How did the pandemic impact your relationships with your healthcare providers? Did telehealth enable you to continue seeing or connecting with your providers to receive the care that you needed?
In this episode of Community Signal, Denzil Coleman, a telehealth coordinator, developing and maintaining digital health interventions at the Medical University of South Carolina (MUSC) Center for Telehealth, discusses how the adoption of telehealth interactions and practices during the pandemic may lead to continued and more long-term improvements and efficiencies in our healthcare system.
Denzil explains that telehealth is “anything where healthcare is being impacted by a patient and an actor that are not in the same location. That includes a video, that includes transmissions of information, asynchronous messaging, [and] remote patient monitoring.” Telehealth can create efficiencies for both patients and providers –– giving patients flexibility to see their providers without the burden of travel and with the option to invite more caregivers into these interactions.
Whereas in the past, patients may have received pamphlets with details about in-person support groups or other care options, today there are online communities and support groups and insurance companies themselves even offer telehealth options. With these options come more opportunities for patients to be more engaged in the care that they receive and for providers to thoughtfully care for patients.
Denzil and Patrick also discuss how:
- COVID, the shifting landscape of the healthcare profession, and the fact that folks are living longer, healthier lives all impacts the healthcare system
- The flexibility of telehealth allows a patient’s support system to become more involved in their care
- Creating efficiencies in the healthcare system should not equate to patients receiving less care
- Value-based care could resemble a community-like investment in overall care
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What exactly is telehealth? (2:01): “To put it simply, telehealth is … anything where healthcare is being impacted by a patient and an actor that are not in the same location. That includes a video, that includes transmissions of information, asynchronous messaging, [and] remote patient monitoring.” –@denzilcoleman
How the pandemic is leading to wider adoption of teleheath interactions (4:55): “Even at the Center for Telehealth at MUSC, where I work, we saw a very significant uptick in telehealth interactions of all kinds since the start of the pandemic, just because pretty much every interaction had to take place that way for patient safety. The forced adoption of the time of the emergency is really what prompted it, but we’ll take it because as people are getting more comfortable with these modalities, we’re able to push digital health forward a lot quicker.” –@denzilcoleman
Online communities can help keep patients engaged in their own care (8:10): “A lot of times, you may give an intervention or a plan of care in which the patient is not fully engaged. Having them as part of one of these [online] communities where they feel supported, encouraged to take part and advocate for their own care, and share experiences, it keeps them engaged. It keeps their focus on their health and on getting better.” –@denzilcoleman
Healthcare optimization could lead to online communities (22:51): “[Healthcare optimization means] expanding the reach of what we already do, expanding the reach of providers who are overwhelmed, overworked, and facing a mushrooming population of people who are living longer, healthier lives. Which is great, but at the same time, we are having less and less people graduate from medical school becoming doctors. Of course, those are being supplemented by what we refer to as mid-level providers and a large increase of people becoming physician assistants and nurse practitioners, which is also great, but our providers aren’t matching the rate of individuals surviving. We have to create the efficiencies. We have no choice. We have to use technology to do the best we can, and online communities are part of that.” –@denzilcoleman
Efficiencies in the healthcare ecosystem do not mean a reduction in care (30:05): “Some [existing healthcare practices] aren’t necessary, don’t add value, or may even be wasteful. … Imagine if you’re with a provider, and you’ve had a long-term condition over the past 30 years. The last 15 of them, you saw your provider every three months, no matter what. Now, in 2021, your provider tells you, ‘I’m only going to see you in person maybe one time a year instead of four, but you’re going to come see me in person. I’m going to do an exam, then I’m going to have a little remote monitoring on a monthly basis. Then we’re going to do a three-month video-only checkup. Then we’re going to do something in six months.’ You only come to the clinic and get an exam the one time. It’s not because we don’t want to care for you. It’s because we want to create efficiencies for everyone in the healthcare ecosystem.” –@denzilcoleman
About Denzil Coleman
Denzil Coleman has served as a telehealth coordinator, developing and maintaining digital health interventions at the Medical University of South Carolina (MUSC) Center for Telehealth since 2017. He holds a Master of Science in Health Information Technology and is completing a Doctor of Education in Educational Practice and Innovation, both from The University of South Carolina. Denzil has worked in healthcare for nearly two decades including stints at Roper Saint Francis and Memorial Sloan-Kettering Cancer Center. He also lectures in and facilitates healthcare management and technology education programs in the United States, United Kingdom, and India.
- Sponsor: Vanilla, a one-stop-shop for online community
- Denzil Coleman on Twitter
- MUSC Health Center for Telehealth
- The American Telemedicine Association
- Alzheimer’s Society
- Serena Snoad on Community Signal
- Community Signal episode about strategies used by anti-vax influencers
- Dr. Kelli Garber and Dr. Ragan Dubose-Morris, who Denzil works with at MUSC
- Dr. David Valentine, who Denzil shouted out
- Dr. Panos Constantinides, who has mentored Denzil
[00:00:04] Announcer: You’re listening to Community Signal, the podcast for online community professionals. Sponsored by Vanilla, a one-stop-shop for online community. Tweet with @communitysignal as you listen. Here’s your host, Patrick O’Keefe.
