Telehealth, Patients-at-Home and COVID-19


Janet Kennedy (00:02):

Welcome to the People Always, Patients Sometimes podcast. A short while ago, our CEO and founder Tom Rhoads, published an article on Med City News called “It’s Time to Integrate Telehealth into the Equation”. It Was an interesting article about how COVID-19 has kind of changed the game when it comes to telehealth and trying to keep our patients in a nice safe environment: their home. As a result of that, we started to have conversations around the virtual office and decided that we’d like to explore that topic a little bit more. I hope you enjoy this discussion of serving patients at home with telehealth amid COVID-19 and integrating it into the full healthcare equation here on the “People Always, Patients Sometimes” podcast.

Janet Kennedy (00:49):

It’s very exciting for me to finally have the CEO of Spencer Health Solutions on the People, Always, Patients Sometimes podcast. You’re familiar with Tom Rhoads’ voice because he’s introduced most of the previous episodes, but he’s been so busy it’s been very difficult to schedule a time to have him on the show. Well, COVID-19 has certainly changed things for everyone in the world. This global health crisis has forced most people to be working from home except essential workers for whom we have great support, love, and sympathy. But for us as a healthcare company, it’s been very interesting and incredibly busy for us even though we have been working from home. I was able to schedule a conversation with Tom and I really want to talk about how is COVID-19 impacting healthcare today and in the future. Tom, welcome to the podcast.

Tom Rhoads (01:43):

Good morning Janet, and thank you very much.

Janet Kennedy (01:46):

Well, it’s all been very difficult trying to work with each other from afar and it’s working out actually very well, although I think we’re all working very hard. How are things over at the Rhoads household?

Tom Rhoads (01:57):

You know it’s good. We have two of our children home from college and they’re doing their daily classes on video chat and zoom and then we have a senior in high school that it’s actually just embarked on the same process and conducting everything virtually. It’s a bit of a crowded house, but it’s exciting for us to have all the kids home and trying to manage today and the noise and everything else going on. But we’re healthy and that’s the blessing.

Janet Kennedy (02:20):

I actually can’t imagine what that’s like having, in essence, five adults all in the same place, all needing to use the bandwidth to do what they need to do. Is that a challenge?

Tom Rhoads (02:29):

You know, it is actually. We work around each other relatively well, but there are definitely times when the bandwidth is being used by all five of us at the same time, so it’s something that forces us to option, whether we’re doing video or just voice, and oftentimes the latter is probably the most, the biggest choice we make.

Janet Kennedy (02:49):

You and I are both in great situations because we have jobs, we have paychecks, we have comfortable homes to live in, but that’s not always the case for a number of people and as follow what’s happening in social media. There are an awful lot of individuals who are really, really frightened that they are immunocompromised. They have chronic health conditions. They really feel a little bit in a panic. Are you getting that sense as well?

Tom Rhoads (03:15):

Without a doubt. I think we see it both in my, my own family where we have several members that have immune-compromised systems and are quite concerned about being in a position of catching COVID, and of course across the public. I believe they estimate that probably six, six to 7% of the population is in that bucket and in a country of 330 million people, that’s, that’s a high number. So it’s scary times for them and for all of us. I think we individually have a responsibility to do our best, which I think we’re embarking on to keep them safe.

Janet Kennedy (03:46):

I know you as a CEO are following both global information coming down as well as trying to manage a company that is in healthcare at this time. What do you see happening on a global or a U.S. perspective regarding healthcare that you find both concerning but also optimistic?

Tom Rhoads (04:06):

Well, I think the industries are beginning to do a pretty good job communicating and I’m getting information from a multitude of sources. The source of probably is most surprising or are the banks, they are putting together detailed prospectus on the spread of the disease, risks of the disease, leadership opportunities, et cetera, and these are a lot of our investment partners and some of the banks we work with. I think the industry as well as doing a very good and thorough job communicating and making sure information’s out there. I think it crossed the world. We’re seeing basically two themes. One is why didn’t we react earlier to this and then two is how will we navigate our way out of it? On the first question, I think it’s pretty difficult to answer. We could say in hindsight that we needed to build 100,000 ventilators and put them in a warehouse, but we didn’t know that this would be a respiratory disease, so it’s a little bit pie in the sky to assume that you can predict which disease was going to affect the population and how you would respond to that.

Tom Rhoads (05:07):

That doesn’t say that we shouldn’t be prepared and then I have deep planning and processes in place. I think based on the response we probably see a lot more of that than people may be given credit for on the other side. How do we navigate out of it? I think we’re doing that. I think social distancing is helping tremendously. I think it’s keeping a lot of people, you know, safe and out of harm’s way. Right now it’s an evolving disease. So at first, we thought it was only transmitted via contact and now we’re saying potentially airborne. You know, the community right now I think is doing its level best to both identify a vaccine that we may see this time next year as well as give us the time we need and contain the spread as much as possible through social distancing and other types of programs.

