Gregg Masters 00:07
PopHealth Week is brought to you by Health Innovation Media. We bring your brand narrative alive by original or value-added digitally curated thought leadership content for omnichannel distribution and engagement. Connect with us at www.popupstudio.productions. Welcome everyone. I’m Gregg Masters, Managing Director of Health Innovation Media and the producer co-host of PopHealth Week. Joining me in the virtual studio is my partner, colleague and lead co-host, Fred Goldstein, president of Accountable Health LLC. On today’s show, making an encore appearance is Douglas Goldstein, aka efuturist, a digital health leader, executive, and speaker on performance improvement with human ingenuity and technology that improves health and life. So Fred, with that introduction over to you help us catch up with Doug and learn what’s on his radar these days.
Fred Goldstein 01:09
Thanks so much, Greg. And Doug, welcome to pop Health Week.
Douglas Goldstein 01:12
Hey, it’s great to be here talking about Real-Time Healthcare and virtual hospital at home.
Fred Goldstein 01:17
Yes, fantastic to get you one. And before we start, I should point out, as we have on numerous occasions, we are not as far as we know, related, but it’s always great to hang out with you and hit the times the conferences, etc. So why don’t we talk a little about what you’re doing, Doug, and this whole concept of Real-Time Healthcare, etc. Well,
Douglas Goldstein 01:35
I’ve joined a really innovative organization called Salt Flats and Salt Flats has innovation house and incubator that’s accelerating the growth of companies across both healthcare and other industries. And it’s actually in Oprah Winfrey’s former studio that’s been renovated into a center to create and support the next generation of technologies and companies that are creating solutions that make a difference in people’s lives. So it’s great to be here. And my focus is data. But more importantly, we are data. We’re data generators. So we’re living in the digital AI, data world. And the focus is how do we help people help themselves to be the better you and how do we help them address conditions anywhere, including their home, and when they absolutely have to be in the hospital or in a clinic?
Fred Goldstein 02:29
You know, there’s been this push to bring in data and obviously, whether it’s wearables, etc, there’s also been this issue on the side of those receiving the data. Is the data any good? What do I do with it? How do I manage all of it? So where are we with that?
Douglas Goldstein 02:44
Well, there’s clearly a data explosion, right, the amount of data is growing exponentially. As we connect more and more things, we’re all those devices are generating data. So the number of steps I take are being tracked by my Apple phone, you know, Apple, watch Fitbit wearables and any transaction, any conversation with Siri, Alexa, they’re all data. So all these data, data, electronic health record the data that I’m tracking on my own health and wellness, my weight data, my blood pressure, where we are data, and many organizations are struggling to really understand how to optimize data. And this whole field of what’s called digital asset management is exploding. It’s estimated to be a $10 billion-plus worldwide market, as organizations are creating more and more data, they’re accessing more and more data. And they’re trying to figure out how to run their businesses with data as one of the new essential fuels for the new economy.
Fred Goldstein 03:42
So let’s sort of unbundle this a little bit, because there’s a ton of different ways you can go with this. What are the basic things that healthcare systems or facilities or doctors should be looking at now and potentially starting with, because it seems like it’s a giant elephant and we really need to eat it one bite at a time?
Douglas Goldstein 04:03
Well, let me create two big buckets. First, let’s say medical data. And that’s data that is generated by me as a patient in interacting with some part of the medical ecosystem because whether it’s a regular check a physical, whether it’s a condition that I’m trying to be diagnosed and treated for, that’s medical data. Now, we’re all very concerned about how we reduce healthcare costs and how we improve. And and frankly, there’s many ways operationally that we can take medical data and enterprise health data both on the claim side and the health system side to improve operations and reduce costs and improve outcomes. But there’s a whole world of data that I just called health data. So the number of steps I take the day my weight, my my self-coaching or my support to achieve a weight loss goal or to change my eating habits. or whatever those health things that are determinants. So there’s this whole field of social determinants of health. And so there’s data that happens, doesn’t all that data around my steps is not in my medical record. So I think we have where we sit right now is that citizens and people are generating data from apps of daily living, the apps, they’re using their physical activity, they’re generating data, much of it is related to what could be used to improve a person’s health or a family’s health, or community’s health. And then you’ve got the medical bucket of data. So I think where we are right now, sake of kind of simplicity is two big buckets of data. And the challenge is, is that reducing healthcare costs, much of the ability to reduce healthcare costs is not in the doctor’s preview, doctors are trained, and the whole system is trained to react to conditions and treat specific conditions, diagnose and treat conditions on a reactive basis, not a proactive basis. So if I’m diabetic, and I want to try to reverse my condition, then losing weight, there’s a whole, a whole number of people are able to change their obesity status, or diabetes status or other health condition status, through better eating habits, or better-behaving patterns. So there’s that health buckets. So if we want to bend the health, the medical cost curve, there’s certainly many things that we’ve done with medical data from a health plan and health system and clinician side. But there’s also plenty of things that people can do individually within their families in their communities.