[00:00:25] Patrick O’Keefe: Hello. Thank you for spending this time with me. We’ll be talking with Denzil Coleman, Telehealth Coordinator for the Medical University of South Carolina’s Center for Telehealth, one of two Telehealth Centers of Excellence in the US, as recognized by the HRSA, a government agency aimed at improving healthcare for people who are geographically isolated or economically or medically vulnerable. I think there are some really interesting corollaries between telehealth and the work that we do as online community moderation, trust, and safety folks.
Thank you to our Patreon supporters who really believe in our show. This includes Serena Snoad, Maggie McGarry, and Rachel Modanic. If you’d like to become one of our backers, please visit communitysignal.com/innercircle for more info.
Denzil Coleman has served as a telehealth coordinator, developing and maintaining digital health interventions at the Medical University of South Carolina Center for Telehealth since 2017. He holds a Master of Science and Health Information Technology and is completing a Doctor of Education in educational practice and innovation, both from the University of South Carolina. Denzil has worked in healthcare for nearly two decades, including stints at Roper St. Francis and Memorial Sloan Kettering Cancer Center. He lectures in and facilitates healthcare management and technology education programs in the United States, United Kingdom, and India.
Denzil, welcome to the show.
[00:01:43] Denzil Coleman: Thanks for having me, Patrick. I’m excited to be here. First time, long time.
[00:01:47] Patrick O’Keefe: It’s my pleasure. Just to set the table, when some people hear the phrase telehealth, they are likely to think of one-to-one phone or video calls with a medical professional but the term telehealth is actually used in a much wider way. What’s telehealth?
[00:02:01] Denzil Coleman: Sure. To put it simply, telehealth is really anything that incorporates moving away from limiting it to care over distance but you can start there. Really, anything where healthcare is being impacted by a patient and an actor that are not in the same location. That includes a video, that includes transmissions of information, asynchronous messaging, remote patient monitoring.
There are a lot of components of telehealth and really what you described is more what people consider telemedicine just a component of telehealth. The definitions, they vary. I like to use the American Telehealth Association’s definitions by default but I tend to understand what people mean by context clues. I’m not a big stickler about it.
[00:02:57] Patrick O’Keefe: You mentioned getting away from being over distance. Why is that?
[00:03:01] Denzil Coleman: Getting away from describing it as care over distance is important I think because it’s a little bit limiting. I think when you introduce over distance, people really think about that first area of telemedicine, that first video of modality. We want people to think more broadly when they consider what telehealth means and what it can do. It’s a lot. I think it’s more of that kind of a cue more than anything.
[00:03:27] Patrick O’Keefe: For example, I have a doctor, my primary care doctor. He’s obviously nearby, 10, 15 minutes away. If someone’s sent over a distance, they might think it’s someone who’s usually inaccessible to them, and yet I talk to my doctor via a patient portal where I’ll send him a quick message, he’ll send me a quick message and that’s telehealth, too.
[00:03:45] Denzil Coleman: Well put. That’s another reason I think why we want to get away from that as the sole definition. It can be a little misleading or confusing.
[00:03:55] Patrick O’Keefe: Makes a lot of sense. Then when we talk about patient-centered online communities, these are communities where patients and possibly members of their support system gather often to discuss a condition that they share, to learn from one another, and to provide and receive support among other causes and these communities can take different forms. Responsibly managed platforms are usually staffed by folks either a full-time, volunteer, or a mix of both with the goal of ensuring people receive accurate information and compassion.
An example would be the Alzheimer’s Society’s Talking Point Community. That program is led by Serena Snoad, a previous guest of the show and one of our Patreon supporters who suggested some questions and themes for this episode. Thanks, Serena.
Has there ever been a bigger time for telehealth adoption and usage than right now?
[00:04:39] Denzil Coleman: Absolutely not, no. The COVID-19 pandemic required everyone to get comfortable or at least to get involved with delivering care this way outside of the conventional in-person methods that they’re used to. Even at the Center for Telehealth at MUSC where I work, we saw a a very significant uptick in telehealth interactions of all kinds since the start of the pandemic, in our world since March of 2020, just because pretty much every interaction had to take place that way from patient safety.
The forced adoption of the time of the emergency is really what prompted it, but we’ll take it because as people are getting more comfortable with these modalities, we’re able to push digital health as a whole forward a lot quicker. Some of the things that I’m getting to work on right now might have taken a little bit longer to get to because everyone now wants to take part and come up with some great solutions, which is fantastic.
