Telemedicine is here to stay. What to expect the day after w/ Joe Kvedar

After nearly 30 years of chasing a dream to connect technology and healthcare, when COVID-19 invaded our everyday lives, Dr. Joseph Kvedar witnessed more movement in his field of expertise over the last month than he has in years. But what does that really mean for the telemedicine industry?

Whether you’re an innovator new to the field or an established player in the telemedicine industry, you’re going to want to hear Dr. Kvedar’s take on how today’s pandemic has thrust telemedicine into the spotlight and how that momentum may play out as we inevitably move into a post-COVID economy.

In this episode, Dr. Kvedar discusses the impacts, implications, and possible outcomes healthcare and health innovator industries may experience due to covid, and offers his own insights and tips on:

• Why telemedicine is taking hold right now and how the technology that enables telemedicine can reach further into our everyday lives via education, finance, and other industries

• The past obstacles to the telemedicine industry and why/how that has changed within the COVID-19 economy

• The challenges telemedicine may face post-covid and the importance of advocating for processes within the telemedicine industry that are being proven as beneficial 

• Opportunities and challenges health innovators may face due to COVID-19

• Tips and insights for telemedicine and health innovators as we move forward - and beyond - the current pandemic crisis

Guest Bio

Joseph C. Kvedar, MD is a professor of dermatology, Co-Chair on digital reimbursement for the AMA, incoming President of the American Telemedicine Association, and Editor in Chief for npj Digital Medicine. 

A 27-year believer in the idea that there could be a better model of health care delivery with the ability to provide care outside of a hospital or physician setting, Dr. Kvedar has had the privilege of leading the advance toward a more connected health experience while working at Partners Health.  

If you have additional questions or insights you’d like to discuss with Dr. Kvedar, you can reach out to him on LinkedIn at Joe Kvedar, Twitter at @jkvedar, by email at  jkvedar@partners.org, or by visiting joekvedar.com.

Episode Transcript

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Speaker 1: Welcome back to the show COIQ listeners on today's episode. I am very excited to have Dr. Joseph Kvedar on with us again today. Welcome to the show.

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Speaker 2: Hey, thanks Roxy. It's great to be with you and your listeners.

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Speaker 1: Thank you. So, before we get started, um, I know that your roles have changed quite a bit over the last few months. So, kind of give our listeners just a little brief, brief background on your experience with connected health and then kind of touch on what are some of the new roles you're you're taking on these days.

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Speaker 2: Well, thanks so much for asking. So, I, uh, in the early nineties had a bit of an epiphany. I'm a dermatologist by training as you know, and, and uh, at that time I was studying as a research project the role of digital imaging in dermatology and it fell into my consciousness or lap or however you want to say it. That we, gosh, we, we were missing an opportunity to not have yeah. To always expect patients to come and see us in the office that we can do things. My technology and I've chased that 20 something years ago. Yeah. Almost 30. Wow. And it, and uh, I chased that dream ever since. And for about 25 of those years, I had the privilege of leading, uh, those efforts at partners healthcare, the delivery system I work in, which frankly largely meant a lot of proof of concept work, a lot of working with, uh, innovative companies to help bring their products into the marketplace.

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We had a variety of things we did. And then a couple of years ago, um, the folks around me, the senior executives and I decided that it was time to scale and that I probably wasn't the right leader to scale it. Okay. And I was much more comfortable on the front end. So, I'm now an advisor to that process and it's going well and I'm on call for them when they need me. They pull me into various discussions from time to time. But what's taking up my time now, which is incredibly, uh, exciting for me is this opportunity. And it's, it's three or four things that I'm doing. I'll, I'll, I'll delineate them in a moment. But they all have the common theme of influencing adoption at the national level, which is like a gift for me. So, the first one I've been doing for some time now that this is our fourth year, but it's been very, very productive as a co-chairing the AMA committee on digital reimbursement.

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A second one is working with the association of American medical colleges to get a telehealth baked into the training curriculum for medical students and residents so that people who come out of training have some facility with this tool set. Yep. The third one is incoming president of the American telemedicine association. So that starts in just about a month. So that's, uh, we're, we're changing our bylaws and it's probably going to be a two-year commitment, so that'll be a lot of fun. And then the, is, I just took on the role of, uh, editor in chief at nature's digital medicine journal and that's about building the evidence base, which is of course important as well. So that's a portfolio of fun things. It does give me, and they definitely overlap and you know, people will call me about one and I refer them to the other side. It feels a great way for me to spend my time these days.