Fred Goldstein 06:45
Sure, so we’re still struggling with the data on the medical side, as I see it, you know, and ensuring one that it’s accurate, it’s getting to the various people and out of the silos that need to use it to execute on the medical and healthcare side. And then you’re talking about adding in obviously, this health data that’s out there. And it’s it’s a as you point out, it’s a huge quantity of information, and how does one then sort out and determine in this case, this information is going to be relevant. But in the other cases, we don’t need it? Who’s going to do that? I mean, where do you see that getting controlled?
Douglas Goldstein 07:20
Well, I think that there’s a movement. So ultimately, the health data right now is in my hands, as the person as a citizen who is sometimes a patient, the medical data, I can view or access parts of it by going into, you know, my medical record, and viewing it. But I don’t control that data. I’m not as you know, I’m a source of it. But I can manage the number of steps, I can increase the number of steps, I can increase my physical activity, I can reduce the amount of alcohol I drank, I can change my eating habits. And I can dress, you know, so I can address behavioral health issues through, you know, reaching out to a coach or a professional or social interactions with my friends. So there’s a whole number of steps that I can take, relative to my own personal health goals, health and well-being goals. So the question is, you know, in order to improve treatment of many, that the medical system is designed as specialist, specialists in neurology, specialists in orthopedic, specialist, so they’re really trying many, many conditions like chronic pain, for instance, that has lasted more than six months, may not be responsive to point solutions. And there are 50 million chronic pain sufferers in the United States. And our former secretary of VA David Shulkin, the ninth Secretary of Veterans Affairs, developed at VA, a VA whole health treatment program. That treatment program, at its core, has a whole-person approach supported by peers and coaches that really help people understand that to address their chronic pain, that ultimately they’re their own cult, they’re own, they’re responsible for their health. And this empowerment through a coaching model and others has proven very effective for 284,000 vets and has improved, reduced pain levels and reduced costs and achieved a number of other factors have been published by VA. So but it essentially isn’t taking an orthopedic approach or a neurological approach or just a it’s it’s a whole person approach that that really is saying is empowering the person to be their own change agent and bringing in the point solutions as appropriate by a Health Navigator. So ultimately, looking at people as a whole person is the opportunity for us to improve health status for adverse health conditions. And chronic pain is only one example. A joint replacement patient who doesn’t do their physical rehab after a joint replacement, who gains weight isn’t going to have the same outcomes as the joint replacement patient who does their physical rehab, that doesn’t gain weight and, and really understands the dynamics involved in helping your own body heal itself through physical activity?
Fred Goldstein 10:33
Absolutely. So would would the given the two cases you’ve discussed? Would it make sense then, if you’re a healthcare system, to look at this, on perhaps a disease-specific, or, you know, a surgical approach specific way to say, Okay, I’m going to be doing knee replacements, or I’m going to be managing persons with diabetes. And I believe that managing those individuals, and bringing in real time data will improve the overall outcomes and potentially reduce the cost of service versus coming at it from the other side, which is, I’m Fred Goldstein. And I’ve got all this data because I track everything. And I’m just going to flood your EMR with it. So is that is that the way to ensure that you’re getting actionable information? It for a relevant condition that will improve outcomes?