[00:05:44] Patrick O’Keefe: You mentioned interactions. Is that how you measure it? Is it number of interactions? Is it time spent number of unique doctors and professionals, number of getting patients, how are you measuring sort of that increase? What data do you look at?
[00:05:54] Denzil Coleman: We measure all of those things for different reasons. When I’m talking about telehealth interactions, I say that because I want to be inclusive. I don’t want to just say, video visits. If I talk about visits, that’s all you’re going to think about. If I say interactions, I can include everything in the ecosystem. I can talk about the remote patient monitoring. I can talk about messages. I can talk about anything in addition to the video visits. I can talk about phone calls. All of those things matter and every single one of those is an opportunity to give someone a quality healthcare experience.
[00:06:27] Patrick O’Keefe: I actually had my first telemedicine visit during the pandemic. I forgot what it was, I was fine. I got a prescription.
[00:06:34] Denzil Coleman: Good, glad to hear.
[00:06:35] Patrick O’Keefe: Thank you. I did that for the first time during the pandemic and I had a second phone call with my dermatologist because I needed a prescription, but they wanted to require a visit and a phone call was enough. Did that, but then as I think about it, one common thing that a lot of people have done, at least in the US I can’t speak for everywhere, is a call to the pharmacist to ask a question. I don’t know if that’s telehealth strictly but at least for some people, it might be an introduction into telehealth, like a way to think about it.
[00:07:01] Denzil Coleman: Of course it is. That’s definitely telehealth and that’s exactly the kind of example I’m pointing to when I say it’s important for us to open our minds to be inclusive with our terminology, with our jargon, and really with what we consider telehealth to be. That’s absolutely the telehealth interaction. It’s not one that I might count in a hospital setting. If that pharmacist is not part of my system, I have a way to track that but that it happened. You could absolutely call it telehealth.
[00:07:31] Patrick O’Keefe: You teach a digital health transformation course and your students are healthcare professionals, providers, C suite folks, and others. Talking about the benefits to the patient for using a patient-centered online community is fairly straightforward. But how do patient-centered online communities benefit medical professionals?
[00:07:50] Denzil Coleman: There are a lot of ways, but the first ones that come to mind are that there are other contributors and actors into the patient’s care. There are family members involved. There are other stakeholders. There are members of the community who can take part and who can complement what the provider is doing. That’s very important.
It’s also good to have the patient’s engagement in care. A lot of times, you may give an intervention or a plan of care in which the patient is not fully engaged and having them as part of one of these communities where they feel supported and they feel encouraged to take part and advocate for their own care, share experiences, it keeps them engaged. It keeps their focus on their health and on getting better.
Providers inherently benefit. It’s not about passing off responsibilities. It’s going to take a village to keep everyone healthy. I hate to use clichés, but we have to do these things together and, the more integrated and intersectional someone’s care experience is, the better. The other side of the communities is you want to make sure that that is indeed what’s happening and you want to make sure that you’re keeping malicious actors out and that’s a significant challenge of online communities.
I listened to the anti-vax podcast and I learned a lot about what’s already happening in the community space to misinform patients in other ways. Here, we have to protect patients the same way.
[00:09:18] Patrick O’Keefe: Online communities that are well run can also sort of lighten the load on medical professionals. You mentioned this in our conversation before the show, which I found interesting.
[00:09:26] Denzil Coleman: Sure.
[00:09:27] Patrick O’Keefe: Because once upon a time, not long ago, you might have a singular focus on a medical professional, on your doctor, on your specialists, on your person at the hospital, at the office-
[00:09:39] Denzil Coleman: That’s right.
[00:09:40] Patrick O’Keefe: -for good reason around your care and your sort of existence around a particular issue. That has sort of slowly shifted over the last several decades. Right now, it feels more distributed in a good way than ever before because that doctor, that person doesn’t have to necessarily bear the full burden of every feeling emotion question, thought that the patient has because, not only do they have a family and support system, they have a way to more easily connect with people. Same way you might get a pamphlet once upon a time for support groups, which are still in existence and still great and still helpful and still important.
[00:10:15] Denzil Coleman: Exactly right.
[00:10:16] Patrick O’Keefe: Maybe not everyone has as ready access to them or maybe they just feel comfortable in their virtual environment and now they have access to that support group instead of just calling their doctor’s office, which is fine also but just providing that extra avenue can take some of the burden off of, I think, what a lot of people would say is an already burdened medical profession right now.
[00:10:36] Denzil Coleman: I couldn’t agree more. That’s really what I was getting at when I was talking about the community involvement, that obviously by-product has lightened the physician’s load. You even think about one of the other benefits is patient education responsibility. Of course, the provider is responsible for giving the education for their interventions by sustaining the education, sustaining the intervention or whatever it may be, patient-centered community, or patient-led community, patient-driven community, however you want to frame it or phrase it can go a long way in making sure that those things take hold. Keeping people on track.
