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Natanya Wachtel:
Brands that can connect with their audiences more viscerally and more authentically will always be successful. With the Insights Out podcast, you will get access to deep and detailed conversations with the heads of leading organizations to understand how they are making their customer relationships work best and how we can all become more aligned to deliver strong value exchanges and better realize the benefits. I’m your host, Dr. Natanya Wachtel. Welcome.

Natanya Wachtel:
Hi. Welcome to another episode of Insights Out, where we talk about all things insights in the healthcare space. Today, I have a very special guest, Dr. Brittany Busse, and she is the co-founder of ViTel Health and has a very amazing story that I’d love her to share with us and tell us a little bit about what she’s working on. And we’re going to focus today on some of the things in the health coaching space and how it’s having an impact on deeper scoring, among other things. So welcome, Brittany.

Brittany Busse:
Thanks, Natanya. It’s really great to be here with you today.

Natanya Wachtel:
Can you give us a little bit of background on you and how you came to build this ViTel Health empire?

Brittany Busse:
I guess I would start out by saying that when I started my pathway towards becoming a doctor, I initially thought I was going to practice in psychiatry. So, I got into medical school and undergraduate degrees in both physiology and psychology, and I really wanted to focus on helping people with addictions, helping people with mental health disorders. And I saw myself functioning in a way more of a therapist, probably, or a guide to these individuals. And as I transitioned throughout my clinical years, my first practice was in psychiatry, and that’s not how I saw it being practiced. I saw a lot of prescribing, a lot of throwing our hands up in the air, saying, we don’t know what to do with these people, and we’re just going to keep adjusting their medications and putting them on more and more things until we maybe exact some kind of a balance that allows them to function in the real world with a whole bunch of side effects. And I took one look at that, and I said, I cannot do that for the rest of my life.

Brittany Busse:
There is no way I can barely take Tylenol, even when I have a migraine. I don’t like to touch medicine. I’m not going to be able to have a fulfilling life if my entire life revolves around rather than creating relationships around writing prescriptions. So I turned away from psychiatry, and I realized that most of how medicine is practiced from an MD standpoint, or even potentially a DO standpoint, I don’t know, I can’t speak to that experience is around writing prescriptions for things and these quick-fix solutions that people just want to walk into the doctor. And by nature of the system that we’re in, you only have 10 or 15 minutes, and the simplest outcome with the least friction is just to give them another prescription and say, I’ll see you again in six months, 12 months, whatever the next appointment schedule is. And I would see that in practice after practice as a medical student. And I can’t abide by this. So I practiced. I decided to go into surgery because I was like, okay, save the hernia, fix the hernia, move on.

Natanya Wachtel:
And I was going to say because the other thing is the whole we are just a bunch of body parts. So the prescriptions are treating maybe a symptom that’s occurring somewhere on the body that’s connected potentially to something else, but that’s a different doctor.

Brittany Busse:
Exactly, exactly. So surgery is taken apart.

Natanya Wachtel:
Organ that you’re.

Brittany Busse:
So, your organs have been taken apart and given to different specialties. And your primary care provider and your primary care physician has an overview of all of those things.

Natanya Wachtel:
Right.

Brittany Busse:
But maybe not the depth that they would require, because there’s so much information and there’s so many prescriptions, there’s so many mechanisms of action that now we’re relying on more and more specialists to have that knowledge base that is narrow but deep instead of wide. So the primary care physician ends up acting as a quarterback for healthcare, even the coach on the sidelines, managing all of the different positions and physicians that the patient is going to and trying to collate that information back to the patient in these 15-minute intervals that they get with them. So it’s really difficult for physicians. It went through my training process. I had health issues of my own, prevented me from continuing in my surgical training, found myself practicing in an urgent care for a period of time again. Really, at that time, before telehealth was the epitome of retail medicine. I paid $50, where’s my Z-pack? There was no relationship. There was a different physician every day on staff. I happened to work four out of seven days a week, so I had some relationship with more regular patients but not like a relationship in terms of providing primary care services. It was a revolving door.

