacit knowledge through repetition and learning
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  and experience,
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  it seems like that's where, you know, a
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  primary care physician is gonna be best suited
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  is to solve those types of unstructured problems.
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  Whereas an evidence based care pathway,
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  potentially a a less
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  knowledgeable clinician, less experienced clinician,
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  less expensive clinician
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  can simply follow evidence based pathways in such
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  a way where you're reliably,
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  following the evidence,
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  applying that evidence to the management of conditions,
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  and then achieving a differentiated result where you're
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  delivering,
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  you know, things like ninety plus percent rate
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  of blood, you know, hypertension control, ninety plus
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  percent rate of diabetes control, and then doing
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  that at scale
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  through technology
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  where clinicians are are leveraging,
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  not only technology, but but remote patient monitoring
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  where you're getting data on, like, the blood
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  pressures,
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  you're getting data on blood sugars, and those
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  are then coming into the electronic medical record.
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  And so you get voluminous amounts of data
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  on which to be able to exact and
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  effectuate clinical decision making.
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  Whereas in a traditional primary care practice, it
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  might be a person coming in for their
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  hypertension visit twice a year, and you get
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  two blood pressure readings,
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  you know, during those visits. It's almost impossible
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  to make really good decisions
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  with limited data
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  and limited interactions. And so digitizing it so
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  that you have much more frequent interactions, you're
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  following the most up to date evidence,
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  and you're getting you're just getting lots lots
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  more data to be able to make those
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  decisions.
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  That makes a lot of sense. It seems
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  like it can really,
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  unburden some of the things that are are
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  so challenging for primary care physicians, whether it's
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  on the operational side or even,
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  to your point, in being able to support
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  them in their decision making and support,
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  the way they're working with patients.
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  Now why are are additional touch points between
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  these office visits so important for managing, especially
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  when you're looking at chronic conditions or or
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  some of the other, things that patients are
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  coming to you with, and and how does
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  this model,
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  make that possible?
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  Yeah. Because, you know, thing like, things happen
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  all the time in terms of in between
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  visits,
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  you know, that can result in alteration of
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  the data.
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  You know, like, I I I, like, I
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  I can recall a patient specifically, you know,
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  who had has diabetes, and I had spent,
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  you know, some time working with her to
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  make sure we got her diabetes controlled.
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  And we did, like, so her, you know,
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  a one c looked perfect the last time
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  I had seen her.
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  But little did I know that, you know,
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  Christmas time for her is a really difficult
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  time. She had lost some family members
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  around, you know, Christmas time previously, and she
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  had a,
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  a a predisposition
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  towards dealing with stress through food.
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  And so her eating patterns changed dramatically over
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  the holidays, and she really started snacking quite
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  a bit more. Her blood sugar sort of
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  skyrocketed.
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  And, you know, she came back to see
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  me a few months after that.
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  And, and what she told me was that,
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  what really got her out of it
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  was the digital medicine clinician who saw her
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  blood sugars rising. I certainly didn't have access
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  to those, you know, sugars, like or nor
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  would I in a standard primary care practice,
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  but the digital medicine clinician was able to
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  see that change, was able to reach out,
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  was able to, you know, find out what
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  was going on, was able to connect her
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  with a health coach and other resources to
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  kind of help her get through that time.
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  And then by the time she came back
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  to see me, her diabetes was once again
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  perfectly controlled,
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  and so we never missed a beat. And
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  and that's only possible by changing the dynamics
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  of how care is delivered away from episodic
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  discrete, visit based encounters
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  to more of a longitudinal,
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  continuous, connected
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  relationship.
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  That's an incredible story, but I can imagine
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  very indicative of some of the things that
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  you see every day with the patients you're
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  working with and those who have embraced this
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  digital medicine model.
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  How does the digital medicine enable more team
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  based approach to care from your perspective?
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  What is that interplay between the different clinicians
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  and professionals that work to actually help keep
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  patients well?
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  Yeah. So so going back to that study
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  that was published in 2022,
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  I mentioned the twenty seven hour day. But
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  another element of that same study
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  was that if
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  if you began to deliver care differently, if
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  you would deliver care through more of a
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  team based approach where what you then did
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  was try to divide up all of those
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  different tasks, like all the things that a
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  primary care doctor would need to do, and
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  then you began to reallocate some of those
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  tasks
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  to,
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  members of a team
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  where the the skill set required to execute
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  upon the task,
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  was was different than than what the the
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  physician, you know, skill set was. Right? And
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  so that included things like, you know, cancer
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  screening or vaccinations or education, but it also
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  included things like chronic conditions management.