You think of one of the oldest ones, Weight Watchers, that is a patient-led community. It’s a very popular one and people join Weight Watchers to be held accountable, to stay on track and to maintain the consistency they need to improve their health in a safe environment. I think that’s something that can be done across all kinds of conditions and different cross sections of patients just to positively impact public health. Why not?
[00:14:35] Patrick O’Keefe: Let’s take a moment to talk about our generous sponsor, Vanilla.
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I assume that, like any medium, there are medical professionals who are great at patient-facing telemedicine work. Just like every other skill, baseball, anything, any skill at all, there are some who are great and there are some who aren’t. What do the great ones do? What are the traits, skills, tactics of people who are great medical professionals used to in-person practice but then they transition seamlessly and they’re great telemedicine professionals too?
[00:12:46] Denzil Coleman: There is an entire subset of characteristics that we in the field like to refer to as telehealth etiquette. I want to give a shout out to some of the teammates at MUSC I work with very closely. Dr. Kelli Garber, Dr. Ragan Dubose-Morris. We actually work together to provide education for providers in this area to make sure that their telehealth etiquette is appropriate.
Your bedside manner as it were, it doesn’t necessarily translate from in-person to the video realm. There are a lot of considerations that people don’t think about. Eye contact, lighting, where you are, how you’re positioned and whether or not you’re looking down and typing or writing notes. All those things come across very differently on camera. It’s really important for providers to understand that and be trained to that. We work to make sure that that is indeed the case.
[00:13:46] Patrick O’Keefe: As we’ve touched on a little bit, one thing that online communities can do is it’s very common for a patient’s family to be part of that community especially ones around specific medical conditions that demand it because of how the condition attacks our bodies, or attacks our mind, or attacks our faculties in some way. When talking about telehealth, how important is it to bring together the families of patients as part of those services or how do you think about that?
[00:14:14] Denzil Coleman: It’s immense and I think that’s where so much value comes in our discussion about communities because families and loved ones have to be part of the care journey for individuals who were dealing with certain conditions. The involvement of loved ones comes in every form from emotional support to that’s the person who’s helping you bathe and get in and out of bed, to that’s the person who’s driving you to and from your appointments, which telehealth, of course, can lighten that load.
If you have to drive 10 minutes instead of two hours, that could be life changing, perhaps to the family members who are taking days off of work to make sure that you get to an appointment or someone has to watch your children. That kind of thing. Yes, it’s very important for families to be involved and to the extent to which we can safely include them in the communication and in the care plan. It’s great.
One of the things that we’ve actually seen that telehealth has made even easier in some cases has been on some of our virtual platforms. We can incorporate the patient in one location. We can incorporate another care team member in another location. We can incorporate a family member in another location if that’s who the provider and the patient would like to have, involved in the consultation or intervention.
When we’re able to open up those kinds of doors, that’s fantastic. You put the shoe on the other foot, maybe there’s someone who’s supposed to be part of your care plan, who is many miles away. Now, that person can be part of that. Maybe that’s not someone who’s going to be driving you to and from your appointments, but that’s someone who’s going to help you with your accountability or that someone who’s going to be managing elements of your life that you need. Telehealth can help.
[00:16:02] Patrick O’Keefe: You mentioned taking time off to take a loved one to their appointment. Would you say telehealth has made it easier for family members to be a part of the care of their loved ones in the sense that, you use the term asynchronous, if things are set up in a certain way, being able to talk to a doctor or a provider over some sort of patient portal or text messaging, phone calls, instead of having to go to the office for every appointment?
Once upon a time, you’re willing to take that time off. Now, let’s say you have a full-time job, but you still want to help that family member. It seems to me like these sorts of tools would help enable you to take a more active role through sort of that asynchronous nature.
[00:16:39] Denzil Coleman: That’s absolutely right. Of course, there are considerations, including safety, privacy, consent that have to be built into that, but as long as the patient is comfortable with it and provides that level of consent, many people can be included and their location doesn’t have to be a barrier.
[00:17:00] Patrick O’Keefe: We’ve talked about online communities so far, mostly as a complement to what a patient is receiving in care from a hospital or medical facility. Do you think that in the future, online communities should be a part or could be a part of telehealth programs like the ones that you administer and train around where the hospital, the medical center, the provider is actually the one hosting the community programs as a part of their overall telehealth services? Do you see that as something that should be happening could be happening? Would you like it to happen?
[00:17:30] Denzil Coleman: Absolutely. It already does happen. We just have providers dipping their toe into it. We have clinics dipping their toe into it, and it’s starting to materialize and make sense. A lot of the barriers don’t have to do with the intentions of the people delivering care or providing a given intervention. They have to do with policy. They have to do with regulations. They have to do with compensation. They have to do with all kinds of other extrinsic factors.