Natanya Wachtel:
Yeah, I was going to say. And the support, like the whole network, was always ever-changing, right?

Brittany Busse:
It is.

Natanya Wachtel:
Like vibration of you have someone who you can triage with or work with that you.

Brittany Busse:
We had a binder full of local specialists, and we could call the specialist and see if they were accepting new patients, but the relationships weren’t there, didn’t have relationships with those people. And when patients had a new diagnosis, for instance, we had. A young man come in. All he wanted was a commercial driver’s license so that he could be a truck driver and he could make money. And he could also get health insurance. When he gave his urine sample for his commercial driver’s license, it was full of sugar. And we said we can’t pass you because you have diabetes. And he, I don’t know about that, but think maybe he did know about that, but there was nothing I could do. Like I wasn’t a primary care doctor. I wasn’t a diabetes educator. I couldn’t put him on a prescription. All I could do was say, you need to get in with a primary care doctor, and here’s the SAC County clinic, and hopefully they can help you, but until you get your diabetes under control, I can’t provide you with the CDL license. And it was just like crushing for him because he needed health insurance in order to get care. And the only way he could see to get that health insurance was to get a better-paying job. And we just had no resources for people with these types of chronic conditions. Nor did I have the time to sit him down and find out what are his lifestyle factors. I was congratulated if I saw 100 patients in 12 hours like that’s a lot. It’s a lot of people in one day. And so I really just wanted to.

Natanya Wachtel:
Can’t even imagine a cocktail party like that. So.

Brittany Busse:
I know it’s like in and out all day out of the rooms. And I just needed something else for me, for my life. Like, I was so burned out, for lack of a better term, burning the candle on both ends. There’s no satisfaction because there’s no relationship. I never got to see outcomes because I usually never saw anyone again unless they happened to be like a worker’s comp patient who was seeing me on a more regular basis.

Natanya Wachtel:
Yeah.

Brittany Busse:
And it was just a lot of me feeling ineffective in what I wanted to do for people and change their lives. At that point, I turned to telehealth, mainly because it was a nascent specialty where I thought I could make an impact and, in fact, was able to make an impact as a medical director working for a company that was trying to actually improve the workers’ comp process, create relationships with patients, make it so that they could have the same physician every single time they needed an appointment, and really focus on continuity of care and better use of health resources. But again, that just didn’t. It didn’t sit well with me in the long run because the physicians themselves, I felt, were always being taken advantage of, and the physicians weren’t happy.

Brittany Busse:
And when they’re not happy, the patients aren’t happy, and the whole system starts to fall apart.

Natanya Wachtel:
Yeah.

Brittany Busse:
We started. Yeah, we started ViTel Health. We came together with that idea of the mission of happy physicians, healthy patients, and that in order to create this, we needed to surround both the physicians and the patients with everything that they needed for this sort of thriving practice from a digital health standpoint, because we weren’t doing anything as far as in-person clinics, although some of our physicians do own and operate in-person locations, but just surrounding people from that digital health standpoint with all the tools and resources that they need, not having a business background, most physicians are hesitant to go into practice. They want they need a lot of legal resources. They require malpractice insurance, they require finances, and they require patients to treat and also to pay their bills, and keep their doors open. And there’s a lot of administrative work that comes with that. So we take.

Natanya Wachtel:
The whole industries, right? Medical billing. You can’t open a back of a magazine without an advertisement for that.

