Latest / StartUp Health NOW Podcast / Three of Telemedicine’s Original Visionaries Weigh in on Its Future

Transcript

Three of Telemedicine’s Original Visionaries Weigh in on Its Future · StartUp Health NOW Podcast

• 0:00
  [instrumental music] Welcome back to Startup Health Now. This is the podcast where we share stories from the front lines of health innovation. I'm Nicole Clark, Startup Health Senior Writer.
• 0:14
  Today's episode is all about telemedicine, a rather timely topic during these COVID times.
• 0:23
  Now, it can be easy to look back on the history of something like telemedicine, and through the view of the present day, believe that everyone always thought it was a good idea,
• 0:32
  or at least one that would inevitably take root. But it wasn't always this way for telemedicine.
• 0:39
  In the US, for example, the initial groundwork for healthcare modernization was laid in 1996 with the passing of the Health Insurance Portability and Accountability Act, or HIPAA.
• 0:52
  But the broad adoption of digital tools that support virtual care has taken time. In the last two months, however, that adoption of telemedicine has escalated. No longer a novelty, it is a necessity.
• 1:07
  As hospitals and health systems worldwide buckle under the weight of the pandemic, remote clinical services have become a critical part of delivering timely care to patients.
• 1:18
  Knowing our history helps us understand the present, and it's important that we study telemedicine's twenty-year-long prelude to now.
• 1:28
  Specifically, it's important that we study the vision of the original health transformers who saw the proverbial writing on the wall decades ago and began to chart a path to a future,
• 1:40
  a future where world-class healthcare could be accessed beyond brick-and-mortar health facilities.
• 1:47
  This fireside chat from the twenty-twenty Startup Health Festival in January features three of those OG health transformers. There's Dr. Toby Cosgrove.
• 1:57
  Toby ran one of the most esteemed health systems in the world, the Cleveland Clinic, and he now sits on their board as an advisor. He's also an advisor for Google Cloud.
• 2:08
  Most recently, you'll find headlines with his name in it alongside the idea for a healthcare-ready reserve, a one-million-strong reserve force that could give jobs to newly unemployed workers while helping brace for the COVID-19 patient surge.
• 2:23
  Then there's Dr. Roy Schoenberg, President and CEO of Amwell. Amwell is the leader in telemedicine with over two hundred of the nation's largest payers and health systems.
• 2:34
  A decade ago, Roy introduced the technology that essentially brokers on-demand telehealth visits between patients in need and available providers.
• 2:44
  And last but not least, Karm Huntress, CEO and founder of RxReview, a Startup Health company. At his health tech company, Karm is putting drug costs into the hands of seventy thousand doctors each month.
• 2:57
  He's enabling them to make prescribing decisions that help patients get the care they need at prices they can afford.
• 3:04
  The three men's paths in the world of health innovation crisscrossed at various points in the last decade. But in January, they all got together at the festival for a fireside chat about the evolution of telemedicine.
• 3:17
  And like with any evolution, telemedicine's unfolding had to start somewhere, and that's what these gentlemen did. They simply started. Take a listen. Oh, well, welcome guys. Thank you, Steven.
• 3:32
  Um, that-- I tell you what, that is an, an amazing story, and it's interesting.
• 3:36
  And every time we, Steven and I talk about Cle-- the clinic, we talk about how kind, um, you were on that first, uh, on that first meeting, and how truly you just right away accepted, um, Startup Health and, uh, and, and our vision and really incorporated it into your innovation summit.
• 3:54
  Um, which goes to the point, what Steven was making is, um, you are a true collaborator. You look at everything and you say, "Okay, we're not gonna do this alone.
• 4:05
  Let's get as many people involved as possible," as, uh, all of you and as your relationships with these two gentlemen have grown. So I wanna start off, because each of you are true health transformers.
• 4:17
  As a physician, we are sort of stuck in our ways in a lot of, uh, in a lot of areas, and we try to innovate, we try to figure out, okay, how is this gonna be-- how can we do this better?
