Episode 55: A Lifeline for Primary Care

With the pandemic putting the crunch on primary care, remote patient monitoring (RPM) offers a potential lifeline while meeting skyrocketing demand for at-home care. Drew Mayer, a partner with MediCorHealth, discusses how RPM can provide an additional revenue stream to keep the doors open with no upfront costs to the clinic. In this episode, you’ll learn how this approach aligns incentives for the provider to monitor their patients’ health data, what instrumentation is involved, and how to overcome roadblocks to innovation in primary care.

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Full Transcript

Announcer: It’s time to think differently about health care. 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-host, Jared Johnson. On today’s episode, we’re speaking with Drew Mayer, co-founder of Helios Medical and a partner with MediCorHealth, a startup that provides remote patient monitoring solutions for primary care clinics with no upfront costs to the clinic. Drew, thank you so much for coming on the show today.

Drew: Thanks for having me.

Michael: Absolutely. So there’s a lot to talk about today. We’ll just jump right in here. You founded or advised several healthcare startups, most of which involve or support primary care. So why is so much innovation needed in primary care today, and how has all that need for innovation changed this year because of COVID-19?

Drew: Primary care is what I believe the key cog in improving healthcare in the United States market. And the reason that is is because specialists, they’re great at what they do, which is their particular piece of the healthcare puzzle. But they’re not put in a position to where they are looking at the entire health picture for a patient. So that’s really what a primary care doctor is for. The average time that a primary care doctor spends with their patients right now in a standard fee for service model is seven minutes, seven minutes of face time, and they’re trying to get a full picture of someone’s health and advise them on could be a foot problem, it could be an itch, it could be whatever it is. And so, that part of the system is just broken.

You know, primary care, they have trouble making the finances work. And so, when you have a key part of your healthcare system not working, it crumbles. And so, I think the focus on primary care is so important. These are clinicians that need backing in order to do their job, which is extremely important. So that’s why what I’ve done has been focusing on primary care and helping them. And interestingly enough, primary care was just sort of crumbling as it was, and then COVID comes around. And, you know, they make money by having people come into their office. People can’t come to their office, so they’re scrambling to figure out, “What do we do?” And there are tons of stories of primary care clinics that are laying off people, that are going under, that just aren’t going to make it. And that’s going to kill our healthcare system. So that’s one of the things that COVID has done that’s really had a huge impact on not just primary care, but on the healthcare as a whole across our country. 

Michael: Yeah. We do a lot of work with orthopedic surgeons, in particular, and some other specialties as well. But that’s something where, you know, right as this all started up, we saw everybody have to close down for a while. And now, some markets are opening back up for surgeries, but, you know, some aren’t still, and everybody trying to adjust to that was just this huge kind of pain point and still is, obviously, a huge pain point.

So we’re talking some about the difficulties that primary care faces, but let’s talk about people that want to change that model, that want to make some sort of change in that system. What kind of roadblocks are they facing besides just the epidemic itself?

Drew: I think a lot of it has to do with just the payer system as a whole. So how does… You know, physicians want to help patients. That’s what they want to do. They want to spend their time helping their patients and creating those relationships and just improving the health of all the people that are coming into their office. But there’s the financial side of the equation. It has to be part of the conversation. A lot of physicians are uncomfortable with that, but they can’t keep the lights on if they don’t take care of that piece. And it’s really the payer system. So, you know, the incentives have to be aligned with better health and allowing physicians to do what they do best. And they’re just not aligned right now. That goes across, you know, Medicare, Medicaid, private insurance. This goes across the whole gamut. So I think that it’s the payer side that really has to align better with providing good health care.

Michael: On the show here, we’ve had the chance to talk to some different folks about primary care, we’ve had a chance to talk to folks about different payment systems that are out there and different models that are out there. And, you know, some of the content that we’ve done around things like, you know, bundled payments, like some of those kinds of models that are out there, that has really reached a pretty wide audience. Like, some of those shows are some of our, like, most in depth listened to kinds of shows. So, you know, we definitely love to hear more about your thoughts and more about how some of the things that you’re working on kind of tie into that. So, you know, let’s jump into remote patient monitoring systems. What is it that listeners need to know about that, and how have you seen demand change for these kinds of systems?

