EPISODE 04
On today’s episode Jenny has invited the perfect guest to discuss the past few years of telehealth and automation development, along with looking at the current and future evolution of these technologies. Lauren Howard, Telehealth Expert, Digital Health Strategist, Startup Operations and Success Executive, and CEO of ElleTwo joins the show.
Both healthcare and non-healthcare companies were shifting slowly to digital and automated/tele-solutions for their customers, but when Covid arrived, the timeframe went from years to days as they scrambled to adjust. Now that there is some time to take a breath and reflect, these same organizations are now working to determine what is really needed and most effective. In the health sector, they are looking to put the ‘human back in healthcare.’ Lauren points out that now is the time to find the balance. The tools are there, but the tools without engagement with clinicians, support staff and providers leave patients lacking full quality care and follow up. Telehealth can be a supplement to care, and can provide more access, but is not a replacement for human-centered care.
The discussion goes more in depth on the flood of startup telehealth companies and how their initial success soon flamed out and how that impacts patient care. They discuss the appropriateness and limitations of telehealth in places like nursing homes, and inpatient vs. outpatient needs among all providers. Engagement, privacy, integration, training and turnover, the list is long when it comes to challenges that face health systems over the coming years. Lauren ends the show with invaluable advice on how organizations can build a groundwork to navigate these hurdles, along with her take on what is coming next!
Watch their discussion below or listen to the podcast, We Are Marketing Happy – a healthcare marketing podcast.
Other Links and Resources
Connect with Lauren on LinkedIn: https://www.linkedin.com/in/elletwo
Connect with Jenny on LinkedIn: https://www.linkedin.com/in/jennybristow/
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Full Transcript:
JENNY: [00:00:00] Hi, I’m Jenny Bristow and I’m the CEO and founder of Hedy & Hopp, a healthcare marketing agency based in the Midwest. We started the, We Are, Marketing Happy podcast because of our passion for improving patients’ access to care. And understanding the innovations and shifts in the healthcare industry are key to making that happen.
Please follow share, and let us know what topics you’d like for us to cover next. Enjoy.
Hi, welcome to the We Are, Marketing Happy podcast, a healthcare marketing podcast where we talk about the technology and innovations that make patients lives easier.
Today, I’m super excited to be joined by Lauren Howard. She is a expert in the digital health space and it’s a consulting company as well as the company ElleTwo.
We’re excited to have you today.
LAUREN: Thanks so much for having me. I’m so excited.
JENNY: So let’s jump [00:01:00] directly into it because we have a lot to discss. My marketing agency focuses a lot on patient acquisition and the consumer experience, but I love how what you do on the consulting side is much more on the operational and clinical side of digital health.
So let’s set the stage around what you have seen happening over the last couple of years, from your perspective on the digital health telehealth scene.
LAUREN: Yeah, absolutely. So I think it’s been a pretty interesting evolution and I think in 2019 we had customers that would tell us it was gonna take them years to implement telehealth, which was the timeline then. There just, there was no offense of urgency for it. And if there was, it was kind of a one-off scenario or, not typical scenario. Six to 12 months for implementation was really standard. Then obviously once the pandemic happened, people who told us the first week of March, 2020, that it would be a year, all of a sudden we’re launching in 48 hours. Obviously that made it very clear that this was all bureaucratic red tape forcing the organizational [00:02:00] timeline, which is the reality of working with large healthcare systems. And I get that.
As we progressed over the next couple of years, I think obviously we saw this huge push toward digital health and to getting things as automated as possible, which was happening in the marketplace before, but nobody really took it seriously. It was very much piecemeal things that they were doing. So we had this heavy focus first on like get whatever solution you possibly can because we have to fix this immediately. Then to, you know, six months or a year into the pandemic, all right. Let’s find the right solution, as opposed to whatever was immediately available.
