Episode Transcript
[00:00:01] Speaker A: COVID19, for the most part, was the sort of the trigger that made virtual care acceptable. Virtual care has been around for 20 years, but it really became mainstream with.
[00:00:11] Speaker B: The need to use virtual care services, and now we're further away from that and we're looking at ways to use them in an optimal way. And with that comes making good decisions for a health system based on not just improving clinical outcomes, but ensuring that there's a good return on investment in the programs that you're building.
[00:00:30] Speaker C: Welcome to An A and M Healthcare Industry Group podcast on the impact of virtual care on health care costs. This conversation will delve into the evolving reimbursement laws and strategies health systems may consider for generating new revenue streams.
[00:00:50] Speaker D: Welcome to An A and M Healthcare Industry Group podcast on virtual care's impact on healthcare costs. I am Matt Proente, a Senior director in Alvarez and Marcel's Healthcare Industry Group. Our conversation today will delve into the evolving reimbursement trends and strategies for generating new revenue streams. I am thrilled to be joined by Dr. Chad Elamutil. Dr. Elamutol is the Medical Director of Virtual Care at the University of Michigan Medical Group where he oversees the strategy and implementation of virtual care services across all specialties, as well as leading a range of projects aimed at enhancing the delivery of virtual care. He also serves as the Principal Investigator of the telehealth Research Incubator Lab and as an Associate professor of Urology at.
[00:01:36] Speaker E: The University of Michigan.
[00:01:38] Speaker D: Dr. Ella Mutel has been invited to testify on telehealth before the US Senate Committee on Finance and was recognized as one of HealthTech Magazines 30 Healthcare IT Influencers in 2023. So glad to have you today on the podcast.
[00:01:54] Speaker A: Great. Thanks so much. I'm really happy to be here and thank you for inviting me.
[00:01:58] Speaker B: It's an honor.
[00:01:59] Speaker E: So at Michigan Medicine you chaired a committee tasked with formulating the institution's five year strategic plan for virtual care. Can you talk a little bit about the process and the main considerations that you had when doing that?
[00:02:10] Speaker A: Yes, certainly. It was a great process that we went through. We really started back in 2022 and we partnered with our office of to come up with this strategic plan. And during that process we conducted focus groups, interviews with various stakeholders, various clinical departments throughout the institution. And we created this higher level committee that included clinicians included leaders, included hits, health information technology folks, nursing, and so forth. So the committee was there to sort of look through our findings and help us kind of come up with ideas of how virtual care should look in the Next three to five years at Michigan Medicine. That was the overall purpose of that strategic planning. And in a lot of ways, we kind of had a blank slate because we're thinking about the future. And we thought about what the main problems that we had in our health system are. And for us, access, ambulatory care access is a big problem. Specialist access is a big problem. Hospital capacity is a big problem. ER wait times are a big problem. So using all of these problems and kind of anchoring on those issues, we thought about what are all the virtual care solutions that are out there that can help mitigate or lessen these problems. And there are about 16 different areas that we came up with. Remote monitoring, tele, virtual inpatient nursing, virtual post acute care. Sixteen different areas that were viable for the next three to five years for us to focus on. Then we went through this process where we really refined it down to about.
[00:03:36] Speaker B: Five different areas for us to focus.
[00:03:38] Speaker E: So you mentioned you had 16 potential areas. What considerations did you use to refine it to five key areas?
[00:03:45] Speaker A: Yeah, it's a good question there. So we really, what we wanted to do is kind of prioritize or weigh these different areas on impact and effort. And obviously we want to do all impactful things, but at the same time, the amount of effort needs to be taken into consideration. When you're thinking about a time span, about five years, and plus all the.
[00:04:04] Speaker B: Other priorities our health system has.
