Technology has allowed healthcare to make great strides in providing health services to people no matter where they are located. Telehealth is now making that massive shift happen in healthcare in 2020. The person leading the way, in many ways, has been Tanya Mack, the President of Women’s Telehealth. In this episode, she joins hosts Betsy Westhafer and Tony Bodoh to share her story and discuss what telehealth and telemedicine are all about. How did the telehealth market change? What were the early mistakes in defining potential customers and a marketing strategy? How do we overcome telehealth limitations that have held the industry back 30 years? How can telehealth experiences determine patient loyalty? Tanya answers these questions and more, taking us into the challenges telehealth still has to overcome, how she is educating patients, providers, and payers about telemedicine, and what keeps her up at night in telehealth.
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We have an amazing guest and her name is Tanya Mack. I’m excited about this episode because we’re going to talk about the massive shift that has happened in healthcare in 2020 and the person leading the way in many cases has been Tanya.
She has been way ahead of her time and people are learning from her years of experience in telehealth, back before people knew what telehealth was. With that, Tanya, we want to welcome you to the show. Thanks for being here.
Thank you for having me. I’m excited to be here myself.
Let’s start off by giving our audience a little bit of background into who you are, your role in your company, and what the journey was that led you to this point?
I’m the President of Women’s Telehealth. We have been in the telemedicine business for many years. Way back then, although bleeding edge in telehealth, we’ll talk about all that’s changed. My business specifically is more of a niche market in Telehealth geared towards specialty care. A lot of Americans have experienced the Zoom telehealth for primary care and low acuity things. On a scale of 1 to 10, mine’s way more complicated, but still a lot of change. It’s more high tech. I’d say, on a 1 to 10 scale, we’re about 8 or 9 and we provide high-risk obstetric services to areas where moms don’t have maternal-fetal specialists, they have OBs. We worked in government clinics, in doctor private practices, and in hospitals as well. We’ve been in a variety of settings. We’ve done about 35,000 high-risk OB telehealth visits over the past years.
To think about what you can do virtually that nobody ever had considered is amazing. Give us some practical applications of what this means to your patients.
All of our patients are B2B because they’re already seeing an OB somewhere in their community. Although in Atlanta, Georgia, we have 39 counties that have no obstetricians, even no delivering hospitals. In a more rural setting, you might be driving to the next county over. On top of that, if you have a problem in pregnancy like, “I have twins,” “I’m diabetic,” “I have a chromosome abnormality,” you will be driving probably a long way to see a specialist. For a frame of reference in Georgia, there are about 30 of these high-risk specialists called maternal-fetal medicine.
They do an extra three-year fellowship, the providers on top of their OB residency. They’re based in an academic center or a large tertiary care hub. In our state, we have Atlanta. We have a few scattered around the state, but if you’re pregnant with twins in the mountains of Georgia, you’ll be ambulanced, helivac, something like that if you have a problem. Many years ago, my business partner and I were 50/50 partners, she’s a physician. We had worked together at another company. She called me from Emory and said, “We have found the next thing that we can help many people with.” It’s telemedicine, where you can pipe in an audio-visual call, and on top of that, we have Bluetooth stethoscope. I literally can put a stethoscope on a patient that’s pregnant in a river bed of Guatemala and hear her heartbeat in my ears in real-time.
I can also scan her baby with a portable ultrasound machine, poured it up, pull it down on my side and watch and direct in real-time what is happening with her unborn baby. We have a lot of connectivity points beyond healthcare Zoom to make all of that happen, but it’s a way to pipe in high-risk specialty services where there aren’t any. Interestingly enough, when we started, we thought all our patients will be rural. Our first customers were five hours from Atlanta, but we’re 50/50, 50% in a big city. You think big hospitals have the specialty, but they either can’t recruit or they’re not enough or their service area is wider than they can service or there’s some circumstance. We’re finding over time that what most Americans thought telehealth was only for, “If I can’t get access rurally or I’ve got to drive or get a long way.” We’re all at our homes. It’s everywhere.
You started out with the expectation that your customers are going to be in the rural hospitals and rural areas of the country and you’re at 50/50. What did you see to cause that shift or when did you see that start to happen?
Whenever you start a new business, especially in tech, you have to learn how to use it. Our first customers, we made a grid of who would be our potential customer. For us, it was anybody that had enough OBs in their community that they could refer patients. They were at least a two-hour drive from any resource that we would offer and they had the technology or were agreeable to having the technology in their clinic. We went around rural Georgia, made this grid, and start talking to medical practices and hospitals that we thought might be our first target customer.