Tom Rhoads (05:51):

I think at the end of the day it’s the community’s response to it that’ll dictate how this goes. I think the tough part to swallow here I believe is the fact that a lot of people are still going to get sick and a lot of people are going to die because of this. It is a, you know, death as they say trails, the infection, you know, seven to 21 days. So it’s something that even as we see infections continuing to go up, the one thing we will see as a tail and that’s, that’s one of the things that we’ve got to keep our eye on and again continue to not panic ourselves but be in a position to drive that down and that’s where everyone talks about, you know, leveling off on this and then driving it back down.

Janet Kennedy (06:28):

You make a really good point Tom about information changing and I think the hard thing for our citizens to deal with is the fact that something they heard last week isn’t the same as something they would hear this week and they have to be open to new information coming in. What’s your take on the rapid change of information regarding COVID-19?

Tom Rhoads (06:50):

I think from a healthcare community standpoint, they’re doing a very good job responding to and preparing for both care of those with the disease as well as trying to communicate out how to de-risk the population against getting the disease. I think is a lot harder for the general population to respond to the rapid changes in direction or seemingly rapid changes in direction due to new learnings. I think the healthcare community is uniquely positioned that they’re used to that type of ongoing learnings. In fact, they strive for it and so they’re expecting changes, new opportunities to position their teams or processes and their responses. But I think for the general population it’s, it’s tough. It seems like we’re kind of swinging from one side of the other. In reality, I believe it’s just a normal path that we would see in a response and learnings associated with something as severe as COVID.

Tom Rhoads (07:45):

I think on the business and banking side, we’re used to having a plan B, plan C, and, and I believe they’re responding relatively well to the new information that’s coming on the scene and some of the new directives for those that aren’t in healthcare and aren’t used to this type of situation in business. I imagine it can be just hardening. And I, I hope they understand that the response that the healthcare community’s taken, I think is a good one, a path well worn over the years by how they go about solving problems as complex as this.

Janet Kennedy (08:13):

One of the upsides of a challenge like this is that new technologies have a chance to really step up and play an important role in helping solve the problem. And certainly, nothing could be said more about telehealth than it’s time has come.

Tom Rhoads (08:30):

Tele-health has been around for almost 20 years now, and I think the industry 20 years ago may not have thought it would take quite as long to have kind of a sea change, but I believe we’re in the midst of it for sure. You know, we’ve always had a population that seemed right for telehealth, high-risk patients, the potential for disease transmission and mobility issues and all those were ride for, you know, the first movers and the world. I think the technology’s done a really nice job migrating itself from something that might’ve been difficult to use at the beginning of years to something that’s very, very easy to use now. And so that being said, I think there’s also a lot of new players, but you know, if you’re thinking medical visits, clinical research, any person that’s at risk of contracting, any kind of contagious disease, he has a very powerful incentive for them to use telehealth in those providers to enable those services so that they can do them remotely. I think some of the challenges, and this is typical in healthcare, is that the, you know, the payment systems have given some incentive but not a lot of incentive to use these type of technologies.

Tom Rhoads (09:36):

What we’ve seen in the last two months is a complete about-face on that where telehealth is now seen and reimbursed at the same rates as an office visit. And I think the population is seeing for the first time just how easy it is to use these services and convenient as well as much, much safer both for the patient and their provider team.

Janet Kennedy (09:54):

Now that the horses out of the barn, do you see any going back to the way things were or do you feel that telehealth has crossed over and may become part of the standard of care?

Tom Rhoads (10:05):

I certainly think there’s an opportunity for it to become a standard of care moving forward. I’d like to think that the horse has left the barn, but the answer will probably lie in the payment structure. If we flip back to a payment structure that you know, marginally incentivizes people and providers to use the service, then I think we’ll probably be back where we were prior to the contagion that said, you know, we’ve talked a lot of years now about being a consumer’s economy.

Tom Rhoads (10:31):

That healthcare is really turning to where you know, the patients are driving the ship, better transparency both in records and pricing, etc. And that there’ll begin making more informed decisions. So I think the fact that they’ve been using it successfully will open the door and expectation at these types of services would be offered more conveniently accessed and we’ll see that as the future. So if I was betting, I’d say the horse has left the barn and we’ll see these types of services expand dramatically and change, you know, what we would view today as the doctor’s office. I think that’ll change dramatically in the future.

Janet Kennedy (11:06):

I can’t help but believe it’s more efficient on both sides of the equation that obviously for the patient to stay in their home, not have to drive to a doctor’s office and put themselves at risk for catching or sharing whatever they’re dealing with. That alone is both hours of time and compounding risk. But from the physician standpoint, I imagine it’s got to be more efficient to be dealing with telehealth. So I can see that this should be the sea change that many are hoping for.