And so there was a shift there, and it led a lot of companies, not necessarily healthcare organizations because I feel like healthcare organizations had a different perspective on it. But it led a lot of companies to really, really push towards super automated non-human oriented products. We were building things that could completely automate your check-in process or completely automate your patient acquisition process or all of these things that were supposed to [00:03:00] be AI driven and super automated.
And some things like that on the clinical side as well. Some AI driven tools. On the clinical side, and what I’m seeing more and more now, and what’s coming to me more in my own company, is people who are coming to me and saying, we want to put the human back in healthcare. We want to get the clinicians back in care management, rather than thinking that we’re gonna have an app do it now.
Is it better when you have good tools? Absolutely. But good tools don’t do much if you don’t have a clinical infrastructure. Yep. And so we’re moving, I’m seeing a shift back toward that. It is not as, obviously as, as quick and hapless as the initial shift to telehealth was in March, 2020, which is probably a good thing, but I think we have tried really hard for two years to take the people out of things, which people who were in healthcare knew was never going to work. We could fix things. We could improve things. Well, you can’t take the clinicians and you can’t take the support step out of healthcare and think patients are going [00:04:00] to actually, you know, get the care that they need or follow throughout things.
I think that’s really what we’re seeing now. Those are the kinds of clients that are coming to us and saying okay, we’ve got the app, but now we need to figure out how to actually get providers engaged with it. We need to figure out how to get providers back into the ecosystem.
We need disenfranchised providers who have been burned out and overwhelmed by the last several years. And the, the conversation is shifting. A little bit, you know, toward this much more human centered, whether human centered is the patient or human centered is actually providing real care management with humans, as opposed to app centered care management, which I think people have been pushing toward in the last couple of years.
JENNY: Are you seeing more focus, interest, and success on synchronous or asynchronous solutions right now?
LAUREN: That’s a really good question. From a telehealth perspective, It really, really depends on the [00:05:00] complexity of the care that needs to be delivered. I would not be surprised if the influx of asynchronous solutions really ramps downward over the next couple of years, because it’s just not the same as far as care delivery is concerned. And I don’t see as many companies trying to get into what is now a flooded marketplace and provide totally asynchronous care. There are people who are doing it. They’re doing it pretty well. They have a care model. I’d be very surprised if we see a whole lot more of that.
But I do have a lot of people coming to me saying, we need to figure out how to reintroduce synchronous care and obviously distance care that that for the most part, is a supplement to the in person care that they’re getting. There aren’t a lot of worlds where telehealth is enough care for somebody who isn’t a healthy 30 year old. No telehealth expert is going to tell you that telehealth is the answer for everything – it’s not.
Yeah. [00:06:00] It is a way to increase care. It is a way to reduce barriers to care, but it certainly does not actually undo the need for care in a lot of other situations. I, I think we’re gonna see a switch toward more synchronous care and I think a lot of that is going to be driven by whatever Medicare chooses to make official in whatever their next ruling is.
If they will actually cover synchronized telehealth for most use cases and CMS is behind it. Other payers will follow suit. It will be easier to get people who are over the age of 50 using telehealth. Yep. And we can do a better, we can do better education campaigns for those groups on how to make telehealth work.
Those groups are really the groups where you need the heavy clinical influence.
JENNY: So, yeah, let’s talk a little bit about if you’re thinking about telehealth specifically as an industry, there have been so many specific use cases or specific problem solving telehealth [00:07:00] companies, and many have become unicorns.
And then, they have begun to lay off lots of people in the last six months. And then there’s also hospital systems and larger healthcare groups that are actually implementing telehealth as part of their practices, an extension of the clinician care. What similarities or differences do you see between these groups as far as the benefit to the patient?
LAUREN: There is a whole nother rant in me on VC funded care and those care models and people building healthcare companies with the idea that they would just go back and fundraise rather than having runway. I can rant about that forever. Let me just say there was never a healthcare company or a telehealth company worth 4 billion.