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Speaker 1: So your board is what you're trying to say. You have nothing,

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Speaker 2: nothing to do. Yeah. And all of it can be done from home, which is gratifying.

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Speaker 1: So, um, obviously we have this, um, absolutely horrific global pandemic that is happening before our very eyes and that's really changed a lot of things for us. You and I spoke, I think it was probably about seven or eight weeks ago when I first got the email from you where you were, you know, just letting your network know what were some of the new and exciting things on the horizon. And I remember being peppered in. There was some of the things that you just mentioned about being dedicated to the adoption of telehealth. And we talked about having you on the show again and you know, just really kind of for our listeners kind of encapsulating what's the, what was the state of tele-health. And I can tell you that a lot of the things that I would have asked you and that we would have talked about seven weeks, seven weeks ago, are very different. Um, and so, you know, I wonder, I mean, obviously there's still a lot of work to do, but I wonder how the coven crisis has served in the silver lining of this as a catalyst. Um, and, and so I envisioned that you probably were thinking that this new mission of, you know, national adoption of telehealth and, you know, all things digital would take you five, seven years to kind of start to make some progress. Do you feel like your mission is accomplished?

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Speaker 2: No, but, but you're right, and you're a marketing person. So, you know, the value of, of getting a word into the lexicon and the word tele-health is now in the lexicon in the U S and that, that is extraordinary. It just can't be said enough how that, what seems to be little thing. Um, I, I mean, I don't have to go to and never have to go to a cocktail party again. When we start to go to the mechanic and tell people what that is, they will know. Uh, and, and that alone is, has been huge. I mean, it is, uh, those of us that are, uh, evangelists or leaders or whatever term you want, it is ours to lose now. Yeah. We can lose it. And you and I can talk more about that if you'd like, but, um, no, it's been extraordinary and, and for good reason, not, not that I would have ever invented this awful, awful, awful crisis, but the fact that people, and it's interesting too, the other thing I'll just quickly mention is, uh, it's not just our industry. I hear little ads on the radio for financial planners saying we can do it by video conferencing. So, everyone's sort of coming around to the fact that these tools exist. Mmm. We, again, we still have, it's it, you said, would it take five to seven years? Are we done? We're not done, but it's a different, different, Mmm. Set of deliverables now than we had for sure two months ago.

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Speaker 1: So, you know, let's talk about that. You know, in my mind there were, um, you know, and you probably have a much deeper and broader perspective than I do, but in my mind there were three things that were kind of acting as obstacles to telehealth adoption and one of them was, you know, legislation and regulatory, um, you know, just physicians saying that, you know, I want to see my patients in person and patients saying that they wanted to see their doctors in person. And a lot of that has changed. So just kind of update us from your perspective. How has those three things changed and in some fashion?

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Speaker 2: Well, um, the, the legal, the easiest one to talk about as a legal and regulatory S S uh, piece. And so, the, the government, now I can't speak to everyone's all 50 States. It's, it's state by state. Things can be different, but the federal government is now paying us at equal value of an office visit to do a phone visit, to do something that we would call an asynchronous visit. Meaning you send me some information over the patient portal, and I report back to you or a video visit. Okay. So, Medicare went that way. Uh, the governor of Massachusetts demanded that all payers do the same. That was about three weeks ago. Um, so, so there's all of that, which is for the most part and, and again, I'm, I'm so pleased, most, most times I'm, I'm proud of my profession and this is one of those times, most doctors that aren't on the front lines are happily taking care of their patients in whatever way they can.

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And we'll figure out the billing later. Right? But we have, we have the green light to do this. One of the things you and I might want to talk about is whether that will stick and how much of it will stick. So maybe we'll come back to that. But the other parts I think erase are really fast. Oh, I should mention, sorry, before I go on, is that state ledge, uh, licensure laws are also loosening up in most States. Not all, but in many States, governors have said, you know what, we're going to not worry about that. And then the third piece, uh, that, that bears mentioning is the, uh, and, and people will want to know about this, but the use of, um, tools like FaceTime and Skype is now allowed, which it wasn't, it's some time ago. And the reason, but that's worth mentioning, excuse me, is twofold.

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One is that it does make it so much easier for you and I to have any kind of interaction because we can choose the platform that suits us both. We don't have to make you sign up for something and download something. If you've already got FaceTime, you can use it. But the other part that comes up, and I want to just address this again, we can come back to any of this, but I want to address this as the privacy side. All this, uh, talk about a zoom bombing and so forth. It turns out that for a healthcare interaction, Mmm. It is extraordinarily rare that you would have your video hacked. Yeah. Um, that, that the part that we're still doing. And of course, we care a lot about, uh, privacy, but the part that we're still doing and the way we always did is recording it and the electronic record and that's very secure. So anyway, just to recap those, those three things that there are new reimbursement law, relaxed reimbursement restrictions, relaxed licensure restrictions and relaxed technology restrictions. So that just helps everyone not think too hard about it and really reduces friction as they say in the industry.