Brittany Busse:
Yeah. So we wanted to put all of that in one place so that they could have a seamless experience from idea of having a clinic all the way through, opening the doors, and providing care to patients. We also found that physicians needed additional revenue streams and also additional ways to impact patients, which is where the remote patient monitoring chronic care management side of the business comes into things. So, where it is used traditionally, remote patient monitoring involves digital health equipment. So Bluetooth-connected devices that monitor patient’s weight, blood pressure, pulse oximetry, glucose, so you can have connected glucometers. There are some doing respiratory so for like, peak flow or other kinds of spirometry measurements. So, all of these different measurements that you can be taking on your chronically ill patients. And again, it’s looking at how do we surround the patients with this health experience. Because we know that health is a lived experience. It’s not something that happens once a year in the doctor’s office. Right? So I go to my doctor once a year, and then health ceases to exist until the next time I see my doctor, and they take my blood pressure again. Your blood pressure didn’t cease to exist in that time period. It’s happening continuously, and it’s great if we can have a measurement of that blood pressure and what it looks like on a day-to-day basis, and how it’s impacted by lifestyle factors like your diet, how much you exercise, how much stress you have in any given point in your life, your social network, your social connections, and all of those things are actually having a day to day impact on these numbers that you were only seeing once a day in the doctor’s office.

Natanya Wachtel:
The air you breathe it’s looking at a whole person in their whole life, which is the insights part of Insights Out here. Why I was so excited to talk to you about some of this is that you come from a unique perspective, shifting towards this complementary approach to wellness, right, that has the hard clinical parts that are needed, whether there’s a surgical intervention that’s needed or a pharmacological intervention that’s needed, but not in lieu of or without considering potentially all these other layers that you spoke about. And so there seems to be a readiness in the marketplace. And I say marketplace meaning of providers and the funders of the infrastructure to shift towards this more collaborative approach to care, and not necessarily seven specialists, but collaborative across different kinds of disciplines in treating chronic disease. And I think that’s an exciting thing we were talking about before. But why do you think this is gaining the traction that it is and where are some of the areas that you see the most impact that either surprised you or is just remarkable?

Brittany Busse:
I think the traction initially was coming from the fact that during COVID, there were a lot of new billing codes that came to be birthed around remote patient monitoring and chronic care management, and there were a bunch of people who stepped into that space, and said, this seems relatively straightforward. We just give the devices to the people, and we take their readings every day, and then we send that off to CMS, and they give us a check, and we get part of that check to ourselves and part of the check back to the doctor’s offices. And everyone makes money,, and we’re all happy. There was a lot of that happening, and a lot of that was not impactful. Right. It didn’t provide any benefit to the patients. The patients weren’t incentivized to use it on a regular basis, which they need to do. They need to use it at least 16 times a month in order for it to remain billable. And people aren’t going to do something just because their doctor told them to do it. We know that and or benefit them.

Natanya Wachtel:
Pejorative. There’s a lot of head in the sand, and it was during the pandemic as well.

Brittany Busse:
Yeah. So we realized that if we were going to offer this service that it needed an arm of impact, it needed the personalization, it needed that the touch part. Right. So we looked at it, and it can be high-tech and also high-touch. And the high-touch portion involved a team of healthcare coaches. What I love about healthcare coaches is there’s several hundred thousand of them in the United States. In fact, I believe there’s more healthcare coaches than primary care physicians currently who have certain certifications across the board. We can talk about different certifications, but they’re there, and they’re ready, willing, and able to be able to guide patients on making different choices when it comes to seeing the numbers that are reflected to them back, rather than the patients just taking the numbers for the sake of taking them. The healthcare coaches are able to guide them on making better choices for food making better lifestyle choices. And then also, from our perspective, it was really important that the healthcare coaches live in the same area as the patient, right? Because a healthcare coach in Ojai, California, telling someone in Detroit, Michigan, that they need to meditate more isn’t going to really have the same impact on that person as somebody who has the same lived experience as them, who understands the community, the layout of the community, access issues as far as fresh produce and grocery stores access, as far as safety conditions for getting outdoors for exercising. All of those things sound really simple to those of us who have the privilege of walking outside safely. But that’s not the case for a lot of individuals. And so we need somebody who understands the barriers to health before that person can give that the patient actionable insights on how to make their health better.

