Healthcare’s Changing Needs Webinar

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So I started a company, Joe Scott advisors. It's really how do we make healthcare easier through innovation. I serve as an advisor to a venture capital fund called Newark Venture Partners. I'm also a channel partner with a company called Sierra, and I have several startups, innovation, or focusing on how they can make healthcare easier, mostly through innovative applications in healthcare. And so as we go through this presentation and we begin to think about it. I'm looking for those innovative technologies that might be out there that we might be able to connect to healthcare systems as we go forward. So I'm actually someone sent a question already about when we get back to the new normal. And I'm not sure that's a universal there's a universal answer to that question, but I did think it was important for us to talk about what it might look like. As we get back to normal.

So phase one. Clearly, there were several areas in the country that were overwhelmed. I live in New Jersey, New Jersey was one of those areas. My son is a critical care nurse in Manhattan at Mount Sinai, and clearly he was at the epicenter of what was going on.

So,those areas were overwhelmed. They're worried about future effects of COVID. And when you look around the country, not everybody was impacted clearly the way some of those. The epicenters work.

We started social distancing, and sure enough the rate of infection starts to go down. We're worried about what happens as we open up when new surge happened and where I'm sure everybody saw what happened in the Ozarks. When all those young people were partying. It's not so much the impact on the young people. Right. it's when those young people then get infected and start infecting other people. So they talked about having those folks who were at that party quarantine for 14 days, will they do that, or will, a new search happen and how will it impact that particular region. So as the weather warms up. We're also anticipating, potentially, less of an impact but as the cold weather returns a new surge is possible. And now that will be combined with an influenza threat, and clearly those folks over the age of 65, who's stressed.

And I think when we talk about the new normal. I think we have to talk about the various categories of folks who might be involved in what that new normal looks like. Clearly people who are over the age of 65 will be different than younger people who weren't impacted as much. Although, having lived in the epicenter.

I know folks who are over 65 who have died of COVID. I also know many many young folks in their 30s and 40s have also died. So, I think we have to be careful about what happens as the cold weather returns and whether or not influenza, will be a double whammy on the impact of coping. Then of course, the next thing everybody's hoping for is that a vaccine will be widely available, and the threat is curbed. The question really becomes what does that vaccine look like, you know, I think if you look at some of the studies that have been done on COVID, why are some populations and areas being impacted more than others. Is there a genetic link to people getting COVID when getting it worse than other folks. Is it just about comorbidities, I think all of that has yet to be answered. So everybody thinks the vaccine might be a way out of this, I think there's more questions than answers. And then of course phase six is there another strain or virus around the corner. And what does that look like and will we be continuing to look at this, in my opinion, I don't think this is something that by the end of the year, we'll be out of. I think it will take two or three years for us to fully recover from all of this, and I think there'll be constant ways for us to look at how it's going to be impactful to healthcare systems going forward.

So what has happened as a result of COVID, clearly significant amount and, and I want to talk about the current reality of the current reality for healthcare systems, as we know that I've had the opportunity to talk to several leaders and healthcare systems, including financial folks, as well as CEOs and clearly they're feeling the financial pressure. Everybody has lost their elective procedures. And I think more importantly, when they started looking at how they're going to get those elective procedures back to their hospitals, there is fear of continued acute care facility losses. And that's on a couple of different levels.

One, I think people are afraid to go back to hospitals for elective procedures, so if you have an option of going to a freestanding surgery center, or a hospital that has COVID patients. I think people are going to start selecting those freestanding surgery centers. So that's one. So, and that's true for radiology. Remember when you look at the finances of hospital based services versus those that are either joint venture, or standalone surgery centers, there is a difference in reimbursement for those different facilities, by pointing I think there's going to be continued financial pressure. Someone asked, what does that look like.

Clearly, people are going to be looking at their capital budgets. There it budgets, PwC just did a survey of CFOs throughout the country and 64% of them said they're either going to cut back on any capital spending, and any new it initiatives, until they fully understand the impact of finances on their health care systems for those hospitals that weren't consolidated yet. This pressure on them is going to be significant.

And I think you have to look at the pyramids of those hospitals that are not part of healthcare systems, but you're going to see more consolidation and partnerships across additional sectors of healthcare. And I think different types of partnerships. So hospital systems that don't have a robust ambulatory network outside of the hospital will be looking to fund those partnerships if they haven't already. And I do think that those hospitals that are impacted significantly from a financial standpoint, that have not yet joined the system will be looking to join a system. I also think there'll be an opportunity for the parasite to begin to partner with the provider side, and look at ways that they might be able to partner and consolidate really managing patients, as we move forward.

Other big ticket item that's out there is clearly the high unemployment rate. If anybody saw the news today, another two and a half million dollar or two and a half million people applied for unemployment. And that's going to increase our Medicaid ranks. For those hospital systems that typically haven't dealt with a high Medicaid population. It is a different, and a payer mix and creates that Medicaid population, many times creates significant challenges in terms of access for those patients state budgets are devastated, which we've already seen some states talking about how they might impact future Medicaid funding and services.

