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Digital Health from a Provider’s Perspective
Episode

Christopher Morris, Associate Director for Digital Health Innovation at NYU Langone Health

Digital Health from a Provider’s Perspective

Focusing on the outpatient section as a means of transforming healthcare

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Digital Health from a Provider’s Perspective

Recommended Book:

The Digital Doctor by Robert Wachter

Best Way to Contact Chris:

christopher.morris@nyulangone.org

 

Digital Health from a Provider’s Perspective with Christopher Morris, Associate Director for Digital Health Innovation at NYU Langone Health (transcribed by Sonix)

Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring health care leaders and influencers. And now your host, Saul Marquez.

Saul Marquez: And welcome back to the podcast. Today I have the outstanding doctor Chris Morris. He’s Associate Director for Digital Health Innovation at NYU Langone. He’s an internist and digital health champion focused on creating strategic development partnerships with health tech startups as a means to transform healthcare. He’s particularly interested in emerging telehealth technologies that reinvent the primary care experience in this era of value-based care. Got to start looking at things that also impact physician wellness, as well as their ability to reach the increasing number of patients. Christopher is an internal medicine, physician, an HIV specialists at the Medical Center where he’s at. And he’s focused on digital innovations as a means to transform health care quality and access the most interested in using emerging telehealth technologies to transform the primary care experience. It’s a pleasure to have Chris on the podcast today. Chris, welcome.

Chris Morris: Thanks. Thanks for having me.

Saul Marquez: Hey, it’s a pleasure. Anything that I missed in your intro that you want to chime in on.

Chris Morris: No. Just in terms of all spot on. I think I have in terms of my clinical practice I have to have an outpatient component to it where I have my own practice where I really try to be innovative and push what can be done in the outpatient setting and I’m focused on HIV care and free exposure prophylaxis for primarily for HIV at risk males in New York City. And in addition I work as a hospital is it NYU. So I’m really kind of in the thick of it both in the outpatient world and then within our hospital Tisch hospital at NYU Langone.

Saul Marquez: Very cool so you’re really kind of getting a good look from both ends. What got you into…

Chris Morris: Yeah 360 perspective.

Saul Marquez: Yeah man that’s pretty cool actually. So as we think about you know value-based care we were chatting a little bit before we got started here. It’s important to consider some of these things from the perspective of an internist but also somebody taking care of patients, in outpatient setting some excited to dive into that with you. But what got you into health care to begin with?

Chris Morris: Mainly being a teenager without really much clarity as to what I wanted to do and my grandfather got very ill, went in for open heart surgery and there’s a lot of time in the hospital when I was 16 I thought “Wow this looks pretty cool the doctors are so impressive” I idolize them and I always figured I grew up in the New York area. I always figured I’d go work on Wall Street like a lot of my friends and I like wow I never really wanted to sit in a cubicle or I always wanted something with a little bit more meaning and they kind of just the sparks lit right when I was 16 and having look back then.

Saul Marquez: That’s awesome man. That’s awesome and now you’re taking it to the next level with how to change healthcare for the better and so curious what’s on your mind as a hot topic that needs to be on every medical leaders agenda.

Chris Morris: Yeah. The reason I even kind of broke from my clinical career was just being completely frustrated with all the inefficiencies especially within the outpatient care world at least at NYU and other hospitals I’ve been at. They’ve really works on streamlining efficiencies and whether it’s in terms of their supply chains or just the patient flow and in different analytic the look at where the outpatient world still very early in a lot of health systems that are undergoing rapid expansion very disorganized and efficient. You have providers that are you know still practicing a one model reimbursement wise or just even culturally traditionally wise and the way they want to do things and you have another provider doing something radically different. And then the patient experience and outcomes as a result can be dramatically different. And I was in residency doing outpatient and just was felt I was seeing so many patients that I did not need to be in the office and I was trying to think of so many different telehealth technologies that were emerging at the time. Now they’re pretty ubiquitous in different ways that we can work with payers and the providers in new digital health technologies to really get rid of the show of having to go to a physician’s office for every kind of simple follow up when the only reason that we’re trying to have patients come is the bill. Under the current healthcare insurance system you know there has to be ways that you can just be able to check in with your physician in an app or even a enhance chatbot type dark hour nursing assistant or something like that and get reimbursement or get something for having that interaction. But in the end I forget what the exact stats are. But you know the average process of a middle class person going to an outpatient care appointment between taking off work, finding parking in is I want to say it’s roughly around one hundred twenty five dollars maybe like 1994, a hundred twenty five dollars in addition to the copay that they’re already paying at the outpatient clinic in addition to losing on average two hours a day. So that’s a huge time loss. That’s the value away from society in general. And it’s also money that is doesn’t need to be lost in the health care system. So using I think kind of stepping back and to original question what technologies need to be incorporated in order to improve value or what’s the next big thing. I really think it is breaking down the outpatient model and using technology to kind of I want to say blow up but really just rethink what is the outpatient clinic even looks like for the next decade or next two decades.