You have that with a lot of psych-based programs where you will have a virtual support group component or you might have a group nutrition class. Those things already happen, and they’re successful. They’re quantifiable and they’re successful. I do believe you’re going to see that more and more often. These are the kinds of things that we have to figure out how they’re best applied, how they’re best designed.
When we do that, we absolutely need that because providers already make those recommendations and suggestions to patients and send them in those directions. “You can join this support group. We have this resource on our campus, please take advantage of it.” It can absolutely exist in the virtual space.
[00:18:38] Patrick O’Keefe: We’ve talked a little bit about offices, hospitals, et cetera. Is this an area where you think, because I know you’re a policy guy too, and we talked about private payers a bit in our conversation before the show, but do you think it’s also an area that insurance companies should be experimenting with as well?
[00:18:53] Denzil Coleman: Telehealth?
[00:18:54] Patrick O’Keefe: Online communities specifically as part of their service offering to their members?
[00:18:58] Denzil Coleman: Absolutely. That’s because they want to minimize harm and risk to the lives they cover. They already intervene in ways that are very similar to hospitals and healthcare institutions. Chances are, if you have a private insurance in the United States, if you look at the card very closely, there’s probably a phone number on the back that you could call to access some form of virtual care, be it rapid access, acute appointment, or something.
They’re already working to expand their offerings and act a little bit more like true traditional health providers and that’s largely in a complementary role, but it can be more. It’s actually very fascinating right now to watch that evolve live because some of them are doing a lot right now.
[00:19:49] Patrick O’Keefe: Obviously, Denzil and I are both in the US, and the US medical insurance and health insurance system is something that I think a lot of folks in other countries who listen to the show might look as a totally like-
[00:20:01] Denzil Coleman: Yes, “what is going on over there?”
[00:20:02] Patrick O’Keefe: -foreign concept and not just being foreign in a country but a foreign concept and idea. You told me before the show that private payers, private insurance companies are actively working to establish the permanence of telehealth, and in many ways are becoming more and more like providers themselves. Can you talk a little bit more about that? What does that mean that they’re becoming more like providers themselves because I feel like that’s relevant to what we’re talking about.
[00:20:24] Denzil Coleman: Absolutely. What that means is they are hiring providers. They’re hiring healthcare professionals. They’re hiring care coordinators to help with everything that’s involved with the lives that they cover with the individuals who pay them premiums on a monthly basis. They do want to make sure that they’re healthy. They do want to pay out as little as possible. It’s in their interest to take active stake in the quality of care that their covered lives receive.
It’s an investment that they’re making, of course, public health benefits but they benefit financially as well from not having to pay out on as many claims, particularly hospitalization and emergency room claims which are the most expensive and most damaging financially.
[00:21:12] Patrick O’Keefe: Not to distill things down to the dollar, but let’s distill it down the dollar. I guess, is when you talk about insurance companies becoming more like providers in some ways, and now this is an area where they should experiment online communities specifically same for hospital medical groups, et cetera, is the thought that it’s, I don’t know if it’s great phrase, a win-win in the sense that it’s both believed that it could potentially offer better care for the patient, but also represent a better financial situation as far as cost goes as well?
[00:21:44] Denzil Coleman: Absolutely. In fact, you’re touching on a major principle of digital health transformation that I love to talk about. Not just digital health transformation, but healthcare optimization overall. Is that, when you create efficiencies and when you leverage technology to do things more efficiently and effectively, the money will come. You are going to save money. You’re going to have lower overhead and less expenses, and you might just make a little bit better of a quality product for your patients.
One thing that I believe we talked about in our conversation before was, of course, reducing costs is a great thing, but it’s best when the cost reduction is the byproduct of the creation of efficiencies and better processes which is what we do when we look at digital health transformation, when we look at just general healthcare optimization. We want to be able to reduce waste, financial waste, and we get to do that.
Online communities and just expanding the reach of what we already do, expanding the reach of providers who are overwhelmed, overworked, facing a mushrooming population of people who are living longer, healthier lives and not dying which is great, but while at the same time, we are having less and less people graduate from medical school becoming doctors.
Of course, those are being supplemented by what we refer to as mid-level providers and large increase of people becoming physician assistants and nurse practitioners which is also great, all great providers, but our providers aren’t matching the rate of individuals surviving. We have to create the efficiencies, we have no choice. We have to use technology to do the best we can and online communities are part of that.
[00:23:38] Patrick O’Keefe: I think if online communities do take off in this way, and I think that’s yet to be seen. It’s a worthwhile experiment to do it, I think it makes a ton of sense and my optimist says it’ll work out great and makes a lot of sense. If that happens, there’s a way to look at it that I think from a medical professional standpoint sees it as an opportunity to lose jobs, right? Because if we’re connecting patients with one another, what’s the math there? They talk to us less, they need us a little less, maybe they need less of us that sort of thing, but also, even if that’s true which I don’t necessarily think that’s true. I don’t know enough to really make a smart quantification so disregard me, but there’s going to be other jobs that open up in a sense of needing to responsibly caretake these communities. I see that happening in two big ways right off the top of my head.