We did a revenue-sharing plan with them because what I’m seeing in Telehealth is we have the host which is the provider, where they are sitting and we have the presenting site, which is where the patient’s sitting, which can be far apart or not far apart. In our first customer case, it was about five hours apart. We revenue shared with them because, in essence, we rented back part of their space and part of their staff to be our hands, our eyes, and our ears. We created a model and we learned how to do it. Step one was learning how to do it. It’s gradually getting more credible customers after you yourself are comfortable with what you’re offering and you have some expertise, then it begins expanding, growing your company, and finding new customers.
When did it switch to urban? We never marketed to urban. A mistake we make in talking about our customers is way too many assumptions about who they might be instead of who they are. We never marketed the hospitals and urban, but we had been a practice before in Atlanta and one of our old brick and mortar referral source called us with Obamacare and said, “We know you have the technology to pipe it in. If we send our patients to the hospital right across the street from you and us, they’re going to pay about a $1,500 deductible. It was right when healthcare deductibles went from $1,500 to about $5,000 to $10,000.” They said, “Our patients that are high risk are going to quit going because they can’t afford a nine-month pregnancy to pay $10,000 on top of their delivery out of their pocket, but If you wire our OB office right here in town, then they’ve got to pay their $40 copay.” We never marketed in town ever. We thought, “Why couldn’t we do it?” We did, and they became one of our customers.
We then started looking at hospitals. You need to know when you have value to your customers. For us, a general metric or driving metric is the number of births per year. If a hospital has somewhere around 4,000 births per year, they typically can afford and have the volume to have one of the specialists there. We made incorrect assumptions. “Maybe all hospitals over 4,000 have those kinds of specialists so we shouldn’t waste our time there.”
In reality, we get another call, “We’re in the capital city, in the United States, Montgomery, Alabama. We’ve tried to recruit one of you doctors for over many years, unsuccessfully we’re in the middle of the state. There’s nothing around. We have three delivering hospitals here and no specialist. We heard about you through a conference and we want to see if this might be right for you,” and a strategic partner walked us into the C-Suite. It was an incorrect assumption about who your customer is that got us thinking, we need to broaden who our target customer is even. That is how we flip the switch from rural to urban, from people calling that were prior customers or people calling, trying to fill a need and they were just frustrated and they heard one little thing that made them pick up the phone. The lesson to me, broaden who you think your customer is, and don’t assume.
That’s a point that we talk about all the time, is validation. Making sure you aren’t throwing stuff up against the wall to see what sticks. Where did you start that led you to this point in your career? I’d be interested in sharing your journey to get you to this point as an entrepreneur in this specialized space. The other part of the question is, you’ve gotten to where you are and you’ve got so much of a head start on other companies in telehealth and we know this for a fact, your phone has been blowing up since COVID hit. Talk us into how you got to where you are and what’s happening as a result of your experience in this field?
Entrepreneurs must be in your blood. My formal training, I went to Ohio State and I graduated with a nursing degree, thinking it was such a broad field. I knew I did not want to spend years and go into debt to be a physician, but I loved science and healthcare. I was trained as a nurse and I left when my husband graduated from engineering school, moved to California, and got introduced to the business of healthcare by working for Johnson & Johnson. They were starting a home health adventure. They mostly are known as a product company, not a service company. I remember interviewing and I said, “I think you need to hire people that know how to talk to doctors. They are not going to see you as a service company.”
They said, “Everybody knows who our company is. We are talking about you from a nurse. We’re not worried about the business.” They opened the doors to the first home health agency that Johnson & Johnson owned in Los Angeles. No one came. They called me back and said, “That thing you were telling us was right.” They sent me to sales school. I got into the business of healthcare and never went back to the clinical side. I know enough to be dangerous, but I was an excellent nurse, but I gravitated into the business of healthcare. The other thing is my parents were both small business owners. My mother was a home builder and my father had an electric and sign shop that did crane trucks.
When you hear about payroll taxes, employees, all these things around the dinner table as a kid, when we come to a risk decision, “I’m not going to be an employee. I’m going to be the employer.” Flipping that switch. It’s always been part of the conversation of your life. It doesn’t seem quite so scary. After some years working in Corporate America, I ended up moving back here to the East Coast, to be closer to family. I connected with my business partner. We grew an OB practice from $2 million to $40 million. We sold it to a big practice management company. She called me three years later and said, “We did good the first time. Let’s do it again. I’m calling you from Emory. I found telehealth. I want you to see it.”
