Is Telehealth a Bubble? ft. Ann Mond Johnson

Podcast

Season 2, Episode 1

Telehealth and virtual care are increasingly important tools for removing healthcare barriers such as access, quality, cost, and provider scarcities.

However, scrutiny continues as we battle regulations and misconceptions in the market for telehealth and other at-home care delivery models.

How do we overcome this resistance? Is it possible for telehealth to be the next generation of care delivery?

Join Chris Hemphill as they guide us through a discussion with Ann Mond Johnson, CEO of the American Telemedicine Association, about the impact of telehealth on the market.

Video Chapters
2:40 About Ann Mond Johnson, CEO at AMA
4:15 Telehealth’s innovative response to the pandemic
9:20 Virtual care and resistance to change
12:30 Opening the door to behavioral health care
16:40 Closing the divide between providers and virtual care
19:30 The vision for telehealth

This conversation is brought to you by Actium Health in partnership with the Forum for Healthcare Strategists.

Chris Hemphill

VP, Applied AI & Growth
Actium Health

Ann Mond Johnson

CEO
American Telemedicine Association

American Telemedicine Association logo

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Transcript

Chris Hemphill (00:24):
The pandemic inspired probably the biggest wave of healthcare digital transformation since meaningful use. Some of the largest investments were in telehealth and virtual care. Do those have staying power past this wave of infections? Or was this all a bubble that will burst with a return to normal? We add questions and Ann Mond Johnson, CEO of the American Telemedicine Association had answers. We’ll hear more from her after the break.

Chris Hemphill (00:54):
Consumer experiences, major disruptors in AI tech are shaping healthcare for years to come. On Hello Healthcare, we dive deep on these issues with leaders who are driving change. I’m Chris Hemphill, VP of Applied AI at Actium Health. And we hope that these stories will help you to create or demand better future in healthcare.

Chris Hemphill (01:17):
And just share a little bit of background with us and what’s driven your interest in the direction down telehealth that you pursued.

Ann Mond Johnson (01:25):
Sure. So … and thank you again for having me. It’s great to have a conversation with you. I came to the ATA by way of other startups in healthcare. So I come to the nonprofit association world through a different path. And my career prior to the ATA was focused on healthcare using data to help consumers make better decisions about their health. So I have a strong bias towards consumerism in healthcare that I think really guides my thinking as it relates to telehealth. Because one thing that we’ve seen in the pandemic is that technology can deliver. And we’ve been able to deliver on what we’ve said we could do all long. Which is really get access to care for people regardless of where they are. And at the same time, keep them safe. Which was really paramount importance during the pandemic.

Chris Hemphill (02:21):
Well, that sounds like an exciting move to have been focused on how healthcare consumers can better use data to better their care. And then move into an extremely important and new modality, as far as your area of focus.

Ann Mond Johnson (02:33):
Yeah, it’s been incredible. And obviously, the pandemic is … as people refer to it, it’s one of the few silver linings that came out of this period, telehealth is just one of the few silver linings. And at the beginning of the pandemic, I think that what we saw was a lot of confusion, a lot of very frightened Americans as to what they were supposed to do. And had this incredible speed of innovative response on the part of the suppliers, providers, people who are really turning on a dime to get people what they needed. So I think that that has been very, very exciting.

Ann Mond Johnson (03:12):
What I don’t think people appreciate today is just how tenuous all of this is in terms of staying in place. And so the reason why technology was able to deliver, why we were able to provide services at such a massive scale in telehealth, virtual care, virtual services is because of the public health emergency and all the waivers that were issued. And now we’re at this very curious stage where for the last 18 to 24 months or 20 months, a majority of Americans have used telehealth, a majority of physicians have used it. And I would say by and large people are very satisfied with it. They can’t envision going back to a life without virtual care. And yet it’s not guaranteed that we’re going to have it.

Ann Mond Johnson (03:59):
So these waivers and the public health emergency, once it goes away, if we don’t make some permanent change, we’re going to lose all this flexibility and this ability to access care where and where we need it.

Chris Hemphill (04:12):
That’s almost heartbreaking to hear. There’s been innovation, there’s been a rapid pace of innovation that we’ve seen from our health systems and from some of the health system leaders that we’ve talked to. I’ve heard like their own research, their own user centered planning that has had an overwhelmingly positive responsive to virtual care. Not a hundred percent positive response because there’s just different scenarios-

Ann Mond Johnson (04:33):
Mm-hmm (affirmative).

