EP33: A Dose of Virtual First Health Care
Kate Brown, the leader of Mercer’s Center for Health Innovation, delivers an outlook and overview of virtual first care, its growth, and the diverse array of telehealth and digital solutions entering the market. In the discussion with host Dr. Nina Birnbaum, medical director for Innovation Acceleration at Blue Shield of California, Kate details the unprecedented growth of virtual first care, highlighting how it might evolve in a post-pandemic world, and what employers can do to streamline the wave of telehealth and digital solutions. After listening, visit this link to learn more about Mercer’s Center for Health Innovation.
Host Dr. Nina Birnbaum, Medical Director, Innovation Acceleration at Blue Shield of California: Hi, everyone. Thanks for tuning into another episode of a Healthy Dose of Dialogue podcast. I'm your host today. I'm Nina Birnbaum, and I'm a family physician and the medical director for Innovation Acceleration at Blue Shield of California. My guest today is Kate Brown. Kate is a partner and the health innovation leader at Mercer. Her team, the Center for Health Innovation, is dedicated to identifying and creating solutions that make employer-sponsored benefits more effective and affordable. She and her team are investigating the latest and greatest technologies and innovations in health to drive better care. In this episode, we'll hear from Kate about how she's working to advance healthcare, particularly through leveraging virtual care. Kate, thank you so much for joining me.
Guest Kate Brown, Health Innovation Leader at Mercer: Thanks for having me, Nina. It's a pleasure to be here.
Dr. Nina Birnbaum: So, I'd love for you to tell our listeners a little bit about your background and how you moved into your role at the Center for Health Innovation. I was particularly really interested to hear that you started out wanting to be a soccer coach, and I'm wondering how you think that led or helped you to be successful in healthcare?
Kate Brown: Yeah, I mean, isn't it totally obvious, like if you want to be a college soccer coach, obviously you can do healthcare innovation. I started fresh out of college working for Apple, and I did some work in operations and logistics for them. And then I had a quarter-life crisis, and I went back, and I got a master's degree in kinesiology because, as a recovering college soccer player, I thought for sure that I would want to continue living that dream and go be a college soccer coach.
And I tried it for a semester or two and realized I really did not want to be a college soccer coach, so I needed to figure out some way to use this master's degree in kinesiology while also figuring out how to make money, right? So, I ended up landing at Mercer in the total health management consulting practice, which is really where all of our expertise around employer-sponsored well-being programs sits.
So, it was a really nice place for me to flex some of my knowledge around health and wellbeing, health education, health behavior, all that good stuff I focused my masters on, but also do so in a way, in a pretty cool and interesting professional environment. Then I ended up being tapped on the shoulder to do the innovation work, and I think in part because my resume said Apple.
So, they were like, yeah, you got it. Come on over! But in all seriousness, I do have, I think, a skill set for looking at things a little bit differently that was kind of ingrained at Apple, and it's served me pretty well in this healthcare innovation role that I lead at Mercer.
Dr. Nina Birnbaum: That actually makes sense, and I think bringing that varied background really does make you more able to think about innovation. One of the things I love that you've said is that your team is comfortable being uncomfortable, and I think that's another core capability to innovation. What's making you all uncomfortable these days?
Kate Brown: Well, yeah, so getting comfortable, being uncomfortable is definitely central to our philosophy within CHI. I think if you want to solve some of the hardest problems within, especially those within healthcare, you've got to be able to think differently and suspend disbelief. Psychologically, I think that it can be really uncomfortable to do so. But some of the things that are frankly making me uncomfortable right now within healthcare, probably the first one, is regression to pre-COVID behaviors with respect to delivery channels. So, every month, the fair health data comes out and we see the utilization of telehealth kind of ticking, ticking downward.
So, I'm kind of worried that we're going to miss the opportunity to capitalize on the positive change that Covid forced upon the industry with respect to thinking creatively about how you can efficiently deliver care virtually.