[00:04:06] Speaker A: So when thinking about effort, we have a core principle here at Michigan Medicine, which is called base plus. So it's belonging, access, safety, experience, and plus is growth. So we looked at how well each one of these areas aligned with base plus. And then in terms of looking at effort, the main things that we were considering were three areas. What's the technology effort, what's the clinical support, and then how long is it.
[00:04:30] Speaker B: Going to take to implement.
[00:04:31] Speaker A: And so that includes, you know, are the people that we need to implement this virtual care service already together? Do we have to gather a group? Does it need to be integrated to our electronic medical record for it to be successful? How ready is the clinical department to.
[00:04:46] Speaker B: Take something on like this?
[00:04:47] Speaker A: And so we weighed effort and impact together, and then that's how we came.
[00:04:51] Speaker B: Up with the five different areas.
[00:04:52] Speaker D: Great.
[00:04:53] Speaker E: When evaluating the various factors that impact the decision to implement a virtual care service, what do you feel is most important?
[00:05:01] Speaker A: Yeah, that's a great question. So I think, you know, when we were, we did sort of weigh a lot of these, like the areas and effort equally. But in reality, as with my experience, of implementing virtual care services at Michigan Medicine. I say that the, probably the area that's most important is the, we'll call it clinical slash operational readiness. And what that means is that how ready is the team and how accepting.
[00:05:26] Speaker B: Is the team of this new virtual care service?
[00:05:29] Speaker A: And you can have a great idea that could potentially make a huge impact. But if the team is dysfunctional, they're not. They didn't buy into the vision. And you can only do so much as, you know, as a leader, you kind of sell the vision, but then they truly have to buy into it. They truly have to work together to be able to make these programs successful. Not just the launch, but also the maintenance of these programs afterwards. So I think that's probably the most important factor.
[00:05:53] Speaker E: And now this is going to be.
[00:05:55] Speaker D: A little bit of a leading question.
[00:05:56] Speaker E: Since we presented on this, but what do you feel is most overlooked? Yeah, consideration.
[00:06:03] Speaker A: Yeah, no, that's, that is a great question. And I think that that is, you know, we, we had this conversation and then we ended up. Yeah, presenting on it. Because I do think that wholeheartedly, I think the area that was probably the.
[00:06:15] Speaker B: Most overlooked was return on investment.
[00:06:17] Speaker A: And it was in the background. I don't think we weighed it very heavily because we were mostly thinking about impact, clinical impact and so forth. And so it wasn't on the forefront, but it became on the forefront when we, you know, put this plan together and started to look for funding for the plan. You know, then, then immediately return on investment became one of the most important topics, as it should be. And I don't think anyone views virtual care services as they have to be a home run return on investment, but they do have to be sustainable. They have to, you know, may hopefully break even after X, X amount of years. And I think, you know, going through this process and then trying to backfill a return on investment analysis wasn't great. I think it's, it's a different model than I use now. Now as we brainstorm and design a.
[00:07:00] Speaker B: Virtual care service or program, we bring return on investment upfront.
[00:07:04] Speaker A: But you know, with, with a lot of these programs, you could get a return on investment if you think creatively about it. And as you're designing the program, you may have to make some, you know, tweaks to your original idea to ensure that not only is it making a great impact on clinical care, but it's.
[00:07:19] Speaker B: Also, you know, making the health system whole too.
[00:07:22] Speaker E: So now it's been a year, year and a half since you established the five key areas. How do you feel Michigan Medicine is positioned today?
[00:07:31] Speaker A: Yeah, I think we're positioned very well. Just the process of going through the strategic planning was incredibly helpful. We know that we will have to pivot. There's going to be other priorities that come up. But really going through that process helped us understand what we should prioritize, helped.
[00:07:47] Speaker B: Us understand how important it is to calculate return on investment, how important it is to.
[00:07:51] Speaker A: Or even, you know, how to do it, that part too. So I think that, you know, we're.
[00:07:55] Speaker B: We're pretty well positioned.
