Redefining Remote Patient Monitoring with Bruce Brandes, SVP, Consumer Centered Virtual Care at Teladoc: Audio automatically transcribed by Sonix

Redefining Remote Patient Monitoring with Bruce Brandes, SVP, Consumer Centered Virtual Care at Teladoc: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket everyone. Saul Marquez here and today I have a guest that I think all of you are familiar with. He’s been on the Outcomes Rocket previously two times. Episode number 76 and also with some of the work that we were doing at the live HLTH event in Las Vegas. His name is Bruce Brandes, and many of you are like, Oh yeah, that’s Bruce. But let me tell you a little bit about Bruce. For those of you that haven’t heard our previous interviews with him. He has 30 years of experience in executive management and entrepreneurial thought leadership to build growth stage technology-based businesses in the health care industry. He currently serves as the Senior Vice President of Consumer Centered Virtual Care at Teladoc. Most recently, Bruce worked to simplify, accelerate and scale health system adoption of digital solutions. As the executive in residence at AVEA, he was previously the founder and CEO of Lucaro and managing director of Martin Ventures. He just has done so many amazing things in health care. Make sure you check out our previous interviews with him, Episode 76 and also our YouTube live interview with him at the HLTH conference today. He is going to be talking to us about the topic of consumer care and really helping us take a look at how we care for people in a different paradigm. So Bruce such a pleasure to have you back on the podcast. Thanks for joining us.

Bruce Brandes:
Saul. Thank you so much. It’s always fun to talk to you.

Saul Marquez:
Yeah, it always is fun to talk to you as well. And I mean, the insights that you have and the angle that you take with some of the things that we take for granted, it really provides us a new way to look at things and to think about how we approach health. So we’ve been working through this pandemic. And certainly, the COVID-19 pandemic has accelerated the rate of adoption of digital health. What lasting impacts do you foresee as a result of these changes?

Bruce Brandes:
That’s a great question. I think everyone recognizes how trends that were already underway were significantly accelerated by what we just experienced and are experiencing with COVID. I think the most profound ongoing change that I think we should all be recognizing and embracing is that the consumer is now known to be at the center of health and care, and those consumers are increasingly expecting the same digital-first experience in health care that they are currently enjoying every other area of their lives. And the challenge, though, that we face, I believe, is that when you think about health care, consumer health care is really confusing because it’s so fragmented and they need help.

Bruce Brandes:
And the interesting thing is you think about digital health and what’s happening right now in the battle for the health care consumer is you have a lot of organizations that understand the consumer really well and are digital-first and are very well funded that are kind of battling for the hearts and minds in the circle of trust of the health care consumer, whether it’s big tech companies, big retailers, health plans and new entrants that are coming in. And all of them are kind of vying for that position. And if you’re the health system, who has been in the community for one hundred years, and I think we all recognize that that trust is earned locally and over time we tend to want to work with people locally. And so we believe that the local health system is really the natural choice of the trusted to be the trusted partner for these health care consumers. And when someone breaks their leg or have a heart attack, they immediately think of the local health system. The problem is the and they immediately trust them. The problem is the other ninety-nine point nine percent of the time when these consumers are just living their lives, they don’t think of the local health system. So I think that’s a real opportunity going forward, recognizing the importance of the consumer and the opportunity that represents for someone to really establish themselves. And we believe that the local health system is very uniquely positioned to claim their spot there.

Saul Marquez:
Yeah, Bruce, you know, some great thoughts there. And, you know, the pandemic has certainly created some seismic shifts and how we view digital care and telehealth today. I think a lot of people recognize telehealth visits are here to stay and it’s going to be an additional side of care. How are we going to deal with this and where are we going to go from here?

Bruce Brandes:
Yeah, that’s a great observation. I think everybody’s heard the statistics of the exponential growth in the number of telehealth visits that health systems and physicians’ offices have conducted since the beginning of the pandemic. I actually like to think about Netflix when we think of to put this in context, think about what Netflix did when they were on a journey to reinvent how we look at home entertainment. They started by mailing DVDs to your house, which was a better experience than going to Blockbuster and having to pay every. And for me, it was incrementally better, but it was still a one to one interaction and they didn’t really become transformational until they reimagined, how do we leverage digital to create a one to many experience and then layer in data science to really be able to hyper personalize the consumer experience that is exponentially better than anything that we were dealing with previously for home entertainment. I think that same opportunity applies to where we are in health care, because if you think about everyone recognizing that telehealth visits are better, it’s a better version of a one-to-one episode of care. The patient can wear their pajamas. They don’t have to pay for parking. I think we’ve all now experienced that. Whether you’re as a patient or as a physician, you understand that this is actually a better experience, but it really doesn’t become transformational for the industry until we start reimagining. How do we apply digital and virtual to think about a one to many experience? And that’s really what creates the opportunity to bend the cost curve and actually completely reimagine the clinical and financial models that underlie a lot of the challenges we have as an industry. And I think most people today recognize that or describe it as remote patient monitoring that one to many transformational opportunity. But I actually think that concept is right. But those words are wrong. They’re actually two problems with remote patient monitoring.