We did everything backwards in business. I don’t have a business degree, but I certainly, as a CEO had to learn budgeting, balance sheets, and profit and loss along the way. We ended up finding the customer first, looked at the demo of the equipment, bought the equipment from Rubbermaid if they would sign a cross-selling agreement because we didn’t even know how to do telehealth. We saw it at Emory, it was fascinating. We said to the rep that was doing the demo, “If you’ll sign a cross-selling agreement, we will buy this machine, we put it in your garage when it was delivered and we’ll hunt for a customer.” After we made our little grid and we signed our first deal, then we did the legal work for the LLC.
We were never without revenue. It was day one. It was not the business plan, go get funding path at all. That’s how I came to be in telehealth, through relationships, comfort level with taking some risks, probably from my family, my brother was the same. He opened three businesses by the time he was eighteen years old and we’ve always had that in the family, made more money than my dad by the time he was 21. It’s always been a thing that we’ve done. You always feel like you pivot or you learn to adjust. It doesn’t seem scary that it’s taking the weight of the world on your shoulders. Although as an employer, I definitely feel like that sometimes. That’s how I got from A to B.
I do want to talk about what has happened in the telehealth field since COVID-19 because when we look in healthcare in hindsight many years from now, it will be one of the biggest pivots that we’ve had. It certainly has been in my career and I bet it will be for the rest of my life. Having spent many years in telehealth, in about seven days’ time, we erased about 30 years of barriers for telehealth adoption and probably advanced telehealth in one week, about five years sooner. We had limitations in telehealth that prevented mainstream telehealth adoption. I’ll tell you what the four big ones were. The first one was devices. If you want to get to your customers, you have to look at where they’re going.
Most of our customers are here on our phone. Even for me, that’s connected through hospitals, being able for a patient where they sit on their phone or desktop, or mobile, we were never allowed to use technology platforms like Skype, Zoom or Teams or anything like that because then they were not HIPAA compliant. Doctors did not know how to use them. We were not paid for smartphone use at all. The devices that became allowable in one week, you throw it out the window. If you have a smartphone, call your doctor, “Doctors, FaceTime your patients. It’s all good. We don’t want you coming in and exposing anyone. However you can get connected, do it and we’ll pay.” The first one was what allowable devices changed? The technology platform was the one big change. Smartphones were allowed and the platforms were broadened. Not hospital’s trails of connectivity like, “I have to do through high-risk situation,” but massive. Whatever you’ve got to connect is good.
The second thing is the payment. I’ve worked with doctors in my entire career. Mostly, if it doesn’t involve time or money, you’re not going to change a behavior in my experience, but we’re not being paid for telehealth. Prior to COVID, probably only 50% of our states even had parity law that would allow providers to be paid for or any kind of telehealth. If there was payment guarantee for telehealth, it was limited by the number of services. Now we can have audiology, pediatrics, neurosurgery, women’s health, almost anything you can think of we’re now in the process of adapting for telehealth. It’s not appropriate for hands-on procedures. I can’t reach through the camera and do anything. Although, with neurosurgery and robotics, you can so we’re extending that.
There were lots of limitations around that, but certainly, the services were broadened. My next contiguous state, when we got that call from Montgomery, Alabama, I said, “We’d love to come. Your state doesn’t pay for telehealth.” For me, they pay only for four specialists. Behavioral health is the most common use of telehealth in the United States and still is pre and post COVID. They paid for strokes, which we’ve had in the ER for clot busters in rural areas. They paid for pediatrics and ICU. My specialty wasn’t even allowable. The services were the second thing that expanded with COVID. You can get many services and access to them. Access to the services that you need was expanded in one week. I opened my email and I saw a rundown of all the legislative efforts in the United States going on to expand the service line and make it more permanent, not passed yet, but in the right direction.
The third one was the payment. You heard me reference payment, some Medicaids paid, some don’t, private carriers. Parity law says in a state, “If I’m coming to you through AV, I can look at your EMR. I’m going to make the same clinical decision. You can sue me for what advice I give you, then I have the same liability and the same quality of care and the same responsibility. You should pay me for telehealth delivered this way and it should be the same as in-person if I can meet the same clinical quality standards,” which many times we can, not often. That is going to be one of the continuing threads we are all looking at post COVID. What are the appropriate clinical decisions by phone, where you don’t have reliable hands-on data? It’s self-reporting.