[00:07:56] Speaker A: The programs that we initially talked about with our strategic plan are all up and running. Some of them are, have started to become mature, and we're looking back, evaluating it, making, you know, new iterations of the program.
[00:08:09] Speaker B: Some of them are still early stage. There's still some, like virtual nursing, for example.
[00:08:14] Speaker A: There's a lot of challenges that we.
[00:08:15] Speaker B: Couldn'T have anticipated at the beginning. But I think that in general, things are moving along well. And mostly because we did this planning.
[00:08:22] Speaker E: Up front and just, just thinking about initially when I was partnering with you, the focus was really on the value of a new patient to justify a lot of the financial return or ROI on virtual care. Has that thinking evolved over the past year?
[00:08:40] Speaker A: That's a good question. I think that the value of the.
[00:08:42] Speaker B: Patient is still very, very important.
[00:08:44] Speaker A: And, you know, of course, we're always putting clinical care in the forefront, but I think, you know, that when you think of it from an ROI model, the downstream revenue that can come from.
[00:08:54] Speaker B: Services that the patient brings in or, you know, operational efficiency is still, still very important.
[00:09:01] Speaker A: And I think, you know, it does it a lot of times. Like, for example, when you're looking at.
[00:09:05] Speaker B: Something like video visits, it's not straightforward.
[00:09:09] Speaker A: And I think that, you know, when we talked in a lot of the conversations that we've had about how deep you really have to go to sort of figure out what the cost side.
[00:09:18] Speaker B: Looks like and what the benefit side looks like is not.
[00:09:20] Speaker A: It's not superficial. So you may think that the only cost is this, and the vendor will tell you that the only cost is licensing. But in reality, there's a big opportunity cost with teaching staff, teaching clerical staff, teaching nursing, and, you know, there's opportunity cost with that. And all that needs to be considered.
[00:09:39] Speaker B: As you think about what the overall return on investment is.
[00:09:42] Speaker E: Right. Just taking a look at it, you know, Michigan Medicine puts the patients first. So the other aspect of your telehealth, virtual care, what has been the impact on patients?
[00:09:54] Speaker A: Yeah. So, you know, in general, especially since a lot of the programs that we thought about in our strategic plan were, you know, initially focused on high impact.
[00:10:04] Speaker B: Areas for patients that I think we're.
[00:10:06] Speaker A: Starting to see that we, we are still in the process of doing some more informal evaluations.
[00:10:11] Speaker B: But there's some areas that we have formally evaluated. For example, automated care, we have a.
[00:10:16] Speaker A: Program where we reach out to patients.
[00:10:18] Speaker B: To collect information like blood pressure for diabetics, get glucose levels and then their clinical team acts on that information, particularly if it's abnormal.
[00:10:29] Speaker A: That program, we rolled it out in two different phases, and in both, both.
[00:10:34] Speaker B: Phases, at least the hypertension group, we found a significant reduction in blood pressure. So it was successful from a clinical standpoint. Now, the return on investment on that type of a model may be less clear or it may be subsidized by automated care. That's being done in other areas that do have a sharper return on investment. But we're certainly seeing impact on clinical care from that program, impact on clinical care from our focus on hospital at home and many of the other programs that we have. But I'm a researcher, as you mentioned in the introduction, so I do see.
[00:11:05] Speaker A: The value in evaluating it very formally.
[00:11:08] Speaker B: Objectively, and potentially even putting some of the findings into peer review publication. So, you know, that process is still in place for some of the programs that we, or most of the programs that we have in our strategic plan.
[00:11:18] Speaker E: Taking a look at the next three years, five years, what elements of virtual care do you believe will become more mainstream? You mentioned virtual nursing. Do you think that that has the ability to be more widespread in terms of adoption across not only academic medical centers, but community hospitals?
[00:11:38] Speaker A: Yeah, I think so, Matt, and maybe be better positioned for community hospitals too. I think that like you mentioned, COVID 19 for the most part, was the sort of the trigger that made virtual care acceptable by even virtual care has.