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  And when you then, you know, broke that
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  all those tasks across a team, you could
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  actually get the workday down to about nine
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  hours per day, which is a much more
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  reasonable workload.
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  But again, that's only possible
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  with, the implementation of a team based approach
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  to primary care. Now, unfortunately,
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  the payers have not, you know, come around
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  and said, oh, okay. Well, then let's go
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  ahead and change the whole reimbursement of primary
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  care such that we'll just give money
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  to all of the the different, you know,
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  tasks that need to be done by the
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  different team members, and we'll just pay primary
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  care more money in order to make sure
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  all this happens. Right? Like, that hasn't happened.
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  And so
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  you then have to now figure out how
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  do I solve the problem
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  of mission impossible for primary care,
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  while being limited by the prevailing financing mechanisms.
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  And the answer is you
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  begin to get really creative in how you
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  deliver care, and so you bring in, you
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  know, pharmacists and advanced practice providers into the
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  model, and then you you allow them to
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  have access to the data
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  and the technology
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  to then begin to digitize the management of
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  chronic conditions.
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  You try to seek, you know, innovative ways
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  of paying for that. Right? Since the payers
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  aren't doing it, you you try to figure
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  out how to maybe put a funding mechanism
• 13:39
  and tie that to then be able to
• 13:41
  deliver those services.
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  And then, of course, you know, within value
• 13:45
  based contracts, that does offer some degree of
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  flexibility to to be able to, you know,
• 13:50
  deliver care differently and and embrace more of
• 13:52
  this team based model. But, yeah, it's it's
• 13:54
  integrating
• 13:56
  clinical pharmacists, advanced practice providers, health coaches
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  into
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  the primary care model as members of the
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  primary care team
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  with a shared goal
• 14:07
  of improving outcomes and delivering better care to
• 14:09
  the patients they all wanna serve.
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  That's so critical to understand and helpful to
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  see how those that process works. And I
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  love the idea of getting creative and using
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  all the data, the technology, and the tools
• 14:23
  available
• 14:24
  to tackle the chronic conditions that patients,
• 14:26
  come to you with and looking at innovative
• 14:29
  ways to really solve some of these problems,
• 14:31
  not only from the clinical side, but also
• 14:32
  from the payments and value side as well.
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  What role do pharmacists and health coaches play
• 14:38
  alongside the physician in this model, and how
• 14:40
  does the team based structure
• 14:41
  change the way that physicians change, spend their
• 14:44
  time day to day?
• 14:46
  So I think what it really does is
• 14:48
  allow the physician to, you know, focus,
• 14:51
  more on the the that component of their
• 14:55
  panel
• 14:56
  that they,
• 14:58
  otherwise might be focusing on managing things like
• 15:00
  blood pressure, diabetes, chronic kidney disease, you know,
• 15:03
  and so forth.
• 15:04
  And and so there there's a couple things.
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  One, it it sort of takes away that
• 15:08
  the the gap.
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  It studies have shown that it takes on
• 15:12
  average about seventeen years,
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  you know, from the public publication of a
• 15:16
  study that it actually disseminates in across, you
• 15:19
  know, practice patterns, you know, all across a
• 15:21
  large cohort of physicians.
• 15:24
  And and so you dramatically shrink the amount
• 15:26
  of time that it takes because what you're
• 15:28
  doing
• 15:29
  is you're having clinicians whose only role is
• 15:32
  to make sure that they are staying very
• 15:35
  up to date on the management of these
• 15:37
  conditions. You're revising your pathways and your protocols
• 15:40
  as soon as new guidelines get developed. So,
• 15:42
  for example, the new lipid guidelines just got
• 15:44
  released,
• 15:46
  within the last, you know, two weeks.
• 15:48
  And we barely had to change our our
• 15:51
  protocols because we were already so up to
• 15:53
  date, you know, on the science.