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Speaker 1: Yeah. So, our company is virtual and has been for day one. So, we've kind of, in a lot of ways, we're operating business as usual. Um, and I've used zoom, that's just been our tool of choice for at least five to seven years, probably about eight hours a day. And I'm not saying it doesn't happen, but I've never had anything happen. You know, maybe a little unstable internet connection here and there, but nothing like, you know, what you're hearing about, um, with the zoom bombing.

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Speaker 2: So just to, to, to finish that one off and not, not to, again, I want to make sure that I don't, that nobody who's listening to us thinks that I take it's lightly. No one in my industry takes privacy lightly. We take an incredibly seriously, but when you have something like an AA meeting and you publicize on Facebook the link, that means anyone can dial in. That's, that's really not hacking. That's just someone saw the link and they were nefarious and their intent. That's, that's really not backing. So just, just want to turn up, put a good face on that.

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Speaker 1: Yeah, that's important

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Speaker 2: when, when you talk about patients, uh, wanting to see doctor in person and doctors when they see patients in person. That's it. Those are really insightful comments on your private speaks to the sociology of, of our culture. It speaks to our industry and I would say a few things about that. One is that no one, um, that I know of is suggesting that the office visit go away anytime soon. That the face to face interaction with a doctor, uh, disappears after this is all over. And I think one of the things again, we could come back to is, is what, what is the, what is the likelihood that we'll all is we'll just face out, right? We can, we can come back to that. What it will all the while those restrictions get restricted again. Yeah. But with that caveat, people are, the answer to your question is people are finding out, and that's mostly doctors.

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I have to say, most patients are pretty comfortable with this tool. Um, but a lot of doctors are finding out that you can conduct care this way. Not all care, right. It has to be high quality. Uh, we, we can't be sloppy. We can't say, well it looks kind of like you have a sore throat there. Maybe we'll give you some, uh, Z-Pak. We, we can't, we can't mess up. But so much of, and what I've asked doctors to do when we talk about this, as I've said, think about, and this patients can do the same, but it's just as a doctor you kind of know what information you need to make a decision. Think about those interactions you had with patients where you didn't need to touch the patient. Sometimes we touch people because it's part of our therapeutic armamentarium. Right. And again, that's great and we mustn't want, we mustn't suggest that that goes away, but there are a lot of times and a lot of examples where it's really mostly about talking mental health of course can all be done this way.

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Um, and and check, you know, like reviewing a lab test. Uh, so many of the conditions that we treat are related to lifestyle, high blood pressure, obesity, high, uh, diabetes. Those can all be checked and, uh, with, with sensors remotely and report it out. So, a lot of stuff we can do, we, we don't do procedures. Yeah. Probably won't in my lifetime. But you think about it, it's really what I think is most exciting about this to just finish off your, well, it was long winded answer to your question is that it's, it's required people to think differently. Yeah. We used to ask them to think differently. I got up in front of so many audiences in the 27 years I've been doing it and said, please just think differently. Just think differently. And people would go off and in doctors rightfully go back to a waiting room full of patients and a six month wait, why did they need to think differently? Right? So, this has forced them to, and I, and I dare say we won't go back all the way to just face to face. I'm almost certain of that, you know, how far back and what bit of those are worth talking about. But we won't go back to face to face.

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Speaker 1: Yeah. Yeah, I definitely agree. Um, I, I think that from what I'm hearing, anyone in my circle, and these are not physicians, these are, you know, more friends and family that have had, you know, virtual visits in some form or fashion over the last few weeks. They love it. And like, it was so convenient. It was so easy. And again, it's kind of like, that's what you've been saying for 27 years.

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Speaker 2: Well, we have a nice, uh, I think, uhm, analogy. There's a program we've been doing for a couple of years out of partners where I work called partner software on demand. It's a virtual urgent care program again existed long before the virus. And um, for for a smallest of things, a little bit sore throat, earache, uncomplicated, urinary tract infection, there's a list of about a dozen things we can get you a doctor on the phone, well on the video within about five minutes and 80% of the time your problem gets answered. What's not to like about that? Right. So again, I think of course there will always be probably always be some patients who, who just want to come in. Yeah. And they should be able to, and we shouldn't, I mean again, in this time, this crisis we can't, but in general we should just bring them in. Right. There's nothing wrong with that. I enjoy seeing people in the office never, never faltered on that. But there's going to be a whole bunch more who are like, just what you said like, man, give me the convenience.