Bruce Brandes:
The first is that the words are wrong. If you truly believe that the consumer is at the center, then the words remote patient monitoring just indicate maybe some antiquated thinking that the doctor or the hospital is still at the center because most people don’t want to be remote. They also don’t want to be thought of as a patient, even when they’re they’re sick. They want to be thought of first as a person, and they want to minimize the amount of time that they actually have to be a patient. And the word monitoring kind of feels like Big Brother. But what they want is to be empowered with the data that they need to be able to share with the organization’s family and caregivers that they trust to help them in their journey for better health and care. So that’s kind of the first issue with remote patient monitoring. And the second is, depending on who you talk to, there are so many definitions of remote patient monitoring today. And a lot of it is defined on very specific use cases that often have been driven by vendors that have a product to sell to support one specific use case for remote patient monitoring. But I think that there’s an opportunity to look more holistically in this one-to-many model. And I would submit to you that a term to consider is whole person, consumer-centered virtual care. And that’s a mouthful. And I’m not a marketing genius, so that may not be the right term. But conceptually, I think that’s a better way to look more holistically at all of the possible use cases that can apply.

Saul Marquez:
Whole person consumer-centered virtual care. I love the idea. And you touched on monitoring Big Brother remote. I mean, we want things to be local and were people. So I think really taking a look at that remote patient monitoring nomenclature and really peeling back the layers, as you did, helps us really understand that. Yeah, we’re probably looking at this not patient-centrically and consumer-centrically as we step away from thinking about this patient-provider relationship. And so then you talk that a lot of the solutions tend to be vendor-driven. I think this is an opportunity for providers to, like you said, earn that local trust. I mean, they’ve been there for a long time. Yesterday, Bruce, I was working out and I noticed something on my neck and I’m like, this doesn’t feel right. So I’ll talk to my wife about it. She’s like, it’s shingles. So this morning I went to my local provider and I set up an appointment online because I know and I, they’ve taken care of us before. So case in point, we do have that trust, and providers have that trust. And maybe it’s not something that they realize or even appreciate, but maybe it is. What are you what are your thoughts there?

Bruce Brandes:
Actually, it’s a great point. And I actually have a similar story. My wife during COVID got a rash, which when she’s working in the yard, she’s allergic to poison ivy. And inevitably, it gives her all kinds of profound side effects. And normally she calls her dermatologist. She’ll make an appointment probably five to seven days later, gets in to see them, and gets a shot, a steroid shot, and it clears her up. And so we went online instead for a virtual visit. We actually asynchronously took pictures of the rash, create your profile, share those. And within three minutes, we had a consult back from a dermatologist who identified what it was because we put in our pharmacy, had already called in an oral steroid for her to take, which was ready by the time I got to the Walgreens. And within 30 minutes of the time that she identified, I think I have this problem, she was actually taking the meds that made her better within an hour.

Saul Marquez:
Amazing. That’s awesome. You guys did it right now.

Bruce Brandes:
But again, that’s still the one-to-one episode of care, that is absolute, that’s a perfect example of better, but not transformational.

Saul Marquez:
So then help us and I appreciate you calling that out. Right. So help us. That’s the one to one what would the one to many have looked like in that example?