Douglas Goldstein 11:29
I think the answer is yes. And let me let me take the the joint replacement. So there is a prevalence of joint replacements, with people who have comorbidities in particular, obesity and diabetes. So in that case, the the whole person approach to a diabetic overweight, joint replacement patient should not just be the point solution of doing the joint replacement, that person should be part of a an approach, where they’re either teamed with a coach or team with a care navigator or teamed with family members, or whatever the best way is to help that person recognize and potentially reverse, you know, manage their diabetes better and reduce weight and change their requirements for medication otherwise, through this through a whole-person approach. So I think the the answer is, the medical model of fixing, you know, with specialist is absolutely important. But too many, you know, I would say today, the majority of patients are seen for a point solution. And there is no whole person approach taken to look at their entire lifestyle because the reimbursement system hasn’t been set up for that.
Fred Goldstein 12:55
Yeah, I agree wholeheartedly with the concept of care managers, or folks, I mean, you know, having done that in the past, rather successfully with a lot of different conditions, I guess the issue. So let’s let’s, let’s move beyond the care the care manager piece and get back to that Real-Time Health information. So let’s say you have someone post-surgical for knees, what, what information would you want to bring in? And and and then furthermore, how do you ensure the quality and consistency of that data?
Douglas Goldstein 13:31
Alright, so I think the the conversation begins with a coaching approach. So a coaching approach, says, doesn’t tell people what to do, but says, What are your goals? What would you like to do as coming out of this? Are you interested in changing your way to your diabetes and improving your health status? And let’s assume the person says, Yes, I’d like to lose 20 pounds, I’d like to reduce my needs for diabetic medications, and I want to have full functionality, so I can play golf again, and I can, you know, play tennis with my kids or whatever, or my grandkids or whatever the motivating factors are for that person. And that person commits, you know, says, Yeah, I have an Apple Watch. Yeah, I’ll track this. And, and so that person sets goals for weight change, or other things that are appropriate for their condition. And then they choose partners or buddies, and maybe it’s keeping their wife in the loop about their progress or keeping a spouse or a friend or, and, and through that social adherence. So I think that ultimately the person has to take responsibility for their own health, they have to set their goals, but they can choose to share that with their care team or with friends and other factors that will motivate people to change behavior. So I think I think the answer is that it’s my responsibility is the patient who wants to improve my health status, but I need support from peers or family members.
Gregg Masters 15:07
And if you’re just tuning in to PopHealth Week, our guest is Douglas Goldstein, a digital health leader, executive, and speaker on performance improvement with human ingenuity and technology that improves health and life. For more information, or to learn more about Doug’s work, go to www.efuturist.net. And do follow him on Twitter by @efuturist.
Fred Goldstein 15:32
Absolutely, absolutely. So let’s say you have a situation, and then I want to get more into this technology and, and how you sort of see that flowing in. And obviously, then, when we could go even deeper into this and start talking about equity, you know, in terms of who does or doesn’t have an Apple watch or something like that, you know, obviously, a lot of the track to be done on an iPhone. But you’ve also talked about potentially going beyond just tracking steps or what you’re eating, you’re talking about some other sort of clinical remote patient monitoring and feeding that data in as well, correct?
Douglas Goldstein 16:05
Well, yeah, so I think it’s a combination of remote patient monitoring, Remote Patient therapy. So if you think about rehab, that could be done in-clinic, much of, you know, muscular-skeletal rehab could be done in the home or anywhere. So that data comes in, and so the people could get reinforcement from both their care team. So if, if my objectives of walking 10,000 steps and doing my physical therapy, rehab for my joint replacement, if I achieved those on a daily basis, then I may get feedback from what could be automated feedback from my creative team. But I could also get, you know, thumbs up from my family members, I could get supportive text messages. I could get phone calls from them saying congratulations, I’m really glad you dropped five pounds as part of your, you know, your goal. So I think it’s, it’s bringing the power of the social network, to bear to reinforce someone who’s making progress against goals they’ve set.
Fred Goldstein 17:04
And does this come in? You know, obviously, there are all these different systems out there, you’ve got because we integrated a bunch of them, you know, 10 years ago, with Mapmy Fitness and RunKeeper and a Garmin or Withings or an Apple Watch, or you know, Strava and all these various things, whether your bike riding, etc. Does. Is there an aggregation thing? You know, we’ve talked about in the past Validic or so is it bring your own device? Is it going to be some sort of standardization? Where do you see that?