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Speaker 1: Yeah. So, from an adoption standpoint, you know, I'm curious your perspective when we think about the technology adoption curve and how that market is typically sliced, right? The innovators, early adopters, early majority, late majority. You know, it's, it seems as though that for years we have still been teetering in this innovator early adopter market and we really haven't crossed that threshold, cross that chasm into the early or late majority market. And it, it seems as though that the unfortunate circumstance of the virus has been the catalyst to help cross the chasm and push it really large segment of the market into adoption. And I think to your point, I think that there's going to be, besides the laggards, I think there's been a lot of people that are going to be like, yeah, this is great.

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Speaker 2: Why didn't we do this before? Yeah, yeah. No, I think we have, we, we've moved, uh, in my opinion, I used to say we were, um, somewhere between early adopters and early majority for years. And I think we've now pushed over. Um, again, sad, sad that it took a crisis to do it, but never waste a good crisis, I guess, so.

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Speaker 1: Right, right. Exactly. That's a great quote. So let's talk about what's temporary versus permanent. And you know, it, it can be through the lens of tele-health, but it can also be through the lens of, you know, any type of virtual care or remote monitoring or anything like that. Um, you know, we're definitely seeing a increase adoption and a lot of those different areas or sub sub areas within digital health. Um, you know, w w what do you think is going to stick and what do we need to do as an industry to help facilitate that more permanence? Um, once this is behind us, cause we all know this, we will get past this, right? Um, what know when, but we know this will be behind us. And so I wonder if there's anything that we need to do now kind of as a health innovation, um, consortium to try to assist that. Um, so we don't just really unwind everything that we kind of accomplished during this window from an adoption standpoint.

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Speaker 2: Well. Um, that's, that's that, that could be a whole nother show. So we'll see if think I think, um, so organizations, I mentioned that I'm an incoming president of the American telemedicine association, organizations like that have the platform to help bring together, uh, providers, uh, vendors, uh, policymakers, et cetera, and really speak with a common voice. And we're doing that now. Um, it's, it's going quite well. We've just had a very, uh, for instance, we're, uh, in the conversations directly with the white house task force. We, we've been very, I think effective our policy people have in getting some of these things done quickly. Um, so not to sound self-serving, but joint join the ATA because that's a really good organization to help move this stuff forward. We think we have a unique opportunity there. Um, but, but also whatever capacity you as a, uh, participant in the ecosystem have to lobby your Congressman to speak to your Senator, to talk to your local health plans.

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One of the things that I really want to see, uh, and you mentioned, I'm so thankful to hear you say that your family and friends are pleased with their service level. I worry that because we're bringing so many new people on both sides of the platform that we'll see service levels, uh, uh, suffer. So those, those of you who had a good service level, tell your employer, tell your health plan. Yeah, we don't want this to go away. Employers listen to their employees, especially benefits people and they in turn speak to health plans. So there's a very natural, uh, communication channel there that's like lobbying the government, but on the private side. So I think people should be very vocal about that. uhm. And so again, I think our dangers so in here is that because we're bringing so many people on, as you pointed out, some of them reluctant that, that we'll see some dips. I mean, it's great that you're, uh, your experience with zoom has been so positive. I think during this crisis, all of the companies have had some lapses in their, in their ability to, um, to get the technology to be perfect. And all the telehealth providers, I just saw a piece yesterday, I think it was published on Friday, and I was believe as in Becker's on every single telehealth service provider seen a big spike in demand.

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well guess what, their, their networks don't grow, um, exponentially overnight. So that means if you have something and you dial into one of them, tell American well and be live, you might get a little longer wait. And that's okay. You know, unfortunate. But it is, it is because we're seeing this spike. So, I think consumers, um, I'm telling everyone in the industry, lean in hard to give everyone a good experience. Yeah. And that they should feel cared for. It is healthcare. It's, it's, it's different. So, if you're anywhere in that care provider or service provider ecosystem, just make sure the person feels cared for. You know, maybe they have to wait, maybe this, maybe that, but take, go out of the way to care for them. That'll help. And then at the end of it, people will say, like, your family members, I don't want to go back. Uh, and, and so then they in turn have to go to the various, uh, payers and regulators and sort of say, Hey, this is nonsense. We're not going back.

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Speaker 1: yeah. Yep. Great wisdom. Um, and I think that, you know, to your point, we really, no matter what role we have, we all have a role to play in some form or fashion. Yeah, that makes sense.