Number one is people like you who work, live, and breathe telehealth maybe– you have experienced online community so not you specifically, but you might not be used to what it takes to manage an online community. You do grasp digital health, the importance of that transformation, a lot of the tools that are in that space, and how that really works well and can apply that knowledge to an online community.
Maybe you need a little bit of training and kind of fine-tuning around the finer aspects of managing online community when it comes to writing guidelines, applying policy, moderation, all those fun things. Also, for people like me, who have built online communities for a long time, that’s kind of the second group probably secondary where those of us who do this work really well can take our know-how and then learn about what digital health is and how that works well and what to do with in those environments like a new industry, like any new industry that you step into.
I think there’s going to be opportunities there as well. If it works out in a great way where online communities make a lot of sense for patients and these larger hospitals and medical groups and insurance companies co-op them in a good way, there’s going to be opportunities there as well.
[00:25:20] Denzil Coleman: I agree. I want to go back to something you just said. I found it fascinating, the idea of providers finding online communities to be threatening and threatening to their work and to their jobs [crosstalk].
[00:25:33] Patrick O’Keefe: Tear it apart. [chuckles]
[00:25:35] Denzil Coleman: Yes, yes. No, no, no. It’s not about tearing it apart because it’s fascinating. I think that’s a really good instinctive position to have. It’s also unfortunately reflective of some of the things that we’re trying to change in healthcare en mass right now. Traditionally, providers have had to make their money on a fee-for-service model.
When they do that, everything has a line item, dollar sign attached to it, and you’re incentivized to have more visits. You’re incentivized to have more interactions of every kind. You’re incentivized to have more procedures. It’s not that I believe providers historically were trying to run up the numbers, but they do want to work and they want to do what they can to keep people healthy.
We’ve shifted our thinking across the board to more value-based care models where things that make providers work easier and more efficient are welcome. We want to encourage that kind of innovation. We don’t want providers to feel threatened that they’re going to lose money and lose opportunities. A lot of value-based care models that are going on right now, they have more to do with giving a provider a more appropriate healthcare system, a practice organization, a lump sum of money, a way to put this. They’ll get a lump sum of money, let’s say it’s a $100 million, from insurance company X, won’t name any names. Insurance company X just says, “Look, here’s that check, it’s $100 million. That’s yours. You have X amount of lives on our policy. That’s what you’re going to get to take care of them.” Now, you’re actually incentivized to create those efficiencies because it’s going to affect your profit margin.
Insurance company X doesn’t want to pay you a la carte, by the transaction, and by the visit. It’s also not necessarily more productive, effective, or beneficial. If we work together to create more value additions across the board in healthcare, we’re going to see improvements. Now, we’re going to see more efficiencies. I think that’s going to be much better for everyone. I thought that was interesting about physicians and their jobs being threatened.
The other side of that is they need help. They are overwhelmed and not just in the current COVID-19 situation, which is awful and it’s impacted everyone in the healthcare industry. People are – sports analogy – everyone playing a little bit out of position right now, just to make sure that everyone, all of us are able to get access to whatever basic services that we can provide. We absolutely need, welcome, and crave those efficiencies. If anyone doesn’t, you should be wary at this point. [laughs]
[00:28:20] Patrick O’Keefe: I’m glad you brought that up because I found it fascinating when we talked before the show about how, as these private insurance companies are working to solidify telehealth, there is that shift happening in the compensation model moving away from a fee-for-service model to value-based care. The reason I think that’s interesting is because it ties to what online communities represent really, which is a long-term approach built around consistency and people coming back over a longer term and building relationships and really getting deeper into that community as opposed to a more transactional relationship.
[00:28:54] Denzil Coleman: That’s right.
[00:28:55] Patrick O’Keefe: I’d love for you to go into a little more detail on that. The move to value-based care, is that a more recent development? Is it a longer term thing that’s getting a lot of momentum because of this COVID era that we’re in right now? Does that comparison makes sense between a transactional relationship versus this long-term investment in a patient? Is that the right corollary to draw do you think?
[00:29:17] Denzil Coleman: Not quite. We’ve been talking about value-based care, increasingly in models of value-based care, tangible models for the past decade in change. We still don’t all agree on what they need to look like. We all tend to agree to an extent that they’re necessary, but how they work, we have to still collectively come to those decisions and agreements.
I would say the push toward it is necessary, and it’s not about shortchanging the patient in any way. I think that’s an easy way to look at it. Some people may see it that way. Patients, I want you to come in less. I want you [chuckles] to have less stops and interactions, “You kicking me out, doc?” [chuckles] It’s like, “You don’t want to see me, you don’t want to talk to me?” It’s like, “No, it’s not that.”
