Physicians historically have been some of the fastest adopters of new tech, according to Dr. Ray Costantini, CEO and co-founder of Bright.MD. What they resist is tech that doesn’t make their jobs easier. In this episode, you’ll learn about the new health tech adoption cycle, bringing better tools to clinicians, and long-term challenges that providers face as they work to integrate telehealth.
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Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans. And many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together, and here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your Paradigm Shift.
Michael: Welcome to the “Paradigm Shift of Healthcare,” and thank you for listening. I’m Michael Roberts here today with my co-hosts Scott Zeitzer and Jared Johnson. On today’s episode, we’re talking with Dr. Ray Costantini, CEO and co-founder of Bright.md which offers direct-to-patient non-video telehealth. Ray, thank you so much for coming on the show today.
Dr. Costantini: Thank you. Looking forward to it.
Michael: Absolutely. So, you know, there’s been a ton that’s changed around telehealth this year and we’re several months into this pandemic, and a majority of providers seem to have found some sort of virtual care offering that they’re doing at this point, some to greater degree of success than others, some to a greater degree of liking it than others. But from the provider’s perspective, is this soar in telehealth usage an opportunity or a challenge?
Dr. Costantini: Yes, absolutely. No, all goodness, I think it is. I think it’s both. I think it’s definitely a challenge and that change is hard. And I will say, I think if there’s a silver lining to COVID, it’s really that it’s pushed providers and health systems to think differently about how healthcare can get delivered. And so, from that standpoint, I mean, I think it is both an opportunity and a challenge. Healthcare has been pretty slow to embrace the consumer experience and to work to be able to meet patients, healthcare consumers, where they’re at, rather than telling them how they need to come to the health system. That’s both. I think it’s an opportunity to really embrace new ways of delivering care, and it’s certainly a challenge.
Michael: Absolutely. You know, and a lot of people have gone through these kind of growing pains, at least, with this initial part of it, right? Like getting the, I finally got the workflow figured out, it seems like we’re being reimbursed okay for right now, at least. So, let’s talk about long-term, what do you think…what challenges are providers going to continue to face as they continue to integrate, but also as they kind of really try to make this a real part of their practice and not just something that they had to do to get by for a few months?
Dr. Costantini: Yeah. That I think is really both the challenge and the opportunity as what you just said there, is acknowledging the fact that remote care is table stakes for a health system. So, you’re not gonna differentiate yourself as a health system by letting patients get care from a different location. And that solves a small set of problems in healthcare. It’s really about finding tools that are built not only to make the patient able to get care from more convenient locations, but really changing not just where healthcare can happen, but how healthcare happens. That means bringing better tools to the clinicians so that they’re actually able to get something out of the workflow. If you think about what happens on video-based telehealth, everything that had to happen in an in-person setting also has to happen via video.
You really just change where it’s at and you put, arguably, a clunkier interface between the clinician and the patient. I mean, I can’t remember the last video conference I had that was actually easier or more productive than an in-person meeting. So, that’s the big thing there is think about not only how can you bring the tools that make it better, but also the other…I think the real opportunity comes from embracing the fact that telehealth isn’t a service line. It’s not something unique. You don’t have a telephone service line. Why do you have a telehealth service line? It’s really about how can you use digital tools to make healthcare better for everybody involved?
Michael: Yeah. I think it’s something that a lot of people can certainly relate to right now, just in terms of ongoing meetings that we have to have with co-workers, whether you’re in a clinical setting or, actually, just before all the COVID stuff happened, we, you know, actually worked in an office and actually came to talk to our co-workers and it’s definitely very different kinds of conversations. And so, I think that’s very, very relatable. So, we’ve talked a little bit about what it’s like to do that over video, but what is non-video asynchronous care and how is that different from some of the stuff we’ve just been talking about?
Dr. Costantini: Sure. It’s really a different tool set. The only thing is, you know, that asynchronous care, it is a tool that helps solve a broader problem. The vast majority of care doesn’t need a video interaction. I mean, if you think about some of the most common things, colds and flus, urinary tract infections, bladder infections, or rashes, I mean, those are some of the most common things to be coming into healthcare, high volume conditions. And I can tell you as a clinician myself, there’s not one of them that needs a video interaction with a doctor to be able to evaluate and diagnose those conditions. In fact, you know, if you think about even the visual ones, like a rash, I’ve never seen a rash that’s interesting enough that I want to see a video of it.
I mean, I want pictures, but it’s not going to do a dance. I mean, it’s not moving around. And as soon as you switch your phone over from a still image to video, you’re losing half or more of your resolution and it doesn’t do me as a clinician any good and it makes the process even harder for the patient. Recognizing what the tools are good for and using them in the right setting, that’s the first piece of it.