Dr. Nina Birnbaum: That's a really interesting area. It's, it's one I'm really passionate about as a family doctor. I've actually learned to deliver care virtually during the pandemic, which was a total thrill to, learn that new skill. It made perfect sense, and then we're really hard at work thinking about virtual care at Blue Shield and working on developing a virtual first health plan here. So, people talk about virtual care, but then also virtual first care. And I'm wondering, do you think that when we think about virtual care, are we talking about a model that's going to incentivize that's going to keep people moving in that positive direction instead of regressing back?
Kate Brown: I do think that the conversation around virtual care holistically will hopefully keep it top of mind and keep people thinking about the potential opportunities that exist within the field. I do acknowledge that there's a lot of confusion around the terminology for it. Yeah. You got virtual care, you got virtual first care, you got virtual health plans, you got telehealth, you got telemed, and so, I don't know who's going to be kind of the convening body that puts a stake in the ground and says, this is what we're going to call it.
But I do think that that's something that we've got to figure out. I personally just refer to it all as virtual care, and I don't know about you, Nina, but I think that if we do it right over the next five or 10 years, I think that virtual care just becomes care. It's just kind of become really central to the delivery model, and I hope that we kind of stop thinking of it as some kind of separate entity unto itself.
Dr. Nina Birnbaum: Right. I do sometimes think, like when we're looking back, we project ourselvesten0 years into the future, and we're looking back on ourselves now, like, what are we going to be face-palming ourselves that we just missed? Like where do you think we are now in terms of the adoption of care, like on a curve? What do you think our future selves would say to us if they looked back on us about where we are?
Kate Brown: I really think we'll look back and say, why didn't we do this sooner? And because I think that that speed of innovation is something that is probably not fast enough within healthcare. And again, like not to overuse sort of the learnings from Covid, but things changed so quickly, and people adapted so quickly during Covid. We demonstrated just an incredible agility as a human population, but within healthcare specifically, there was so much change so quickly, and it was amazing to see. Yeah. And so, I hope that we can keep some of that speed. I think we have dropped off a little bit, but that's something that 10 years in the future, I suspect we'll look back and say like, oh, we, we really should have pushed a little bit harder and gotten here sooner.
Dr. Nina Birnbaum: Who do you think we have to convince, or what's the next step that we have to take to move forward?
Kate Brown: I think there are a lot of steps that have to be taken. You brought up your personal experience of learning how to deliver care virtually from the provider side, I think that that's a big area that needs focus. Not to say that providers aren't willing or aren't already sort of moving and learning in that direction, but I think that needs to continue because it is a behavior change for providers. So, I think that's one area of focus. I think from the consumer perspective, consumers learned during covid how to engage with these channels, and in some cases, they started to revert back to brick-and-mortar care settings.
But I think continuing to promote to consumers when it's appropriate to use virtual channels, so ongoing consumer education, I think, is really important. And I represent Mercer, and we consult to employers about their benefit programs and that's a huge area of access for many people. And so, I think employers play a role in giving access to those virtual programs and providing that education to their people. Again, about what's an appropriate time to use virtual care? What resources are available to you and how do you appropriately engage? So, I think all of that has to happen. And then there's like this whole big thing about reimbursement that is just a whole different issue of, , how do, how do we appropriately pay for these visits that happen virtually and can you actually have a successful, sustainable future of virtual care in a fee-for-service environment? That's a big question as well.
Dr. Nina Birnbaum: Yeah, that sort of touches on the bigger issues of this is just care and can you actually have sustainable care at all for service environment. You touched on something though that I'm really curious about and it's something that from being a practicing physician and even a physician leader in the healthcare system to shifting to the payer side, Seeing the perspective of the employer is something that I just never thought about much as a practicing physician. And one of the things we're learning about employers is they're just barraged by point virtual point solutions, and they're trying scrambling to provide these benefits to their employees because their employees want them. They're, they're saying, why can't we have this? Why can't we have virtual behavioral health and, , virtual diabetes care and all these kind of things.
But then they turn into a a universe of point solutions, which is really discoordinated, I wonder what, what's going on in that area that you're looking at in terms of innovation? How can we make it so that employers can bring these packages forward to their employees in a better way?