Bruce Brandes:
Well, in that example, that’s probably all she needed was the one to one, because it wasn’t an ongoing, more significant issue. But if you look across somebody’s entire health care journey, I think that there are, when we talk about the term of remote patient monitoring, what is it that people are describing today? What are they trying to solve or what are the use cases? And if you look at each one of these, it’ll kind of help you to understand more holistically, I think, what someone’s needs are. And these are generally more acute type of episodes, but not necessarily so. The first use case for remote patient monitoring that most people think of today are really around transitions of care. How do we prevent 30 or 90 day readmissions? So when someone is discharged from the hospital, we’re going to send them home with some devices and we’re going to monitor them. And then on the thirty first or 90 first day, we’re going to take our devices back. And frankly, they may or may not be ready for me, for us to take them back. But it’s really about the funding model within a bundle and it makes sense. And I think this is where the puck is right now. And I think there are a lot of people implementing solutions to address readmissions and using remote monitoring to help to do that. And I think that that’s a really important use case and a valid use case. And where people are today, I think where people are going, where the market is going is extending beyond that, looking more broadly for a second use case that applies remote monitoring for the hospital at home. And this is a lot of people from a marketing standpoint are saying they do hospital at home, but true hospital at home.

Bruce Brandes:
We were having a conversation with a major academic medical center the other day that was describing to us that they have six hospitals, but they’re building their seventh in 2021. And it has an unlimited number of beds because it’s actually a virtual hospital and it’s their plan. And there are others that are doing this to do to hospital at home is actually taking somebody who would otherwise be admitted to the med surge floor within the four walls of a hospital. And instead, we are actually admitting them and providing hospital-level care to them in their own bedrooms. And that’s not just the technology, but the wrapper of all the other clinical services that are needed as well. So the second use cases around hospital at home. Then there’s also a third use case, which is actually more benign, which is for aging in place for our seniors, which really requires more passive monitoring to make sure that your grandma hasn’t had a fall or that he or she’s taking their meds and that the refrigerator door hasn’t been opened for five hours so that we can safely keep them at home longer. There’s a fourth use case with people living with chronic conditions where people want to be not just at home, not just in their doctor’s office, not just in the hospital, but just outliving their lives.

Bruce Brandes:
And there’s a tremendous opportunity, I think, to meet people where they are so that their chronic condition doesn’t define them. But we have the ability to help empower them to manage their conditions while they’re living their lives with connected devices and other technologies and services. And then there’s a fourth use case, which is actually different, A fifth use case, which is different than the first four, which is something that we’ve actually been doing for a decade or more, which is actually critical care. And this is the scenario where you have a patient who is actually acutely ill and needs to be in the hospital. But actually the clinicians, the specialists that may be needed at any given moment to care for that patient might physically not be at the bedside. They might be in their offices. They might be in another hospital, or they, frankly, could be in another state. And this is a great way that we’ve been able to keep people closer to home, meaning staying in their community hospital, their rural hospital, without having to be admitted into the academic medical center. And so if you look at all those that oppose five different use cases for what people are calling remote patient monitoring, they’re not really absolute lines in between each one of those use cases.

Bruce Brandes:
And in fact, most people in their health journey, just like we were talking about for an episode of care, you’re going to flow in and out of those different use cases over the course of your health journey as you either improve or deteriorate. And so the challenge of looking at this in a silo and solving for it with a vendor solution for each individual silo reminds me of the late 80s, early 90s, when health systems were buying siloed departmental systems for pharmacy lab radiology surgery, only to find out that they didn’t really talk to each other and it was fragmenting the experience. And that’s what led to obviously the investments in electronic health records. And I think the same thing is happening now with virtual care, where we really need to look at it holistically across the whole person’s experience, the needs across the entire continuum of care and recognizing that we need a common platform that can span all of those those different use cases. So I’ve just given you a whole bunch. Let me pause there, see what questions are coming in.

Saul Marquez:
That’s good, Bruce. I appreciate the level of granularity on this, obviously, you’ve been giving this a lot of thought and we need this, we need to be able to dive deeper into the intricacies of how we’re deploying this care, where we’re deploying it, who’s giving it. You gave us five different use cases. And I think as we get better at this, it’s important to have these distinctions. And so thinking about the term that you just use here today, whole person, consumer-centered virtual care, what do you think is needed from digital health to support the realization of that?