And then the second one is by making this more asynchronous, meaning that the patients are probably gonna have to be lined up at the same time, it actually makes it more convenient. And it lets us bring a whole new value to the table, which is really this concept of care automation. And really, that’s why we are more than a non-video asynchronous care product. We’re really a care automation company. Our job is to build software that helps clinicians and patients connect in the best way possible and streamline that process. You know, doc spend…of the 20 minutes that a clinician spends on a visit, they’re spending about three of that with the patient. I mean, that’s bad for everybody. The doc doesn’t like that. The patient doesn’t like that. We’re taking some of the most expensive human resources on the planet, these physicians, highly-trained physicians who are in high demand and we’re having to spend most of their time on administrative burden. They’re asking questions they know they need an answer to before they even walk into the room.
They’re spending almost 50% of their time typing, doing data entry, and order entry. It takes 100 clicks, on average, to be able to do a visit inside of an EMR system. I can’t think of the last task that I had that took 100 clicks outside of care. So, lifting that burden, that’s what our software does. It really streamlines that process, interviews the patient through this conversational AI platform, gathers all the information the clinician needs, transforms it into a differential diagnosis, so kind of what’s likely to be wrong with the patient, and a pre-written chart note for the clinician, a set of orders that are there for the clinician to be able to easily review and make changes to, billing files, personalized patient education materials. It’s elevating the clinician so that they’re at the top of their license and freeing them up to be doing the things that human beings are really good at, which is critical thinking and relationship building. And, you know, they have more time now to be spending with complicated patients who really need more of that interaction and making the process easier for everybody involved.
Scott: I think that’s a really good way to put it. If anybody has the time while you’re listening to this podcast, or do it afterwards, just go to Bright.md and take a peek at the potential, not just from the physician’s perspective, but from the patient’s perspective as well. As you’re telling me all this, it’s a real win-win in my mind. We’ve got to come up with something better than non-video asynchronous here.
Dr. Costantini: Yeah.
Scott: But, you know, doc, in reality, you know, I was thinking about some of the cases you were talking about and pediatricians listening to this, internists, which I know you are, listening to this, urologists. I mean, there’s a lot of stuff where it’s just like, look, if you’re talking about a UTI, I mean, frankly, about the only thing you really need to do is get the most important thing, and not the only thing, is like, “Hey, we just need to test to see what you got. You know, pee in a cup. And then I can make a decision about what to do for you.”
Dr. Costantini: And the interesting thing is that the clinicians are spending all their time gathering the information and then they don’t even get to talk about the results. I mean, if you think about the patient’s experience, you come in, you get interviewed. Again, the clinician is getting a whole bunch of information they know they needed ahead of time, but don’t have. Then they send you away to go get the rest of the information that they need. And then when they get the results, you get an email about it. That’s like the opposite way that it should be happening. We should be getting all that information to the clinician ahead of time so that when you’re talking with them, you can actually talk about, what does this mean? What should I do? It’s actually a human engagement. It’s re-humanizing healthcare in a lot of ways so that clinicians have computers that work for them instead of the other way around.
Scott: I couldn’t agree more. I think that a lot of the implementation way back when, when they started talking about EMRs, etc., it was really just about duplicating. You know, okay, we used to write it down on paper, so here’s how we’re going to do it, you know, so it goes automatically into a record. Great. You know, and that’s a great start. And now, we’re ready for the next level. You know, now we’re ready to have a conversation of like, “Look, we got all these powerful tools, why the heck, as somebody who’s got a terrible cold or potentially UTI, or you can come up with a myriad of issues, I want to go see the doctor to tell me to go get a test.”
Dr. Costantini: Exactly. It’s about moving care forward. It’s about getting the right information from the right places and to the right places in order to be able to move care forward, whether that’s changing your location, getting you to a new setting, whether that’s getting a test ordered, whether that’s giving you a diagnosis. I think you’re absolutely right. We’re in a post-EMR world. The EMR systems, we got what we asked for from those. As an industry, we asked for a system that would optimize billing and that’s what we got. The good news is it brought some infrastructure with it. And so, now, we need to really bring the tools that leverage that infrastructure and make it way more valuable.
Scott: Yeah. I couldn’t agree more. You know, so then, you know, kind of thinking, like, I don’t think anybody on this podcast, whether you’re a patient, you know, in a practice and providing care is, hopefully, is everybody’s kind of excited about the possibility of using it. So, now, we have like, how do we pay for it, and how is it integrated into our workflow? You know, I know the CARES Act opened up additional funding for telehealth. Is it doing the same for these other services for you?
Dr. Costantini: Well, I would say…
Scott: Was there kind of…?
Dr. Costantini: …regulation always lags innovation.
Scott: Yes, it does.