• 4:29
  But the truth is, we're sort of taught that this is the way to do it. So I just wanted to start with you, Toby, a-as really the first out of all of us who was a true health transformer.
• 4:40
  What gave you the insight as you were running the Cleveland Clinic to say, "There's a better way, and we can do it"?
• 4:47
  Well, as I've traveled around the world, I always, uh, uh, found that there's no shortage of great ideas all, all over the place, and I used to go and steal shamelessly from other people's ideas.
• 4:59
  And I realized that there was, uh-- and really the way forward was gonna be around innovation. And we had to continue to get new ideas and to bring them in and change healthcare, which is a very difficult thing to do.
• 5:11
  And so I was delighted when I had an opportunity to see someone who really fostered that. And so I was hugely supportive. Well, we, we, we, and, and we thank you for that.
• 5:21
  Um, and so m-moving to you guys, uh, Karm and, and, and Roy. So Roy, you're in healthcare, so you sort of were thinking, uh, okay, yeah, I'm seeing patients, I'm practicing.
• 5:33
  At what point did you, A, come up with the idea of American Well? First, does everybody know what American Well is, right? American Well is really the leader in telemedicine.
• 5:43
  And, uh, for those of you who don't know, the first time, uh, we met Roy was probably two thousand and seven. Yeah. Yeah, at a, at a, at a, at a conference.
• 5:53
  And he was telling us his vision, and I, and I'm a practicing physician, and I was like, "Oh, is, is that gonna work?"
• 5:59
  And, and you-- remember you said, "Yeah, we're doing it in Hawaii 'cause that's the only place that will allow it right now." That's right.
• 6:06
  So can you share with us just a little bit about American Well and your, your, your journey?Well, I'm, I'm, I'm gonna try to be brief 'cause it's such a long period of time.
• 6:15
  We, we met roughly when electricity was invented. [laughs] We were... You know, the truth was that when we started American Well, at the time,
• 6:26
  when you start thinking about from a consumer standpoint what you could do with healthcare, you could probably for the most part read about it. You could go to WebMD and read some stuff and do a lot of self-help.
• 6:36
  Whereas in other industries in parallel, you could start getting things done.
• 6:40
  You could begin to buy books on Amazon, you could get airline tickets from Expedia, you can actually get transactions to happen, but not in healthcare.
• 6:49
  So the crazy idea back in 2006 was let's use this new thing that's called the internet to try to bring, in real time, patients and physicians together and allow them to actually have live, live healthcare.
• 7:02
  And that started it, and we did not anticipate that this was gonna take so long, I can tell you that. Yeah. 'Cause immediately everybody was like, "Oh, this is gonna work and be wonderful," right?
• 7:11
  It made sense, so why wouldn't it, right? [laughs] Yeah. Yeah. And just to move on to Karm, to sort of bring everybody into the conversation.
• 7:21
  Um, Karm is one of, uh, the startup health companies, and he's been with us for about t- since, uh, about 2014. Um, and truly an innovator and a change maker a- and a health transformer.
• 7:33
  His company is taking, um, medicine and bringing true, true transparency to it, something that, um, has long been lacking, um, i- across the board.
• 7:45
  So can you tell us just a little bit about your experience and, and what brought you to say, "Wait a second, we, we should, we should do this in a better way and let people know what they're getting"? Yeah.
• 7:55
  I mean, our, our timeline isn't as long as yours, but, uh, I tell a lot of people we're overnight success in six years, right? So that's the reality of, of digital health companies.
• 8:05
  Um, you know, I started the company for the simple fact, I mean, I now get to say it's 2020, and we still don't really have drug cost transparency for doctors, um, a- and patients especially.
• 8:16
  And so we really started on that journey to say, "Look, let's figure out a way to get transparency in front of doctors, you know, to let them know what a, a patient's gonna pay at their pharmacy today."
• 8:26
  It's taken us six years to get here. I'm happy to say, um, you know, we're in 320 health systems now. We work with a lot of the major US, uh, EHRs, bringing this directly to doctors when they're prescribing.