Saul Marquez: Yeah I think that’s a really interesting perspective, Chris and as I sit here listening to your awesome perspective on the outpatient setting I can’t help but think of banking and how I never go to the bank ever.

Chris Morris: No.

Saul Marquez: No I never go to the bank. You know unless it’s something crazy like buying a house and buying a house right now you know then you have to show up.

Chris Morris: True that

Saul Marquez: Thank you. Thank you. And it’s just it’s something that could happen in health care too. The challenge is the reimbursement structures like you mentioned right and having those traditional structures catch up with what people expect today. So I don’t know. I mean with the size of health care deductibles today you could say maybe there’s a smaller market not the entire health care population but a smaller market that would want to take advantage of these and use you know Flexible Spending Accounts and their deductible payments to get more convenient care. What are your thoughts on that?

Chris Morris: Yeah I completely agree and I think we’re hopefully heading in that direction. I would say it’s challenging for, I work for an academic medical center. It’s very challenging for us to be agile and certain aspects of kind of offering that type of care to that one like subset patient population that is interested in that when you know all of our current resources and clinic staff are geared towards that traditional model of getting someone in and just knowing what that diagnosis ICD 10 code is and kind of being at the patient provider level agnostic of the insurance or something like you know and some other things. So we’ve been and I think a large lot of health systems have been reluctant to kind of completely jump in and develop that type of model when it takes a lot of resources to develop it and the long term play especially in this political environment. We don’t know necessarily what age is just the kind of thought process is going down the road. You know I think the same could even be said with the Affordable Care Act and the way new ACO’s or the fourth generation eight years have had much more leeway in what they do with the money their reimbursements and especially in the use of telehealth and new technologies. But those models definitely take increasing financial risk and there’s still uncertainty this many years after the formation of the ACL model with all the consolidation that’s been undertaken if it still makes sense to leverage a part of your health system in order to develop these new technologies and not worry about reimbursements as much as the beginning.

Saul Marquez: Now I hear you man that makes a lot of sense and so let’s get a little granular here. Let’s dive into some of the stuff that you’ve done. I know you’ve got a portion of your responsibilities as health tech and how you can use that can you give the listeners an example of how you made an implementation or started a project that has created results or improved outcomes?

Chris Morris: Sure. I think the best example on what we’ve just discussed is my work that’s been in parallel with NYU but technically it’s a private company I own that really thought to improve the experience of free exposure prophylaxis for HIV at risk males in New York City. And so I was trained in Boston. I was starting to see a ton of patients coming in for Truvada prescriptions which for the listeners that don’t know you, physically Truvada is part of an HIV regimen and if you take it once a day it is significantly significantly reduces your chance of HIV transmission during sexual intercourse. So I was having young very very healthy people come into the clinic booking half hour after half hour. I said this is ridiculous. I can’t have all these young professionals coming in and kind of they were taking off work every three months and sitting in the waiting room for hours and I felt so bad because I know I can do that and making them kind of have small talk in an exam room while basically I was just trying to get them in to bill them. I was yes I was trying to engage on their risk factors and in making sure everything was largely all right but I could have done that with many different modes of technology as well. If the reimbursement was there so I started my own practice solely focused on this and what I did was moved to Manhattan and I developed a partnered with a company to develop a telehealth platform very simple video base there was a payment system on the back and intake forms pretty commoditize stuff at this point and I knew that if I was going to do a full assessment remotely I really wanted there to be different aspects of the physical exam included especially since I was partnering with HIV patients who are at Central risk for having different types of infections or side effects that maybe have to be a little bit more attuned to that. A video based based visit wouldn’t suffice. So a search the market for all the cool add ons deliver that visual stethoscope O2 scopes that look in the ear and the blood pressure cuff really worked on the user interface and experience in terms of how all these gadgets can connect via Bluetooth to a platform. This was kind of pre title care coming on to market or several of these other companies that have now nice shiny digital extension to the digital examination tools that I was able to put together something and I put it in a box and I called it black bag it was my big experiment and I use movers courier service in New York City. So when someone signed up for an appointment with kind of the black box would would have all testing supplies they would have all the instruments I needed to do a remote physical exam and that included a tablet and so I would do visits that I still do visit. I kind of reduced the number I do over the last year but so the patient walked into the physical exam they put it all in the black box again and then just send it back to me at Uber which was scheduled to pick it up at the end of the appointment and I charged. I tried to arrange for insurance reimbursement even out of network but it just wasn’t what the reimbursement model just wasn’t there at this point. So I just charge the flat 50 buck fee basically made 10 bucks to visit but really just enjoyed the experience of trying to be innovative and pushing the boundary as to what outpatient medicine can be. And I definitely proved that you can safely do this and you can do it rather efficiently with some are a lie when you reduce the overhead associated with the traditional primary care model.