Natanya Wachtel:
So, having a representative set of different socioeconomic cultural backgrounds, ethnicities, proclivities and that so that people see themselves in the person that they’re looking to have an instant connection about their most primal, awkward things, right? What areas where they’re struggling. And you have to have a lot of trust there. And so that’s another big area. That trust has been quite eroded with this lack of relationships. So I think that’s really profound. And hopefully, more organizations take a page from your book in this way because these are small details, and they might not be in the business plan specifications, and they might not be in the deck, but they truly make a difference in the ability to connect and affect positive change in people’s lives. And you guys have the receipts, for lack of a better way of saying it, to show that you are seeing changes in these early stages of these programs.

Brittany Busse:
Yeah. And there are receipts on both sides. Right? So people are getting better. They’re feeling better. We have patients in their 70s and 80s telling us they feel better than they have in their 50s. But there’s also the receipts on the financial side. So whether you’re a physician trying to maintain a private practice with all of the overhead associated with that, worrying about being bought out by a large health system, or maybe thinking that might be a good idea right now because you’re struggling, we can provide that financial cushion as well. Or if you’re an insurance company looking at these types of solutions, the bottom line for that is that it saves money because you can actually reverse chronic disease. You can prevent people from getting worse. You can help them get better. The relationship that they have with their primary care doctor and with their healthcare coach keeps them out of the emergency department. There are lots of studies showing that people who have relationships with primary care doctors have better health. And they. Have lower utilization of these costly services, the procedural, the emergency, etcetera, that costs insurance companies and individuals money. So we can look at how much money this is saving overall. Yeah, on a business standpoint as well.

Natanya Wachtel:
Yeah. The pharmacoeconomic models that are emerging are some of the new things that, and it’s almost embarrassing to say radical concept in the states that if you because there outcomes and then if you actually focus on wellness first and the patient motivation and the patient determination to take a role and be collaborative in that together that ultimately longitudinally it’s huge cost savings from the test from the ER visits, as you said, from disease progression and other Co-morbids that often come with as the disease progresses happen, it’s exponential savings as well as less of a burden on the whole system. And yet, this is not the gold standard right now. So, it’s still incredible to me that you guys are part of the pioneer set. But I’m really excited to help spread the word and have hopefully those folks listening and others that we engage with to understand that as a physician, you’re not talking about Disintermediating the doctor, and I think that sometimes can be something that is there and or as an organization or health system might be like, we this is avoiding these other necessary pieces of care. And that’s not at all what we’re saying here. And that’s an easy way to just push it to the side. But I think community as the foundation of health is something that you had said when we were talking earlier.

Natanya Wachtel:
We can’t say that enough. And I think breaking it down into these parts, like you said, helps people understand the power of that statement and how everybody wins. Like you said, the receipts are on both sides. So it’s even if you’re, I hate to say this, not one of the people who is focused on the feelings side of how a patient feels and treatments, and you’re focused on the cost per patient per year, you still win with this model. If you’re focused on the relationship you have with a patient and how they feel about taking a leadership role in their own care, you get the receipts on that side. So it’s a win. And the fact that the financial models aren’t so difficult, I think there’s a lot of other areas where we look in integrative, where it’s difficult to get reimbursement because of what’s going on there for either for testing or for treatments. That’s a different road here because of our PMCM. The model is made here for everyone to win. So what I’m hoping is that we inspire other groups, telehealth companies, health systems to think of this as an integrated rather than a bolt-on. And that’s the other thing that I think is really great about the way you’re looking at it isn’t just, oh, and if we have this thing over here for coaching.