I think that's important that we look at kind of the whole unemployment Medicaid and state budgets. And then of course, we've all seen the disproportionate impact on minority populations. Those minority populations and low income folks are often the frontline workers in grocery stores. They're the folks who are out on the front line, who don't necessarily have the ability to isolate, they're getting infected at higher rates, and they are going to impact the healthcare system, as we go forward, really, how do we make healthcare easier, through innovation. I think there is, there was a pent up demand for convenience from consumers around healthcare. I think it's been exacerbated by COVID-19. I think there's a focus on the digital transformation, and how we might be able to use some of that digital technology impact not only COVID, but the entire healthcare system going forward. And the third thing is around value based care, and what some of the impact of COVID has on acute care facilities, and why we believe that value based care might be the next big thing in health care because it will be competitive.

So consumer demand for convenience, just want to add were at the airport spas, since they can't do massages are now offered coded testing. So, kind of a unique pendant for those airport style locations in terms of what I don't do out there undergraduates can think about some of the big ways we might be able to use some of these alternative sources for making healthcare easier. So we've seen personalization against History Prior to healthcare. Believe that tell us now out of the box. It was really slow to start pre COVID. And now, a must for every practitioner, and I should say, it was slow to start in many areas of the country. There were exceptions. Places like Kaiser, where they were seeing 65 to 70% of their primary care visits through telemedicine. Now, Necessity is the mother of invention telemedicine, all of a sudden became the go to all the primary care physicians in terms of still being able to reach their patients postcode.

When we try to implant telemedicine in our primary care practices. There was nothing but a big pushback on pre cobit. Now I think it's become a standard. I think it's become a standard, based upon different patient populations. Clearly someone over the age of 65, who doesn't want to go out is practicing social distancing, the last place I want to go was to a physician's office where there might be COVID patients there. And so we're seeing a demand for telemedicine clearly for that primary care practice.

Clearly urgent care was one of the areas that was an immediate uptick from telemedicine in the beginning. That will continue. And so any way we can keep people out of those acute care facilities or even in a physician's office through telemedicine. I think will be become important. And I think telemedicine is important not only for the primary care practitioner, but for a variety of other types of healthcare services, including behavioral health.

When you look at the opportunity for us expanding the capabilities of behavioral health through telemedicine, it's significant. The issue isn't the technology, because telemedicine is a relatively simple technology. The issue is the number of practitioners that are available to be able to provide the services, particularly in behavioral health. So if we can somehow figure out how to get those practitioners onto a platform.

And when you think about behavioral health and a whole host of issues associated with behavioral health. I think that's a key for offering a really meeting the consumer demand for convenience going forward. When we look at pharmacy male owner has ticked up significantly, because people don't want to. If they can have their prescriptions delivered to home, wasn't always the primary choice for consumers, but as a result of COVID, we're seeing more and more mail order pharmacy. I think that's going to impact those retail pharmacies that dependent on that foot traffic for the pharmacy to to for some of our other retail opportunities.

And again the opportunity to really manage patient populations and medication management, it becomes another important telemedicine aspect. We talked about increased demand for convenient accessible behavioral health services, really, that's all about how do we come together, providers of services, and an easy way to telemedicine perspective, we will continue to see expansion of patient monitoring and at home health services. The ability to connect all those various patient monitoring tools. Everything from, you know, remote temperature monitoring. to. If we look at COVID, one of the big issues with COVID is that people start seeing their blood oxygen saturation. Before they have acute respiratory symptoms. It's when that that oxygen starts to drop in their blood. When patients should be heading to the hospital not waiting for the respiratory symptoms because sometimes it's too late, that happens.

So how do we begin to look at all those various things that we're monitoring for patients, put it together in a convenient way for the patient, but also for the providers, so that all that information, and those home health services can be provided without the patient, leaving their home, or having to go to a physician's office or another site of care.

And then of course, alternative sources of revenue outside acute care facilities becomes really really important. Those joint ventures surgery centers radiology centers, the ability to drive revenue outside the hospital. I think becomes hugely important in terms of salvaging some of the revenues are available to healthcare systems going forward.

Of course, we've talked about continued digital transformation. So digitalization is shaking up the conventional patient journey. We're seeing more and more predictive analytics for personalized care. And when we look at predictive analytics, it's not just about what's in the medical record or what information is available for a particular patient, but it's also about the genetic information that's available, and how we might be able to use that for personalized care. And for treating COVID patients, still a lot of research being done around what's going on from a genetic standpoint, and what information is available that can help us identify maybe those patients who are an increased risk for significant adverse outcomes as a result of their genetic predispositions.