Certainly, the service line, payment, devices, last big section to change was licensure. In Telehealth, you have to be licensed as a provider where the patient sits, not you. These doctors in pre-COVID had to have licenses in multiple states to cross state lines. Invariably, the states that had the need for specialist or access to care often had the strictest licensure guidelines. The fastest we’ve ever gotten a doctor licensed in these past many years has been 90 days. The longest it has taken has been three years to get a license. That is a big barrier to doctors crossing state lines, even if you’re physically close to me or if I can pipe it in, I may or may not be worth getting a license there if it’s too hard to do business. That’s another customer lesson that we’re learning in COVID is you have to be easy to do business with. When you get complicated, it’s too much. We all talk about the 80/20 rule where you have those 20% of the customers that take up 80% of our time. You have to make it easy to do business.
Those are the four big areas that COVID changed services. If I have a state license at all, as a medical provider, not me, but the doctors that I employ, if I call their board, if I give them copies of my license, we can see in this COVID environment in almost any state. It’s all been thrown out the window. We had our first permanent change from Medicare that will continue past COVID. It had to do with the home where telehealth is happening the most. It had to do with home payment and home services continuing past COVID and Medicare is leading the way. Medicare has been around telehealth for many years. They have also been the most restrictive. For Medicare to come in and change all the rules in a week and see the patients has been dramatic.
I can’t imagine an industry that has had such a seismic shift and the complexity of it. All of those four points you went through, I never thought about. I don’t think the average citizen would think about, “That impacts licensure and payment.” Talk to us a little bit about the education for the normal people like us that are new to telehealth. When my husband and I were watching TV, there was a commercial from one of our local hospitals about telehealth in every single break. I know there are lots of ad campaigns that hospitals are doing, but what are some of the other ways that the industry is trying to educate us as potential and future customers?
It’s not just us, it’s the providers as well. One of the things that you don’t realize is perhaps your half of the equation of the connectivity point as the customer, but what if you had the provider that doesn’t know how to use it either? We have now simultaneous education. Our medical schools, nursing schools, therapy schools in general, do not teach in their curriculum telehealth. They are putting together short-term classes like, “Doctor, learn how to use Teams.” The big Microsoft Teams commercial on TV. There are still lots that we can do, like sharing a screen if I want you to see your ultrasound report or me, I can put that up and show the patient where the baby’s problem is, but it doesn’t connect anything.
It doesn’t connect to my billing and to my electronic medical record. I’ve got to open another app in another place. It doesn’t give me direct clinical information in a Bluetooth way. It’s all how the patient’s self-reported. I would say what you’re feeling as a consumer is the same as most doctors in America feel, “Where do I go to learn? How do I get involved? How can I maximize my time with my doctor? What if things don’t go well?”
I’ve had one Telehealth visit to my primary care doctor for a medication refill. It was on one platform and it took nine phone calls in addition to the platform and they still could never connect. We ended up calling on each other’s cell phones. It is very much learning on a simultaneous track. Some things, like learning with all of us, it’s get educated yourself. For doctors the American Medical Association have some modules where they can go and learn the basics of telehealth. Their employers are teaching them whatever platform that they’ve engaged during COVID period on how to use them. It is still evolutionary.
For patients, we have people that can’t see the screen or can’t hear. We had one lady that we connected to and she is leaning closer because she can’t hear. We always know that when we’re deploying something, we ask people, like you to use an external microphone or amplify, or we educate them on how to get their best experience. In America, if you’re going to a brick and mortar, wherever we go, whatever specialty, we’re in our mind thinking, “This is going to be a while. I’m going to show up. I’m going to have to wait for fifteen minutes, then I’ve got to go in the back, then I’ve got to go in the exam room.” What probably is a 5 or 10-minute visit ends up taking 2 to 4 hours of our day. Interestingly enough, in this COVID, for whatever the reason, scheduling, or points of connectivity and awareness, we are being much more on time with Zoom calls.
One positive thing has been when they do get it and when the patient has learned how to connect or how to use their device or whatever, and the doctor does the same, when it is going well, it’s going very well and that’s encouraging. Steps to learning are the same steps as we learn anything. Get educated, do your homework ahead of your Zoom call or remote visit, make sure that you know how to hear, you have a camera and your face is lit. These are simple steps to make sure you have and make sure you write down your questions so you don’t forget once you connect. They’re still not in the room walking out. The same thing with doctors, be patient. Take your time, and do a few free videos, learn, schedule a little bit longer appointment time in case there is a technical problem. Those are things to learn, but we are all learning remotely in America. There are apps that you can use to learn about a telehealth visit, whether you’re a patient or a doctor. I would encourage the patient before their visit to try those.