Saul Marquez: Interesting. Very cool man. I mean kudos to you for going outside of the box and trying. A lot of people don’t try and try stuff right. I mean it’s the key is figuring it out.

Chris Morris: Yeah and I think one of the serious challenges is being a physician entrepreneur, oftentimes you’ve trained for decades and many of us have student loans. I do my health and in order to be an entrepreneur you really need to take the leap and make this your company, your passion, your full time effort. And when you are a physician when we’ve been through the system of training and you have all this long it’s really hard to do that.

Saul Marquez: Yeah

Chris Morris: That is to say OK I’m not going to go for my comfortable outpatient private practice or even work in a community health center with a pretty comfortable salary to work on this passion of mine that maybe I have a little capital the seed funding or something like that or I’m to try to bootstrap which I did largely just failed to be able to cover my costs. But being a physician innovator is really something that I haven’t seen the model perfected in my travels across the country and in discussions with other academic medical centers. It’s a tricky thing to really be able to support physicians that have these ideas.

Saul Marquez: Damn I’d say it’s a great call out. And so this is a good segway to the question. But what’s one of the bigger setbacks that you’ve had, and what did you learn from it?

Chris Morris: There’s so many. I think as your and maybe innovation. Yeah or I think working with one of my in my roles and I experienced it firsthand is a startup trying to work with academic medical centers especially when they’re early stage and trying to and as we said before like what, why, or what are the barriers to a lot of medical centers even coming up with this really cool clinic and just allowing app development in and really minimizing patient provider interaction. And you know we all know that just academic medical centers can be very slow risk adverse with long sales cycles. So as someone that was trying to build something as a physician entrepreneur who needed relatively quick access to capital or like an MVP or a pilot I was able to kind of pivot and just go do my own thing in this model where I could get directly reimbursed. But there’s not a lot of disease processes that would allow me to do that. And every time I try to engage with an insurer or with an academic medical center it just as conversation and the conversation that really goes nowhere and eventually really no insurer wanted to partner with a smaller startup right out of the bat that was trying to me that was trying to do something innovative I would go on phone tree that United Healthcare and I’d try to go to conferences and meet them in person. But it was really challenging to go directly into the health system or insurer. And I think we’re seeing that a lot now that I’m kind of on the other side of that. I play both side startups and early digital health companies going straight to private large private practices. You know the groups owned by private equity firms that have hundreds of physicians that aren’t necessarily academic based store that are in the most shining markets Midwest kind of large conglomerate medical groups where change can actually occur a lot quicker and more efficiently in settings like that. And I think I would have if I was bringing out another digital health product or relaunching I would certainly consider trying to find that private setting and really make an impact and an impression there first and then leverage that into further contracts or discussions with insurers and academic centers.

Saul Marquez: That’s a great insight. And listeners definitely valuable for us to consider new ideas and how how different hospital systems and the groups that own them now respond to risks and their appetite for new ideas. This private equity model you know you guys know the practices are getting gobbled up by private equity nowadays is a good one to approach and to think about. So a big thanks for from mentioning that Chris.

Chris Morris: Yeah I actually know I think when you go here you know Rock Health come out with their most recent numbers and the startup health that the digital investment is over last year already and it’s a entrepreneurs market. I’m starting to see that on my end as an AMC based innovator that’s looking to partner with entrepreneurs. They’re becoming really selective regarding who they want to work with because they know if you’re gonna go with a large AMC they’re going to require a lot of time and investment on their end and does it make sense to go with an AMC and you know I think we still have an academic medical center of a lot to offer. There’s a lot that we need to improve on but a lot of these companies that are well-funded are saying we’re just going to go direct to these provider groups or to try to go direct to consumer and then kind of bypass the AMC at this point.

Saul Marquez: Yeah that’s very interesting. So when you were thinking about one of your proudest medical leadership moments, what comes to mind?

Chris Morris: It’s not entirely related to digital health.

Saul Marquez: That’s okay.