Some of these things aren’t necessary, don’t add value, or may even be wasteful. The conversations, I can imagine if you’re with a provider and you’ve had a long-term condition over the past 20, 30 years, and the last 15 of them, you saw your provider every three months no matter what. Now, in 2021, your provider tells you, “I’m only going to see you in person maybe one time a year instead of four, but you’re going to come see me in person. I’m going to do an exam, then I’m going to have a little remote monitoring on a monthly basis. Then we’re going to do a three-month video-only checkup. Then we’re going to do something in six months.” You only come to the clinic and get an exam the one time. It’s not because we don’t want to care for you. It’s because we actually want to create efficiencies for everyone in the healthcare ecosystem. We don’t need necessarily all of it.
Also, the other side of that is we did what we knew, and we continue to do what we knew without always challenging and innovating. We know we did what was easy. Fee-for-service persisted, often time, in large part because it’s a daunting challenge to re-envision that. It’s a daunting challenge to apply it. Of course, the biggest driver for something like that is everyone waits for the one shoe to drop with Medicare with CMS and you see what they do, and then a couple of the larger carriers as well.
Again, I won’t name any names or do any plugs, but you see a big three or four go into a certain direction, and that’ll set the tone. We all want to get paid for what we do. As long as the money’s coming in, we’re able to pay our people and keep the lights on and keep these businesses, these hospitals in the red, these health systems in the red it’ll workout, but we’ve got to do it together.
[00:31:56] Patrick O’Keefe: Is there something that you would like to do in a telehealth program that you haven’t yet been able to?
[00:32:03] Denzil Coleman: Wow, that’s a great question. Well, we’ve been talking about one of them. I’m excited about the potential for closer interaction and combination of community involvement with telehealth. I think there’s a lot of potential there to include telehealth into patient-led, patient-driven, patient-centered communities. I would love to be involved with something that interacts with patients a lot more.
This actually brings me back to my first dissertation idea. I don’t know if I told you about this, but what I first wanted to do for my dissertation was to do some study and intervention on patient education because this is what we’re here for. We’re here to make sure that people get what they need. One of the biggest challenges I found in telehealth in my early experiences with it were just a lack of patient education on how to engage it, and how to best take part.
I wanted to work on patient education. My professors, they wisely explained to me that I don’t control the patient environment as far as data collection goes. I couldn’t be able to require patients and track patients to give me the information I need because their lives are slightly outside of my scope of influence, as much as I would like to help them. I had to restrict my dissertation to what was which was my work environment and providers.
I found a way to work on dissertation there. I brought all that up because I think that could be a way to positively impact patients’ lives down the road by giving them access to information and support and things that they need to complement their care very well. I think telehealth can do that and it can be designed. There’s got to be a lot of thought for safety and protection of reputable information and all of that.
[00:34:00] Patrick O’Keefe: What do you think that role is in– I don’t want to say the age of Google because it’s such an old phrase, but for example, my physical therapist when I went to see them, probably, I think it was during COVID. It was for my back, which coincidentally is killing me right now. These last few days, for some reason, I hurt myself. My back is just killing me. It’s awful.
I think he said to Google for exercises. He could give me a printout of stuff, but he’s like, “Just Google this phrase and you’ll get the exercises you need.” I don’t resent that. I didn’t say you’re being lazy. I thought it was funny in the moment when I was thinking through what that was. We trust Google as a reasonable arbiter of information and that they do a pretty good job around that information.
In general, at least in the circles and in most people that I run into, you trust Google that’s your search engine of choice. Yes, you have a certain degree of scrutiny to things on the internet, but when you enter something, Mayo Clinic will be at the top. They sound like they put in general the really bad stuff at the top. If it’s not indexed, a lot of it’s removed. Some of it’s still there.
You still have to be discerning. He’s basically like, “Search and you’ll find this information. I was like, “Okay, cool.” I did, it took me two seconds. He’s right, the exercises were there at a reputable site. That is to say that, once upon a time, there was probably this urge to want to put information on a website that is out there, and then that’s how we’re educating people.
Long way of asking, how does that impact the role of telehealth? What do you want to layer on top of that from an educational standpoint that takes people beyond what they could just get on Google or some other website and actually makes it worthwhile for you to do as opposed to duplicating something that’s already out there?
[00:35:38] Denzil Coleman: Wow. That’s a fantastic question. I think there’s a great opportunity to inject just a true humanity into that experience. Of course, you can guide people toward the correct resources using a community effectively, but I think there’s opportunity to do that and more. There’s an opportunity to do that and truly bring a human joy into the patient’s life through a community.
I say that because I’ve seen the impact of community on lives throughout my own life. I’m a big proponent of that, I do believe in it. I think there’s a lot that we need to get back to about our collective humanity in these challenging times. If we were able to do that effectively with healthcare, when with science and with healing people, I think that’d be great. I’d love it.