Betsy and I have talked about the transformation economy, how people have to learn, have to transform and take on new identities like, “I’m a doctor and I work in this office,” or “I’m a patient and I go here.” That’s all been thrown out the window for the moment. Talk us a little bit through the idea of customer-centricity, because healthcare traditionally has not been customer-centric. There are probably two elements of this from your perspective. I’ll let you take it however you want, but there’s the customer-centricity for the doctors being the customer. You’ve got the payment systems, insurance, technology, and the consumer that the actual patient themselves and the customer is interested, that is or is not present there. Give us your perspective on where that’s heading. What’s happened there?
Any business owner and organization need to think broadly about their customers. With a P&L sheet or a balance sheet, we think of the customer as who’s writing me the check, the customers who’s paying the bill. The customer is in my mind, when I think of revenue generation. That’s who comes to mind first. In my business, I have an unborn baby customer, a patient customer, a payer that is paying the bill. The patient may not be paying the bill so they’re involved in the mix. In this COVID, even though they’re not paying my revenue, I’m dependent on the technology piece to deliver what it is I deliver.
I think of my strategic partners, vendor chain, global supply chain, what have we all learned from the China lesson? When we’re having a cold war with China and things get shut down, even if you’re not sourcing from China, that part that you wanted is from China and so there is all this disruption. We need to think of our customer-centric is not revenue-based, it’s, “Who is my revenue dependent on?” Where along the supply chain do we have these relationships that all need to come together to make the delivery? We’re smart to look along the way, “Who are our strategic partners that make introductions? What are my vendor relationships like? Do I have one, not my regular chain for a backup?” That’s an important piece of it.
For me, I have a contract with the payers, but we all know, “You get your explanation of benefits if you’re a patient,” and they deny as step one. There’s all this fighting, but I don’t want to fight them too much because they could boot me out of their panels. What is the middle ground that I can both get paid and keep my relationship with that payer going? My lesson with the customer-centric circle is to think not just about revenue producers for you, but who affects that chain, and what are the relationships that you need to maintain in that chain? We try to do that too. A good example with Telehealth has been our patient satisfaction.
We do patient satisfaction surveys. Telehealth is a little different, we’re all sensitive because, in pre-COVID, people have told us it’s not the same relationship between the doctor and the patient. It’s a step removed and impersonal, but that was the perception reality. We’re thinking, “We’ve got to connect all the dots here. How can I make it more personal and better?” We send out a survey after the first Telehealth visit and have for ten years because we’ve been sensitive to how was your telehealth experience since it was probably the first time you ever have one and you don’t think you’ll have one when you’re pregnant. It was always unusual. Our first patient visits, we would want to say, “What was your experience like? Did you get along with the doctor? Do you know what you’re supposed to do? How was your audiovisual?”
We’re asking questions that won’t be asked in a brick and mortar store. If we have a frequent flyer or a repeat customer, which is about a third of our patients, we’re going to do it after the second encounter also to make sure we start to develop some consistency. And then we’re expanding it to, “The doctors are also in my supply chain because if they don’t refer a high-risk patient to me, I will never see the patient.” My customers are also the obstetric doctors that were first so let’s see how happy they are. We talked in the broadcast about validating, listening, and assuming. The bigger circle in keeping that loop of, “You better listen, ask, prioritize and don’t assume,” were always the customer lesson for us. We think we’re doing good until you hear that one thing and it’s like, “I never thought of that.”
You make such a great point about all of the points in the supply chain and you don’t think about healthcare in terms of supply chain necessarily, but it’s such a good point. I would add to the employees that touch the customers on some level. We have a company that’s looking in their customer-centric vision, including the employees and they have to be well-treated and have to have good experiences.
If we polled all Americans and say, “Would you source your healthcare online?” The overwhelming majority would say, “No, I’m going to call a friend, I’m going to get a referral or ask my current provider or someone we know was the main reason on how we source things.” Now, it’s all different. We’re doing our own resources and a lot of it is my experience. If my experience is, “Six times I try to get on your platform. I wait in your Zoom call. I’m direct B2C,” and you can’t even connect on the other end, done. Our tolerance online is 10 to 30 seconds. It’s short. We’re all used to surfing on the web, fiber speeds, instant. We haven’t had instant healthcare. We’ve had wait for a healthcare.