Kate Brown: Yeah, you're absolutely right that is a pretty common experience for employers of all sizes. Frankly, there's, there's pressure from vendors who are creating these solutions. There's pressure from their people. Demanding these solutions, and then you've got the benefits team sitting in the middle going like, okay, I want to match these up, but I also have to operate within the financial reality of providing our benefits and can we actually provide these services?
So, Here's, here's what I think could happen today. It is very complex, it's very fragmented, and we see a lot of startups, a lot of point solutions. They followed what's called a land and expand model, right? So, they go into an employer and they say, we are experts in diabetes management. And the employer says, great, we believe you.
Let's contract, and then that diabetes management vendor says, oh, we acquired this other company that does behavioral health, so now trust us for behavioral health and now trust us for cardiovascular support and blah, blah, blah, blah, blah. . So that land and expand strategy has been pretty common in the market, and I think that's one pathway that employers can follow is from an administrative perspective, it's maybe easier for them to have those services with one vendor in one bucket. And arguably the employee or patient experience is probably better because there's kind of one channel through which they can get support for multiple conditions. So that's one of the things that I see in the market, but actually I think probably longer term and this is more interesting to me personally, because I just don't know what's going to happen.
But I'm really curious. I think especially with respect to the growth of virtual care, there's a bunch of different possible conveners, so like, Groups that are going to bring all of this together and package it up to an actual user experience that makes sense. And people know where to go when they need care. So, it could be point solutions, it could be kind of the digital navigator or digital, a aggregator space. There are also some models emerging that are built around virtual primary care. and they're kind of, again, that land and expand model. They're putting a stake in there, but they want to maybe expand into a brick-and-mortar network and plug in condition specific solutions.
But really interesting to me, and, and I think we're starting to see this is like, what are the health plans doing? And are they going to try and be conveners? And then. Also, what about local health systems that actually have the docs? Are they going to try and put in place sort of virtual care infrastructure and own more of that patient experience? So, all of those different kind of conveners are, are really interesting to me. That's what I'm watching. And I think depending on which convener seems to win the market, it could really change what options are available to the employers and then what options are therefore available to the employee.
Dr. Nina Birnbaum: I think there's a frustration among employers of, we've asked and asked for you to provide efficient care, high quality care at a reasonable cost, and, and sometimes employers feel like we have to take this door, our hands, and there we have the point solutions. What specific things do you think employers are looking to from health plans and providers working together to, to make it easier for employers?
Kate Brown: I think embedded within the lead up to that question, is maybe an assumption that health systems are pretty well positioned because they do own so much of the care delivery today. And so, I think they have a huge opportunity to potentially claim that convener space from a virtual care perspective.
And I think in particular, and I haven't seen this in the market, so this is totally like Kate's wearing her imaginary cap today and looking out 10 years in the future. Right. But, if a health system decided that they wanted to partner directly with some of those point solutions and embed them into the clinical workflow for their doctors, and say, okay, if you're treating a patient, , and there's a referral into this diabetes management solution for ongoing lifestyle coaching and monitoring, or whatever condition specific thing it might be.
I think if a health system served as that convener and had those very specific sorts of ongoing maintenance type of care plans built within their services, they could take that package and go directly to an employer and say, "Hey, you've got a huge concentration of people in this market. We've done all the work to convene it for you, and this is what you're going to go get if you work directly with us." So, I don't know. Again, this is like imaginary—probably a decade in the future — but I think it's a big opportunity for health systems to actually do that work that employers have been asking for, I don't know, decades.
Dr. Nina Birnbaum: Yeah. I think that's really, really thoughtful and I think one of the things that limits the ability to do that is data flow, that health systems don't actually have all the data for the patients they take care of that payers don't actually have a way necessarily to easily aggregate and share back out that data with the responsible healthcare systems. So what lets you have around, like in data integration as relates to virtual care or as relates to the ability to knit all of these solutions together?