Chris Morris: One time I was on a flight from Tokyo to Boston and there was an in-flight emergency…

Saul Marquez: What were you doing in Tokyo?

Chris Morris: When I do not tell you my over the just for I was actually up skiing in Hokkaido

Saul Marquez: Hey that’s where my wife is from.

Chris Morris: Oh yeah. It’s beautiful up there. It’s really gorgeous. So yeah I round three four hours into the flight there was a medical emergency were over the North Pole. You kind of fly over the arc of the you know the the last guy down and Boston and I basically ran an ITU in the back of a plane for a good four to five hours until we could land in Winnipeg Canada and we got the person off the plane alive. Unfortunately it passed subsequently but we really I was the leader of this this group and we had people from all over the cabin of different backgrounds people who trained and had some medical training from Asia to the states the researchers coming to Boston and I was able to really organize this group for hours in a very challenging situation. And the minute that you say well what was the most or significant thing from medical leadership that you can ever remember. I’ll never forget kind of one this situation as the lead on this flight.

Saul Marquez: That’s amazing man. Good for you. That’s exciting. I mean sadly the patient died but yeah you were there. They could’ve died on the plane and you kind of bottom some time now hopefully make it right.

Chris Morris: Yeah that’s how I look at it.

Saul Marquez: That’s awesome. You guys ended up landing in Canada because of the situation or…

Chris Morris: Aw yeah. So we had to talk to the pilot and decide if it made sense to go to Chicago.

Saul Marquez: Yeah.

Chris Morris: We’re just kind of get down in Winnipeg quickly and it turns out actually my chief resident in when I was training was from Winnipeg and you know he’s talking about the the kind of robust health system in Winnipeg.

Saul Marquez: Yeah like let’s go there.

Chris Morris: I told the pilot let’s go there. I’ve heard good things about it.

Saul Marquez: That’s awesome.

Chris Morris: But then aside from that you know I think in terms of leadership is…

Saul Marquez: Great story.

Chris Morris: Doing things that are really progressive and not letting a culture necessarily say no. And I was one of the one simple intervention that we is commoditize at this point texting with your patient. I was back when I was a first year resident. My leadership didn’t like me I was or I was a little too cutting edge with my use of technology. No one was even thinking about sending estimates Texas to their patients. And you know I did all the reading of half like 20, 50 times and kind of I was like no you know it by getting their permission I’m doing it the encrypted text message platform like it’s okay. You know they didn’t want me to do it. And then I continued to do it and there was this subset of really really challenging substance abuse addicted HIV patients that we just couldn’t get into clinic. And I started noticing every time I would start texting them and maybe give them an avenue to text me one when they needed and I was doing nature I was just not for emergencies. But you know if you’re feeling down or if you just want to chat for a few minutes like I can send back text pretty quickly you know try to make their day by showing them that I’m not engaging in their care with them that the team and the man of no shows that we had in this group after I started that intervention was that it was astounding and now you know it was using.

Saul Marquez: The amount of no shows went down?

Chris Morris: Yeah I do. It was dramatic. So in terms of leadership it’s when you see something that doesn’t make sense or that’s just really counterintuitive as long as you’re you’ve looked into the policy and you’ve looked into not really hurting anyone there’s no reason that we shouldn’t be doing this take the leap and do it whether even if you’re in an enterprise or it’s much easier and take a leap like that when you’re an entrepreneur in a startup. But you know it’s important to take the jump while even at a larger enterprise and kind of demonstrate to people that you know we have to be a little risky or think outside the box if we’re really gonna move forward.

Saul Marquez: I love that Chris. What an inspiring couple stories you just shared and definitely paving the way for other health care practitioners to break outside of the box to do things better. Getting closer to the end here, we’ve got our lightning round followed by just the closing thoughts from you. So let’s pretend you and I are building a medical leadership course and what it takes to be successful. It’s the ABC’s of Dr. Chris. And so I’ve got four questions for you followed by your favorite book. You ready?

Chris Morris: Okay.

Saul Marquez: All right. What’s the best way to improve health care outcomes?

Chris Morris: I think the direct self-insured, the new self-insured payer models all I or a health that are kind of building the relationship right between the employer and the health care system and cutting out that largely that middleman is we’re seeing the largest amount of rapid cycle innovation and cool things and improvement in care. And I’ve had the opportunity several years ago to work and do an internship with NY or a practice and I see that as a huge component of our future.

Saul Marquez: What’s the biggest mistake or pitfall to avoid?