• 8:38
  And, you know, my, you know, my mission, my view of the company is we've got to get this to every doctor, every pharmacy, and every patient in the US, and that's the way it should work, right? Yeah.
• 8:46
  It's, um, the-- We have all these, you know, you can look up the price of literally anything in your life right now on your phone in two seconds. Um, drug cost transparency is an absolute imperative.
• 8:57
  Um, you know, we've got it as-- it's, it's really become an e- epidemic in terms of, you know, people going bankrupt over not being able to afford their drugs.
• 9:05
  And so, you know, bringing transparency is one of the first steps to really moving the industry forward, and I'm glad to be a leader in the space now and, and, um, you know, work- we work with about 70,000 doctors on a monthly basis and do millions of these transactions now- Yeah...
• 9:19
  a month. Um, so it's really exciting.
• 9:21
  A- a- and the amazing thing, for those of you that, um, aren't physicians, generally, and up until, up until really, um, the last year or two, um, we didn't know what the drugs would cost.
• 9:33
  We-- Patient would come in and you would write the prescription, you'd say, "There you go. Go ahead and get it filled." And unless the... And very often a patient would go, and one of two things would happen.
• 9:43
  They would look in the pharmacy and say, "Oh, that's $300," and they just wouldn't get it. We wouldn't know 'cause they wouldn't call us.
• 9:50
  Um, or some patients were, were, were, uh, proactive enough to call and say, "Hey, that's $300. Couldn't you give me a different drug?" And our immediate reaction was, "What? Of course, I could. Yeah, sure."
• 10:00
  Now, granted there's some drugs that, that, that, that you need, but for the most part, you could always come up with an alternative that was cheaper and help with the, help with the patient.
• 10:10
  So Toby, so you ran b- probably the most esteemed hospital system in, I would say the country, but probably the world. Um, you're global. You've bring- brought innovation, um, to medicine.
• 10:25
  What is it about these two companies? Because, uh, for those of you who don't know, um, Dr. Cosgrove sits on the boards of both of these companies.
• 10:33
  What is it about these companies that you looked at and said, "Oh, I'm, I g- I gotta be part of this journey"? Well, first of all, uh, I believe that we've gotta change the way we deliver healthcare.
• 10:43
  Um, and my first one that I, I had experience was with American Well, and it, it came out of an experience that I had with my daughter.
• 10:53
  We were out in Nantucket, and she gets a rash on her face, and, uh, I take my cell phone out and I take a picture of it and send it to the head of dermatology at the Cleveland Clinic, and, uh, he-- and it says, "Poison ivy."
• 11:07
  And I think we just saved a trip to the emergency room, sitting there for hours, going in and getting examined, you know, half a day in the emergency room.
• 11:16
  And I-- it's one of those slap your forehead moments of, "Oh my god, why shouldn't we do something like this?" So for what? Four years ago, uh- Four years ago...
• 11:24
  we've had started our relationship with, uh, at the Cleveland Clinic with American Well- That's right... uh, which was after we had searched the, uh, the surroundings. We thought that this was the best option.
• 11:36
  Um, and so I was very impressed with not only the concept, but also what they did, um, and how they performed with us.
• 11:45
  And then, so when I was asked to join the board, I was, uh, a believer in this, and I think that, and we're gonna see a huge percentage of healthcare go, uh, distant, virtual.
• 11:58
  And then, uh, then as I stepped down as CEO, along came, uh, Rxastu. [laughs] And I knew several of the, uh, the, uh, backers, uh, venture capitalists who had invested in it.
• 12:13
  [clears throat] And I thought that this began to bring transparency to the cost of h- uh, pharmaceuticals.
• 12:20
  [clears throat] And in both cases, I thought that there's an ex- a group of people that I'd like to be associated with.
• 12:26
  I respected, uh, what they were doing, and I thought we needed to push in those particular directions. So I was delighted to be part of trying to help them do this.
• 12:35
  Um, and I don't-- You can ask them whether I'm helpful or not. They may have different mind- [laughs]... but I'm delighted to be associated with them. [laughs] Along for the ride.