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Speaker 2: Yeah. And that's right. Because what was once a sort of a curiosity or, or, uh, people would say, yeah. You know, and, and I, I used to, again, I was saying this to, uh, off camera that I, I look, I, I'm giving a couple of virtual talks coming up and looking at my slides from six weeks ago. They all seem kind of quaint there. Um, but there are things like saying that, that, uh, uh, we, we as an industry need to get to a point. This was a quote I would say we need to go to a point where this is like your stethoscope. It isn't something that you look at as a curiosity or an option. Wow. We've got to that point now. So now what? Right. So I think the idea is making sure that we perfect the, uh, triaged points. A lot of people, for instance, here's an interesting, I think, um, analogy, a lot of people are, at least I'm told anecdotally, hospital systems are implementing a lot of these chatbots on the front end because so much of screening for this virus is very algorithmic in nature. Um, and you can do that with software. So, making sure when you implement something like that, that the person interacting with that software can get to a person, right? That you're not trapping them in some God-awful loop.

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Right? Right. And we can't, we can't do it that way. So, it's thinking through things like that. That would all I think have a role that, um, and if we do that, if we band together and make it again, it's healthcare, make it feel that way, then I think we have an enormous opportunity for success.

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Speaker 1: Yeah. Yeah, definitely. So, let's talk about, you know, again, just kind of the broader scope of connected health, digital health, remote monitoring, um, you know, in all of the, the health innovators that are out there right now. Um, you know, there's definitely some obvious things. Um, but how do you think that health innovators are being impacted by Kobe? What are some of the, um, opportunities and what are some of the challenges that they're facing?

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Speaker 2: Yeah, great. No, that's a wonderful question because I do hear from a lot of them. Um, and then I hear from, because as I said at the top of our conversation, I'm no longer directly involved in day to day decision making around purchasing. Um, I can refer people. Uhm, and so I would say a couple of things. There's a theme. This is just sort of advice for take it or leave it, right. Guy who's done this for almost 30 years. Um, I hear a lot including companies that I advise and I'm not so sure that that's the wisest. So, I hear a lot from people. We want to do something, we're going to create a COBIT, X, Y, and Z. And everyone in their heart of hearts wants to be part of the solution. And that's great. And it does bring out, you know, people who are in business that are kind of, um, especially on the, the investor side can be cold hard.

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It's bringing out the best in them. That was, that said, if that thing that you want to create is a pivot for your company, that's not a good idea because you're going to burn through capital. You're going to distract yourself. I think you're better off now if for instance, buoy health has a company that's local here that does symptom checking. So, for them to do a covert symptom checker, it's right, right down the fairway. Yep. Right. So, something like that. Great. Thank you. Yeah, thank you for that. And we appreciate it. And, but for a lot of people come in and say, you know, I think we could do X. If it's not within your normal project business plan, I wouldn't recommend it. It's it, it might make it feel good today, but boy, I'll take you off kilter. And as you know, and you've, you've done so many of these sessions with so many interesting people, it takes a lot of effort to get this stuff right.

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So that's, that's one thing. I think the other thing that is frustrating, um, is that so many people now and again, I get a lot of incoming, which I'm grateful for. I love to be, uh, something I didn't mention when you were asking me about my, um, the hats that I wear as I'm, I'm a board member and advisor to a number of companies. So, I love the commercial side. Yeah. Uhm, So I do end up hearing from a lot of people and what I have to say to them is, yes, you're right, you have the perfect X. But the people where I work, for instance, and I can really only speak most thoughtfully about them, they've already made the decision to ask why to do that. Even though your ex is perfect, they've already decided to hire why they can't stop what they're doing and vet what you have.

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They just can't. And that's sad, but it don't, you know, think that you're going to make the usual 18 months sales cycle go down to two weeks. It's not, it's the opposite. Like they're shutting out people because they're focused on, okay well we made a decision to implement X and you know, in the remote monitoring space that's probably the hardest because there are so many interesting new patches or rings to wear or, or sensors or things like that or, or things where you can hang up a sheet of what looks like a sheet of paper in the house and monitor people. Most of that's not getting any traction whatsoever was either doesn't have FDA clearance or you know, it doesn't have a clear marketing path here. You're the expert on that. Um, the path to market. So I hear from a lot of those people and they're frustrated and I'm sorry and I don't blame them cause a lot of those innovations are exactly what we need. But it just, in a crisis, they're not going to go anywhere, unfortunately.

