How Dr. Kurth Handled the Covid-19 Peak Virtually in NYC: Through virtual consultations and daily conversations, Dr. Kurth managed Covid-19 symptoms, listened for complications, and provided reassurance. Virtual tools helped her stay focused and informed while preventing things from getting worse.
Dr. Rebecca Kurth, an associate professor of clinical medicine, handled the Covid-19 peak in New York City by seeing patients virtually and by phone. She spent up to 30 minutes speaking with each patient each day, managing symptoms of the virus, listening for possible bacterial infections or other complications, and providing reassurance. Her virtual office provided quick access to her patients' health records, helped her stay focused on her tasks, and served as a reassuring background for video calls. While facing uncertainty, Dr. Kurth learned more about the illness to provide micro-interventions and prevent things from getting worse.
The Benefits and Limitations of Telehealth for Medical Care: Telehealth allows for safe and efficient non-emergency medical care from the comfort of home. While it may not be suitable for all health issues, it can provide increased access to care and reduce the risk of illness transmission.
Dr. Rebecca Kurth faced a dilemma when Covid-19 hit New York City: should she reopen her office or switch to telehealth? She decided on telehealth to keep her patients safe and realized it had many benefits. Patients enjoyed speaking from home, and it allowed Kurth to see more patients and diagnose minor problems, like low back pain. However, some health issues, like earaches or abdominal pain, require the doctor to physically examine the patient. Kurth believes telehealth will continue post-pandemic for certain types of care. Telehealth is an efficient and enjoyable way to receive non-emergency medical care, be seen more often, and avoid the risk of catching or transmitting an illness.
The Telehealth Revolution: The Shift to Virtual Medical Visits: Telehealth has become more popular during the pandemic as a safer and more convenient way to receive medical care. While it offers benefits, there are concerns about delayed screenings and vaccinations as well as potential unintended consequences.
The COVID-19 pandemic has led to a telehealth revolution, with more doctors and patients turning to telehealth visits for increased safety and convenience. This shift has led to a surge in telehealth visits, with some practices seeing a hundredfold increase. While there are concerns about long-term medical consequences due to delayed screenings and vaccinations, telehealth offers potential benefits, especially for those in rural or underserved areas. Regulatory changes and increased insurance coverage have also helped facilitate this shift. However, questions remain about who may be left behind in this revolution and what unintended consequences may arise. Overall, telehealth appears to be here to stay.
The Potential and Flexibility of Telehealth in Modern Healthcare: Telehealth has various medical applications, including psychiatry, dermatology, and stroke care, and uses secure messaging for remote diagnosis and prescriptions. It's not limited to doctors and has the potential to transform modern healthcare.
Telehealth has been around for a long time, with the earliest form dating back to the invention of the telephone in 1879. However, until the COVID-19 pandemic hit, take-up rates were low and less than 1% of Medicare patients used telehealth services. Telehealth can be used for various medical specializations, such as psychiatry, dermatology, and stroke care. It's not just video visits and telephone calls; e-visits and e-consults provide secure messages between patients and healthcare providers, allowing for remote diagnosis and prescriptions. Telehealth is not limited to doctors - nurses, clinical psychologists, and social workers can also use it. Rural hospitals without a full-time ICU, for example, can use tele-ICUs. Telehealth's flexibility shows that it has numerous applications and potential in modern healthcare.
Telehealth Surge in the US during COVID-19 Pandemic: The US government's regulatory changes during the pandemic, including relaxed patient privacy rules and telehealth payments comparable to in-person visits, allowed for an unprecedented surge in telehealth and increased access to medical services, paving the way for a new era of healthcare.
The COVID-19 pandemic triggered a surge in telehealth in the US, where between 10 and 15 percent of medical visits are now conducted remotely. This unplanned telehealth surge was made possible by the Trump Administration's regulatory changes, including relaxed patient privacy rules and the allowance of remote consultations from home rather than medical facilities. Furthermore, the government made telehealth payments comparable to in-person visits, which was a significant incentive for providers. The relaxation of state licensure rules allowed practitioners to operate across state lines, which increased flexibility in providing medical services. David Cutler, a health care economist, sees this unprecedented development as an opportunity to increase access and cut spending, paving the way for a new era of telehealth.