• 12:43
  Well, I do wanna ask each of you something because R- Roy, w- we're a digital-- w- we're here at a digital health festival.
• 12:51
  Where do you see, because, right, so now American Well, you've, you've, you've, you've struggled through and really pushed through a lot of the legislation, um, and acceptance over the last ten, fifteen years to get telemedicine accepted.
• 13:06
  Yeah. Where's it going now? Well, [clears throat] I just wanna-- one remark about what, what, uh, Toby said, and then answer your question. Sure.
• 13:16
  Um, you can't overemphasize how pivotal a decision like Toby's decision to bring in telehealth into the Cleveland Clinic was on the evolution of this entire industry.
• 13:29
  Because you have to keep in mind, there was a long period of time where telehealth was public enemy number one,
• 13:36
  whether it was the AMA or the medical boards, or anybody that you would ask would say, "You're gonna do terrible things. You're gonna separate physicians and patients."
• 13:45
  And then it took people like Toby to come up and stand up, and nobody can question the medical authority of the Cleveland Clinic, to say, "This is part of the language that is gonna be part of our future.
• 13:57
  It's not perfect. We're gonna have a lot of learning to do and everything else, but we've gotta start somewhere." So we did technology stuff, and all of that is great. Yeah.
• 14:07
  These are pivotal moments in history on the adoption and the acceptance of these technologies in healthcare. That is the importance of that decision.
• 14:16
  I just wanna- So I was gonna say, so it's mindset, mindset that we can do it, and then the collaboration that I was talking about before, that if we're gonna do it, we can't do it alone. You couldn't do it alone.
• 14:27
  No question. We couldn't do it alone. You couldn't do it alone. That but together, there's power. There is, there is incredible amount of, um,
• 14:35
  security in the statement or, uh, you know, really foresight in the statement. This is far from perfect. This is the first step, but we gotta start taking that first step. And saying that opened up the door.
• 14:48
  I can tell you stories about the ripple effect, you know, literally like domino that happened following that.
• 14:53
  But the moment Cleveland Clinic stepped in and said, "We're going to incorporate this into the way that we think about enveloping our patients and caring for our patients," everybody started saying, instead of saying, "This is terrible, it's gonna kill everybody," saying, "Okay, how can we use that?"
• 15:08
  And that changed the world. Yeah, and let me just make a, a point here. I think that innovation really happens at the borders of different disciplines.
• 15:17
  You've got the, the healthcare, uh, and then you've got digital, and the two don't understand each other- That's right...
• 15:23
  but when they combine, they can do some really pretty exciting things, and, uh, that's where innovation happens.
• 15:29
  And, and the more that you can begin to connect those two and understand what's going on in each other's world, I think the, the faster those things happen. That's exactly right.
• 15:38
  And I think that answers your, your, your other question, which is, you know, a little bit like if you all think about Amazon, interesting thing.
• 15:47
  A- Amazon kind of took a decade to flush the pipes on online retail by selling books, and it learned a lot of lessons about people willing to put their credit card in and all, and websites and so on.
• 15:59
  And then ten years later, or a little bit less than that, started introducing everything retail into Amazon. Telehealth is known so far for urgent care, and it flushed the pipes well. We learned a lot through it.
• 16:12
  It's a simple, relatively easy healthcare transaction. Now that that is over, we have a next decade of revolution of saying, "Now that we know that that works, let's bring the equivalent of all of retail.
• 16:26
  Let's think about how we're using this to do cancer. How are we doing-- how are we using this to let people gracefully age in their home?
• 16:33
  How are we doing this to follow up on chronic patients, to discharge patients earlier from?" There's a long list of those things where the technology can come in, but we probably needed to go through adolescence. Yeah.
• 16:43
  There's no way that you can, you know, do, kind of cut the corners there. And I think this is exactly where we are.
• 16:49
  We're at the pivoting point where we know this thing works, we know it's kosher, we know it's safe, we know people like it. Now let's change healthcare experience with it. I agree. Absolutely.