Brittany Busse:
Yeah. So, for us, it’s really it has to be the whole solution. I think the digital health devices show people in real-time how their body is operating. So, I think it’s both sides of the coin. Some people might say, oh, I only want the healthcare coaching, and I don’t want to monitor the devices. Okay. You’re not going to get more fit or lose weight if you’re not keeping track of your weight. It’s just that’s just the nature of it. Like you could, you have to keep track of something, whether you’re keeping track of calories or you’re keeping track of the weight. Like you have to see that reflected. That’s just the way our brains work as humans. We need biofeedback, and we need to see the results of the efforts that we’re making on behalf of our own selves, on behalf of our bodies. Right. So, as a mind-body integration, like you have to see those results in real-time. So if you are taking your blood pressure regularly or your blood sugar regularly, and you’re seeing the results in real-time of, oh, when I ate this food, this happened. And then when I ate this on this day, along with exercising, then this happened.

Brittany Busse:
And then, over time, we can track those trends. So it’s really important to note that we need to have that feedback. And then the coaches can actually interpret that feedback for you and then help you make more impactful decisions. Right. So we talk a lot about these changes. And people think, oh, I’m going to have to make some kind of huge change in order to get healthier. And overcoming the barrier to health looks insurmountable for most people. And I think we get this idea because if you look at like social media, Instagram, or whatever, and I’m going to go follow a health influencer or a wellness influencer, and now they’re telling me that I need five hours in the morning to go for a run and to meditate and to journal, and then I’m going to make my juice from scratch with all organic produce and then got to clean the juicer. They don’t want mentions of that part that takes forever. And then you have to wait a few hours. Oh, I forgot, I needed my lemon water before my juice, and then I needed my juice. And then. And by the time you’ve done all of these things like you’re three hours late for work.

Natanya Wachtel:
Yeah, yeah.

Brittany Busse:
Then you work for two hours. Maybe because you got to get home and you got to start doing your evening ritual so that you can be ready to go to bed by the time the sun goes down.

Natanya Wachtel:
And also, it’s very much focused on what you can’t do, what you can’t do. And one of the things that’s really great about a lot of the behavioral side of the coaching is all about finding those micro changes that motivate you to celebrate wins, and it’s basic, but it’s so it’s the different flip of the switch. And so with that, you’ve been able to see people reduce their medications because of these small changes that they’ve made over time. In a few months, you’ve said, right. So, can you talk a little bit about some of the changes in terms of like how their chronic condition is changing? And obviously, you mentioned, which is great. They’re feeling better is number one.

Brittany Busse:
What we know about medications is that all the medications you have side effects; for instance, if you’re taking metoprolol or another beta blocker usually ends in L for your blood pressure. The side effect of that is that your heart can’t beat as fast. And so if you take it, a lot of people complain of fatigue when they take blood pressure medications. So, by lowering the blood pressure, we block the heart from beating faster when you try to exercise. And that, in turn, makes you tire out more quickly or feel like you’re in unable to exercise. So by helping people reduce their blood pressure using a nutraceutical or a food component food as medicine, we could actually reduce the medications and get rid of the medication side effects. So now, like you said, it’s a stepwise progression. Now exercise becomes more, oh, I have more energy suddenly because I either reduce the amount of beta blocker that I was taking or I’m not taking it at all. So now I have more energy. Okay, what could I do with that energy?

Natanya Wachtel:
A positive reinforcement loop builds.

Brittany Busse:
And even something as simple as drinking more water will make.

Natanya Wachtel:
Yeah, I was going to say.

Brittany Busse:
And have more energy these little things. I heard another researcher talking about food swaps, and that’s something we use a lot in health coaching. It’s not about restricting what you eat; it’s about swapping the things out on your plate. Right. So, I’d say a normal US plate. You have a big 16-ounce steak and a little vegetable, and a giant baked potato, right? So you go to the restaurant, and that’s what they give you. And in the case of wanting to live healthier, you don’t have to completely change your plate and say, okay, now I have to take off the steak. There’s no steak, and there’s no baked potato. Like, I have to take those away and just fill my plate up with vegetables. Okay, ideally, like maybe we could move towards that, but what if we just reduced it to a six-ounce portion of meat, half of a baked potato. You can still have your potato if you want. And we just filled up the rest of the plate with a variety of different vegetables that are seasoned well and taste amazing. You’re still getting the things you want. You’re not depriving yourself, but you’ve added in more vegetables, more things that taste amazing, more things that you haven’t tried before. And by virtue of adding in rather than taking away, you’re going to get healthier.