The Future of Telehealth Post-Pandemic: Challenges and Opportunities: Telehealth experienced temporary regulatory changes during the pandemic, but its future is uncertain as it depends on political-economic decisions. Despite challenges with insurance coverage, the hope is that telehealth will continue to be reimbursed and utilized post-pandemic.
The pandemic brought about temporary regulatory changes that allowed for increased telehealth visits and waived co-pays, but these changes may not continue once the crisis is over as they depend on political-economic decisions. The biggest challenge faced by telehealth has always been the financial one, with fragmentation in insurance coverage leading to confusion among patients and providers. Money will likely determine the degree to which telehealth continues post-pandemic. Abuse of telehealth, however, is not a major concern, and the hope is that Congress will continue to reimburse telehealth visits as patients have shown an interest in using them and there have been no stories of widespread abuse.
The Ups and Downs of Telehealth Reimbursements by Insurers: Insurers were reluctant to reimburse for telehealth, but the pandemic changed that. With the uncertainty around deferred care and its impact on insurers, telehealth may become a new normal, or insurers may cut back reimbursements if utilization stays low.
Historically, C.M.S. has been disinclined towards reimbursing for telehealth due to a tendency to focus on where the hockey puck is and not where it's going. Private insurers had a bonanza because the use of medical services plummeted, but individuals and businesses who were writing them checks are unable to pay now. Although most insurers have been making a lot of money in the short term, they're wondering if the care deferred due to the pandemic will come back and bite them. If it does, insurers may need to impose more drug co-pays and stop telemedicine reimbursements. However, if utilization stays low, insurers will be in a much better position to accept telehealth as a part of routine care.
The Future of Telehealth in the US Healthcare System: The Covid-19 pandemic has elevated the use of telehealth, and while it may decrease after the pandemic, it could still improve the system. Redesigning care and switching to telehealth visits could address pricing failures and inappropriate care, and the future of telehealth looks promising.
The Covid-19 pandemic has accelerated the adoption of telehealth in the US healthcare system. While the spike in telehealth usage may drop after the pandemic, it will likely settle at a higher baseline level than pre-pandemic. Redesigning care and converting a significant share of in-person medical visits to telehealth visits (around 25%) could help improve the system and address two fundamental drivers of the broken, costly US healthcare system: pricing failures and inappropriate care. The future of telehealth is likely to be sticky, with providers and patients already investing time and energy in figuring out how to use it effectively.
The high cost of healthcare in the US and the potential solution with telehealth: Telehealth, a system that can improve convenience and accessibility, can lower costs by eliminating the need for staff and office space. Although it may not necessarily lead to cost savings, it does reduce the need for in-person clinical visits.
The high cost of healthcare in the US is driven by administrative costs, higher prices of pharmaceuticals and physician visits, and more intensive medical care with unnecessary testing, hospitalization, and procedures. A system that is difficult to access and use also leads to poorer outcomes. Telehealth can improve convenience and accessibility, and lower costs by eliminating the need for staff and office space. While currently reimbursed at the same rate as in-person visits by C.M.S., telehealth visits can ultimately be done for around 85% of the cost of an in-person visit. However, some experts argue that telehealth may not necessarily lead to cost savings, but rather reduce the need for in-person clinical visits.
The Pros and Cons of Telehealth Visits: A Balanced View: Telehealth visits can help reduce costs, but may affect revenue. Providers worry about the absence of additional services. However, telehealth can prevent expensive hospitalization by using technologies for preventive care. Prevention is underdone, despite successful treatments for high cholesterol and hypertension being available for only about half of patients.