Drew: So remote patient monitoring, I mean, obviously, it’s blown up. It’s exploded. And we really started getting into it before COVID hit, but with COVID, the interest in remote patient monitoring has exploded tremendously. And remote patient monitoring has been around since the early 2000s, but the payment hasn’t been there. So it was just too expensive to really implement, even though remote patient monitoring is proven time and time again to provide better health care and reduce costs, tremendous reduction in re-hospitalizations and hospitalizations and just reduce costs the entire system.

So remote patient monitoring, it’s a win across the board. And I hate to say that, this win, win, win, but it truly is. So the physician is able to get more information on their patients and often more accurate information. So if they get one blood pressure reading when a person came into the office, that may be inaccurate because it was super hot outside, the person had to jog across the parking lot, whatever it is. But if they have 120 days blood pressure readings, then they have a much better picture of this person’s health, and they can make better choices. The patient can provide their doctor with medical information with very little effort. And they feel like, “My doctor is really looking out for me and I’m getting better care.” And they are.

And then the third piece of it is the clinic is compensated well for doing this work, and that is on the Medicare side. So Medicare, in 2019 came out with three new codes and a fourth code in 2020 that really compensate providers with wealth for doing this work. And so it’s all aligned there. And by doing that, a lot of these primary care providers, by having RPM, can really have an income stream that helps them keep their doors open while providing better care and helping them be a better physician. It’s a complete win. 

Jared: That’s awesome.

Michael: So talk to us a little bit more about what these systems look like. Let’s get into some of the specifics because, you know, I could see some people thinking like, “Oh, am I just like putting on the Apple Watch and keeping some systems going to, you know, get all these readings?” or what kind of systems are we talking about?

Drew: So a lot of that has to do with the payer. I’ll talk about the way that we work on this at MediCorHealth. So, Medicare has specific devices that they will allow you to use in your RPM model. You know, RPM is still being defined within CMS. So there’s some gray areas. And we try to take a conservative approach. But in general, you have weight scale, a blood pressure cuff, pull socks, and glucometer. And those are kind of the four big ones. There are some other ones you can throw in there. And they all have to be FDA-approved, and even there’s some leeway in that. But really, what happens is the physician decides, “This patient may have some type of chronic disease that I need to monitor, and I’d like to get more information.” And they provide that patient with…they would either do it within their office or a company like ours, MediCorHealth would provide the patient with a device.

And that device would be, let’s say, for example, a weight scale. So the weight scale, the patient would step on the weight scale on a periodic basis, which is defined by the patient and the doctor together. And then that information is automatically uploaded into a monitoring system. There are people that monitor that data to see if the data that is being generated is outside of the parameters set up by the provider. If it’s outside the parameters, then the monitoring group, they will communicate using the standard operating procedure that’s been set up with the provider and then an action will be taken. And that could be a call to the patient that says, “Hey, it looks like you gained 10 pounds overnight. Did someone else step on your scale or what’s going on there?” or maybe, “We really need you to come in because we see some concerning data.” And that’s sort of the simple process that a patient goes through. So still the doctor is determining what happens and determining the communication, but it’s really simple.

Michael: As you’re telling me about this, it made me start thinking a couple of different questions. So one being, first of all, it sounds like, you know, we’re talking about primary care groups. So these are, like, even very, like, small practices can get involved in this kind of stuff, or it’s just, “Hey, there’s just a few doctors at this practice, and this is something we’re going to engage in?” because normally, when you think about this sort of more proactive health care model that can provide these kinds of services, you know, you’re thinking about the really, really large healthcare systems and very prohibitive costs that go alongside that.

Drew: You know, it’s a great question. So I’ll take a step back and talk about MediCorHealth a little bit and it answers your question. So, MediCorHealth was started by a physician, Dr. Steve Springer, and he started it in his clinic. So it wasn’t really a company at that time. It was just, “I think RPM is going to be beneficial in my patients.” And he started within his own clinic. And he was able to go through all of the problems and hurdles implementing this RPM model within his clinic. And he finally built something. He said, “This really works. And I love it. And it works for me as a physician, it works for my patients, and it works for the clinical staff.” And so he took a different approach than a lot of the companies that may be doing RPM that are looking at it from a software standpoint or device standpoint.