Not at least a new one. Let’s be honest. So, there are a lot of things that have happened in the telehealth space in the last couple of years that absolutely built a business [00:08:00] model model on a short term emergency. And yes, COVID’s gonna be around for a long time, but at some point we were gonna get to business as usual and people were not going to be desperate to get care on their phones.
And then also there’s this other competitive aspect of it. Where if you take a large investment from somebody nobody’s giving you money that they don’t want back. And so it creates this intense pressure to find care models that will deliver, and that means care models that other people aren’t doing for some reason.
And maybe it’s compliance, maybe it’s prescribing rules, maybe it’s just not ethical. So I think that’s why we have seen this huge combination of obviously the influx that it created with the pandemic, but also this really huge investment in flooding the market with money that had to be paid. You have to hit revenue targets to pay those things back. And if you have an inflated valuation, you have inflated revenue targets. [00:09:00]
JENNY: And then whenever you begin expanding your services and focus outside of your core value proposition in order to meet those revenue targets, then you’re not doing what’s best on behalf of the patient.
LAUREN: Yeah, exactly.
And so, it’s not surprising to me that we have seen so many expansions and contractions and not to say that everybody made bad decisions or revenue driven decisions. I just. You know, it was a bunch of eager entrepreneurs who were building companies who easily got capital the first time and assumed it would be easy the second time.
And so they weren’t working with runway. They weren’t focused on the things that make it a healthy company. I saw a LinkedIn post yesterday that basically said we shouldn’t be celebrating capital raises because you have to pay that money back. Like, if you have a capital raise, it means your company’s not profitable.
I responded to it with like, can we be best friends? I think that’s the point, is it great that somebody believes in you enough to invest in the company? Yeah, but like, [00:10:00] let’s talk about that for what it is that’s taking on debt. With an idea that you’ll be able to pay it out at a huge multiple.
And how do you reach that huge multiple on the health system side of things. They struggle, but very differently, you know, you probably see how systems with six or eight different telehealth platforms because people think telehealth is telehealth. When the reality is ambulatory telehealth or outpatient telehealt or inpatient telehealth or residential telehealth or even telehealth that is geared toward geriatric patients. Or, telehealth that it’s geared toward young people, mental health, all of those have different needs. They have different workflows, they have different implementations. I’ve frequently seen telehealth being implemented in nursing homes, which is fine. Obviously if we can get more care or more availability of care in nursing homes, great. But you can’t do a patient based connection in a nursing home, because [00:11:00] who’s going to catch the link. If you have a patient that has severe dementia, they’re certainly not going to be operating a mobile phone or an iPad to get on the visit.
And then you have high turnover, sometimes the staff doesn’t know how to use the system and you don’t even necessarily know what patients are available to be seen that day because they change. So you need something. That’s basically like an open ended video connection that can be, that can go from room and that doesn’t require tools for charting.
It doesn’t require patient IDs. It doesn’t require names and dates of birth. It requires secure links and you want telehealth connection to always to be secure, but we don’t need to credential in for that. And when you add these security features that make telemedicine so secure that it’s safe to use when the patient’s at home and the provider’s at the office or wherever you actually preclude nursing home patients from using that system, because it’s, there’s no way to really easily build [00:12:00] that structure.
And so I think that’s really the challenge in the health system perspective is a lot of times they go into procurement thinking we’re gonna get in the one platform that’s gonna serve all of our patients. And if you don’t have somebody who truly understands kind of the dynamism of telehealth and health in the same way that a psychiatrist exam room is different than a general practitioner exam room.
The telehealth platform has to represent those differences. It can get really muddy. And so, there’s a lot of pressure within the health system environment to integrate with existing systems that nobody’s using. You know, the, the uptake on some of these patient portals and these patient engagement systems is really low.
But then to use telehealth, they often kind of force patients to get information through those systems that they are resistant to using to begin with. Whereas if you were to just set it up so that somebody within the office can send out a link patient can click the link and get in without having to [00:13:00] get all of their notifications through whatever this primary system is, you’re, you’re reducing friction. You’re not increasing it. So I think that’s really the challenge on the health system side. And we’re gonna probably be seeing that for a while.