Telehealth visits can reduce overhead costs but may also result in lower revenue due to payment equity and the absence of additional services offered during in-person care. The concern of healthcare providers is that telehealth visits may only offer essential services and not the low-value tests and procedures that providers currently make money from. However, telehealth can prove valuable in preventing expensive hospitalizations by using technologies for preventive care and healthcare monitoring. Prevention is currently underdone despite successful treatments for high cholesterol and hypertension being available for only about half of patients.
The Benefits of Telehealth and Its Potential to Improve Healthcare: Telehealth can enhance preventive care and manage chronic conditions, leading to better patient satisfaction and cost savings. Collaboration with technology partners can maximize its benefits, improving access, quality, and patient experience.
Telehealth has the potential to increase preventive care by making regular activities easier to manage at home, such as taking medication or monitoring vitals. Remote monitoring and the use of artificial intelligence can aid in managing conditions like congestive heart failure and diabetes, while also improving patient satisfaction rates. Telehealth is part of a larger system of healthcare that should use information technology more effectively. By using telemedicine and partnering with companies like CVS and Walgreens, healthcare providers can improve lives and save money on conditions such as heart attacks and strokes while also focusing on access, quality, costs, and patient experience.
The Potential Impact of Telehealth on Cancer Diagnosis and Other Medical Outcomes: Telehealth has the potential to revolutionize healthcare by providing more convenient and accessible options for patients. Proper implementation and careful research are necessary for better medical outcomes and could benefit those who struggle with traditional healthcare access.
Remote monitoring has been successful in managing congestive heart failure and diabetes, but its population-level impact on cancer diagnosis and other medical outcomes is yet to be seen. Access to healthcare is crucial for better outcomes, and telehealth could be a more convenient and accessible option for those who struggle with traditional medical care. Telemedicine, if implemented properly, could revolutionize the way we care for patients and potentially keep them out of hospitals and inpatient settings. However, it could also lead to a power struggle for control over a patient's medical care. Further research and careful implementation of telehealth could lead to better medical outcomes, especially for those who struggle with traditional healthcare access.
The Inequality Risks of Telehealth in Healthcare: Telehealth may worsen existing disparities in healthcare, benefiting the wealthy and leaving lower-income groups without access to needed care. The costs vs. savings balance could also vary, but there is potential for technology to make healthcare more affordable and accessible.
Telehealth may exacerbate existing inequality in healthcare by first benefiting those who are economically and demographically fortunate, while those in lower income groups may miss out on much-needed medications and screenings. Medical innovation always diffuses to higher-income people first, and the same may be true for telehealth. The winners may be physicians with more flexible schedules and patients who can receive care remotely, while losers may include office-support personnel and landlords of medical offices. The spending balance may increase or decrease depending on how much is spent on primary care relative to what is saved. While technology from telemedicine could potentially lower spending over time, there is a possibility of an increase in spending in the short run. Health-care systems are now open to change more than ever, making it a good time for the incoming administration to focus on priorities such as making healthcare accessible and affordable.
The Next President's Focus Should be on Medical Care: The cost of medical care is too high, and a full-frontal assault is necessary to reduce it. Patching up the A.C.A and costs while changing the payment model for doctors are essential steps towards efficient patient care.
The next president, whether it is Biden or not, has to focus on medical care. The recession has left people without coverage, while the cost of medical care is too high. A full-frontal assault is necessary to address the administrative costs, wasted resource use, fraud and abuse, and prescription drug prices. The cost of medical care can be reduced by at least $1 trillion a year. The focus should be on patching up the A.C.A and costs instead of getting rid of private insurance and implementing Medicare-for-All. The fee-for-service system in most primary care needs to change to a payment model where doctors receive a set amount per person per month, adjusted for how ill they are, which encourages them to care for patients efficiently. The president has to address other issues too, not just medical care.
Leveraging Telehealth and Alternative Payment Models for Better Patient Care: Providers can improve patient access and satisfaction by utilizing telehealth and alternative payment models. Opting out of insurance and prioritizing patient needs can lead to better overall outcomes.
