In a captivating episode of the Edelheit Experience podcast, Chairman and Co-founder of Global Healthcare Resources, Jonathan Edelheit, sat with Kate Brown, head of Mercer's Center for Health Innovation, to discuss the latest trends and disruptive innovations in the employer-sponsored healthcare space.
Kate Brown is an expert in managing and improving employee population health through corporate wellness initiatives and also holds a master's degree in kinesiology and a Certified Employee Benefit Specialist (CEBS) designation. She is also a speaker at this year's Healthcare Revolution conference, the nation's largest event for self-funded employer healthcare, benefits, and well-being. Register for free to learn how the top employers in the country are working their way to the conference's 3 moonshots:
1) Reduce employer healthcare and benefits costs by 25% by 2025.
2) Reimagine engagement and well-being.
3) Provide 40% of healthcare services virtually and through technology by 2025.
Jonathan: Could you give us some brief background about who Kate Brown is?
Kate: I lead the Center for Health Innovation at Mercer within our US health business. I have been in an innovation role for Mercer for about four years. Prior to that, I was a Total Health Management consultant, which, in Mercer parlance, is similar to population health management from the employer side of things, and before that, I was getting a master's degree in kinesiology.
Jonathan: One of the most innovative changes in healthcare is the acceleration of virtual care; could you tell us more about this?
Kate: I think since the coronavirus pandemic, everybody who has paid attention or even has lived life during this period has probably had some sort of interaction with a virtual care experience. We've seen huge upticks in the use of telemedicine and virtual visits for seeking healthcare. I believe one good thing that came out of COVID is that we've realized that you don't necessarily always have to be in a brick-and-mortar setting in order to receive appropriate care.
We've also seen that virtual care is starting to encompass things that employers previously would call point solutions. So when you think about the different digital health companies that are focused on specific conditions or specific condition management protocols, all of that also falls into virtual care delivery. Virtual care also offers bigger, disruptive opportunities in the employer setting as it is scalable and provides wider access to more people.
Jonathan: What is the difference between virtual care and virtual-first care?
Kate: I love that question. If you read about virtual care, you'll see a lot of different terminologies. In part, that's because, as I mentioned, digital healthcare is at its early stages. There aren't a lot of formal definitions around this space, so everybody's trying to plant a flag and figure out what virtual care and virtual-first care are.
Virtual first-care, however, has a formal definition that was put together by a group called Impact, a coalition that was formed by the Digital Medicine Society and the American Telemedicine Association, and with which Mercer is involved. The group defines virtual first care as medical care for individuals or a community accessed through digital interactions guided by a clinician and integrated into a person's everyday life. So although this is a succinct, one-sentence definition, it describes a lot of the things that are already happening in digital health. However, the struggle today is that most of those digital health companies I mentioned that deliver virtual care, say for a specific condition, are all fragmented.
Jonathan: You just mentioned "fragmented." Could you give more insight into that phenomenon and the impact of fragmentation in care delivered virtually?
Kate: I'll take it from a patient perspective. Suppose a patient has coverage through a carrier but also has point solutions or digital health solutions for managing diabetes, cardiovascular issues, or their behavioral health needs. In that case, the employer might have set it up so that they have a different company that's specifically focused on each of those conditions. So if you're a patient who has those comorbid conditions altogether, you don't necessarily know what the right front door is for you to get your needs met. That fragmentation comes out because you might get into one front door but not be able to go to a side door to access a related solution for you. You might have to go back outside and find a different door. So that's what I meant by the fragmentation in virtual care, at least from a patient perspective.
Jonathan: What do you think are the risks or challenges of this fragmented system of virtual care with multiple companies providing different solutions for one patient?
Kate: Certainly, if the patient data isn't shared across those entities on a patient-specific basis, you run the risk of poor outcomes and medical mismanagement. A lot of those issues could actually be solved if health records were actually owned and organized by the patient rather than by the entities that are managing that individual's health or a specific condition. That's not how it exists today. Today, all of the data exists in silos. And so if the data are not shared appropriately, and if there's not usually somebody looking holistically across the patient, all of the risks of poor patient outcomes, poor treatment, and unnecessary treatment are possible.
The other thing that's important from an employer perspective and, to a certain extent, a patient perspective, depending on what plan they're enrolled in, is duplicative cost. If employees are getting services from one provider that's being duplicated in another place, that's unnecessary spending and not good for the system.