Dr. Costantini: I think that’s the nature of it, in fact. You have to have that innovation before regulators know where to be looking and where to be going. I think that the interesting thing is that we are seeing that happening. I think it’s happened predominantly around video-based telehealth. The nice thing about care automation is that it doesn’t have to be non-video and we can help health systems, you know. I mean, you think about it. Again, if you’re doing a video-based visit, your most capacity-constrained, rate-limiting resource is still physician time. And it takes just as much time, if not more, to do video encounters as it did to do in-person encounters.
So, by bringing care automation to your video encounter, clinicians can now come into that video encounter with a virtual medical residents note written for them and the interview already there, so they can come in and make those visits more productive, high value, more efficient. So, there’s ways to be able to apply care automation, regardless of whether it’s purely asynchronous or whether there’s video involved. So there’s kind of that methodology of kind of meeting regulators where they’re at, but we really do need to be thinking more progressively.
I don’t know why we…well, I think I know why, but I don’t see good reasons why we tell clinicians what tools to be using to be delivering care. I mean, we don’t tell them whether or not to use a stethoscope. Why are we telling them whether or not they need to be using video? I mean, do you really need…same thing. I mean, from a clinical standpoint, I would defy anybody to tell me why you need a video encounter to be evaluating a patient’s cold. And yet we tell clinicians, “You get paid for evaluating that cold via video, but you don’t get paid for evaluating that cold and the patient with the cold without that.”
Scott: Yeah, I couldn’t agree more.
Dr. Costantini: And that’s pretty nonsensical. So, those kinds of things, we’re pushing really hard. We’re supporting our health systems. We’re working with other regulatory bodies to really help legislators understand the need to be more progressive around this.
Scott: You know, it’s funny, it’s almost like a multipronged attack, right? At its core, you’ve got to change just the habits of people. Some people just, you know, they’re just so habitual in terms of what they do. I mean, when telehealth, just to stick with telehealth for a second, it was like a lot of people were like, “I don’t know. I mean, now I got to change up the way I’m doing it.” And then once you try it a few times, you’re like, “You know, it’s not that bad. Okay.” I have a couple of friends of mine who are…we do a lot of work with orthopedic and spine surgeons and the neurosurgeons, you know, at first, you get the grumpy old person who’s much like, “I’m not doing that.” And then you go like, “Yeah, but look what you could do.” And they go, “Hey, I’m going to do that.”
Dr. Costantini: I’ve never seen a grumpy neurosurgeon. What are you talking about?
Scott: Come on now. Don’t get me in trouble. I’ve got a lot of friends. No, no, they’re great folks. They’re super smart folks. And actually, yeah, no. I think, yeah. Clinicians, I think this interesting rep for being resistant to technology. And I’m not pointing this at neurosurgeons, specific. I think, in general, there’s this reputation around that.
Dr. Costantini: I actually think it’s pretty undeserved, in fact. I think the grumpiness that you talk about doesn’t come from the fact that they’re hesitant or uninterested in using tech. Actually, here’s an interesting bit of trivia for you.
Scott: It’s a lack of time. It’s a lack of time.
Dr. Costantini: I’d actually push back. I don’t know if that’s totally true. The first professional group to surpass 90% penetrance on use of smartphones is physicians. Physicians love tech that makes their job easier. What we’ve done by bringing them tech that doesn’t make their jobs easier is build a group of skeptics.
Scott: Yeah. That’s a very interesting point. And you know, it’s funny, so you’ve got this one prong of, “Hey, just listen to how this could work for you.” And I think you will get a lot of people to buy into that. Then you’ve got this other prong of getting it paid for. Does Medicare help with that? You know, the CMS, can they help that?
Dr. Costantini: Absolutely. I mean, they’re the largest payer in the country. And so, you know, they are the bellwether. What we see there is that Medicaid has historically led this push towards a value-based care model. In value-based care, the conversation around these kinds of things is easy. And I’m exposing a little bit of my belief around where healthcare should be going from a policy standpoint. But I mean, the truth is we shouldn’t have to be worrying about whether or not you can bill for this modality or that modality. We really should be moving to a model where clinician, health system, and patient interests are aligned and what you’re getting paid for as a health system isn’t filling hospital beds and ambulatory surgical suites and cath labs and imaging centers.
You get paid to keep patients healthy, and that’s one of those capitated models. And I think that’s the direction that CMS has been pointed for a while. It’s a slow process. But in the meantime, I think we need to be thinking about both. How do you reimburse for these in a fair way, in a fee-for-service world? How do we stop putting these unnecessary restrictions on clinicians about what tools they can use when they’re in the best position to be making that decision anyways? And how do we keep moving forward around models that align interests between everybody involved?