JENNY: Interesting. So what advice would you give to a health system? If they were looking at moving into procurement to be able to begin identifying telehealth systems for their different lines of business or service lines, what advice would you give them to be able to properly understand the needs?
LAUREN: Don’t have your C-suite or your procurement VPs making the decisions? Not that they should make the final decision. What I used to see all the time was the high level people make the decision without consulting the people who are actually using the system. And then they would never launch because the people who would use the system would go, there’s no way this is gonna work in our environment.
This doesn’t replicate anything that we’re doing right now. And it’s way too cumbersome, or we we’re missing information, or we have to make phone calls in advance because the [00:14:00] telehealth system doesn’t have enough information in it. And so first thing is really, really look. Who’s launching telehealth.
And when? If you’re doing a phased launch, that’s great, but we should be talking to everybody in those phases to make sure you are getting as new system as soon as possible. And also recognize when you have somebody that has a telehealth need that absolutely does not align with anybody else’s and maybe it makes sense to do a smaller contract for a smaller group than to try to force a square tag into a round hole with another system.
I would really advise, find somebody who knows telehealth in all its iterations. So they can say, this is not system I would use. I think it’s gonna be cumbersome. Everybody, but dermatology will love the system. Dermatology needs a system that’s gonna give them access to high quality cameras.
So they can really look at lesions and abrasions and things like that. Yeah. And that’s just an example put out in there, but that’s the kind of stuff that people don’t think about. And that’s what usually leads to failures [00:15:00] to launch.
Jenny: So what do you see is coming up next with innovations or movement in this industry?
Do you think are going to either change the landscape or allow for better patient adoption over the next couple of years?
LAUREN: Yeah. I think two things are gonna happen. And I think we’re already seeing a little bit, actually, we’re seeing a little bit of both already, but first thing is we are gonna get away from a bunch of multipurpose telehealth platform.
I don’t think we’re gonna have 10, 15, 20 major players for general practice telehealth or multi-specialty telehealth. I don’t think we’re gonna see a lot more investment in that or new companies. And I think we might actually see contraction. I think companies are gonna start absorbing each other.
This is entirely my hypothesis, not proven by anything entirely. The other side of it is, I think what we are gonna [00:16:00] see that new innovative companies that are highly successful are very much niche based. So they’re gonna find their patient population. It may be a small one, but a small one that has historical trouble getting care.
And so they’re going to be willing to invest in their own care because it’s available to them through a ervice.And you will see really, really successful niche environments like programs specifically for diabetics programs, specifically for people with autoimmune disease. Maybe even beyond that like program specifically for people with rheumatoid arthritis or lupus or something like that.
So that care is becoming very much centralized to what the patient actually needs. And you can go find your environment because overall we’re seeing people moving toward. Communities that they’re comfortable in and this kind of global idea that it’s okay to be whoever you are, find the people that support that.
And I think healthcare’s gonna move in that direction as [00:17:00] well, which is you don’t need to go to a doctor who specializes in every gastroenterological illness. You can go to this doctor who specializes in and who speaks your language. And so exactly, I think we’re really gonna see pushes toward that kind of very niche based care from a digital perspective that supplements the in person care that you may be getting from your general practitioner.
JENNY: Well, Lauren, thank you so much for being on today. I’m gonna link to your LinkedIn profile so folks can reach out to you. That’d be great. But how else, how else can folks reach out to you?
LAUREN: Yeah, so my LinkedIn, I’m active on there all the time. My email address is on my website, as well as my LinkedIn.
You can shoot me a LinkedIn message. My assistant is also available on LinkedIn and link through my page and she is awesome way easier to get than me. If you need anything from me, reach out to her and one of us will be available.
JENNY: Awesome. Well, thank you. I look forward to [00:18:00] following along and seeing which of your predictions, if not all of them, come true.
LAUREN: Thank you so much for having me on. Take care.