• 15:55
  And the clinicians certainly were already so up
• 15:57
  to date. And so
• 15:59
  now you've got clinicians reliably applying up to
• 16:03
  date evidence based science as a member of
• 16:05
  the care team can still have
• 16:08
  reciprocal interactions with the provider
• 16:11
  and a shared electronic medical record so that
• 16:13
  the primary care provider can see exactly what
• 16:16
  changes are being made and when they're being
• 16:17
  made and and how
• 16:19
  it's it's, you know, how it's unfolding.
• 16:22
  And then what it does is it gives
• 16:23
  the primary care physician more time back in
• 16:25
  their day to devote to some of the
• 16:27
  other things that have gone unaddressed. So, for
• 16:30
  example, you know, things like advanced care planning,
• 16:32
  which, you know, studies will show, you know,
• 16:35
  is is
• 16:36
  under delivered,
• 16:37
  you know, across large populations of just having
• 16:40
  that conversation
• 16:41
  about end of life values, goals, and preferences.
• 16:44
  But who better to have that conversation
• 16:46
  than their trusted primary care physician? And so
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  it's it's just rethinking the management of a
• 16:51
  panel across all that voluminous amount of work
• 16:54
  that needs to be done
• 16:56
  and who is best suited to be able
• 16:58
  to execute upon that work, which member of
• 17:01
  the team is best suited, you know, to
• 17:04
  accomplish those given tasks.
• 17:07
  That's helpful to understand. And certainly, seeing how
• 17:11
  the different clinicians interplay with each other, seems
• 17:13
  like a a much
• 17:15
  better, more streamlined, and coordinated way to deliver
• 17:17
  care, especially at scale. Now I know we've
• 17:20
  talked a little bit about, burnout and some
• 17:22
  of the pressures on primary care physicians. So
• 17:25
  how are health systems under pressure to expand
• 17:28
  access to care?
• 17:30
  We're also tackling burnout, which is critical and
• 17:32
  probably the two,
• 17:34
  biggest challenges for many health care organizations today.
• 17:37
  What does digital medicine do to help address
• 17:39
  both of those, and and, you know, where
• 17:41
  what are you seeing in terms of trends
• 17:42
  for digital and remote care?
• 17:45
  Yeah. So if we look at,
• 17:47
  that twenty seven hour day, you can break
• 17:49
  it down into
• 17:51
  various blocks of time.
• 17:53
  And,
• 17:54
  about eight hours of that twenty seven hours
• 17:57
  is would be the amount of time it
• 17:59
  would take to manage
• 18:01
  all of the chronic conditions for a panel
• 18:03
  of about 2,500
• 18:05
  patients.
• 18:06
  And so to as much an extent as
• 18:08
  possible, pulling
• 18:09
  off, you know, some of that chronic conditions
• 18:12
  management, never
• 18:13
  undermining the importance of the primary care,
• 18:16
  clinician,
• 18:17
  patient relationship. That still is very important.
• 18:21
  But instead of a primary care clinician having
• 18:23
  to see a person with diabetes, you know,
• 18:25
  two to four times a year, it may
• 18:27
  be seeing them once a year as the
• 18:29
  check-in and to be able to do the
• 18:31
  diabetes foot exam and to preserve
• 18:33
  the relationship.
• 18:35
  But meanwhile, the patient's diabetes is perfectly controlled
• 18:38
  and, you know, all of the appropriate labs
• 18:41
  have been ordered and, you know, so so
• 18:43
  it it it basically
• 18:45
  facilitates
• 18:46
  the job of co managing a panel where
• 18:49
  the the primary care clinician still has ultimate
• 18:51
  responsibility for the outcomes but has assistance
• 18:55
  in in generating those differentiated
• 18:57
  outcomes.
• 19:01
  That's
• 19:02
  helpful to know. It makes a lot of
• 19:04
  sense. And speaking of clinical outcomes and,
• 19:08
  what types of outcomes have you seen improve
• 19:10
  through digital medicine, particularly for chronic conditions?
• 19:15
  Yeah. So, basically, it's,
• 19:17
  you know, we believe in within our own
• 19:19
  digital medicine programs looking at sort of HEDIS
• 19:21
  metrics.
• 19:23
  Hypertension control rates are typically right around ninety
• 19:26
  four percent. Ninety four percent of all of
• 19:27
  our patients have their blood pressure controlled.
• 19:30
  About ninety one, ninety two percent of our
• 19:31
  persons with diabetes have their diabetes controlled.