[00:36:33] Patrick O’Keefe: As you hint at, we are in a weird time where, I don’t know if medical professionals have been distrusted at this level in my lifetime. There’s always people who would distrust, but in such visible like percentages of people that we see on TV, it seems anecdotally like more, or at least they’re able to come together more easily, and then unify and present a unified front at some public venues.
To say that is to say that you’ll always have some people who are suspicious. My mom taught me to question everything, question authority like–Also, I got the vaccination as soon as I could. There are some things I’m not questioning. What I’m saying is that, do you think there’s an opportunity when you talk about that human connection, that personal touch to things where you do host those services within your own website, within a patient portal, within somewhere where the patient has a familiarity with that medical group, that office, that doctor?
[00:37:29] Denzil Coleman: Go on.
[00:37:30] Patrick O’Keefe: The information comes from them in this portal and they’re sharing it. Is that an opportunity to get through to more people in an environment where it is more conducive for people to hear those things and learn from what’s being shared?
[00:37:47] Denzil Coleman: Absolutely. You don’t necessarily control someone’s receptiveness. If you have a good relationship with a provider, and you trust that provider, chances are what they’re having to say to you about science– [laughs] I’m sorry, I’m only laughing because I see so many examples of things. I’m hearing people who would probably talk about antiquated medicine, and people who would probably rather try bloodletting than vaccine right now.
It’s very, very strange. Using this as an example, speaking with a provider you trust can go a long way and having those kinds of relationships, I think, going back to creating efficiencies, if we do that, we have opportunity to create the time that providers need to be the kind of people they like to be. I think this is just part of that. Obviously, when you have a great provider relationship, I hope everyone listening knows what this is like. I know not everyone has that luxury of like, “That provider is my man.” I hope you have. If you have, you can imagine–
Shout out to Dr. David Valentine back in New York, that was my guy back in the day. It means everything and you remember it, and there’s a trust there. If we can continue to add value, create efficiencies for providers, and for health systems, then providers, they’re dying to get their hands dirty to do what they do and to exhibit their talents and know that’s not just procedures, and that’s being smart, well trained human beings who interact with others. Absolutely, I think that will be great.
[00:39:30] Patrick O’Keefe: I’m impressed because we got to the end of this conversation without a single mention of HIPAA, which I think is just something to be celebrated. We managed to avoid it by not talking about it. Although, we did talk about it, we just didn’t mention the law. You said privacy, but you never said HIPAA.
[00:39:46] Denzil Coleman: Exactly. We talked about privacy. We did not talk about HIPAA and they are not the same thing. It’s very important– [crosstalk]
[00:39:50] Patrick O’Keefe: I know. It’s almost a meme online to talk about HIPAA these days.
[00:39:53] Denzil Coleman: “You violated my HIPAA.” What? That’s not HIPAA.
[00:39:58] Patrick O’Keefe: Exactly, yes. One P not two.
[00:40:00] Denzil Coleman: Yes. Two As, one P, for starters. I don’t mean to sound condescending.
[00:40:05] Patrick O’Keefe: Yes. Not at all.
[00:40:06] Denzil Coleman: It’s very frustrating, but [laugh] the Health Insurance Portability Accountability Act has to do with the sharing of your information from parties that are not yourself. That’s what you should be considering. If someone asks you for information that you choose to volunteer or not, HIPAA has not been violated. I’m so sorry to inform you of that.
You have the choice to not disclose information about yourself. Now, a violation of HIPAA would be if you did not disclose that information when you tried to get into the establishment that didn’t let you in, and then they went and stole your medical record, leafed through it, and got the answers they want, there you go. There’s a HIPAA violation. Sorry.
[00:40:53] Patrick O’Keefe: Yes. I was impressed, but we did it now. Denzil, it’s always a pleasure. Thank you for coming on the show and spending some time with us.
[00:41:01] Denzil Coleman: Yes, sir. It is my pleasure. I’m honored to be a guest. This is a fantastic show, a fantastic platform. I learn a lot from listening and I’m excited for what’s to come both with you, with the show and with the things that we’re talking about. I really think there are a lot of incredible opportunities. Just talking to you here on the show and off-mic, it’s really inspired me to think a little bit more about what we can do and how communities can positively impact health and digital health, so thank you.
I do want to give one last shout-out to Dr. Panos Constantinides because we talked about my opportunity. I get to help people learn digital health around the world. I do that through his course. Thanks to you Panos for being a mentor and for helping so many.
[00:41:48] Patrick O’Keefe: We’ve been talking with Denzil Coleman, telehealth coordinator at the Medical University of South Carolina. Follow him on Twitter @DenzilColeman. Denzil is D-E-N-Z-I-L.
For the transcript from this episode plus highlights and links that we mentioned, please visit communitysignal.com. Community Signal is produced by Karn Broad and Carol Benovic-Bradley is our editorial lead. Thanks for listening.
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