Jared: Very interesting, this whole part of the conversation. And I think when we start talking about tech, you know, here’s a very relevant, current place. We’re talking about tech being very involved in a very high point of care situation, which is coronavirus screenings. And when you think about artificial intelligence being involved, we see headlines going around what’s going on and how are we making America safe and how are we screening for the coronavirus? But there really is rapid advancement in tech that’s going on to help, and that’s the fact, especially with AI. So, what about that side of it? Like how does AI help to screen for the coronavirus? Like what is actually happening there?
Dr. Costantini: I’d say it’s more than screening. And I think that’s a really important piece. You know, I mean screening is important, but what we really need is we need to get patients’ diagnosis and treatment. We need to get them referrals. We need to not just be a signpost that tells them where to go to get care. We really need to be the destination that gets them that care. It’s one of the things I’m really proud of, Bright.md. We’ve been in a unique position to really help around that. We put together an AI-based coronavirus screening tool that we offered for free, we still offer for free, to health systems across the U.S. But even more than that, we had coronavirus evaluation built into our platform two weeks after the first domestic U.S. case. We’ve helped health systems scale up.
They scaled up in hours to be meeting, you know, 400, 500 times the patient volume that they were having days before. And they were able to do that really quickly. We had a health system doing several thousand visits a day through our platform just around coronavirus related symptoms. And they were able to not only screen those patients, but evaluate and diagnose them, get them prescriptions where it was appropriate, get them referrals when it was needed. So, truly get them care. And that didn’t usually take hundreds of docs to be able to do that kind of volume of visits in a video-based or an in-person setting. And they were able to do that ramp in hours and staff all of those visits with about a dozen physicians and nurse practicing PCs. You know, those kinds of…it is. It comes back to the same thing, using tools to change how healthcare happens to make it better for everybody.
Michael: So, right. You know, when we think about that side of it, that’s fascinating to me because it’s historic, isn’t it? I mean, the ramp up period. And I think we’re all starting to get used to that piece of when we look back at history of 2020.
Dr. Costantini: Let’s not normalize it, but yes. We’re all getting acclimated to it. Yes.
Michael: I think that’s where I was going with it was that I don’t want that to be lost in the shuffle. I don’t want us to have heard so much about what’s going on that we do normalize it because that is a trend that there’s so many implications to what can happen with tech. When we even talk about like the options that a health system has to use this technology, we were just talking about how, for the most part, I would agree with you that providers aren’t resistant to tech. They love tech that makes their job easier. What they resist is the tech that doesn’t make their job easier and that has happened. And I think that’s a part of the significance to me when we hear about how quickly some tech has been adopted for this specific situation for helping screen and eventually treat coronavirus. So, now, we have kind of this almost like a new version of the tech adoption cycle within providers, within the medical community. And so, to me, that parts, I don’t want that to get lost in the shuffle either.
Dr. Costantini: I agree with you. I think there’s two things that are happening. I had somebody that gave me this analogy the other day. I’d love to take credit for it, but they said all of these problems that healthcare has had over the last…that have continued to be, that have evolved over the last decade, decade and a half, patient access and provider burnout and rising cost of care, and these new entrant, competitors are coming in, you know, these are all real challenges that healthcare has been facing for a long time. And they are the bear that has been threatening the healthcare delivery system in the U.S. for a long time. COVID is a fire that’s come up between that bear and U.S. healthcare systems.
And right now, everybody has to be focused on that fire, and it’s looming and omnipresent for where everybody is focused. But it hasn’t made the bear go away. All of those problems that were there before, they’re still there. And when we managed to put that COVID fire out, the bear is going to be just as present and arguably hungrier and kind of pissed off because it’s singed. And we’re gonna have to be dealing with that even more pressingly. Health systems are coming to recognize that the only way they’re going to be able to do that, the only way they’re going to be able to compete and stay relevant is really by rethinking how they deliver care and how tech can be playing a role in making that better for everybody.
Scott: Yeah. Amen. Amen to all that. I’ve always said that COVID just exacerbates, you know, what’s out there in a positive way and a negative way. And then most of the time, it’s bringing up a lot of negatives, but the positive side is, hey, we’re being forced to deal with it. And I couldn’t tell you just how excited I was as I perused the site and what possibilities are out there for us, specifically from your company and I’m sure a lot of other solutions out there. But I think we’re hitting that end point where we got to start talking about like, wow, we could talk for another half hour, but we gotta wrap up the show.
Dr. Costantini: Well, this was a pleasure. I enjoyed talking with you, guys. You guys run a fun show and it’s a really thoughtful conversation. So, certainly appreciate it.
Michael: As our sincere pleasure.
Scott: Thank you so much for joining us.
Announcer: Thanks again for tuning in to the “Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.