• 17:01
  The interesting thing, and I didn't even sh-- I haven't shared this with you. Um, uh, at my hospital, I actually, uh, get the benefit of working with, with, uh, both of their technologies. Yeah.
• 17:11
  Um, and the first time we made the push for telemedicine, I had a patient who probably drove about three hours up and three hours back to see me for, uh, for her, for her visit.
• 17:22
  And when we started rolling out telemedicine, I asked her if she would like to do it, and she said, looked at me, she goes, "Can we?" I said, "Of course." She says, "Absolutely."
• 17:30
  And, uh, so her visit came, you know, a, a couple months later, and, uh, and after the visit was done, and it was a great visit, um, I said, "Well, what'd you think?" She said, "I loved it. Can I show you something?"
• 17:42
  I said, "Absolutely." And she's-- It's a cancer patient, so time is very valuable to her, right? She wants to enjoy her life and have...
• 17:51
  And she literally takes her, she had her computer, and she takes it out, and I see her walking up a little, sort of almost like little steps, and then she turns the computer around, and she was out on her boat, and she was in the bay, uh, outside of Maryland, and she said, "This is why I love this."
• 18:09
  And I thought-That's it, revolutionizing how we're gonna care for patients. So I- I have to applaud you and thank you, because you really have made a difference in patients' lives. Um, Karm, I wanna bring it back to you.
• 18:21
  Um, same thing with Karm. I literally probably, we were talking about four or five months ago, had ordered a, a drug, and a ping came up and said, you know, "This, this is gonna cost this patient, you know, $260.
• 18:35
  There's a, there's a better alte- you know, better alternative, $26." Clicked on it, it was done. Patient got the drug. I was happy. The patient was happy, even though the patient didn't even know. It was seamless.
• 18:46
  Um, so it's revolutionizing, um, access to care and increasing, I think, p- patients' ability to actually take care of themselves without going into debt and without having to make decisions.
• 18:58
  Um, as you've rolled this out and you've developed this company, do you think this transparency is going to move into other aspects of medicine, or do you think it's gonna be isolated to pharmaceuticals?
• 19:09
  Yeah, I mean, I think we had to do a lot of proof in the early years to say, you know, d- are doctors actually gonna change?
• 19:14
  You know, one of my favorite quotes from Toby is like, "Doctors need to change and patients need to understand." Right?
• 19:19
  And, and I think providers, you know, really do or in this moment of change, especially with technology kind of coming into their workflows. And so we, we really had to prove it out.
• 19:27
  You know, we, when a doctor does take a, a lower cost alternative, we see about $60 in monthly savings to the patient. And if you think about a chronic med or something, that's significant dollars over a year period.
• 19:38
  So I think... And, and, and then, you know, the payers are saying, "Okay, there's real ROI here."
• 19:43
  So I think absolutely, and we're, we've got one payer that's starting to expand into, you know, labs, imaging, radiology, really creating point of care tools to help providers make more informed decisions.
• 19:54
  Um, you know, and I think that's really ultimately, you know, what, the way f- we think or, you know, my vision for the company, it's all about helping the provider make the right decision, right?
• 20:03
  And, and the way I love to look at it is informed autonomy, right? We've gotta give them tools and technologies at the point of care that really work alongside them.
• 20:11
  Um, don't, you know, I, I, I think most of provider burnout or big chunk of it is just alerting. Just, you know,
• 20:18
  popping in the doctor's face telling them that they're wrong constantly, which is not really how they wanna [laughs] do their job. Yeah.
• 20:23
  And so, you know, we really believe in sort of l- leaning into guidance-based tools that live alongside their workflows that are seamless, like cost transparency, that really guide them to make the right decision.
• 20:33
  You know, with, inside our company, our, in our teams, we say, "Hey, the biggest thing is getting the doctor to make the right decision on behalf of the patient." Um, and those decisions are highly complex, right?
• 20:43
  And getting more complex, especially with precision medicine and where we're headed.
• 20:46
  So we really wanna get to a future where we're thinking about clinical issues, thinking about cost issues, thinking about social determinants of health, bringing that all- all together, um, to help them right, make the right decision.