The point that you bring up, you make one phone call to a doctor’s office, “Do you have telehealth?” They say, “No,” done. We’re sourcing differently. I agree with you that the employee, how they handle and how we train them to look for opportunities, resolve problems on their own, speak to people to engage and enroll them and in a way, help lead and train them as to what their experience will be if they do choose us is critical.
It’s such an interesting time for what happened because as you mentioned, historically, healthcare was something we accepted long wait times and that’s going to be an opportunity for some in the medical profession. It’s going to be the worst thing ever for others if they don’t learn to shift and be more customer-centric. I find this very exciting for this industry because if anything needs to be customer-centric, it’s healthcare. What’s more personal than your healthcare?
We were talking about the idea of major healthcare systems in the United States were caught with their digital pants down. When a hospital or healthcare organization loses 40% to 50% of their revenue in less than five working business days because nobody’s coming, elective surgeries are out, the government shut you down, your margin isn’t that probably. You’re out of business in a week. How do we adapt? As patients, we’re going to benefit from a lot of that and have many more tools. Nothing is going to replace hands-on procedures and if you’re sick, you need to go to the hospital. You have to be sick because we have home monitoring in Telehealth, visiting nurses and micro-hospitals and all these other things changing, but in terms of shifting expectations, shifting deliverables, what motivates a healthcare system to change their conservative ways.
It’s passing to me because we’ve got these systems that are built around physical facilities. The meetings industry, which is a place that I spent a lot of my career is the same way, large hotels, large convention centers, there’s still a need for them and for hospitals. Anywhere I am with the right device is a place where a doctor or a nurse practitioner, they can meet me there. The cost associated potentially with healthcare can come down. It won’t happen immediately because we still have these facilities out there that we’ve spent a lot of money on, but the cost can come down because I don’t need to have a brick and mortar location to do a lot of the basic things that need to be done in healthcare.
Probably some of the more advanced things too, we can have a different approach to this, which is exciting because of what’s going to evolve out of this. We alluded to a little bit about the education, but you talk about how there are not enough people in that telehealth space yet. Give us a little bit of what keeps you up at night because of the change, not specifically for your company, but maybe broader for telehealth as a whole?
There are a couple of things. One, is we are going to have to train the workforce to catch up with this gap because people have learned to do a Zoom healthcare call, but not much beyond that. After they catch their breath from this loss that they’ve had, we still have major organizations that have furloughed hundreds of healthcare workers and hospitals still not up to where they were before because of COVID and people not coming in. We have this gap between the need and the ability in the competency level for what all will be required, not what’s the easiest low-hanging fruit to be required.
The federal government has the National School of Applied Telehealth. It is basic. It hasn’t been updated in many years, but it does offer basic level training for the telehealth presenters. People are responding in a very scratch the surface way, but we’ll go deeper, the more that we get connected. Addressing through formal education programs in our medical schools, in our nursing schools, patients are going to have to add curriculum and do online training. There are lots that are going to be changing. “I’m a trainer, where do I go to get telehealth training?” You’re not going to find very much so people will be filling that gap and I know people are doing that. A worry I have is that we’re going to have some things we can do by telehealth.
We can do a lot more, but there are not people that know how to do it. Who knows how to connect all the dots to get an ICU feed to a doctor? A lot of hospitals aren’t set up that way. We have to address the education gap. The other thing that I’m watching with weighted breath and as somebody who pays a lot in malpractice insurance for the doctors that we have, we’re looking at reliability of data. Data has been coming around. If you think of a Zoom call, if I say, “I have an ear infection,” “I’ve had a fever,” “My ear hurts. It’s red, it’s inflamed. Look at it,” there’s no reliability there. For all you know, I stuck a toy in there. We can’t see anything. There’s not an otoscope in my home.
You wouldn’t know if I have a fever, no vital signs from a thermometer have come into your data bank, there is self-reporting and then there is real-time true data. One of the biggest discussions going on in telehealth is what is the line in the sand of appropriateness and adherence to a clinical standard so that for the information that’s given, it’s reliable enough for the provider on the other end to make the same quality, the same standard of care clinical decision? A good example in my business is we have about 40% of our pregnant women in my practices are gestational diabetics or insulin or Type 2 diabetes, a high percentage. We will tell them all the time, “Tell me what your diet log says and what you’ve been doing.”
They’ll say “I’ve been adhering to my diet. I’m doing great. My blood sugar is this, it’s that.” I don’t have the glucometer coming straight from your blood test to me, as a doctor, it’s what you report. I say, “I’m going to have your OB draw your A1C level and we’ll see how compliant you’ve been.” We then get the real number, nothing like, “I’ve been compliant every day.” It’s totally mismatched. We are going to come into having to connect the data to the self-reporting and matching it up and paying appropriately for appropriate levels of care. This is where one fabulous thing in telehealth that was happening pre-COVID and we’ll continue as telehealth technology itself changes.