Noncompliance is another factor that we see within the consumer patient population, which is driven by the confusion caused by the multiplicity of solutions. If you don't know where to go when you need a certain type of care for a specific condition, you're more likely to just not take action, and you get lost in trying to navigate it all.
Certainly, there are solutions out there trying to stitch those point solutions together and create a better-navigated experience and a concierge-level experience. To some extent, we've seen success with those solutions.
To solve this problem at an organizational level, employers with multiple vendors should audit and understand how their vendors work together and integrate their processes. However, the challenge here is that a lot of these companies are relatively new and don't have the infrastructure to integrate these systems on behalf of some of these employers. But from what I've seen, there are currently a lot of efforts in the market to integrate data and drive interoperability.
Jonathan: In regards to virtual-first care, how big of a focus and how important is user engagement?
Kate: The focus on consumer preference and consumer engagement as opposed to patient engagement is definitely an important thing that we're watching. It's something that the disruptors are more focused on than the traditional carrier incumbents basically because they come from a different place philosophically. For instance, if you're one of these startup companies, particularly if you started in the direct-to-consumer space, your focus on engaging people will be different from an insurance carrier.
Regardless, I do think that for these types of solutions to be effective and to deliver on all of the promises that they make around better quality, better outcomes, lower cost of care, and therefore more efficient care delivery; people have to actually use the systems and use them appropriately. So the engagement piece can't be undersold at all. That's why there's so much attention on the Googles, the Apples, and the Amazons of the world getting into this space because they clearly have a big advantage from a consumer engagement perspective. It's only a matter of time until they figure out what exactly is happening within healthcare and start to crack that nut as well. That's a big threat to the existing healthcare ecosystem.
Jonathan: With the virtual-first care solutions intersecting with traditional health plan offerings and how they've been offered in the past, what does that mean for healthcare?
Kate: Yes, we are starting to see more of this fusion happen. For instance, we're seeing the emergence of virtual primary care, which essentially is when you access your primary care physician via virtual means. And oftentimes that primary care physician you'll never need to see in person, you'll get your care provided via an app or via video chat, and then if you need to be referred to a specialist or need to be referred for in-person care, you're directed to a physician.
Typically this plan is within a network that those physicians are already partnered with. A lot of the carriers have made announcements about these types of plans. Over the last few months, we know Aetna's doing something with Teledoc. We know UHC is launching a pilot. Kaiser is another example of an integrated delivery system with their doctors being the providers themselves. Nonetheless, we're starting to see the carriers realize that the trend of the last couple of years of virtual visits wasn't just a temporary thing. It really represents a new care delivery mechanism that should be paired with traditional health plans.
Kate: Personally, I'm excited. I think that it'll do a lot from a convenience and access perspective. For instance, when you need to seek care today, you can have a telemedicine vendor that you can see for an acute issue immediately. Further, you can have access to the same provider every time, which is a nice feature for those who might not have a lot of health concerns, but maybe occasionally need something. Knowing that they're going to see this same virtual care team and that their health records are all going to be there and accessible by the providers is a great thing from the customer's perspective.
Further, we have seen a lot of rural hospital systems closing. As healthcare providers move out of some of those rural facilities, there's lower access in the community. However, virtual visits could solve some of that problem and bridge the gap in healthcare access in these areas.
Jonathan: What do you think could go wrong with this new model?
Kate: As optimistic as I am about virtual care, I think we have to watch carefully and try to influence what goes on from a cost perspective. Cost and associated cost savings are a big unknown here. These virtual care plans are, in some cases, in the pilot stage for a year. Others are just launching. We're seeing that a lot of the carriers are saying that these virtual-first plans will yield savings, but we don't really have the real-world data yet to back that up.
Therefore, the risk is that these plans aren't structured appropriately in terms of reimbursement for virtual visits versus in-person. If they're not structured appropriately in terms of engaging the right people to use the plans, then there's the potential that those cost savings that they're projecting may not come to pass. And certainly, we're a country that doesn't need to add any additional cost into the healthcare system.
The other factor that could influence the success of this virtual-traditional model is the cost structure between in-person visits versus virtual visits. If not done appropriately, you could risk that being a duplicative spend. If somebody goes to the virtual visit, for example, and virtual care can't solve their problem, they get referred and basically pay twice for the same medical need. That's another case that would not be so good. So it will be interesting to see how some of these carriers think about addressing that. I think this is a big opportunity for bundled pricing and value-based care models because, ultimately, those are shifting away from the fee-for-service model that clearly doesn't work.