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Speaker 1: So, you know, in my experience over the last few weeks and working with innovators is it's, it's been, um, there hasn't been really kind of an, you're alluding to this like if there isn't been literally like a cookie cutter response, um, that really analyzing that current strategy and what those different scenarios could be is, is where I think there's a lot of value and I'm seeing anyone that can pivot. Like the buoy example that you gave, um, can pivot really within a couple of days. And it's, it's really more of a micro pivot, right? Changing their business model. They're not changing their innovation; they're not going out and starting something new from scratch. Um, it's just kind of reframing or retooling the solution to that, the highest priority and unmet need at that time. Um, but what I'm seeing is that if there was a pipeline of relationships that those customers, um, are, there's a certain segment of the customers that are reaching out and going, Hey, could, could you do this? And that is in, that is really flourishing. So there was an existing kind of warm, it might not be a customer yet, but it was some kind of warm relationship. Then I'm seeing something that can come to fruition, but hold relationships, like you said, just doors closed.

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Reach me after Covid and probably give me a 30 day window to recover.

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Speaker 2: It's so true. You really nailed that. That's, that's perfect. Yeah. If, if you have a good relationship with someone, then yes, they're probably going to call you and say, I know you're innovative. Are you working on this or that?

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Speaker 1: Yeah.

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Speaker 2: Uhm, It's not though. You know, just to reinforce kind of another way of looking at this, not the usual RFP process. Those kinds of things just aren't happening. It's like, yeah, we know Sam. Sam does this interesting patch that you can slap on people and monitor them in their home. Let's order, you know, a thousand of those from Sam. Yeah. You know, that's, that's, I mean, there's some thought that goes into it. It's not completely random, but it's not like, let's do an RFP that takes six weeks and then we do the, we're not working now.

00:31:16:12 --> 00:31:46:07

Speaker 1: Right, right. No, not at all. Yeah. So, what about the, um, the financing piece? What do you know, what insights or exposure do you have to this? Um, you know, what about those health innovators that were, you know, planning to participate in all those pitch competitions at the conferences, you know, the last month or so, and it just got canceled. Right. And, um, you know, they just had high hopes of raising, getting a bunch of, you know, infusion of capital and, you know, what do they do now?

00:31:46:17 --> 00:32:41:14

Speaker 2: Yeah. I, I wish I had some, maybe you can help me with that. I'll give you some, it's just thoughts. Yeah. Um, yeah, my, um, own savings depleted by about 20% in two weeks. Yeah. So, I'm, I'm, you know, I'm, uh, I'm not been a prolific angel investor. I've made a couple of investments here and there. I'm not probably going to do that for a while. Right. So, you know, I'm, I'm, you know, Mo, most people in my, in that network of angels are probably feeling the same way that whatever their end was, it's and minus 20% now. And that just feels small. But you know, it could, could be that it's hundreds of millions, but if it's a hundred million less, that still feels small. So that's, that's just a psychological thing. I think in that space. The VCs I think for the most part are looking at their portfolio companies and wanting to make sure that they help them get through it.

00:32:41:14 --> 00:33:20:18

So again, that means less new investment. They all, as you know, they leave money aside for people they invest in for things like this. So, unless you're tanking and they were trying to get rid of you anyway, they're probably going to help you along. But again, that, that's, that's not good news for someone who's looking for new funding. I think it's really challenging, and I don't really know PE. Um, I'm on the board of one PE owned company and I don't have a good sense for so that world, whether it's, uh, whether it's grinding to a halt or not, I, I assume like everyone else they're saying contracture their capital and therefore they're, they're being a little more careful. But

00:33:21:01 --> 00:34:06:00

Speaker 1: yeah. And so, my experience with that is, is again, kind of that it varies, right? It depends on what, what niche, what solution, you know, what, what pivot, like what opportunities they have. Um, and then also some, just the psychological profile of, of that situation and those team members involved. You know, some people, um, I think are, um, really risk averse in general. And so, they're just like, we need to just stop what we're doing and wait and see. Yeah. And then there's other people that are like opportunity and they're, you know, so high. Right, right, right. Exactly. Um, so I'm, I'm definitely seeing a mixture of the two, um,

00:34:08:21 --> 00:34:28:04

Speaker 2: that I'm a buy low sell, high type, but, but I don't have a lot right now of cash to buy things with unless I sell stuff. So, so it's just, I mean, it's a, it's a, and this is the, the term that's overused and I'm going to use it anyways, unprecedented, but we just don't know how this, this market's going to turn out. It's, it's just so extraordinary.