Chris Hemphill (04:34):
Different times that it works for people. And even in a lot of our own research, we’ve seen that-

Ann Mond Johnson (04:39):
Right.

Chris Hemphill (04:39):
So when we see such an overwhelmingly positive response from consumers and the way people are able to interact. What are the threats that you said we were on a tenuous ground?

Ann Mond Johnson (04:49):
Well, I think … first of all, it’s important to know that a lot of the regulations and laws that were in place that dictate how we’re able to access services were put in place 14 years before the iPhone was invented, in 1997. So, this enormous period in the last 18 months where there’s been this rapid uptake in telehealth would not have been available before. And so from a federal level, it has to do with things like what we call, the rules 1834 M, which is in Social Security Act in 1997. Which says that you can only get virtual services in a certain location if you’re in a certain location and if you’re from a rural community and then it would be reimbursed. And that’s a pretty fine slice. What we’ve seen, of course, is that it’s much more broadly used and disseminated than that.

Ann Mond Johnson (05:42):
So those are the sort of things that have to be put in place to make sure that we take back those laws, that we change how services are regulated and so forth. I think the other is that there have been requirements of having an in-person relationship with a physician before you can use telehealth. And that we firmly believe is not necessary, it’s not clinically required, it’s not clinically justified. And we view telehealth as modality of care that a clinician should be able to use in consultation with their patient.

Ann Mond Johnson (06:21):
Having said that, the idea of telehealth being a panacea, it’s not for everyone, it’s not for everything. And so we’re mindful of that. And so at the ATA, what we’re really focused on is ensuring that from a policy and advocacy perspective, we work at the federal and state level to make sure these restrictions that were in place before are permanently rolled back. And then likewise, we are working with our members, which include over 400 organizations, delivery systems, provider groups, academic medical centers, payers, solution providers, to really operationalize hybrid. Because I think that what we’re going to have in the future is a continuation of what we’ve enjoyed in the last 18 months, which is this mixture of in person and virtual. And the use cases for virtual are just much broader than any anybody thought possible.

Chris Hemphill (07:19):
I like the way that you frame that up, use cases or virtual. Meaning, like you said earlier, it’s not a panacea, but there are use cases where-

Ann Mond Johnson (07:27):
Mm-hmm (affirmative).

Chris Hemphill (07:27):
It’s effective and useful. Meaning, if we back up a little bit, you’re focused on consumer decisions and everything like that. It’s probably true that consumers appreciate being able to have a choice in what they’re able to do. Right?

Ann Mond Johnson (07:39):
Mm-hmm (affirmative).

Chris Hemphill (07:39):
So, it leads me to wonder, when we’re looking at these 14 year old plus policies that are kind of shaping what’s able to happen today. Sounds like you wouldn’t be here if there was just a delete button to eliminate that stuff. So what is the resistance to changing these policies and changing these incentive structures so we can be adaptable to virtual health?

Ann Mond Johnson (08:01):
Well, I think that part of it is just getting Congress and other legislative and regulatory bodies to act. I think that I’ve learned, new to Washington, new to policy is that sometimes that sense of urgency is difficult to manage and to pull forward. But I think the other is that sometimes there’s just vested interest in keeping things the way they are. So sometimes you’ll hear the notion of patient safety or this concern about fraud, waste and abuse, program integrity and so forth.

Ann Mond Johnson (08:33):
And in point of fact, the data don’t … they don’t bear it out. So in point of fact, that patients are able to access safe, effective, and affordable care that virtual services are not more prey to fraud, waste, and abuse than any other face to face service. And unfortunately we have a tendency to confuse telemarketing with telehealth. So there’s been scams with telemarketing where people will call and prey on unsuspecting individuals. But in point of fact, that’s not telemedicine, that’s not telehealth, that’s not who our members are. And so we see it as a real opportunity to change all of that.

Chris Hemphill (09:14):
Excellent. So it kind of makes me wonder, who stands to benefit from keeping things the way they are? Just curious about where those pressures might come from, resisting the change that we need.

Ann Mond Johnson (09:24):
Well, I think, again, it’s a lot of people who have a vested interest or afraid of change. So it can come from a lot of different circles. And what we have to remember is that, for example, with banking. When it moved to your phone, right, because all of us, or over 90% of us have smart phones or the ability to do things on our phone. When we moved to banking online and to mobile apps, it wasn’t that we wanted to call up Chase and have a conversation with a teller. We wanted to do things the way we wanted to do them. And so I think being much more consumer driven, having that user bias, that user orientation, having that idea of reimagining the experience from the user’s perspective is really what’s going to prevail.