• 20:57
  Yeah. Today, it's really about just, hey, can we get every doctor using, you know, having transparency [laughs] at the point of care? Yeah. Um, you know, so sometimes I feel like I'm just a plumber, right?
• 21:05
  Just sim- you know, let's just show them the cost of the drug. Wow, you know, it's amazing. Um, uh, but, but, but ultimately these things are making real impact on patients' lives and it's pretty exciting. Yeah.
• 21:14
  Well, the other interesting thing is you're empowering, which, which you have to understand, doctors are a tough crowd. Yeah.
• 21:20
  [laughs] Because think about it, we're, you're changing their behavior, but you're still giving them the autonomy to do it themselves instead of having a system that just changes the drug.
• 21:30
  Because then, you know, doctor writes a, writes a medicine. If they all of a sudden hear, "Oh, that got changed. Why? Nobody even asked me."
• 21:37
  But you're giving them the opportunity to make the right choice and do the cor- sort of correct the behavior before it goes any further.
• 21:43
  Yeah, I think the two things that we learned that were just instrumental in our, our growth and kind of understanding provider behavior, we spent a lot of time trying to get this stuff into the workflow in the right way.
• 21:53
  And, you know, you would say that like, oh, obviously, you know, the doctor wants to do the right thing by the patient and all this thing, all these things.
• 21:59
  But ultimately, um, they're s- under such pressure day to day to get their job done. The reality that we got to was that it's about less clicks and lowering their cognitive load.
• 22:10
  And if you do those things, less clicks, you know, if a doctor has a short- shortcut to get somewhere, they take it- Yeah...
• 22:14
  whether you like it or not, and they'll do some weird things because of that, uh, especially with EHR environments today. And two, if you just give them the answer, if you say, "Hey, is, are you okay with this?" Right?
• 22:24
  "Is this, this okay?" Um, and lowering that cognitive load on them 'cause they're seeing, you know, 15, 20, 30 patients a day, those things are really impactful to helping them.
• 22:33
  And, um, you know, I hope one of the derivatives of this bur- business is really helping provider burnout- Yeah... and changing the paradigm there because technology is still inhibiting them in a big way today, for sure.
• 22:43
  Yeah, absolutely. So as technology, Toby, as technology, again, running one of the, the, the, the most esteemed clinic, um, you know, hospital systems in the, in the world, um,
• 22:54
  I- I've often heard you said there's a change in medicine. Medicine is moving away from the hospitals and back into the communities. So d- how do both of these companies sort of fit into that vision?
• 23:06
  And truly, where do you see medicine going? Do you see it being
• 23:11
  a, a system where, hey, listen, the only time people are really going into the hospitals is when they need surgery, and other than that, we're gonna strive to do, um, to, to keep patients healthy outside of coming in and seeing us?
• 23:25
  Yeah, well, I think you're seeing the, that healthcare is changing in a major way. And as, as you look forward, you know, I think you're gonna see a change in, uh, where people are taken care of.
• 23:36
  It'll be more outside of the hospital, more in, at, in clinics and at home. And you look at, um, minimally invasive surgery is certainly a great example of that. Then you look at who's gonna be looking after them.
• 23:48
  Mm-hmm.
• 23:48
  And it's going to be more, uh, physicians assistants and, uh, nurses, uh, that are, and right now, uh, we have 4,000 doctors at the Cleveland Clinic and 2,000, uh, physician as- assistants, and I think that's only gonna be- Wow...
• 24:04
  equal in, in the near future 'cause there's just not enough docs. You know, 100,000 doctor shortage across the country.
• 24:11
  The diseases we're gonna treat are gonna be more and more chronic diseases and less and less acute diseases. And that's... A- and f- and finally, um, how we're gonna treat them is going to be, is gonna change.
• 24:22
  It's gonna be less and less invasive, um, and hopefully more and more preventive.And less expensive, right? And well, with, with that, that's the hope. Yeah. That's a hope.