Chris Morris: It’s like Donald Trump saying I didn’t realize how complex his healthcare was kind of that to think that you’re going to get anything done with especially in a larger health system with any type of speed or without encountering bureaucracy somewhere or someone that’s probably going to try to maybe not support your efforts as much they’re going to universally that’s going to happen. So don’t pretend that there’s this kind of perfect marriage between enterprise startups or even if it’s just a regular kind of established that way Medtronic or dealing with a health system that’s always going to take a lot longer. And it’s true that that cell cycle is going to be longer.

Saul Marquez: Totally agree my friend. And how do you stay relevant as an organization despite constant change?

Saul Marquez: That’s what drives me every day is trying to think about the five, ten year strategy and how these new technologies are going to impact the way we practice and clinical care and how do we do that. I think part of it is we’re doing a little of this at NYU and taking that model of that private practice where I could just do whatever I want and setting up within our clinic one part or one floor where we can just be disruptive and not be afraid to throw around completely what would seem just crazy idea or a something that’s completely antithetical to what we’ve done in the past and accept that. And I think you can gain a lot of that culture takes really good aspects from places like Amazon that really have that culture of like oh we made something really cool. No one liked it. Okay let’s move on and not worry about it and have one foot in a really good effort that doesn’t really exist as much in health care culture. And I think creating an environment for that is going to be really important as academic medical centers enter the next decade because no one really knows where we’re going with these technologies and where the ANC sits. So I think it’s important to be pretty diversified as a health system and be able to then rapidly cycle up with these articles as as we see them what where the markets kind of go.

Saul Marquez: What’s one area of focus that drives everything in your practice?

Chris Morris: Making sure the patient has the best experience. I would say it’s still number one for me obviously having and clinical outcome but humanizing the patient is still the most important thing that I need to do on a daily basis. When you get bogged down by insurers and bureaucracy and additionally you know on different tech blogs of reading about oh they’re doing this this and that but oftentimes it’s not touching or hasn’t made it down to your average patient and they see many patients feel isolated and frustrated in our current system because a lot of these cool things that we’re talking about haven’t happened yet and they’re far away off mapping for all of for a large patient population and just to remember that they’re human, they’re probably struggling at the worst time or a very challenging time with their life. And just simple thing like having a bit longer of a conversation, making sure that they get that ginger ale that they’ve been asking for for three hours that everyone always says oh come back and bring it but actually bring it you know that that’s the most important thing. So just know that we’re all in this together with the same common goal.

Saul Marquez: What book would you recommend to the listeners, Chris?

Chris Morris: I unfortunately don’t do a lot of reading outside of health care. I’m looking at my bookshelf right now.

Saul Marquez: Or podcast.

Chris Morris: Yeah I listen to some podcast whenever someone asked me about digital health and younger physicians they don’t know what digital health is or envision a way to incorporate it into their practice. I always say get or read Robert Wachter. The Digital Doctor which I always go back in reference on occasion and I think it’s a really comprehensive and concise view of it took a few years old at this point but kind of where health technology is today how it’s affecting practice and kind of where it’s going to go in the future.

Saul Marquez: Love that Chris. Folks you could get all the show notes, transcript for our interview as well as the syllabus that we just put together for you. Just go to outcomesrocket.health/morris as Dr. Morris here with us and you’ll find all that there. Chris before we conclude I’d love if you could just share a closing thought and then the best place where the listeners could get in touch with you.

Chris Morris: So my closing thought would be a cliche as it is you know that it’s certainly a digital health and health care in general is a marathon and not a sprint. There may be a period in our efforts but you can’t get bogged down by the long if it was just implementation cycles. It definitely get me down at times you just want the care transformed rapidly. But we have to be patient. We have to convince our leaderships that this needs time and that we have to be patient in order to get these new deep learning systems in place that are in a transformed care. We have to be patient. We have to give time and we can’t view everything as an immediate or a lie. When we’re evaluating new types of interventions because the most important and the best things that that come in history generally have been given time to percolate and be developed over and generally into grant money or or just time in general and we’ve shifted a lot of digital health funding into the VC world and into private equity whereas the basic science is traditionally grant-based you know take a time in a lab and fight for more funding. But we do need and we step back in and just realize that this is going to take time and we have to allow our leadership to understand that.

Saul Marquez: Some great closing thoughts there Chris and where can the listeners follow you or reach out if they want to connect?

Chris Morris: You can hit me up on LinkedIn, I believe it if you just linked in Christopher Morris M.D. NYU or my email address is christopher.morris@nyulangone.org.

Saul Marquez: Outstanding will provide links to those contact data. And Chris this has been a pleasure man. Thank you so much for spending time with us.

Chris Morris: Great. Yeah. Have a great weekend. Take care. Thanks for having me.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

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