Chris Hemphill (10:19):
Hello Healthcare is brought to you by Actium Health. Healthcare leaders use Actium CRM intelligence to activate patients and drive meaningful engagement. You can make it simple to identify and predict patient needs by using AI driven next best actions. Learn more ActiumHealth.com. And now back to the show.

Chris Hemphill (10:46):
A lot of the times when we start listening to our consumers and our patients-

Ann Mond Johnson (10:50):
Mm-hmm (affirmative).

Chris Hemphill (10:50):
They start telling us that the types of modalities that we want to see virtual care, asynchronous care and things like that.

Ann Mond Johnson (10:57):
Right. Well, and people don’t even necessarily know all the options, we’re still learning. So a great use case, going back to that phrase, is behavioral health. And pre pandemic, we had a shortage of clinicians, we had a significant percentage of Americans pre pandemic with mental health issues or a crisis of one kind or another. And unfortunately, a horrible distribution of services that were available and horrible wait times. And what’s happened particularly during the pandemic, is that with behavioral health delivered virtually is that more Americans are able to have access to those services. It’s easier for people to get access to those services. And they’re just much more available than they ever have been before. Fortunately.

Chris Hemphill (11:43):
Excellent and excellent hearing about the widening of those use cases. I’ll just give a personal example. There was a company called Wobot, a friend of mine recently went to start working for them. And this isn’t a virtual care modality, there are ways that clinicians can click in. But whereas before, I don’t have a therapist or any kind of behavioral health. I’m someone who otherwise wouldn’t have started looking at techniques around cognitive behavioral therapy. And I wasn’t really aware of these things going on, I wasn’t aware of these ways to manage stress and depression and-

Ann Mond Johnson (12:17):
Right.

Chris Hemphill (12:17):
Things like that. But it opened the door just in a kind of an unexpected way.

Ann Mond Johnson (12:21):
Right, right. That’s great.

Chris Hemphill (12:24):
One thing that strikes me, I was asking about who might have an interest in keeping things the same. One question that comes up is as we move towards virtual health, and you have your opening doors for different types of business models, companies that are specifically focused on that, or Amazon, for example, to open up their versions of virtual care. There are like a significant, in the provider landscape, a significant number of incumbent providers. Do you see that a virtual care having a competitive of impact on like existing hospitals and providers today?

Ann Mond Johnson (12:58):
Oh yeah, absolutely. Because the existing way of doing things, you have a bias to keeping it that way. And/or you have a vested interest in making sure that your brick and mortar are safe and that you’re getting well compensated so that you can continue to invest in that model of service. And again, what people have realized is that, we can do a lot more with virtual than we ever thought possible. So the technology continues to accelerate, the fact that people are able to have their kids ears checked virtually using equipment, very reasonably and find out whether or not they should take their kid to the ER, whether or not they should have antibiotics prescribed by their pediatrician.

Ann Mond Johnson (13:45):
So these sort of things mean that we don’t have to inconvenience ourselves, we don’t have to go and access care where it’s provided. The care is provided where we are and meeting us where we are. Which I think is really, really important. And so I think that what we’ll continue to see is digital would become more and more faked into how we do things. Just as it is with banking.

Chris Hemphill (14:12):
And a key focus that you mentioned was, we don’t want to harm our brick and mortar operations. But we want to provide an easier experience for consumers.

Ann Mond Johnson (14:20):
Mm-hmm (affirmative).

Chris Hemphill (14:21):
So it would make sense that virtual care can be extended. And that can show kind of a happy marriage, a happy relationship between existing providers and how they incorporate virtual care into-

Ann Mond Johnson (14:32):
Mm-hmm (affirmative).

Chris Hemphill (14:32):
Their own pathways. That paints a clear advantage for providers to just be able to deliver on more modalities. I’m curious about if there are overarching virtual care providers that might take a lot of those earlier phases of the relationships, early triage or early things that people can do online. Should provider organizations see any aspects of virtual health as a threat?