Kate Brown: Yeah, I agree. It's a huge limiting factor, I think for every part of the industry, including for employers, right? They're constantly trying to get a better sense of what's happening with their people, and it's very difficult to come by that data. I don't know how attainable this is, but I do think that it has interesting potential. So, the way that the infrastructure has been built to date, at least my rudimentary understanding, is you've got different entities with different data structures, different electronic medical records, different systems of record, whatever it might be, and they're all living in different places. They're all coded differently. There's not already, like a ton of interoperability. Obviously, there's been some pushes to, to go towards standard formatting and to make records more interoperable to require data sharing, right, all of that is kind of happening, coming, like, yeah, some progress has been made, but not a ton.
We're like inching that way but the fundamental issue of like different infrastructure still remains. And I think it would. Very interesting and very impactful if rather than shifting data ownership from amongst those different silos and trying to kind of mash them all together into one data management system, if instead we flipped it on its head and really made individuals, the owners of their own complete personal health record. Yeah. And let's get really crazy and put it on a blockchain and allow an individual to provision access to that blockchain. And then revoke access when they're no longer seeking care or when they're no longer employed with a specific entity.
I think that has huge disruptive potential. And it's going to be so hard, if not impossible to get there. But that notion of really flipping the data ownership from each individual entity within the system to it being a patient-by-patient ownership, that then gets provisioned out as needed. I think that's like, that to me is super exciting. I don't, I don't know how to get there, but that's what I would love to see.
Dr. Nina Birnbaum: That makes a ton of sense to me. And I, , it's so funny, as a doctor, I never thought I would get goosebumps about data exchange, , but like when you, when you see people who, who's literally their health and safety suffer because of the inability to know what happens somewhere else, and that they are responsible for trying to translate what one doctor said to another doctor. It just breaks your heart and it, you, you just feel like, oh, we have to be able to fix this. We, , we, we should, we have the technology, , so yeah. I'm, I'm then thrilled to, to hear that's something that you're focusing on. , we, we, we spent this time talking about virtual care, but we didn't really land on why, like, why does that matter? What, do you have a sense of what problems in the healthcare system that we're facing today that virtual care actually offers a solution to?
Kate Brown: Yeah, so I love this question because like you said, like there's so much energy and attention on virtual care right now, and we see it sometimes within the clients that we work with.
They're like, we want to do virtual care. Okay, that's great, but why? Like what? What strategy are you trying to accomplish through virtual care? And I think that. That is the question. Because virtual care is not a strategy unto itself, period. It is a way to achieve certain strategic aims that you might have within your employee benefit program.
And it can achieve certain strategic aims. So, for example, access is a huge area of of focus for many of our clients. And obviously access looks different depending on which employer organization we're talking about, but that is a pretty common strategic goal. Employers want to provide access for their people to access healthcare. Virtual care can certainly address that. So, if you have certain rural populations, if you've got populations that don't traditionally engage with the health system, there's arguments to be made that virtual care can help you with that strategic goal. Diversity, equity, and inclusion is another thread that a lot of employers have within their strategic goals.
So again, if virtual care can help to connect patients with providers that look like them and that they want to engage with, that can very nicely align to a diversity, equity, and inclusion goal. Certainly, cost savings is something that I would. Pretty much every employer is interested in. And again, I think the argument can be made that when used appropriately, virtual care can deliver cost efficiencies. So again, all that to say like virtual care is not a strategy. It is a tool to help employers achieve their strategic goals.
Dr. Nina Birnbaum: That's great. I, sometimes I do think we get so enamored with the, with the tool that we forget what we're using it for.
And so it's always important, I think, to take that step back and really think about it. Well, are there any other big points you'd like us to, to hit or talk about things your team is really focusing on and excited about, or worried about, about virtual care before we wrap up?
Kate Brown: I think one other thing, Nina, and I'm curious to maybe turn this back around on you, but , we're worried about the inherent supply issue, if you will, of healthcare providers.
Yeah. Right. So we don't have enough doctors, we don't have enough nurses like. Doesn't matter if you have a great virtual care solution, if you don't have anybody to man the other side of it. So what do you think? What are, what are we going to do about that?