So he was able to look at it from a small…from a single doctor practice, “How do I make this work?” And then, what we have done now is we’re taking that out and expanding that model. So one of the hurdles he said is, “This is a lot of money to buy devices for a primary care physician.” So we took that hurdle out and MediCorHealth buys the devices. So the physicians don’t have to buy the devices for the clinic. So a small group, there’s no out of pocket costs. MediCorHealth does all the monitoring. So all the staff-required, which is a significant amount of staff to onboard people to monitor, to communicate with the clinic, that’s all taken care of. So they don’t have to hire anyone new and their staff doesn’t have to take on more time and there aren’t more resources needed within their clinic, you know, with staff that’s already probably overworked.

Then on top of that, the software is provided so they don’t have to pay for software. They have new licenses. They don’t have to do training. None of that has to happen. So it’s this 100% turnkey that you can plop down in any clinic and take care of these patients. Originally, the model had someone embedded within the clinic. However, with COVID, it’s really hard to do that. So everything’s remote. So the onboarding is remote, everything’s remote with the…and so we don’t need to have anyone in the clinic and you don’t need to meet with patients, though that’s a model that does have some benefits.

So a small clinic can very easily do this because it’s at no cost. In fact, when I talk to clinics about this, I say, “Look, this is found revenue. You’re not doing a whole lot different. You have more data to help your patients, you’re still treating them the same, but you just have more information now, and it doesn’t cost you anything.” So it’s a huge win for these clinics. And a small clinic can do this. Extremely large clinics can do it. Now, some large clients may just want to do it themselves because they have the financial resources. But a lot of them say, “Look, we don’t have the monitoring. We don’t want to hire the staff. We don’t want to train people, so we’d rather have a third party do it.” And that’s where we come in.

Jared: Yeah. What’s really interesting is that how you zeroed in on cost is the key part, Drew. And I think that’s, that’s not by accident. I think that is a hurdle in almost everything. And I do see the need to focus on that when we’re talking about why don’t new innovations get adopted more easily? If we’re making something better in the patient experience, why are more providers doing it? It’s great to hear that the adoption is accelerating because of COVID, and that’s encouraging. I think one of the other parts is as we think about other costs associated for the provider, not just with remote patient monitoring, but in general, is such a problem in health care.

Like Michael was saying, we’ve spoken with several other providers on this program and we’ve spoken with benefits consultants. We’ve spoken with a lot who, for instance, are involved with direct primary care, DPC. And I know one of your companies, Mint Benefits, helps DPC practices, you help their members with medical cost-sharing. So I’m just curious, you know, from your standpoint, why is cost still such a problem in health care? I know it’s a big question, but where do we even start to see any change? Why is cost such a problem here?

Drew: It’s a big question. And obviously, there’s lots of extremely smart people that are working on that problem. But I think that where I like to start and the little piece that I can have some input on is I think that the general public has not taken the reins on their own healthcare. And I think that’s where it needs to start. When I talk to people about alternatives to their health insurance that may be offered by their employer, I always ask the question like, “Why are you relying on your employer to provide you with health insurance? They’re not the experts in that. They hire someone and…” but it seems very odd to have your employer be the one driving one of the biggest expenses that you have and their motivations are very different from yours.

So, I think that cost…I think it starts with the general public. And we should be looking at why does an MRI cost $2,000 when it’s paid for by insurance yet I can go pay cash for one that is $500? If my insurance pays for, I just think, “Oh, it’s paid for,” but that’s not really the case, somehow we’re paying for that. Somehow we’re paying for it. It starts with the individual. Individuals have to take responsibility over their health care. And I think that’s where this cost starts. Now, there’s lots of factors, you know, payers, how they pay, what motivates them, why they do it. Lots of factors in that. But I think, you know, for me, you have to start somewhere and for me that’s where it starts.

Jared: I definitely see the value of that, Drew. And I see just this part of the conversation, lately, I haven’t heard it talked about as often as…you know, I’m surprised. I’m expecting that we’d be talking about it even more. And I looked at things and maybe it’s just because of some of the conversations we have been having, we have had direct primary care providers and benefits consultants here on the program because cost is such a big factor, as we all know, in some of the innovations and the paradigm shifts that are happening right now in healthcare.