• 24:33
  Well, we're, we're, we're getting a little bit low on time. I know b- right before we walked up, a couple people had asked, "Oh, you're gonna have time for questions?" Was-- I, I don't know if they're there.
• 24:41
  Does anybody have any, any questions? Yes. We should have a mic somewhere. Yep, coming. Oh, we got two. There you go. Stereo. Test. All right. All right, my name is Nate Tang. Uh, I'm a senior college student.
• 24:59
  I've been accepted to medical school. Um, my question is for Dr. Cosgrove. Um,
• 25:05
  so I read up on the Cleveland Clinic, specifically a Harvard Business School case study on the clinic, and I was intrigued by your leadership and vision and direction on the value-based care that was talked about in the case study.
• 25:17
  Um, my question is pretty simple. Do you think that the value-based care model that Cleveland Clinic undertook is the way that the industry, as well as other health systems, should follow?
• 25:28
  Um, what are some of the good, the bad, and the ugly, and what are your thoughts and convictions on that?
• 25:33
  Yeah, I, I think that, uh, we've what, been now 12 years moving gradually towards value-based system or, uh, and I think one of the big things that's gonna happen this year is Medicare now is going to be paying fifty percent of their payments are going to be around value-based systems.
• 25:50
  Mm-hmm. Uh, and I think that will continue to push. Uh, certainly insurance companies are going the same direction.
• 25:56
  It's very slow, like most things in medicine, but I think we're coming to a tipping point right now, uh, that's gonna be pushed by, uh, Medicare.
• 26:04
  And frankly, I think it's great that people are now worrying about keeping people well instead of only seeing them when they're sick. Fantastic. Yep. One we have maybe time for... Oh, sure. There you go. One or two more.
• 26:20
  Hi there, Dr. Cosgrove. Uh, great to hear from you today. I'm, uh, Natalie Hodge, founder of Prevent Scripts, and I have a question for you. This goes to any other healthcare CEO that's in the room today.
• 26:32
  How are you going to be a- to align incentives between your specialty group and your primary care group, given that
• 26:44
  the specialist will be making less over time and your primary care providers will be providing more value? Yeah. So- Of course...
• 26:54
  um, I'm not sure that's a simple answer, but let me just tell you how we, we, we pay- How are you gonna do it? Let me tell you how we pay people at the Cleveland Clinic.
• 27:01
  First of all, all of us are salaried, so there's no in- financial incentive.
• 27:05
  Uh, what we do is we look at the pay that happens across the, uh, the United States for a particular specialty, and we try and pay in the seventieth percentile of that.
• 27:16
  Some people, um, who are-- And, uh, we have research, education, and clinical care. Uh, it's, a- and all of those figure into what your major contribution to [coughs] the organization is. And if you are, uh, doing
• 27:33
  X number of things plus writing papers and teaching, you'll get paid more than somebody else who's just doing X number of whatever it is [clears throat].
• 27:41
  So, and I th- I think it-- I, I love the model because I could honestly say to someone, "You need a heart operation and it's not gonna make any difference in how much I get paid." Great.
• 27:54
  Sure, one, [clears throat] one more question. Hi, my name is Emily Feenstra. I'm from Henry Health. Our health moonshot is increasing the life expectancy of Black men by ten years.
• 28:03
  They have the lowest life expectancy of any population subgroup. And the thesis is really that low life expectancy can be tracked back to untreated stress and mental illness.
• 28:12
  So I wanted to follow up on this point that in telemedicine, it really started with urgent care and can for- can transform the system.
• 28:19
  And I'm really curious how telemedicine companies and providers using telemedicine are thinking about expanding to other specialties, particularly as you think of buy versus build and whether you really build out those services yourself as opposed to acquiring companies started off in other specialties.
• 28:39
  Yeah, um, that's, that's a great question. So the first thing I would say is that, um, we see a whole onslaught of additional services beyond urgent care that are coming in. Behavioral health has definitely led the way.
• 28:52
  The thirst for behavioral health services across the country is unbelievable. We have tried to do as much as we can to build a supply. We, we contracted with a couple of groups.