Jonathan: Will the cost be cheaper for virtual versus in-person? I've heard some employers complain that they're being charged the same amount for virtual as in-person instead of paying less.
Kate: Yes. It's a hot point of contention right now. From an employer perspective, if a visit is shorter and it doesn't require the same brick-and-mortar infrastructure, and it doesn't require the same office staff to make sure that the visit is proceeding as planned, then there are fewer costs associated with that virtual visit than in-person. Consequently, they should be charged less. However, the perspective is different from the provider community. The providers feel it is still the same time that they're spending with patients, and it shouldn't matter whether that care is delivered in-person or virtually because the whole argument is that the quality should be the same or better.
Again, I believe that bundled pricing arrangements would be ideal for addressing this. If you're a patient and you go to a virtual visit, and that need can't be resolved, you have to go to in-person care rather than getting charged every single time interact with the care system as it's set up today. If instead we looked at it from a holistic perspective and said, for instance, for this ear infection, regardless of what the touchpoints were, this is the rate that you pay to get it treated. That's an ideal model. That's where I hope this goes, but we have a lot of work between here and there.
Jonathan: Now, if we fast forward to the future to 20 or 30 years from now, what do virtual-first care and virtual health plans look like for everyone?
Kate: It may be hard to tell, but I believe that healthcare systems in every state here in the United States are going to adopt some sort of virtual component. And it won't just involve connecting patients with some random provider as most brick-and-mortar providers will be the ones delivering the virtual visits. So it's a bit of a jump from where we are today, where it's bifurcated. If you have a primary care physician with whom you have a relationship, you would probably prefer to see that provider virtually, and during COVID, we saw a lot of that, but some of that has shifted back. By 2030, it will be really upon the patient's choice to schedule a virtual visit with their regular, everyday doctor instead of driving miles to see them.
In the next ten years, I also see employers driving the de-fragmentation of digital healthcare to optimize patient care and cost savings. Employers will get out of that game and get carriers to become the conveners of these different digital health companies for all of these different solutions. Employers will change the narrative and ask these carriers to build the infrastructure to integrate patient data flow so that the user experience from a healthcare perspective is as comprehensive and easy as possible rather than having HR teams across the country try to do this same work over and over again.
Jonathan: Now, are there other digital trends you're watching?
Kate: Yes, remote patient monitoring is definitely something I'm watching and, in particular, combined with the end-of-care at home. So this is something that has popped up much more in Medicare space than it has in the commercial population just yet. But I think there's this recognition that using remote patient monitoring technology enables people to receive a lot more care at home than they did previously. That's an interesting shift. As I mentioned earlier, during COVID, a lot of stuff happened at home, right; a lot of care delivery happened at home, but it's built on older systems of care and because we were responding to what was going on with the pandemic and what we had in front of us.
Going forward, the deployment of RPM or remote patient monitoring technology in a built-for-purpose standpoint for care delivery at home holds huge potential, especially for the senior population. Therefore, seniors do not have to travel a long distance for a follow-up, and their caregivers don't have to go through that stress to seek medical care for them either. So knowing that you could seek medical care either for yourself or for the person you're caring for without leaving your home is a big area of growth regardless of the population we're talking about.
Jonathan: Would you say that the COVID pandemic will influence massive investment in virtual care in the future?
Kate: The pandemic definitely came with intense fear, deaths, and disease, but a big silver lining from where I'm sitting is that a lot of people have realized that you can do things differently and the world won't implode, and that to me is kind of the most encouraging thing. It's been a huge opportunity for us to try and do things differently within the healthcare system, and there's a lot more openness and appetite for that because the circumstances have dictated. This has driven the massive adoption and acceleration of virtual care and would also stimulate more investments in this area.
Further, another silver lining that's come out of the pandemic is increasing mental health support. More employers, in particular, have recognized that mental health is something that everybody has and everybody needs to manage. And so, we've seen corresponding growth in that space.
Jonathan: Any final words of wisdom before you go?
Kate: If you piloted anything during the COVID pandemic, keep doing it, keep piloting, and keep innovating. Even after things go back to "normal."
To get a more in-depth view into Kate's views and experitse, check out the Healthcare Revolution session "Cutting the Fat in Virtual Care" which Kate is hosting on April 26. Remember, all you have to do to be able to attend this session, and many more, is register for the conference for free.