Natanya Wachtel:
Yeah, I did that myself and I. My only regret is that I didn’t have my pinnacle shift sooner because I also struggled with the idea that you can’t have this, and you can’t have that, and that’s bad for you. That was ingrained, right? And then you rail against it every once in a while, whether you’re whatever your triggers are, if that’s a thing, I think this approach is something that everyone can get on board with. They’re not necessarily, like you said, restrictive, that you need a juicer and all organic foods all the time. It’s really just about that intersection of the human connection. And it’s almost like a medical sage guide, right? Like someone that’s on that journey with you who has clinical knowledge and psychological support and psychosocial support and validation, and then layering in all the other measures that you need to make sure things are going well, like you said, through the Spirometer or the blood pressure medication cuff, or checking the vitals, if you will, along the way. So it’s not just subjective, but like you said, by recording it, I remember working in some pharmaceutical CNS products where people really forget, like a week ago, how they felt, or a few days. Once you have your new normal, it’s your new set point. And so there’s another beautiful thing I think here is that you can see longitudinally the change. And that in and of itself is motivating to keep going and keep trying. And I just think it’s incredible. And I’m so glad that you were able to share some of this with us today. We’re coming to the end of time, unfortunately. So, I was wondering if there’s anything you’d love to end with in terms of either your hope for the vertical if you will, and or within ViTel Health.

Brittany Busse:
I’d say that our goal right now is really just to help empower as many patients as physicians as possible. So we can do that either by going directly to where the patients are and then trying to reach their physicians or by having the physicians come to us. And as you mentioned earlier, this isn’t about disenfranchising physicians or dislocating them from their position with patients like the physicians that we work with. Some of them were initially afraid of that. They were like, but if they see the healthcare coach as helping them with their stuff, what they’re going to be like, what do I need you for? And now he’s come to realize that the healthcare coach feels like his right-hand person. He can tell a patient all day in the 15 or 20 minutes that he spends with them. Here’s what you need to do to help your diabetes, or here’s what you do to help your blood pressure. And then they go home, and they forget, or life gets in the way, or whatever happens. And then the healthcare coach can say, remember what your doctor told you. This doctor and myself, we both care about you and your health. And that’s why we told you those things. Not because we just want to take away your fried chicken or your delicious food that you were eating. We actually want you to live healthier, longer. We want you to have more health span and not just more lifespan. And by caring about the patient, by showing them that people care about them, that helps them care about themselves as well and not really helps take those first steps. Right? I think what you talked about before and the culture that we’re used to around health, diet, exercise, whatever it is, it’s shame-based, and shame doesn’t motivate anyone.

Natanya Wachtel:
No, and it’s not sustainable. So the fear of shame when you have maybe a health event like a cardiac event, sometimes people adopt a new radical diet because they basically thought they were going to die. And then, like I didn’t. So let’s do that. And that’s took me a couple of times to get to that line as well. I’m not proud of that. But rather than wait, I don’t have to literally wait till something’s falling off to maybe effect positive change and go towards it. And I think that’s an incredible message, and I thank you for bringing together all of these worlds and help make it accessible for more people, all kinds of people. And just thank you for what you’re doing. And full disclosure, I’m spending some time with Brittany and ViTel Health, and I’m really excited about the future here. And I hope to see more conversations and more interdisciplinary approaches to whole-person health. So, thank you so much for coming today and speaking with me.

Brittany Busse:
My pleasure, Natanya, and hopefully, we can have more conversations in the future as it grows.

Natanya Wachtel:
Absolutely.

Natanya Wachtel:
Thank you for listening to Insights Out. We hope you enjoyed today’s episode. If you have a specific topic in mind and you want us to discuss, please reach out to us by visiting NewSolutionsNetwork.com. See you next time!

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