Dr. Nina Birnbaum: Oh boy, that is something that literally does keep me up at night. And, and thinking, what are we going to do about it? As someone who's led physicians and nurse practitioners and PAs, I've actually thought a lot about it and really gotten my hands in there and tried to do things about it. And maybe this is going to sound unorthodox, but I actually think the most important thing we can do is help young clinicians and people interested in being clinicians. So, high school and college level people to understand the meaning behind what it means to be a clinician who takes care of people. I think there's been a lot of talk about burnout and about like workload reduction and, oh, people are going to want to be virtual care providers because they can work from home and it's more pleasant for them.
They can spend more time with their family and those things are true. I don't want to like to downplay them, but I think one of the. Under emphasizing is how meaningful of a career it is to take care of people who are, who need you, who are looking to you for advice when they're, especially when they're scared or facing a really important decision in their life.
And the more we can tell that story and bring in people who connect to being a clinician for that reason, I think we're going to have a stronger workforce in that way. So, if I were queen of the world and got to decide how to attract and retain healthcare providers, that's what I would focus on. I didn't know “Queen of the World” was hiring? Where do I submit? I keep looking at LinkedIn for the Post, but I can't find it.
Kate Brown: Yeah, that's, that's interesting because I think there's some research that shows. Members of Generation Z in particular are really interested in purpose driven work. Yes. And so maybe that inspires just a little spark of hope that there is a community out there of future clinicians that could be motivated to join the field.
Dr. Nina Birnbaum: That's what I'm hoping. And, and I think that the tie back to virtual care, interestingly, it, it, it, I always think of it as like a back to the future approach to things that the care that we all aspire to is that, kind of Marcus Wellbe, like the doctor who carries their little black bag around and like knows everybody in the community and like, makes house calls and sees people at the high school sideline of the soccer game.
But we, we, we've moved so far away from that because of workload and cost and pressures of life. The virtual tools and people who are comfortable using them, these sort of digital natives, these are going to be able to go back to that kind of deeply personalized relationship-based care using a tool that just makes it easier for people to connect. And that's where I feel like what gets me really excited when we talk about the innovations coming from virtual care.
Kate Brown: I love that vision. Yeah. The return of the house call been saying that we made it for virtual house call.
Dr. Nina Birnbaum: Yeah. Yeah. It's very real.
Kate Brown: Yeah. Well, okay. Well, I ca it's been just so wonderful to talk to you today.
Dr. Nina Birnbaum: I'm sure there's so much more that people could learn in spending an extra hour with you. I want to end with some fun rapid-fire questions. So, get comfortable in your seat. Ready? Right. First one letter or email?
Kate Brown: Email for convenience. Letter for meaning.
Dr. Nina Birnbaum: Okay. How about this? Doctors or robots?
Kate Brown: Doctors. But I feel like I have to say that because you're a doctor.
Dr. Nina Birnbaum: Nope you can say robots? I've been saying bring on the robots as soon as they can do better than us. We'll be able to take a good vacation. All right. How about this one? Metaverse or IRL (In Real Life)?
Kate Brown: Oh man, IRL for sure. There was like something during the pandemic that was like, we're doing team building forever in the metaverse. And I was like, no, you can't do that
Dr. Nina Birnbaum: I'm with you there. There's nothing like sitting down and here's your last one, dragons or unicorns?
Kate Brown: Dragons, breathe, fire and fly, which unicorns can fly, but no dragons for sure.
Dr. Nina Birnbaum: Okay, awesome. Well, Kate, it's been so much fun to talk to you today, really. And thank you to all of our listeners for taking time to listen. I hope people really walked away with him. Inspiration from Kate and her team on the world of possibilities for virtual first healthcare and as well as just the possibilities for the healthcare system that it is not all dire, and there's a lot of optimism to be had. For more information about the health, the Center for Health Innovation, you can visit www.mercer.us, and please join us next time as we continue to bring you a healthy dose of insight and perspectives from conversations with leaders who are transforming healthcare. We would love to hear your feedback. You can share your comments and let us know your thoughts by writing a review on Apple Podcasts, and you can also join the conversation on LinkedIn or twitter at dose of dialogue or visit our website@www.ofdialogue.com. Thank you all for listening.
Join the dialogue