Ann Mond Johnson (14:55):
If they don’t adopt it and view it as a modality of care, that it’s going to extend their capabilities as well as make it easier for their patients to reach them. Then yeah, I can envision some of them being threatened by it. But again, we have a shortage of clinicians in the US, we have an aging population that’s getting increasingly sick. This is an opportunity to get people care in a way that is very safe and is very effective. And I think that the other area that we spend a lot of time focusing on is the whole notion of how do you use technology to address access? How do you use technology to eliminate disparities? So we’re not interested in using technology to heighten the divide. We want to close the divide.

Chris Hemphill (15:44):
I’m really interested in how you see the relationship between … like in your studies on data driven and data driven consumer experience in the past, combining with telehealth now. Well, like there’s a reason that you came and sat down with me to talk about this. I’m just curious about how should we be thinking about this from like a consumer oriented perspective?

Ann Mond Johnson (16:03):
To appreciate that people want to get care, they want to stay safe. Most people don’t want to come to a physician’s office or to a hospital if they can at all avoid it. And so we want to make it as easy as possible for people to stay at home, be monitored at home, remote monitoring is huge. Hospital at home, if you have a home that can accommodate that kind of infrastructure work. I mean, those are really huge improvements. And so I think the idea of looking five years out and saying, “Where is this all going to be?” We’re all going to have an element and an increasing element of digital and virtual care in our lives. Much more so than we have today. Which I think is going to be to everybody’s benefit.

Chris Hemphill (16:54):
Excellent. And just another one on the, where is this going to be, question. How do you see like the policies that you’re focused on and what the ATA is attempting to promote? What is your vision on what we might be seeing in the next 12 to 36 months in terms of policy? And that’s kind of going all the way by back to the beginning point that we’re on tenuous ground with-

Ann Mond Johnson (17:16):
Right. So if we do not change where we are from a regulatory perspective, legislative perspective, we will go off what we refer to as the [inaudible 00:17:27] health cliff. So we are advocating hard on behalf of our members, on behalf of the entire community and the industry to ensure that the restrictions associated with 1834 M, the geographic and site specific restrictions are eliminated. We want to make sure that in person requirements are eliminated, that you can very clearly establish a relationship between a patient and a physician virtually. You don’t need an in person visit. There’s a lot of work that has to be done as it relates to substance abuse and the Ryan Haight Act. And ensuring that clinicians are able to prescribe substances that are, again, used to be a very arcane and tedious fashion of getting those provided. And this is at both the state and the federal level. So there’s a lot of work to be done. So over the next 12 months, 24 months, our work’s cut out us.

Chris Hemphill (18:25):
Excellent. Well, I’m really excited to see some of that work go forward. I want to see more consumers and providers be able to offer choice down modalities that are just effective and helpful.

Ann Mond Johnson (18:37):
And raise the bar for all Americans so that they get healthier in their State.

Chris Hemphill (18:42):
Well, fantastic. Thank you for sharing this detail and some of the work that you’re leading. What’s the best way that folks can either get in touch or start learning about resources that they can help?

Ann Mond Johnson (18:53):
We have an amazing website, AmericanTelemed.org. And we just wrapped up telehealth awareness week, which was another week long effort of promoting the value of telehealth. It was the first time we did it, we did it with over two dozen endorsing partners, patient organizations like Mental Health America, and the ALS foundation and Susan G. Komen And the National Organization for Rare Diseases, as well as had over 60 congressional leaders who signed on to support telehealth awareness week. So it’s a very bipartisan issue and we talk about how we can advance this in a very appropriate and safe fashion.

Chris Hemphill (19:35):
Fantastic. And happy to hear that it’s a bipartisan issue because-

Ann Mond Johnson (19:39):
Mm-hmm (affirmative).

Chris Hemphill (19:40):
Halfway through the conversation, I was thinking, “Well, who can look at this?” And-

Ann Mond Johnson (19:43):
How can you argue that people need care?

Chris Hemphill (19:46):
Exactly.

Ann Mond Johnson (19:47):
Right. So, well, thank you, Chris.

Chris Hemphill (19:47):
Thank you, Ann.

Chris Hemphill (19:51):
Thanks again for tuning into Hello Healthcare. If you like what you heard, we appreciate a review on Apple, Spotify, or wherever you’re listening. You and your feedback fuel us. This Conversation is brought to you by Actium Health. To get the latest on what these healthcare leaders are saying, subscribe to our newsletter on HelloHealthcare.com or join us for our weekly sessions on LinkedIn. Thanks. And when we see you next time, hello.

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