Douglas Goldstein 17:36
Well, I think we have we have two, so clinicians like Rich Milani at Ochsner has, has integrated that to the, you know, to the care plan. So there are clinicians who are creating care plans that are not just prescribing drugs, the care plan involves physical activity, eating, and, and so part of that is he’s got an O Bar, and someone gets a prescription to help manage their hypertension or whatever condition they’re managing. And they stop at the O Bar, which is the Ochsner Bar, where they pick up their wearable or device that sends information back to the care team. So the care team is part of that loop. And they can choose to share it with others. Now, there’s other solutions out there, whether it’s Noom or others, that don’t touch the care team, and that are encouraged people to set their own goals and provide feedback themselves and other people they choose to share within their community. So I think you have two nodes of focus relative to help people achieve the goals that they set, either by themselves or in conjunction with their clinician as a response to managing multiple conditions like a joint replacement diabetic who wants to lose weight?
Fred Goldstein 18:43
Sure. So let me ask you this. So, you know, the question always comes down to do I get paid for this? Or how do I cover this? And so you add on navigators, and obviously, now we have the CCM codes that can be used in Medicare, you’re seeing if you move to risk-based contracts, as Gregg and I’ve talked about, you can suddenly afford to put some of this stuff in because it’s gonna save you on other things. But you’re my concern with some of this is you layer in this extra stuff. And do we need a layer or an a tool that says Doug’s information came in? We don’t need to worry about anything. It looks good. Fred’s information came in. It’s problematic. A doctor needs to look at that. Is there is that system built yet? Or where are we with that?
Douglas Goldstein 19:30
Well, yes, I think we have the artificial intelligence is being built at the edge to basically process information. So let’s say I choose, let’s say my care team chooses I choose to share my steps and easy and other things that I’m tracking daily, my physical therapy routines with my care team, there’s algorithms and rules out there. So companies like care.ai have done this to only provide alerts based on when they’re, you know, if if I’ve started losing weight, and then I start gaining weight again, then it generates an alert. So yeah, we can embed analytics and machine learning in the edge. So doctors, nurses, clinicians are only alerted appropriately because of their focus on on treatment. And then other, you know, you can create rule sets that alert family members or whatever, particularly if someone’s alone, and, you know, living alone, and but they’re sharing their data with family members. So I yeah, I think that we can automate, we can automate those analytics companies like Moterum have done that in the stroke and Parkinson’s space. Companies like biorhythms are doing that in the maternal monitoring fetal monitoring space. So there’s a number of companies I’ve worked with that have essentially I saw a theme across many of the companies I’ve been working with as, as real-time. And so real-time fetal monitoring, real-time management of stroke recovery at home, real-time management of, you know, joint replacement patients at home with both activities and therapies for them do, but also reinforcement for when people are doing the positive behaviors and making progress towards jointly set goals.
Fred Goldstein 21:24
Absolutely. And I think you know, some of those examples, you talked about, you know, real-time monitoring for maternity issues or for stroke are, are clearly examples where this is going to have some great impact, potentially, you also mentioned this concept of point solutions. And it seems like in healthcare, we always seem to create silos. Is there any effort to begin to aggregate those point solutions? Instead of having a healthcare system or a provider have to say, well, I need this for this piece of data? I need that for that piece of data. I need that for that piece of data. Do you see any of that going on yet?
Douglas Goldstein 21:58
Well, that’s actually work I’m doing right now with Salt Flats in terms of finding focuses. So a couple of initial focuses on on women’s health, particularly in childbirth, and then neurological care. So neurological care addresses issues around MS, Parkinson’s stroke, chronic pain. And I’ve been blessed with the companies I’ve been working with, and the people I know that have identified some companies that have developed integrative solutions that take a whole-person approach, but also have extreme expertise in those areas of Alzheimer’s, MS, Parkinson’s, stroke, and maternal health. So the answer the answer is yes, we’re seeing those companies being developed we’re seeing significant capital going in to support the development of point solution companies, but that are taking a holistic approach to viewing people as people not just as a stroke patient or just as a Parkinson’s patients.