[00:11:53] Speaker B: Been around for 20 years, but it.
[00:11:54] Speaker A: Really became mainstream with that, with the.
[00:11:57] Speaker B: Need to use virtual care services. And now we're further away from that and we're looking at ways to use them in an optimal way. And so, and with that comes like making good decisions for a health system based on, you know, not just improving clinical outcomes, but ensuring that there's a good return on investment in the programs that you're building.
[00:12:15] Speaker A: I think one of the things that.
[00:12:16] Speaker B: I love about virtual care and why.
[00:12:18] Speaker A: I've, you know, would invest in my career in this, and I want to continue to do that because I think.
[00:12:23] Speaker B: There'S really no ceiling in terms of what can be done.
[00:12:26] Speaker A: One of the greatest benefits that we.
[00:12:28] Speaker B: Have right now is that most people do sort of buy into the future of digital health. You know, even from like a congressional standpoint, from a policy standpoint, there's bipartisan support. The Medicare program for the most part is favorable in terms of reimbursing virtual care. So there's a lot of good momentum for virtual care now. It's just sort of figuring out how.
[00:12:51] Speaker A: It could work best in less of.
[00:12:53] Speaker B: An emergency situation, but actually integrating it into healthcare delivery. And I think the models like virtual nursing, for example, are good. And those are potentially models that will scale. We see it scaling pretty quickly, but that's actually one of those things that it is harder to find, that return on investment. So you have to see, is it improving nurse turnover? Is it being used for mentoring new nurses with nursing shortages? There's a lot of kind of less experienced nurses that are on the floors. But using a virtual nurse for mentoring may be a good way of doing it. Does it improve operational efficiency in terms of admissions and discharges that leads to reduced length of stay? All of those things have to be considered, hypothesized, tested before it can be scaled. And it's going to be different in a community hospital versus an AMC versus a large integrated health system.
[00:13:44] Speaker A: But I think that there's potential, and.
[00:13:45] Speaker B: If you don't see it right away, you know, digging into, figuring it out is going to be important to do early on before you design something that's just not sustainable. Hospital at home, I think is another big area too, that's taking off. There's a lot of congressional support for hospital care at home. Some of the latest movement in this area is potentially extending the reimbursement up to 2029. I think people do see value in that. Patients see a lot of value in that. Not being stuck in a hospital for something that's low, complex, low complexity, but actually being moved out to have high level care at home with community paramedics, IVs at home, home nurses, and so forth. So those are big areas. I mean, we can't go through this podcast without mentioning AI. I think a lot of the AI solutions that I've seen so far are really improving operational efficiency rather than necessarily reaching out to the patient and providing care. But at least right now, that's kind of how the industry is. But you know, for the most part, there are ways that it could actually make health systems more efficient, which can reduce costs, which can, you know, get a return on investment in different ways, rather than just direct revenue capture, so lots out there.
[00:14:52] Speaker A: I'm very excited.
[00:14:53] Speaker B: I love this job and, and I think that there's a big, big opportunity in virtual care in the future.
[00:14:59] Speaker E: Certainly AI is all the rage right now, and I would love to check in with you in a, in a year or two to see the roadmap that you believe AI and virtual care will be on. Any last thoughts, comments that you wanted to make?
[00:15:13] Speaker B: No.
[00:15:14] Speaker A: I mean, I think you hit it on the nose. It's a quickly evolving industry and I'd.
[00:15:17] Speaker B: Be happy to come back and sort of chat, talk about where we are, what we've learned, what the landscape looks like for AI for other virtual care services. We're doing a lot of creative things over here and it's definitely an exciting area. So I really appreciate the time and to talk to you.
[00:15:34] Speaker E: Yeah. And thank you for taking it with me. And others within the healthcare industry get a little glimmer of what Michigan Medicine and the University of Michigan Medical Group is doing on the virtual care front, and thank you for your time.