And so, I think when I look back at all of that, I start to realize where are those starting points? This is boiling the ocean. This is, you know, eating an elephant, you know, one bite at a time, those kinds of things. And so, thinking back to some of the small steps to take, it’s going to take innovation in areas like what you’re talking about, like an RPM solution, and in my mind, to just relax one other stressor that’s on a primary care doc. It’s going to take these kinds of things all together, kind of added up to really, in my mind, show us the types of things that we’re trying to do. And so, I appreciate hearing that because I think, you know, all of this really does have to do with what’s on a consumer’s mind and what’s on a provider’s mind. And, Michael, I don’t know what you about that. I think there’s really a marketing angle on this still as well. Did you have some thoughts on that?

Michael: Yeah, you know, as you’re going through and talking about, you know, all these different remote patient monitoring systems that are available, as a patient, that’s the kind of stuff I hope my doctor is bringing to the table. Is that something that practices are kind of pushing out there as a way to talk about why you should see this doctor as opposed to somebody else?

Drew: I think practices are scrambling right now and they don’t know what to do. I mean, health care, it’s a funny world. There’s massive amounts of money in healthcare and technology is still a mess. And it’s shocking. And that’s not a surprise to anyone. I mean, that’s not going to be that way forever. I mean, all the big technology players, obviously they’re getting into health care. But it’s still shocking how far behind technology is. And I think that practices are just scrambling right now within…they now understand that this isn’t just kind of a nice-to-have. This is you’re going to have to have it.

And I had an interesting path on this because I really had spent a lot of time in direct primary care. 

One of the big things with direct primary care, you can call your doctor, you can text your doctor because of the way that they are able to work within the data privacy. And that can be a long conversation, but basically, they have some different…they don’t have to use portals and they can use some other alternatives too in order to communicate with the patient. So that was a big selling point, just being able to communicate directly with your doctor, call them anytime, text and have phone appointments. And all of a sudden, boom, COVID hits and everyone has to do that. They’re not choosing to do it, they have to do that.

Then they’re finding, as COVID has matured a little bit and people are starting to get used to it, that they need to have it. Their patients are gonna start demanding it. And they may lose patients over not having effective systems in place. And that scramble, I believe, it’s still happening. So physicians are trying to figure out, they’re being forced to do something they should have been doing already. And what I like seeing is the market demand saying, “We want this. You need to provide this.” And that’s a great catalyst for change. And I hope we look back at this time and see that there were some positive changes that happened with health care that were forced by COVID.

Michael: Yeah, absolutely. Just to kind of recap that thought, so it’s not necessarily a marketing angle as much in your mind, but there is just the staying competitive angle of it that really kind of comes the marketing side there.

Drew: Yeah. I absolutely think it’s going to be competitive. You have to do it. In fact, yesterday I was traveling and I saw…it was a banner hanging up in a town that I’d went through that said, “We now offer telehealth.” They were marketing it. They were using it. They were saying, “Hey, you should come to us because we do offer telehealth.” Now, I think anyone that thinks that that’s going to be the differentiator now is crazy, everyone’s gonna have to have it and they are. But I think that what it’s done is it’s woken up the market to say that individuals say, “Look, I want more out of my providers.”

And then, that’s going to put pressure on primary care physicians that really don’t need more pressure necessarily, but they’re gonna…hopefully, then payers are also going to come into the mix, and it’s all going to bring everyone together, which has happened so far. All these fewer restrictions on telehealth visits and being reimbursed for the same amount as if it were in person and those types of restrictions have been lifted. But that’s got to be permanent, and we got to demand it.

Michael: Absolutely. Absolutely. Drew, thank you so much for coming on the show. I think there are so many more things that we could go into. I think it’s so exciting for Jared and I to hear just about how many ways that primary care, in particular, is changing. And, you know, there is a lot of pain this year in the system in terms of how we adjust. But it does sound like there’s a lot of possibility for very positive changes, and I share your enthusiasm, your hopefulness there. So, again, thank you so much for coming on the show. We really appreciate it.

Drew: Thanks for the time, really appreciate it.

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.