Tom Rhoads (11:35):

I would agree. I telehealth offers, you know, from a provider side if we just, if we look at their day and opportunity for a large percentage of their patients to be seen quickly and conveniently so they could not only increase their patient satisfaction, which is a key measurement and the triple aim because you’re being seen at the time, you know, you’ve scheduled, et cetera. But it gives them an opportunity to see more patients, but while not degrading the level of care because they just don’t have, you know, a lot of the front end issues and the office issues and things of that nature.

Tom Rhoads (12:07):

I think there’s an interesting opportunity here as well where if you’re saying a particular doctor, I think we’ll eventually see where I say, well we think you might need to see a specialist of some sort for this particular issue and now they can begin bringing those specialists in line very, very quickly. Possibly even on call, depending on how large office they are to view or have conversations with as individuals. So I think, the future can be very bright and very efficient. And I think for the patient, very satisfying as it relates to where this can go and how they can better connect their care team. I wasn’t around when Spencer was formed, so I’m curious about as you were designing the concept of the Spencer device. Was telehealth always intended to be a part of this product? It was telehealth. If you think in terms of someone you’re trying to have a direct patient relationship within their home, you need to think in terms of a convergence strategy, meaning that for us to have a proper level of care for that individual, we not only have to kind of address the management issues, which alone can account for about 30, 33%, 35% of hospitalizations for an older patient group, but you have to be able to manage a lot of the other indicators that are associated with adherence or re-hospitalizations or advancement of the disease.

Tom Rhoads (13:27):

And that’s biometrics that you can grab passively, questions and answers so that you can serve them and better understand how things are going if there’s progression, et cetera, keeping their family involved, and then most importantly, I think the telehealth. So if you can’t turn on the last screen there to allow them to actually conduct a call in the safety of their home and be in a position, to get some advice, then I think you’ve missed the boat. Tele-health was always an important aspect of our direct to the patient platform and it really opens a door not only for the care management provider based markets but also in the specialty and clinical research markets.

Janet Kennedy (14:06):

Tom, I understand that one of the reasons that you are interested in founding Spencer Health Solutions was because a personal situation regarding an elder in your own family and the elderly are very, very much in need of an at-home solution. However, they also are the least comfortable with technology. So in designing Spencer, how did you bring in to the technology, the fact that it needed to be easy for the elderly to use?

Tom Rhoads (14:35):

From an early point, we definitely felt that we had to be relevant across all demographics. So when you look at that range, the first question you got to ask is who’s going to have the most difficulty with a piece of technology? I have the least familiarity with it and therefore become your kind of focal point to make sure that it is easy to use for them and if it is easy to use for them, therefore it has a cascading effect across the rest of your demographic. So the elderly definitely pop into that as a population. They typically won’t volunteer to use technology. Usually, their families have a lot to do with what they use and how they use it.

Tom Rhoads (15:14):

As an example of a phone, they probably have smartphones primarily so they can text and video chat with their family and their family’s probably demanded, especially the grandkids that they use those so that they can communicate and they do. They use them now very effectively. So for us, it was important to understand that population, make sure that our technology was indeed easy to use by their definition, not ours. And then by doing that, we should be in a solid position to be as relevant to a 20 something population. I think the other misnomer in this type of development is that 20 something year old because they’re very technology-centric, are very open to complexity. Because of that, we’ve not found that to be true. They’re looking for technologies that are already easy to use and intuitive as well. So we knew if we could solve for one end of the spectrum, then it should have an effect on the entire demographic.

Tom Rhoads (16:03):

And I think we’ve seen that. I think as we move forward and look at other technologies that come into the market or serving this population, they’re going to have to live by that standard. We went to a great extent to make sure that we did meet it, with extensive user groups and testing and feedback on human factor studies and things of that nature. And I think we’ve hit it on the head, at least based on the feedback we’ve gotten, which is the most important and relevant measurement of whether you have something that will work longterm.

Janet Kennedy (16:29):

Excellent. Well, I find the Spencer interface out of the box easy to use. While I consider myself a technology person, I’m not necessarily a device person and I don’t need to have any of that experience in order to use Spencer. It’s very, very intuitive and super easy to interact with, literally right out of the box.

Tom Rhoads (16:53):

Glad to hear it.

Janet Kennedy (16:53):

Okay! We’ve had a great conversation about telehealth today and I know it’s one that’s going to be front and center in conversations around the world and in the healthcare industry. If you have some questions about telehealth, go into our blog post and you’ll find a fact sheet where we give you some updates on what’s happening in telehealth right now. Tom, I can’t thank you enough for joining me on People, Always, Patients Sometimes.