It used to be that we have these big bulky carts, they had to go through a Kodak to get your EKG from your chest pads to my screen. It used to be a lot of wires, connectivity, open portals and going through firewalls of hospitals and that looks like pairing up your iPhone to your car stereo. It’s like apps and a laptop. Where we used to have big bulky equipment, my first bit of equipment investment was about $35,000 per unit. Now the system, I can do the same thing with a laptop, with apps, and with Bluetooth technology for about $5,000 to $6,000. We’re going to be able to spread that out and do a lot more. One of the things that keep me up is self-reporting as the only input I have as a provider, my malpractice, my payment, and everything being dependent on that, but it’s not true clinical data. We’re going to have to connect the dots so that doctors can see EMR easily, can move images and pictures around easily and there’s Bluetooth technology in the home that’s real and not self-reported.
The third thing that keeps me up at night in telehealth is it’s been fabulous to have jet fuel to your adoption in your business, but what is staying and what is going back to the way that it was? A good example of this is HIPAA Compliance. Protected health information has been a theme for American healthcare for years and decades. “I don’t want everybody to know my business. I decide who gets access to my healthcare and I own my healthcare data.” When we threw all that out the window, I could be sitting in your driveway, parking in on your Zoom call if you didn’t set it up right. This whole issue of security coming back around to security and protected health information is one of those things that will be repealed.
You have to be on a HIPPA-compliant platform. FaceTime isn’t going to cut it for now and forever. That’s an example of going back. In going forward, we expect payment, like you mentioned, “If I don’t need all this brick and mortar, why am I paying $100 a visit for two minutes of your time for a medication refill? It should be like $10.” This reform of what will go and what will stay from the lessons that we learned for me every day in the news is like drinking from a fire hose. In my email, I looked at probably 20 or 30 bills that are pending in states about changes that may be coming. We are all in Telehealth waiting to see what’s going back, what’s going forward and it will be expanded for sure from where we were. We will never go back to the way that it was and the requirements ever. We will never do that.
How far will we go, what will be paid, what will be allowed, what will be the new rules? That is all to be determined. Talking to customers when your business is evolutionary, like mine, how do we truly keep our pulse on? Where are we getting information? What’s the correct information? How does it apply? It’s regionalized too because states control a lot of the health money, not the feds. You have to keep up in multiple places. A good lesson for keeping up with customers is you have to stay current, relevant and you have to know what’s happening. To me, it’s like a hyperspace. In Star Wars, it’s like we’re cruising along, then we hit the hyperspace button and we’re out of there. That’s how it feels to me.
As much as you, in your role, in your industry, have to stay on top of it, it’s incumbent upon us as potential telehealth patients to do the same. I want to know, where is this going? What does the future of healthcare look for me as a non-healthcare person? I can’t imagine a bigger shift for an industry. I know a lot of industries are going through shifts. A lot of companies are having to think differently, but healthcare touches every single person and this has been a fascinating conversation. One of the things that we enjoy doing on the show is giving our guests an opportunity to give a shout out to a nonprofit or community service to give back in some type of organization. Are there 1 or 2 organizations that you would like to put a spotlight on that are doing good things out in the world?
There are many. Wherever you sit and wherever you’re reading from, rather than name one, a couple of things that I’m worried about that are more localized than anyone could find is we have a lot of homeless, pregnant women in America. We don’t think of them. They’re not coming in for healthcare. They’re appearing for delivery, may have gotten the antenatal care, maybe not. One of the things that we do is we help support a homeless pregnancy shelter here in our hometown that we know, and we talk to them. I was reading an article, something about a high percentage of Americans are having to move, don’t have income and support system is disrupted.
We think traditionally in America as pregnancy is a time where it’s happy news, but there are people struggling. Whether it’s the homeless shelter or the women’s shelter or something like that, I would say, look around your community, support how you can, whether that’s through dollars, time, awareness or reaching out or donations. There are lots of women that do not have resources in our country and they’re invisible. That would be my big plug. I sure appreciate the opportunity to pass that along.
There’s a comment you made that I wanted to reflect on and that is you said, “We’re never going back.” It’s like the rubber band has been expanded, the human mind being that rubber band, it’s never going to go back to the way it was. I think that while it will contract to some extent back toward where we were, we’ve also given technologists, physicians, and others, this ability to foresee what could be and they will find a way to now push that envelope even further over the next 5 to 10 years. Whatever does contract back, we will push it out again because we’ve had this vision and this reality.
