When it Comes to Healthcare- There’s a Mismatch Between What’s Possible and What’s Allowed


Chris O’Dell, Director of Digital Strategy and Alliances at Stanford Health Care


-Digital is not a strategy but a means to deliver innovative care.


-There is mismatch between what’s possible and what’s allowed- laws and institutions must go hand-in-hand with the human mind- Thomas Jefferson.


-Healthcare systems have common goals. When it comes to educating our legislatures, systems should consider banding together to address the newer opportunities for care delivery. Healthcare systems might consider joining organizations like the Alliance for Connected Care.





Alan Pitt: Here on Healthcare Pittstop, I am pleased to have Chris O’Dell, Director of Digital Strategy and Alliances at Stanford Health Care. As a former Stanford grad, I have a lot of loyalty to Stanford, and I’m really interested to hear what they’re up to. Chris, thank you very much for being on Healthcare Pittstop.


Chris O’Dell: Thanks, Alan.


AP: I appreciate your time. Tell me a little bit about what you do, your role there, and Stanford Health Care’s vision for leveraging digital tools for the future.


CO: As the Director of Digital Healthcare Strategy, I identify and enable digital health programs and initiatives that align to the broader Stanford strategy. I’m a firm believer that digital health is not a strategy in itself, but instead, a means to effectively grow currently differentiated services, and an innovative way to adapt to new industry transformations. So our digital health solutions have a particular focus in four different areas. We seek to improve access, leverage our limited physician resources, reduce physician burnout, and enable clinical transformations at Stanford Health Care.


AP: That’s really interesting. Stanford’s quite a unique place there. Do you think your physicians have burnout there as much as everywhere else? They seem so involved with the new and latest thing.


CO: I think that the difficult part, from a digital health perspective, is to acknowledge that physician burnout is a reality, and then fairly weigh it against all of the other measures that you have. So if you’re seeking to improve quality, and perhaps impact your cost and improve your patient experience, you want to make sure that the physician is considered in that equation. But it’s very difficult to measure those pieces against each other. They’re apples, oranges, bananas, et cetera.


AP: I’m glad to hear that that’s one of your initiatives, because often, it’s all patient-facing and people forget that there’s a whole ecosystem of folks that have to get engaged. We’re both very involved with telehealth. How does Stanford Health Care see telehealth meeting the mission of the University?


CO: Telehealth is a good way for us to create a clear digital front door to our health system. So telehealth allows patients to stay connected with their care team before and after they have a visit at Stanford, but increasingly so, even before they become a patient—through things like remote patient monitoring. We see telehealth as a means to create a portfolio of solutions that support our mission for human-centered care, and it’s a particularly good way to provide better access to patients so that we can meet them consistently throughout that continuum.


AP: That’s so true, because the brick-and-mortar environment often makes it difficult to have frequent touch points with patients to build relationships. I think that moving forward, that’s very, very important if we want to deliver quality care at lower costs. From a technology perspective, what would you like to see? I’m the former Chief Medical Officer for a large telehealth company, and I’m always wondering if Avizia, the company I’m involved with, if we’re delivering what you need. What are vendors not delivering that you’d really leverage there at Stanford?


CO: Well, I guess I’ll start by saying, I think that technology is rarely the problem in itself, and hopefully it still is a good thing, as a CMO at a company. But I guess I’ll say that because we see strong demand from patients, we see strong demand from our providers, and we see that the technology makes sense and works, and yet, we don’t see telehealth broadly adopted at our system. And I think many other systems have seen that similar trend.


CO: I guess I’ll borrow from a framework that was actually published in New England Journal Catalyst by colleagues over at New York Presbyterian, where they outlined four challenges that are inherent to developing a telehealth program and health system. The four areas are liability, licensure, reimbursement, and workflow.


CO: And so when we look at launching a telehealth initiative, we try to understand how it might amplify or create new practice liabilities for our physicians. We try to understand if our physicians are going to be licensed in other states, or if they’re just going to practice in California. We try to think about how we can overcome reimbursement hurdles, particularly those that are imposed by Medicare, which tended to be kind of a telltale for the other insurances, and in turn, make sure that we fairly compensate our care teams. Then, we think about how the telehealth incorporates into our existing provider-and-patient workflows and how to create new, more efficient workflows where we can. So to the extent that technology companies can help providers solve the liability, licensure, reimbursement, and workflow issues, I think that they can be increasingly differentiated so that the provider’s not constantly solving that for themselves.


AP: Yeah, I’m not sure that the licensure and reimbursement issues are something that vendors can really help you with. Liability, I think, maybe, because I think we could improve the experience for both the patient and the physician. Workflows, definitely. I mean, the big push now in telehealth is -Is it a separate app or is it something inside the electronic medical record? I personally look at the electronic medical record as the operating system, and telehealth as an application that rides on top of that so that physicians don’t really have to swivel. It’s kind of a big deal. Do you have any thoughts around that?


CO: Well, I think that that’s exactly right. And you’re right, I don’t think that the vendors can solve the problem, but they can certainly maintain an understanding of the current state in reimbursement. I’ve been surprised at how much inconsistency and misinformation there is, even around something like Medicare reimbursement. Providers approach the reimbursement very differently even when they are located 50 miles from each other in the same state. They should have the same national reimbursement structures, but they interpret it differently, and in turn, it can have a drastically different effect on the financials of their business.