00:34:28:15 --> 00:34:34:12

Speaker 1: Yeah. Yeah. I don't think any of us can really predict how long or the end result of this.

00:34:34:15 --> 00:35:05:24

Speaker 2: I did hear something from this is, um, second hand. So, if I get it wrong and someone listening knows they can write us an email and correct me, but I heard about a conference board prediction that we would see and I won't probably get the numbers exactly right, but next quarter. So Q2 we'll see about an 8% draw. We've already seen a big drop in Cuban of course, and then it's going to rebound pretty quickly in the fall. That's what I'm told. So, I love that. That's great. So yeah,

00:35:06:24 --> 00:35:11:15

Speaker 1: I've done that before that path too. I'm all about that. So

00:35:11:21 --> 00:35:12:08

Speaker 2: we'll see.

00:35:13:01 --> 00:35:14:00

Speaker 1: Oh yeah,

00:35:14:03 --> 00:35:16:12

Speaker 2: yeah. Thank God we're not in the hospitality industry, right? I mean.

00:35:16:16 --> 00:35:44:11

Speaker 1: Oh yeah, yeah, absolutely. Um, so, so as we think about, you know, those companies, remote monitoring companies, you know, all of these different health innovators, um, do you have any, you know, wisdom or guidance for them is they just try to survive the season? And it could be, I don't know if it's, it's, it is. So

00:35:44:16 --> 00:36:43:03

Speaker 2: it depends on how you run your company and how you, how you, um, what you do with your capital, right? If you're capital efficient and you have capital, then the prep, perhaps this is an obvious thing, but I'd say work on your product, right? This, I mean, one of the things that I've always criticized that industry for is that the products are never easy enough for anybody. Never easy enough for the consumer, the patient or the provider. So, make something that's so easy that I don't have to think about it, make it as easy as an iPad or as easy as that interface, right? That I can just pick it up and do it. Nobody's done that, that I'm aware of. And so, I would say everyone should be working on that. Who has, if they have capital and resources, yeah, maybe you're not out selling but let's, let's get the products better. Cause they're, a lot of them are, are, are designed by engineers for engineers, right. They need to be designed for people who are not, who are afraid of technology.

00:36:44:06 --> 00:37:24:20

Speaker 1: Definitely. Yeah. So, the other thing that comes to mind is, um, you know, cultivating relationships right now. So, there's definitely going to be those, uh, those, you know, hospital administrators and frontline staff that we are just not getting in front of and we shouldn't be getting in front of. Right. We don't need to add one more burden or interruption to them. Um, but I think, you know, cultivating relationships of just champion them and supporting them and encouraging them and just being human really. Right. Cause at the end of the day, we're just all people just being human with other people and not selling anything. Right. Now

00:37:26:11 --> 00:37:56:05

Speaker 2: I can't tell you how many offensive emails I get where people are like, Hey, I saw your piece in the Boston globe. We're selling this to be kidding me. Really the, the, the, the, the tyranny of, of the mass emailed to your inbox is even worse now and it's, it's almost offensive. So, yeah, I know you advise a lot of people on how to do marketing, but this is not the time to send everyone in your inbox and dear X email. That's,

00:37:56:23 --> 00:38:32:02

Speaker 1: Oh my goodness. I mean, I went from, you know, let's say 500 emails a day to 1500 emails a day in every company that I didn't even know had my email address is emailing me to tell me what they're doing to keep their employees safe. And it's just really, it's, um, yeah, kind of amazing. Um, so is there, you know, as we talk about this, is there anything else on your harder on your mind, um, in the context of this discussion that we should talk about?

00:38:33:03 --> 00:39:31:05

Speaker 2: Well, I think we've covered a lot of it, but just to, I think, uh, anyone in the supply, what I call the supplier side, meaning the tech companies or the telehealth companies or the remote monitoring companies or behavior change through apps. As I said, use the time to make your stuff more easy to use. Yeah. It's, none of it is easy enough. And you know, the other things, I'll digress for a second, but one of the other things that was in my lexicon six weeks ago when I would give a talk and for some reason for the last couple of months I was giving talks to docotr groups. I don't know why it just worked out that way but was people would come up to me and say, okay, I'm all set. Now what do I do? What can I do as a practitioner? If you're not part of a big system that uses Epic or you're not part of, well, the answer is it's hard because you gave the sign up for American well, which is not really what you had in mind because you're going to do their cases.