• 29:04
  We brought more physicians, more psychiatrists, therapists, and so on.
• 29:07
  But the real answer to your question is actually that there's no way that we as a single company are going to be able to deliver that, correct that around the country.
• 29:17
  What we have to do is we have to work very diligently on bringing those technologies into where the clinicians are in real life, not working for us, and allow psychiatrists, psychologists, and, and other providers from inside the community to service, to s- surface their cycles and distribute them through telehealth to all of those places that are challenged.
• 29:40
  If we really build that, if we look at telehealth as a switchboard for redistribution of healthcare services, we're going to have more than just economic good, we're going to have a lot of social good, and I think that's a big part of the consideration.
• 29:55
  Yeah. Let me just add two things to that. Our biggest user of telemedicine at the Cleveland Clinic has been the Neurologic Institute, which includes neurologists, neurosurgeons, and psychiatrists.
• 30:06
  Uh, and this is a tremendous opportunity. A lot of people would rather talk to a screen- Yeah... uh, than they would to some, an individual in person.
• 30:14
  The s- the, the second point I wanna make is [clears throat] I think we've all underestimated in the past the influence of the social determinants of health.Um, and interestingly, um, if you look at healthcare providers, we have not, we're not paid to look after those.
• 30:32
  We are not trained to look after those. We don't know how to do this aspect of things.
• 30:37
  And so what we're seeing is increasing, uh, interest in beginning to partner with all the agencies around the, uh, the community that look after those sorts of things.
• 30:49
  And United Way, for example, is, uh, is a big partner, and they're stepping out and looking at things like lead paint, uh, and housing, uh, a-across the, the organization.
• 31:00
  But if you look at the social determinants including housing, food, um, education, jobs, income, all those things are sixty percent of somebody's, uh, well- uh, health, way more important than the physical, uh, administration of healthcare, uh, in terms of people's longevity and their wellness.
• 31:20
  So we've got... And the common denominator of those is, is really interesting. The common denominator is poverty, of all those things.
• 31:30
  So clearly, you know, that begins to say, okay, we, do we need to talk about minimum wages, uh, as part of that?
• 31:38
  So there, the, the, it goes way beyond healthcare into our, our entire society and how we begin to think about, well, we can do that.
• 31:46
  And that, to sort of put an emphasis on that, if you look at the longevity in Western Europe, it's greater than the United States, but the cost is much less.
• 31:55
  And they spend more on social programs and less on healthcare and have a better result. Awesome. Well, I think we- we're out of time, but, uh, you can see, uh, uh, ending on Dr. Cosgrove's sort of, uh, last point, right?
• 32:09
  This goes beyond healthcare. This is really, um, it, it's a, it's, it's the human community.
• 32:15
  Every aspect of what these innovators and health transformers are doing are affecting and changing lives on a daily basis in multiple ways.
• 32:24
  It's not just the fact that we have telemedicine or that we're looking at transparency. It's really changing the way we take care of each other. So I wanna thank all of you for being here and for, for doing what you do.
• 32:38
  You are, you're making the world a better place, so thank you. Thank you. Yeah, thank you. [audience applauds] At StartUp Health, our motto has been, together we can.
• 32:48
  By uniting a global army of the world's top health entrepreneurs, we believe we can solve the world's biggest health challenges, including challenges like the one we currently face.
• 32:59
  Earlier this month, we launched a pandemic response moonshot. To learn more about our commitment to invest in startups working on COVID-19 solutions, visit startuphealth.com. I appreciate you joining me today.
• 33:12
  Tune in later this week when I talk with Kevin Deadner. Kevin's the CEO and founder of Henry Health. There, he's on a mission to increase the life expectancy of Black men by 10 years.
• 33:23
  We'll get into his company's culturally relevant behavioral and mental health services, and then I've asked Kevin to share his insights on how to address racial disparities in the pandemic response.
• 33:36
  Meanwhile, stay safe, stay healthy, and if you can, stay home. We're all in this together. [outro music]