Providers should consider using telehealth and email to see more patients and incentivize the use of telehealth through alternative payment models. Opting out of insurance can allow doctors to focus solely on the needs of their patients and become better doctors. Accepting all changes that benefit the patient's health should be a top priority for providers.
423. The Doctor Will Zoom You Now
Two doctors and an economist discuss the impact of the pandemic on telehealth, its potential benefits and drawbacks for outcomes and costs.
Freakonomics Radio
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609. What Does It Take to Run a Cannabis Farm?
Chris Weld worked for years in emergency rooms, then ditched that career and bought an old farm in Massachusetts. He set up a distillery and started making prize-winning spirits. When cannabis was legalized, he jumped into that too — and the first few years were lucrative. But now? It turns out that growing, processing, and selling weed is more complicated than it looks. He gave us the grand tour. (Part three of a four-part series.)
- SOURCES:
- Chris Bennett, operations manager at Berkshire Mountain Distillers.
- Luca Boldrini, head of cultivation at The Pass.
- Yasmin Hurd, director of the Addiction Institute at Mount Sinai.
- Chris Weld, founder and owner of Berkshire Mountain Distillers.
- RESOURCES:
- "As America’s Marijuana Use Grows, So Do the Harms," by Megan Twohey, Danielle Ivory, and Carson Kessler (The New York Times, 2024).
- "Evaluation of Dispensaries’ Cannabis Flowers for Accuracy of Labeling of Cannabinoids Content," by Mona M. Geweda, Chandrani G. Majumdar, Mahmoud A. ElSohly, et al. (Journal of Cannabis Research, 2024).
- "The Complicated, Risky — but Potentially Lucrative — Business of Selling Cannabis," by James R. Hagerty (The Wall Street Journal, 2023).
- "Marijuana Content Labels Can’t Be Trusted," by Shira Schoenberg (CommonWealth Beacon, 2022).
- "Growing Cannabis Indoors Produces a Lot of Greenhouse Gases — Just How Much Depends on Where It’s Grown," by Jason Quinn and Hailey Summers (The Conversation, 2021).
- "Blood and Urinary Metal Levels Among Exclusive Marijuana Users in NHANES (2005-2018)," by Katlyn E. McGraw, Anne E, Nigra, Tiffany R. Sanchez, et al. (Environmental Health Perspectives, 2018).
- "The Carbon Footprint of Indoor Cannabis Production," by Evan Mills (Energy Policy, 2012).
- EXTRAS:
- "Cannabis Is Booming, So Why Isn’t Anyone Getting Rich?" by Freakonomics Radio (2024).
- "Is America Switching From Booze to Weed?" by Freakonomics Radio (2024).
Abortion and Crime, Revisited (Update)
With abortion on the Nov. 5 ballot, we look back at Steve Levitt’s controversial research about an unintended consequence of Roe v. Wade.
- SOURCES:
- John Donohue, professor of law at Stanford Law School.
- Steve Levitt, professor emeritus of economics at the University of Chicago and host of People I (Mostly) Admire.
- Jessica Wolpaw Reyes, professor of economics at Amherst College.
- RESOURCES:
- “The Impact of Legalized Abortion on Crime Over the Last Two Decades,” by John J. Donohue and Steven D. Levitt (The National Bureau of Economic Research, 2019).
- “The Demise of the Death Penalty in Connecticut,” by John J. Donohue (Stanford Law School Legal Aggregate, 2016).
- “Environmental Policy as Social Policy? The Impact of Childhood Lead Exposure on Crime,” by Jessica Wolpaw Reyes (The B.E. Journal of Economic Analysis & Policy, 2007).
- “The Impact of Legalized Abortion on Crime,” by John J. Donohue and Steven D. Levitt (The Quarterly Journal of Economics, 2001).
- “State Abortion Rates: The Impact of Policies, Providers, Politics, Demographics, and Economic Environment,” by Rebecca M. Blank, Christine C. George, and Rebecca A. London (The National Bureau of Economic Research, 1994).
- EXTRAS:
- "John Donohue: 'I’m Frequently Called a Treasonous Enemy of the Constitution,'" by People I (Mostly) Admire (2021).