Bruce Brandes:
So if you think about it, there are a couple of components. And one I think that we have to recognize is there’s an explosion of consumer and patient data that’s being captured, whether it be from connected devices that are doing active or passive monitoring. It could be something as simple as your Fitbit or something is as complex as your continuous glucose monitor or a heart monitor, as well as contextual data that might come from the EMR meds compliance. Other digital-related data capture. The challenge I think that we face is there’s so much information. So what’s needed from digital health that I think as we capture more and more of this data, it’s overwhelming. And so I think to be able to think about those five use cases across the spectrum, a continuum of care and thinking about the explosion of the monitoring and contextual data and other information that’s being gathered that’s relevant but needs to be synthesized and contextualized for somebody to be able to actually make decisions. I think that the pieces that are missing in between all of this is a platform, is a single platform that’s purpose-built for health care, that understands high trust and scalability and EMR and other technical integrations, as well as clinical workflows and all of these other things. One platform that I think of the technology like what AWS does for cloud computing, how do you just take all the technology stuff out of the way so you can just focus on the consumer and on those use cases in their needs? And then the other piece that I think is really needed is really sophisticated data science that can aggregate all of the data sources and health signals that we just described that are exploding and be able to interpret that and then apply it back to the consumer, the individual it could be to the caregiver in some of these scenarios and allow them to understand how to digest it, how to take action on it in digestible ways that’s relevant for that moment in time.

Bruce Brandes:
And then depending on how they react to that information being applied to them, they may or may not accept it. And so the system needs to iterate to get smarter. And then at scale, as you have more and more of this, just like Amazon knows what I want to buy or Netflix knows what I want to watch better than I do, I think our health system can get smart enough that we know what the best thing, best course of action is, what the best suggestion might be to any given provider or any given consumer to help keep everyone healthier and to deliver a more efficient health care experience.

Saul Marquez:
Yeah, it’s really about making it turn-key, almost. I mean, giving providers the ability to really focus on the customer, the patient, and giving them those insights to be able to act on them even when the larger populations and we’ve got the doctor shortage problem, too. So so being able to bridge a lot of those physical gaps with data science. As you we have provider leaders listening to this. And what would you say health systems should be doing now to control their virtual care future, Bruce?

Bruce Brandes:
Yeah, well, I think the first thing I would say is we have to recognize that virtual care on its own is not it’s not going to solve all the problems it has to be married with high touch and physical care. And so that’s where I think as a health system leader, the real opportunity exists to think about what health systems historically have built is their core competencies, and to really reimagine what you need in a partner to help you to build out the virtual capabilities, not in a fragmented way, not in something that’s not scalable or health care specific or something that understands where you are, but also where you need to go. And I think that by picking the right partner that has a more holistic platform approach rather than niche siloed opportunities and put it in the context of the strategic problems that you’re trying to solve. Don’t buy tech for tech’s sake. It’s really all about what are you trying to do? Are you trying to move from fee for service more meaningfully into value-based care and go into an arrangement recognizing that historically most health systems are at a data disadvantage when they go to try to take on risk to the payer or others that might have better data? How do you level that data playing field so that you can actually go in and take on risk in a way that, you know, you can be successful because you have the data and you have the ability to affect behavior change and other examples?

Bruce Brandes:
So to move into value-based care. Other examples are how do you pay a fee-for-service world, how do you figure out how to shift commercial market share to your favor? And how do you figure and leverage this virtual care as a way to do that? How do you leverage virtual care as a way to all of a sudden figure out how to become profitable at government rates? And I think that there’s a tremendous opportunity to think about where you are today and in your financial models and in your clinical models and think about how virtual can accelerate, just like it has with telemedicine visits. That is a great first step. But you need to think about where will the market need to be two years, five years from now, particularly with all the competitive pressures that are coming in for health systems, how can a health system control its own destiny? I think they really need to look at the top strategic priorities that they have organizationally and find the right partners. They can’t do it all themselves. They have to find the right partner or partners to help them to get there in a quick and meaningful way. Accelerated and risked.

Saul Marquez:
Yeah, Bruce, you’ve called it out. Well, and a lot of what’s happened today is really a vendor selling into a system. And these are the capabilities and that’s what they go for versus these are the goals of our organization and this is where we want to go. How can you help us? And so I love that you’ve highlighted all of these different things for us to consider as we think about the future of health and care. As you mentioned it, it’s critical that we partner because we can’t do it alone. So why don’t you just really kind of leave us with the best place that the listeners could get in touch with you and learn more if they want to continue the conversation?

Bruce Brandes:
Sure. Well, first of all, my email address is bruce.brandes@teladoc.com.And to learn more about Teladoc, it’s Teladochealth.com.

Saul Marquez:
Outstanding Bruce, it’s always fun to connect with you. And certainly, I want to stay in touch within maybe within the next six to 12 months. I’d love to hear an update from you on how this is going and how it’s resonating with providers across the country.

Bruce Brandes:
Fantastic. Saul as always. Great to speak with you and thank you for the opportunity.

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