Fred Goldstein 23:02
And getting back to the maternity issue, obviously, is, as you think about that, there are clear disparities in terms of outcomes for individuals in lower socioeconomic groups or people of color, are you seeing that these types of solutions will ultimately be available for them in a similar manner as available to others?
Douglas Goldstein 23:23
Yeah, so we’re seeing other companies, you know, companies such as Tuzag their websites we are tuzag.com, are tailoring content to an eighth-grade level or a 12th-grade level or to people’s media preferences or educational level? So yes, we’re seeing content from these growth, these companies that are growing, seeking to provide interventions in areas of maternal health or others, where the way I would view information with my socio-economics would be different than the way it could be the same information but presented in a way that is more receptive to me in in diagrams and words versus in somebody else who may have a different educational status or may have just a different preference and how they want to view information. We’re hyper-personalizing that content in the outbound delivery. We’re seeing many companies do that.
Fred Goldstein 24:21
Yeah, I think clearly in the content area, there’s been progress made. I’m wondering from the technological solutions in which there’s either a piece of technology or a or some approach that, you know, does it does it get out to the person in rural Mississippi? Can it be made available there in the same manner as it can elsewhere? Do they have the ability to use that service in their area, that kind of thing?
Douglas Goldstein 24:49
Well, the answer is absolutely. Some of the work I’m doing with my colleagues and sister companies. Steven Morales from Optimity Advisors is we are profiling these virtual Virtual hospital at home initiatives that are being put forward by Sanford Health and Atrium and, and other. So leading health systems and health plans are clearly trying to figure out how do we replicate higher acuity services anywhere or in people’s homes in lower-cost settings? So the answer is we’re building a summary of those and a series of, you know, short white papers on progress being made in supporting rural health by leaders such as Sanford Health and others. So the answer is, it’s being done, and it’s a top priority. And frankly, the movement from inpatient, outpatient, outpatient, the clinic, the clinic to the home, and moving care to lower lower cost, settings has been a long-term trend. But now we see the not just the creation of sensors, but people are using, you know, people of all educational levels of all, you know, are using mobile phones are connected to their devices are doing selective things with that, and we can do remote patient monitoring, through telephone lines, or, you know, and there is a clear effort by the, you know, FCC to make high-speed internet available in rural areas to allow higher bandwidth and other sorts of things. But that, yeah. And COVID has accelerated the adoption, and, and reinforced the preference of people that know being a patient as a periodic unwanted purchasing, if I can take care of myself and I can support my conditions by taking my own temperature at home or do my own COVID test at home, and then sharing the results. And, and in a validated way, which could be, hey, clinicians watching me do my COVID test, so they can validate that I did the swab in the right way. So we have all those options, it can be done through audio that can be done through audio-video, that can be done anywhere through mobile devices in in rural areas or urban areas.
Fred Goldstein 27:02
One final question. You know, you’ve been at this a long time we’ve been at this a long time, obviously, this move to from inpatient to outpatient or outpatient to home hospital, at home, etc. Clearly makes sense, the technology is there. Do you think we’ll actually see cost reductions from this at some point? Or is it just going to be an ever-spiraling move forward as the system just changes what it does?
Douglas Goldstein 27:27
Well, I’m gonna say, Yes, I think that, yeah, we have an opportunity to bend the cost curve, because I think more and more people are very aware of their health, and the number of people who quote 10 years ago, we call them quantified self. I think the number of Quantified Self are getting up to 30 or 40% of the population just based on me watching what people are doing with their devices.
Fred Goldstein 27:48
Absolutely. So yeah, we’re gonna have to wrap it up there, Doug. It’s always been a pleasure. Fascinating discussion. So thanks so much for joining us on PopHealth Week.
Douglas Goldstein 27:57
Real-Time Health is here. Thanks.
Fred Goldstein 27:59
And back to you, Gregg.
Gregg Masters 28:00
And thank you, Fred. That is the last word for today’s broadcast. I want to thank Douglas Goldstein, aka efuturist for his time and insights today. For more information or to learn more about Doug’s work, go to www.Eefuturist.net and do follow me on Twitter via @efuturist. And if you’re enjoying our work here at PopHealth Week, do subscribe to our broadcast and like us on the podcast platform of your choice and consider sharing our work with your friends and colleagues. Bye now