• 19:34
  But it's not only that. Like, it's it's
• 19:36
  controlling
• 19:37
  hypertension and diabetes with
• 19:39
  the
• 19:40
  most efficacious medicines that not only control the
• 19:43
  blood pressure and the diabetes, but that
• 19:46
  reduce
• 19:47
  heart attacks, reduce strokes, you know, that are
• 19:49
  that are basically cardioprotective
• 19:51
  and kidney protective.
• 19:53
  An example of that are are just the
• 19:55
  the use of a class of medicines known
• 19:57
  as the SGLT two inhibitors, which are decent
• 19:59
  diabetes drugs, but are phenomenal
• 20:01
  drugs for chronic kidney disease. And so looking
• 20:04
  at that patient holistically
• 20:06
  across those chronic conditions
• 20:08
  and making sure that, you know, an SGLT2
• 20:11
  is not only serving its role of controlling
• 20:13
  diabetes, but that, you know, in patients who
• 20:16
  have, you know, protein loss in the urine,
• 20:19
  that that, you know, they're on the max
• 20:21
  dose of the right type of medicine called
• 20:23
  an angiotensin receptor blocker to reduce that amount
• 20:26
  of protein also on the SGLT two inhibitor.
• 20:28
  You know, what that does is that then,
• 20:31
  you know, basically
• 20:32
  slows the progression of of chronic kidney disease,
• 20:36
  because we believe that there is an an
• 20:38
  end in sight to the days of diabetes
• 20:40
  or high blood pressure even resulting in end
• 20:42
  stage kidney disease because of the the types
• 20:44
  of medications that we have available.
• 20:46
  It's just really a matter of reliably
• 20:49
  delivering those medications to the right persons. And
• 20:52
  then the other things that we have seen
• 20:54
  in addition to our control rates
• 20:56
  are just that, you know, when patients are
• 20:59
  enrolled in the digital medicine programs,
• 21:01
  they have, fewer admissions to the hospital. They
• 21:04
  have fewer emergency room visits. And that makes
• 21:07
  sense. Right? Because if you are indeed reducing
• 21:10
  the amount of heart attacks and strokes
• 21:12
  and, you know, the instances of acute kidney
• 21:14
  injury and all of these types of things,
• 21:16
  you're you're reducing avoidable utilization
• 21:19
  in a way,
• 21:20
  that that's best for the patient, and correlates
• 21:23
  with those better outcomes.
• 21:27
  That makes a ton of sense. And, I
• 21:29
  I appreciate your analysis and and,
• 21:32
  examples there. No. I I know a lot
• 21:34
  of health care organizations and systems are moving
• 21:37
  towards more value based care, trying to figure
• 21:39
  out how they can inject value into,
• 21:42
  the broader,
• 21:43
  you know, ways that they're thinking about care
• 21:45
  delivery. So how does this model support those
• 21:47
  types of organizations and that move into value
• 21:49
  based care?
• 21:52
  Yeah. So so this is the transition that
• 21:54
  has to be made. Right? And and,
• 21:56
  you know, I've heard it described before as,
• 21:58
  you know, someone standing, having having, you know,
• 22:01
  two a foot in one canoe and another
• 22:03
  foot in a different canoe and having to
• 22:05
  sort of balance, you know, because,
• 22:07
  you know, if if you're, just a 100%
• 22:09
  in the fee for service, then,
• 22:11
  you know, you're really gonna miss out on
• 22:13
  sort of the transitioning that's taking place as
• 22:15
  as we all feel the need to lower
• 22:17
  health care costs and improve the health of
• 22:19
  the population we serve.
• 22:21
  But if you you put your your feet,
• 22:23
  you know, all entirely in the value based
• 22:25
  canoe,
• 22:26
  you actually, you know, risk losing enough, you
• 22:29
  know, a significant portions of revenue that were
• 22:32
  driven by things like, you know, people having
• 22:35
  bypass surgery or, you know,
• 22:38
  people getting coronary artery stents or, you know,
• 22:41
  or hospitalizations
• 22:42
  for for heart attacks and things like that.
• 22:44
  Right? So, you know, you you really it
• 22:47
  what it does is it it begins to
• 22:49
  give you an,
• 22:51
  a and and the ability,
• 22:54
  to deliver care differently
• 22:57
  in a way that you would never get
• 22:58
  reimbursed for in a pure fee for service
• 23:00
  environment.