The other interesting thing is because of COVID we have more cooperation on the planet in healthcare than we ever have before. There have been a number of proprietary lines. We are learning from each other and not just in the US but even with telehealth globally, we’re supplying other countries. We are working in Kenya with high-risk pregnant women. Not only the rubber band but the space in which the rubber band is working will be bigger too.
This is fascinating work you’re doing, and I’m definitely going to be following along and want to stay in touch. Thank you for taking the time to talk with us. I am sure that our readers are getting great value from your perspective on the customer experience in such a dynamic changing industry.
I’m passionate about telehealth. I’m happy to be in it and to continue to be in it. Thank you for giving us a voice.
This interview has me reeling a bit because we’ve never experienced in my lifetime that I can recall anything close to the type of disruption that we’re seeing in healthcare and disruption from a, “What are we going to do with the situation?” The hospital is losing 40% to 50% of their revenue in five days. Also, disruption, which I would call more transformation, the positive side of it. We’re having the laws rewritten and regulations rewritten in seven days. As far as I can point to in my life, we’ve never seen something like this happen. I’ve been through some telehealth myself and with my family, but not realizing all that had to happen. It’s not as simple as popping open a Zoom call and having a little chat with a doctor. I had no idea for all of the work that had to be done on the backend and why it took him time to be able to respond this way. The CEOs of these hospitals are still reeling. They don’t have an answer. It’s not like it’s going to be something that’s resolved immediately, but it is definitely something that is going to affect us long-term.
The CEOs are fighting for survival versus, “How can we adjust our business for the future?” They’re trying to get through, which I thought is daunting in light of all of this disruption. The other thing that strikes me about it is when we talk about disruption, there’s been a disruption in the music industry and in the automobile industry and all these different disruptions that are big and affect a lot of people, but in healthcare, it’s bigger than anything and it affects everybody. What Tanya was talking about on so many things, payments, training, data, and compliance, all of these things that have to be addressed, is going to be years if not, decades for this to shake out. It’s incumbent upon all of us to stay on top of this and understand how it affects us personally, our family and our loved ones when it comes to telehealth and where it’s going.
Another element to this that holds much promise, and it gives us good direction for the future, not just in healthcare, but I think Tanya did a great job of talking about all of the cooperation. The payers, vendors, technology devices, and all of this cooperation that has had to happen in a very short period of time. You mentioned the automobile industry. We’ve seen automobile manufacturers because they don’t need to make cars when people aren’t buying cars, they switched over and start making medical devices. That’s one example. I do believe that as we move forward past COVID, past the quarantine and the lockdown and those situations, that business’ path forward is one of cooperation, as opposed to the competition that we’ve seen before. We’re going to find better ways to strategically work together.
It’s like bringing a specialist into a hospital, they could have been seen as competition in the past, but because there are limited specialists, they’re cooperating. She’d been doing this for many years as she said, but that’s something that as we start to look at our businesses, and if we get to know our customers better, that will allow us to say, “Here’s who we can serve the best.” One of our past guests said, “My ideal customer is the one who I can help succeed.” That to me stands out. I could keep going back to that because in this case, “How can I help the patient? Who can I help be successful and narrowing the customers I serve by who I can serve the best and then finding strategic ways to partner with other people to make that happen better?”
That’s a perfect way to conclude this because that is absolutely what we all need to be asking ourselves, “Who can I serve the best and how can I bring in others to help make that happen?” Thank you for being here. We’re appreciative of the comments that we’ve gotten. If you enjoy our show, drop us a quick review on whatever platform you’re following the show on, and we want to keep doing this, Tony, and I love bringing this content to you and these amazing guests that we’ve had. We’ll see you next time.
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- Women’s Telehealth
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About Tanya Mack
If you could save a baby or a mom in this world today, would you? Despite fainting her first day of nursing school, this has become Tanya Mack’s life calling: making a positive difference for moms who are bringing new life into the world. From the moment she first saw a telemedicine cart almost 10 years ago, it opened her eyes to a world of new possibilities in healthcare technology and the power of being able to provide specialty care to safely deliver high-risk OB Moms and their babies – especially in rural areas, where access is scarce. Telemedicine has set Tanya on a path to become a healthcare adventurer, leading change and navigating risks in pursuit of the vision of helping others with the tools available in modern healthcare.