608. Cannabis Is Booming, So Why Isn’t Anyone Getting Rich?
There are a lot of reasons, including heavy regulations, high taxes, and competition from illegal weed shops. Most operators are losing money and waiting for Washington to get out of the way. In the meantime, it’s not that easy being green. (Part two of a four-part series.)
- SOURCES:
- Jon Caulkins, professor of operations research and public policy at Carnegie Mellon University.
- Adam Goers, senior vice president of The Cannabist Company and chairperson of the Coalition for Cannabis Scheduling Reform.
- Precious Osagie-Erese, founder and C.E.O. of Precious Canna Co.
- Nikesh Patel, C.E.O. of Mammoth Distribution.
- Nikesh Patel, director of the San Francisco Office of Cannabis.
- Tom Standage, deputy editor of The Economist.
- RESOURCES:
- "Most Americans Favor Legalizing Marijuana for Medical, Recreational Use," (Pew Research Center, 2024).
- "Whitney Economics U.S. Legal Cannabis Forecast - 2024 - 2035," by Beau Whitney (Whitney Economics, 2024).
- "Beer Sellers Use a Loophole to Break Into Weed Drinks Market," by Redd Brown (Bloomberg, 2024).
- "Cannabis Producer Seeks Boston Beer Merger," by Lauren Thomas (The Wall Street Journal, 2024).
- "California's 'Apple Store of Weed' Declares Bankruptcy With $410M in Debt," by Lester Black (SFGate, 2024).
- "Is the State Democratic Chair Influencing Who Can Sell Legal Weed in this N.J. City?" by Jelani Gibson (NJ.com, 2023).
- "When Prohibition Works: Comparing Fireworks and Cannabis Regulations, Markets, and Harms," by Jonathan P. Caulkins and Kristina Vaia Reimer (International Journal of Drug Policy, 2023).
- "Did Minnesota Accidentally Legalize Weed?" by Paul Demko (Politico, 2022).
- EXTRAS:
- "Is America Switching From Booze to Weed?" by Freakonomics Radio (2024).
- "The Economics of Sports Gambling," by Freakonomics Radio (2019).
607. Is America Switching From Booze to Weed?
We have always been a nation of drinkers — but now there are more daily users of cannabis than alcohol. Considering alcohol’s harms, maybe that’s a good thing. But some people worry that the legalization of cannabis has outpaced the research. (Part one of a four-part series.)
- SOURCES:
- Jon Caulkins, professor of operations research and public policy at Carnegie Mellon University.
- Yasmin Hurd, director of the Addiction Institute at Mount Sinai.
- Michael Siegel, professor of public health and community medicine at Tufts University.
- Tom Standage, deputy editor of The Economist.
- Ryan Stoa, associate professor of law at Louisiana State University.
- RESOURCES:
- "Cannabis Tops Alcohol as Americans’ Daily Drug of Choice," by Christina Caron (The New York Times, 2024).
- "Deaths from Excessive Alcohol Use — United States, 2016–2021," by Marissa B. Esser, Adam Sherk, Yong Liu, and Timothy S. Naimi (Morbidity and Mortality Weekly Report, 2024).
- "Nixon Started the War on Drugs. Privately, He Said Pot Was ‘Not Particularly Dangerous,'" by Ernesto Londoño (The New York Times, 2024).
- "A Brief Global History of the War on Cannabis," by Ryan Stoa (The MIT Press Reader, 2020).
- Craft Weed: Family Farming and the Future of the Marijuana Industry, by Ryan Stoa (2018).
- "How the Sugar Industry Shifted Blame to Fat," by Anahad O’Connor (The New York Times, 2016).
- "The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?" by Kelly D. Brownell and Kenneth E. Warner (The Milbank Quarterly, 2009).
- A History Of The World In Six Glasses, by Tom Standage (2005).
- "Cancer and Coronary Artery Disease Among Seventh-Day Adventists," by E. L. Wynder, F. R. Lemon, and I. J. Bross (Cancer, 1959).