• 23:01
  But as you're improving these clinical outcomes and
• 23:05
  you're reducing the amounts of heart attacks, the
• 23:07
  amounts of strokes, You may actually eat into
• 23:10
  your revenue of your bypass surgeries, but it's
• 23:12
  in a good way. It's because you're preventing
• 23:15
  people from needing bypass surgeries. And at least
• 23:17
  in under value based financing, you're getting, you
• 23:20
  know, some of those dollars that flow back
• 23:21
  into the system. And so you're being rewarded
• 23:24
  for keeping people healthy and out of the
• 23:27
  hospital
• 23:28
  rather than
• 23:29
  for just, you know, reacting
• 23:32
  to disease and poor clinical outcomes as they
• 23:35
  occur. And so I think that the need
• 23:37
  to embrace
• 23:39
  digital technology
• 23:40
  and transformations and care delivery is essential
• 23:44
  to help facilitate,
• 23:46
  this
• 23:47
  journey towards value based care transformation
• 23:50
  and overall, hopefully, making health care more affordable,
• 23:54
  by making people, healthier. And yet preserving the
• 23:58
  economic viability of the systems that are able
• 24:00
  to participate.
• 24:03
  That's helpful to understand. And, you know, it
• 24:05
  is really an amazing kind of picture that
• 24:07
  you're painting of what the possibilities could be
• 24:09
  and potential
• 24:10
  if the digital medicine model is correctly integrated
• 24:13
  and taken advantage of, from the health system
• 24:15
  perspective.
• 24:16
  Now, before we wrap up here, I wanted
• 24:18
  to look a bit further into the future
• 24:19
  as well.
• 24:20
  With the last minute or two, how do
• 24:22
  you see digital medicine being integrated into more
• 24:24
  of the standard primary care over the next
• 24:26
  five to ten years? What are really some
• 24:28
  of the exciting possibilities and potential there?
• 24:32
  Yeah. I think it's,
• 24:34
  you know,
• 24:35
  basically
• 24:36
  bringing these digital medicine clinicians fully into,
• 24:40
  the primary care team where they become active,
• 24:43
  you know, co participants
• 24:45
  along with the primary care provider,
• 24:48
  in order to
• 24:50
  not only reduce
• 24:52
  the twenty seven hour day and the burden
• 24:55
  of that,
• 24:56
  but maybe even allowing the expansion
• 25:00
  of primary care panels. And and the reason
• 25:02
  why that's important is because right now, there
• 25:04
  are not enough primary care physicians in The
• 25:07
  United States such that every single patient, and,
• 25:10
  every single person in the country
• 25:12
  could have their own primary care provider.
• 25:15
  And the only way that it would become
• 25:17
  possible for every person to have their own
• 25:19
  primary care provider
• 25:21
  is
• 25:22
  to transition to a primary care team where
• 25:25
  a primary care,
• 25:26
  provider is able to care for a larger
• 25:29
  panel
• 25:30
  and yet still deliver care effectively,
• 25:34
  and I believe the only way that becomes
• 25:36
  possible is with the complete integration
• 25:39
  of of digital medicine
• 25:41
  and and digital care
• 25:44
  into primary care,
• 25:46
  and then, you know,
• 25:48
  embracing
• 25:50
  future technologies
• 25:51
  like artificial intelligence, generative AI,
• 25:54
  to also be able to help
• 25:57
  to us to figure out how to remove
• 25:59
  as much work as possible from the plate
• 26:01
  of a primary care doc
• 26:03
  so that the plate doesn't, fall and break,
• 26:06
  but rather is able to be, you know,
• 26:08
  balanced,
• 26:09
  perfectly,
• 26:11
  by a kid you know, while still caring
• 26:12
  for a a larger panel and giving everyone
• 26:15
  access to the primary care that they need
• 26:17
  and deserve.
• 26:19
  That's fascinating. Doctor Cole, thank you so much
• 26:21
  for joining us on the podcast today. This
• 26:23
  has been an amazing discussion. I I learned
• 26:25
  a lot and a lot of exciting things
• 26:27
  happening. So I appreciate your time today, and
• 26:28
  I look forward to connecting with you again
• 26:30
  soon.
• 26:31
  Thank you for having me.