So I think predictive analytics becomes really really important for personalized care. Again, the focus on home health digital solutions, and how we pull together all those various aspects, using predictive analytics and those digital solutions, going forward. And then we have to look for innovative opportunities to address COVID and future pandemics great information and a lot of people working on anonymous patient tracking, where you sign up for an app. I'm actually working with the company right now. You sign into the app. It allows you to track your phone. Again, you have to get permission, because a lot of the controversy around this is clearly patient privacy issues, but it also asked you to voluntarily report if you'd become COVID positive, so that they can notify anybody who's come within six feet of your phone in the past five days that they've been potentially in touch with somebody who's now COVID positive. So the ability to do patient tracking and have it be a robust process. I mean think about the implications beyond just tracking COVID from a public health perspective, but for employers for, you know, people who work in office buildings, the ability to track somebody who's become COVID positive within the work environment. I think will become essential if we're really ever going to get back to what we were on pre COVID testing so many different types of testing out there, and so many new technologies.

I was talking to a company who has a rapid fingerstick test was developed in Sweden. They are 300 there their number 300 in line for FDA approval. So, I think, the FDA is way behind in trying to get some of these tests approved. They claim that they're 99% accurate, but soon they'll be patient testing, or you'll be able to do a finger stick and see whether or not you've got the antibodies, again, becomes part of that comprehensive approach to innovative opportunities to address COVID from a patient tracking and testing standpoint, supply chain becomes important for healthcare systems, the supply chain was really challenged during COVID.

You know, pictures of healthcare workers in garbage bags trying to protect themselves. and it's not something that any healthcare system wants to see, but no other innovative opportunities to identify where there are supplies that can be used in those areas that are going to be hardest hit, as we go through. For. There's lots of new technology around testing for body temperatures. There are zero touched body temperature measurement tools that are out there, you can stand 18 inches away from the testing machine, and it will tell you your body temperature. They put them in malls, they're putting them into hospital waiting rooms. And clearly, being able to test somebody's body temperature becomes important during the acute COVID testing period.

So I think those tools, and then the ability to track those results through a patient tracking app becomes a comprehensive approach for innovative opportunities to address our current crisis. And then lastly, home respiratory testing and monitoring to detect early serious symptoms.

There are several companies that are out there, you can buy a pulse ox online now. It's an easy device that you stick on your finger and it tells you what your oxygen saturation is, if your COVID positive you should be managing monitoring or your oxygen saturation, and you should be looking for when that saturation drops before you get respiratory significant acute respiratory symptoms as an indicator they need more help than just staying at home.

So all of those things, I think become a comprehensive package for helping us get back to normal, but more importantly tracking kind of where we are today. Then last but not least, the move to value, all the things that we've talked about is really about how we can manage patient populations going forward.

So Value Based Payment Models have been less impacted during COVID. Remember, if you're getting some type of capitation rate. doesn't matter if you're having an elective procedure fact you're probably made more money, right, when you're getting some type of regular, normal payment for managing patient populations. So, will that in fact push healthcare systems to look at Value Based Payment Models.

Going forward, and to really begin to change the healthcare system to really providing value based care. I think you'll see payer provider partnerships, on the rise. Things like co branding Medicare Advantage programs or Medicare Advantage opportunities I think they're there, you'll see more and render that as you go forward so the health systems branded Medicare Advantage administered by local insurance provider.

Of course we're still continuing to see the federal push for alternative payment models. And this was a big big push prior to COVID. I think it's going to continue the primary care first models. The bundled payment care initiatives, all those things for reducing the overall cost of care and providing better care that keeps people healthy. We'll continue to see those, and it does support the move to value.

And then last but not least, one of the considerations in googling the value is how do you begin to manage and expanding Medicaid population. As a result of the significant unemployment and the increase in the Medicaid ranks going forward. It is a different patient population, it requires a different set of management tools for Medicaid, that will become.

So, the key competencies required for value based care includes managing patients across the continuum, improving access we've talked about this telemedicine convenient accessible touch points, home health and home monitoring all become part of that move to value in a core competency, to provide the most efficient care, using AI to leverage data and create efficiencies becomes extremely important in terms of managing patient populations, understanding what some of the triggers are, and really trying to identify those high and rising risk patients, so that you can keep them from going to the hospital and, and keep them healthy outside the hospital. I think care management solutions for keeping people healthy and managing chronic conditions, become really really important. And again that's using a whole host of tools that are available out there to really begin to manage patient population. And then, best optimizing the efficiency of hospital operations hospitals can no longer continue to operate at the levels that they're operating on, they have to be able to improve the efficiency and look for ways that they can reduce the overall cost of care and provide better, and higher quality outcomes.

Key to this is managing the post acute provider networks, so that whole continuum includes everything from pre hospital care to acute care to the post provider network. And then looking at community based care models with community health workers that help identify and facilitate their non clinical folks are out there to help facilitate patients, getting to their health care providers, so that we can manage them most effectively.

And then last but not least addressing social determinants of health, and not just housing, food insecurity and transportation, but clearly behavioral health, look at social determinants of health about 40% of the cost of care are associated with behavioral health issues.