On April 28, HC3, in collaboration with Sandbox and the Blue Venture Fund, hosted a conversation regarding the future of access to care. During the event, a panel of experts addressed the effectiveness of the adoption and scalability of digital solutions and telehealth in the health care market, opportunities to streamline access to care for vulnerable populations and define trends, and potential solutions for systemic changes we can make in the wake of the pandemic.
Steven Collens, CEO, MATTER and Co-Founder, HC3
Anna Hahgooie, Managing Director, Sandbox Industries & Blue Venture Fund
Salma Khaleq, Vice President of Provider Strategy and Partnerships, BlueCross & BlueShield of Illinois
Lee Shapiro, Managing Partner, 7Wire Ventures
Watch the Recap | Link to YouTube
Steven: Telemedicine was one of the most rapid changes over the past year. Where have you seen growth or recession as the pandemic has worn on and what do you see a telemedicine’s role as we more forward?
Salma: We saw a rapid increase in telehealth access and utilization at the start of the pandemic – a 400 percent increase overall. Sixty to seventy percent of last year’s spend was specific to behavioral and mental health telemedicine services. It has been a great modality for expanding behavioral health and innovation. For the provider, the question is how well it will integrate with coordinated care, risk agreements, etc.
Steven: Will telemedicine increase access for those who had barriers?
Salma: It is more likely to act as a convenience extender or replacement for existing care and not so much a new access point. There are still a lot of barriers to care that make it challenging to make telemedicine truly optimal.
Steven: What are the new innovations and technologies to increase access?
Anna: Telemedicine as a standalone is really an extender to any new care model, to the extent that you are curating convenience or access to a care service, ultimately it has to be integrated into that experience. Telemedicine for telemedicine’s sake is not the future. It has been important to have the ability to connect remotely, but it is a small piece of all of this.
Telemedicine is also not enough to eliminate barriers to care for underserved people. So much of the barriers that exist have to do with trust, along with the belief that as you engage someone, they will be looking out for your best interest.
Steven: How do you partner with people in the community to start to create an entry point?
Anna: Whether via telemedicine, chronic disease management programs, or other modes, success will be limited if a trusted agent within the community is not being leveraged. Meeting directly with the community or having appointed and trusted leaders in the community acting on behalf of all their best interests is partially how you carve out the right entry point.
For example, there is a barber going around giving haircuts to the Black community. How do we use the conversations of this trusted community leader to talk about diabetes screening? Taking it a step further, how do we use telemedicine as a way to provide that screening?
Lee: There is hope that the trends we have been observing will translate to increased access to care. For example, when schools closed, a lot of students had problems getting access to the care that they needed. So, a company pivoted and worked with payers and reached out to parents to continue providing students with the care and medication they needed.
There has been a great expansion of access to care and the method of delivery of services to these communities that have been underserved in the past, including harder to reach rural areas. Using these modalities to meet people where they are is so important and can continue to expand access. Consejo Sano coordinates text outreach with managed Medicaid plans as a way to reach out and talk to people in a way that is culturally sensitive. There are also specialized outreach opportunities for people who are in addiction recovery.
Steven: Have there been shifts with access and equity with digital solutions? Have you seen telemedicine exacerbating barriers to access?
Salma: It all comes back to the business model of the organizations that are focused on Medicaid populations. Digital innovation for employer groups is critical. How do we get an employer to purchase a particular product for an access service? There is an exacerbation of access barriers, because whether or not you already have insurance dictates whether or not you have access to these solutions. Where you register for your insurance or coverage dictates how and if you are able to access services. Until last year, Medicaid did not even allow providers to bill from telemedicine. That kind of regulatory barrier makes it incredibly challenging to integrate solutions into both Medicaid and Medicare.
Steven: What are some of the models and solutions that focus on Medicare populations?
Anna: The government has the power to open the gates for innovation, and entrepreneurs focused on innovation will be critical. We have seen this in Medicare Advantage. As the rules of the road became much more defined over the past few, it incentivizes models that reward companies – like Oak Street Health – for taking on risk to address vulnerable populations.
Medicaid is many decades behind in forming structure and strategies. However, we have seen more innovation and clarity from the state overall. States have developed more refined plans to determine what the coverage is going to look like, as well as the types of programs and populations they’re going to measure. We have also seen increases by 10x in startups focused on managed care populations – primarily focused on specific groups such as addiction or maternal care.
Lee: We realized early on that working with providers would be challenging, because the business models were off for what Livongo was trying to accomplish in meeting the needs of consumers. We found receptivity in self-insured employers who said that they would be willing to pay a fee for cost savings (e.g., with unnecessary visits to emergency room). Livongo was able to demonstrate meaningful first year savings, so we extended to other chronic conditions. We were dealing with people of all different demographics nationally, so it was important to think about how to communicate differently within these communities. Companies need to meet people where they are, and truly understand their circumstances in order to gain trust.
Steven: Are companies like Livongo expanding access to care or is that a separate issue?
Lee: I think there is a common thread, but access needs to be dealt with as a separate issue. However, these innovations are bringing recognition to important issues like nutrition as health.
Steven: What has been successful in improving access and equity?
Salma: Embedding these efforts into local communities is an important facet of all of this; solving for social determinants of health can only be done successfully at the community-level. We have made several investments in community organizations, most recently made an investment in a housing effort. Blue Door Neighborhood provides wellness and fitness classes, which we transitioned to virtual during the pandemic.
Steven: How do we pay for these solutions in health care?
Selma: Blue Cross and Blue Shield has embedded health equity into their ACO and HMO contracts and have provided inclusive and bias training. They are also working on a hospital program that increases diversity among clinical staff; it is first time that they’ve looked at how clinical workforce represents communities served.
Anna: If we want to start solving these complex problems, we need to have patience for an iterative process that will be wrong at first try and keep tweaking the work rather than building new layers upon layers.
Steven: Quality makes a big difference. It’s one thing to expand access to mediocre health care and it’s another to be able to provide and incentivize quality. How is that evolving and how is that affecting solutions that are permeating?
Salma: Our philosophy has changed a lot in terms of providing incentives. The challenging aspect of quality is how many metrics there are, but we believe it is a foundational aspect of the way we do business. We have developed a scoring metric for every provider in the state to understand their quality and their performance relative to their peers. This will help consumers understand what they are going to get when they show up to the office. There is still work to do, but if we don’t explore this then we miss the opportunity to really make a change in our health care.
Steven: To what extent are you seeing or pushing out more models that develop, design, and or scale solutions that ultimately improve health of diverse populations?
Salma: We’re in a world where it is often challenging to integrate in the way we’d like. It’s really about having a platform that we can integrate different solutions into to provide a more cohesive process for the member. On the provider side, we want to incentivize and continue to work with providers who are willing to take risk to provide more holistic care, but also support them in areas that they may not have as much experience with.
Lee: We have to build consumer experiences that eliminate repetitive forms or processes.
Steven: For many people, their interactions with the healthcare system is not that great. Companies like Amazon are renowned for creating a consumer experience but are not shifting to healthcare. Where do you see this going? Anna: You think about this one problem with paper forms in health care, and we still haven’t created a solution, but the innovation is happening in other parts of our lives. There is a tipping point in health care where consumers are done with sitting in an office filling out the same paperwork, they have had experience with telemedicine that makes care more convenient. We need to focus on the endpoints (getting therapy, getting medication, etc.) and how do we most efficiently get to those endpoints.