00:39:31:13 --> 00:40:24:02

Yeah. You know, it's, there's, there's a PR, uh, and I don't know a lot about it, but there's a platform called D O X Y. Dot. M E doxy me not, it looks like it's not bad. Right. Our docs are using it. Some of them, um, and during the crisis, so we'll get a sense of it. But yeah, something like that where I can just go in and sign up and let my patients know that I've got this. So, we don't have enough of those. We definitely don't have enough of those. So those are the things on the supplier side that people can be working on. Uhm, As a patient. Just keep taking notes of what you like and what you don't. Um, because that, that should be, we should follow that. We are, you know, w when we peel it all back, we're a service provider industry and we don't do enough of that.

00:40:24:02 --> 00:41:00:22

I've said that for years, but, but we should be listening to what people want and if, if what you want is you say, I want an in person experience, we should peel back that on and say, well, about what, what is it about that makes you feel that way? And maybe you had to wait a long time, or you had a jagged video or things that we can fix. Um, and as a clinician keep thinking about when do I actually need to have the person in front of you? What are those decision points where it really doesn't make sense for me to do it by technology? So those are the three things I would say.

00:41:01:24 --> 00:42:23:21

Speaker 1: So you touched on something that, you know, we've had conversations. Um, I actually did a session on this at the connected health conference last year on co-creation. And so as I think about the, the telemedicine associations role, um, you know, if I'm a consumer and I have some perspective on what I like and what I don't like, you know, I'm probably going to tell my friends and family, but it's, but, but how do we get that in your hands or your organization's hands? Um, so that way you guys could aggregate that feedback. Um, and I see companies like Starbucks and Lego land and Proctor and gamble that do really incredible jobs on setting up web pages for that type of data collection. Um, to continue with ideation. Um, like what you didn't like, but what w what would you like to see next kind of thing. And so maybe that's something that we can do as an industry to help facilitate that more permanent nature, is to create that collection mechanism for all of that feedback. And then kind of prac packaging it into some kind of way where we know what to do with it next so we can continue to serve and meet the industry's needs.

00:42:24:17 --> 00:43:43:07

Speaker 2: Oh, that's very insightful. I mean, I just, uh, reviewed a paper. I ended up suggesting the editors reject it, but it was on using Yelp reviews and so forth. I, I think as I would say this, as doctors, we've been largely passive there with one exception, which is the notion of patient reported outcomes. So, we're getting a lot of practices that will hand you a tablet when you walk in the waiting room and you tell them some things about your experience. And of course, there's the, uh, um, age caps on those standard surveys, which a lot of people that are convinced are kind of not very meaningful. At any rate, I think you're, you're, you're onto something now at ATA, we, we are uhm, grappling at this point with how best to reach patients and consumers recognizing as you well know that that's an enormously expensive proposition and we're not, we're, we're not an organization that has the kinds of resources that an American heart or one of those bigger organizations has. So we have to think that through and, um, but I think you're onto something in terms of their repository and if, especially if we could somehow use a, some natural language processing technology to, to codify it all

00:43:43:16 --> 00:44:18:21

Speaker 1: completely. Yeah. And you know, as a, as a whole, if, if we really want to shape the future of healthcare and we want there to be some permanence behind these, you know, small, uh, adoption increases that we've experienced here recently, then we kind of have a responsibility to come together, providers, vendors as a whole and, and kind of pony up for the solution because it will serve us well as a whole. Um, we come together and try to figure that out. Um, you know, it will be better suited than if one entity tried to take it on.

00:44:19:05 --> 00:44:45:13

Speaker 2: Yeah. No one, one way to sort of summarize what we've been talking about is we as an industry, because of this crisis, we threw a lot of spaghetti against the wall at once. And so as we see what sticks, we have to refine it. Um, make sure that it's professionalize, make sure that it's not chaotic. Make sure that it's well organized, make sure that it's thoughtful. Yeah. And then it will stick long term.

00:44:46:00 --> 00:44:55:16

Speaker 1: Yeah, absolutely. So, Joe, how do folks get ahold of you? If anyone has any questions for you after watching and listening to you today?

00:44:56:15 --> 00:45:15:14

Speaker 2: So, I'm, uh, I'm on LinkedIn. Uh, J Joe, uh, Kvedar, K-V-E-D-A-R. I'm on a Twitter @jvedar. You can email me. It's my first initial last name, jkvedar@partners.org. I also have a website, joekvedar.com. That has a lot about me on my website.

00:45:16:02 --> 00:45:20:17

Speaker 1: Excellent. Well, thank you so much for your time today. I thoroughly enjoyed our conversation.

00:45:20:23 --> 00:45:24:09

Speaker 2: Likewise, look forward to, uh, spreading the word with you.

00:45:24:23 --> 00:45:25:10

Thank you.