AP: That actually is a lead-in to my next question. We met through something called the Alliance for Connected Care, led by a woman named Krista Drobac, who’s back in DC. Stanford Health Care was really the first hospital system to join this agency, this alliance. Why exactly did you do that?


CO: I think the short answer is that our telehealth needs were not being met by other organizations, and we wanted a clear strategy of where we should focus our resources to solve some of those reimbursement barriers that I talked about. We liked the alliance’s ability to segment that kind of strategy into two ways, which is, how do we achieve short-term wins (and they’ve done so for us in areas like telestroke, remote patient monitoring, and Medicare Advantage), while also maintaining the long-term path of broader telehealth reimbursement, and creating consistency between all government and commercial programs. We were able to get results, and we felt like the stories of our patients and physicians, and the barriers that they were running into from a telehealth perspective were able to be heard by our government and were reflected in legislation.


AP: That’s really interesting. I believe that the alliance’s role should be that of convener, where not only are the vendors there who are trying to build stuff, but healthcare systems and payers who really have an interest in delivering higher-quality, lower-cost care should be really interested in how can we get things changed. To me, most of the legislation in Washington seems 1970s. I don’t know if you read Thank You for Being Late, Thomas Friedman’s new book, but he talks about this kind of mismatch between what’s possible via technology and what’s allowed via human legislation, how we set things up. Those have to better align if we really want to get the benefits of technology.


CO: It’s funny you mention that, I recently was out in Washington, DC, and I’m new to the entire world of going out to DC and trying to represent your needs to your government. And so I asked myself kind of a similar question, which was, “Why am I out here?” At the time, I was walking through the Jefferson Memorial, and came across a quote by Thomas Jefferson that said, “I am not an advocate for frequent changes in laws and constitutions, but laws and institutions must go hand-in-hand with the progress of the human mind, and that becomes more developed, more enlightened, and as new discoveries are made, new truths discovered, and manners and opinions change. With the change of circumstances, institutions must advance and also keep pace with the times.” I thought that accurately reflected what we were trying to do, which is we don’t want a constant change in Senates and the laws, but we want to make sure that they enable us to offer these new discoveries to our patients, and evolve with what’s currently available.


AP: That is a great quote. We need more leaders like Jefferson in these difficult times. Do you have any messages for government legislators about what we should do both in your State of California and at the Federal level that would really help get us out of what is really a difficult situation in terms of delivery of care and keeping costs down?


CO: I’m a strong believer that we need to create a system that accounts for the health of populations, and does not restrict preventative services that can prevent expensive downstream utilization. The current way that we pass bills is that telehealth’s often considered a cost because the bill cannot adequately score the downstream savings that would be created from the preventative service. So my recommendation is: We need to figure out that problem. Because what’s increasingly happening, and this is particularly true for the Medicare fee-for-service population, that we’re creating a divide in benefits based on the way that our populations are organized. So in the Medicare fee-for-service population, they’re scoring these preventative services as a cost, but in our Medicare Advantage populations and areas that are more capitated, they see it as a huge value for the patient. So depending on the patient’s insurance, they’re getting disparate access to valuable telehealth services. The health system perspective is: We need to be able to create consistent programs for all populations and make sure that everyone has access to those types of services.


AP: I couldn’t agree with you more. It seems insane sometimes because—well, frankly, I partly blame the telemedicine community because we haven’t been really good at identifying those downstream benefits of telehealth. So what’s called the Office of Management Budget, OMB, tends to really score things in a very odd way, which doesn’t show that because I had a telehealth visit, I didn’t have to be admitted to the hospital, or didn’t make an urgent care visit in a way that makes a lot of sense. Do you have any specifics? I mean, I know the opioid crisis is top of mind for just about everybody. Do you see telehealth as playing a role in solving that problem?


CO: Absolutely, I think that there’s two big areas where I see telehealth solving that problem. The first one is just to allow a really limited pool of specialists to provide examinations to patients in hard-to-reach communities. And I use that word hard-to-reach communities rather than rural communities, because a lot of what we need to see is lifting up the rural site restrictions that are currently placed on these examinations, to allow pain management specialists to treat patients who are not able to get to the pain management clinics. Telehealth is a particularly effective means to do that.


CO: The other way that I think, that kind of goes hand in hand, is once you’ve had that examination, and for patients who are already addicted to opioids, treatments like buprenorphine are particularly effective. But you need to be able to prescribe and dispense those in the clinics where the patients are. So you can’t bring the specialists to the clinic, so you have to find a way to both have the examination, and then, check and adequately dispense the appropriate treatment. We see those as the two most effective ways that telemedicine can help.


AP: It is such a bizarre area because the rules for writing prescriptions for OxyContin, up until a few months ago, were so lax. But the rules to write for treatments like suboxone for opiate addiction, were very difficult and very limiting.


AP: Chris, I want to thank you so much for your time today. I’m sure folks will really appreciate your insights. Also, to your point, I’d really like to ask other healthcare systems to consider joining in this effort to help bring legislation in line with what we can do with technology. So some of those larger systems inclusive of NYP you mentioned, Northwell, Mercy Virtual, Ascension, any of you that are willing to consider joining us in this effort, we need help educating our government about what is possible. Thank you very much for your time. I appreciate it.


CO: Thank you, Alan.

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