- EXTRAS:
- "Why Is the Opioid Epidemic Still Raging?" series by Freakonomics Radio (2024).
- "Daron Acemoglu on Economics, Politics, and Power," by People I (Mostly) Admire (2024).
- "Let’s Be Blunt: Marijuana Is a Boon for Older Workers," by Freakonomics Radio (2021).
- "What’s More Dangerous: Marijuana or Alcohol?" by Freakonomics Radio (2014).
606. How to Predict the Presidency
Are betting markets more accurate than polls? What kind of chaos would a second Trump term bring? And is U.S. democracy really in danger, or just “sputtering on”? (Part two of a two-part series.)
- SOURCES:
- Eric Posner, professor of law at the University of Chicago Law School.
- Koleman Strumpf, professor of economics at Wake Forest University.
- RESOURCES:
- "A Trump Dictatorship Won’t Happen," by Eric Posner (Project Syndicate, 2023).
- The Demagogue's Playbook: The Battle for American Democracy from the Founders to Trump, by Eric Posner (2020).
- "The Long History of Political Betting Markets: An International Perspective," by Paul W. Rhode and Koleman Strumpf (The Oxford Handbook of the Economics of Gambling, 2013).
- "Manipulating Political Stock Markets: A Field Experiment and a Century of Observational Data," by Paul W. Rhode and Koleman S. Strumpf (Working Paper, 2007).
- "Historical Presidential Betting Markets," by Paul W. Rhode and Koleman S. Strumpf (Journal of Economic Perspectives, 2004).
- EXTRAS:
- "Has the U.S. Presidency Become a Dictatorship? (Update)," by Freakonomics Radio (2024).
- “Does the President Matter as Much as You Think?” by Freakonomics Radio (2020).
- "How Much Does the President Really Matter?" by Freakonomics Radio (2010).
Has the U.S. Presidency Become a Dictatorship? (Update)
605. What Do People Do All Day?
EXTRA: Roland Fryer Refuses to Lie to Black America (Update)
604. Did the N.F.L. Solve Diversity Hiring? (Part 2)
603. Did the N.F.L. Solve Diversity Hiring? (Part 1)
Related Episodes
Improving health outcomes and quality of life
Kate Wilber is the Mary Pickford Chair in Gerontology and director of the Secure Old Age Lab at the USC Leonard Davis School. She's also the co-director of the National Center on Elder Abuse, which is housed at the Keck School of Medicine of USC. She recently spoke to George Shannon about her research, including her work exploring ways to provide long-term care services and supports that allow older adults to be as independent as possible and the challenges and opportunities that technology provides in this area.
Quotes from this episode
On building on lessons learned during the pandemic
“I think a lot of what we saw were challenges that we already knew were there - how fragmented services are, how older adults can be at risk of isolation, how important the home community-based services and programs and opportunities to interact are for everybody. And I think showing the importance of community, which we didn't have during the pandemic, except a bit on social media and phone calls and maybe people getting together outside. So the key question is, how do we take the learning and the recognition of what we already knew into the future to build on these important lessons, to do better with our aging service delivery? I was going to say our aging service delivery system, but that's a huge problem. There isn't a system; there's just a lot of different components of a system.”
On innovations in long-term care and supports
“We have to prepare for an aging population. And until recently I felt like we didn't do that great a job preparing, but I see a lot of exciting innovations, which to some extent may have been jump-started a little bit because of the challenges of the pandemic. We have a variety of models of senior living and I think we're going to see more innovation there or the innovations that have been developed take off because they did better in the pandemic too. So if we look at what kind of care was best for older adults who maybe were isolated or need long term services and supports during the pandemic, how do we build on that? And how do we make sure that we translate what we know into reasonable programs and policies.”
On barriers to implementing technology solutions
“People not only need to have some kind of device. They need to have broadband, it needs to work. And we've seen that in some parts of the country, especially in rural areas, broadband it's not available. All the things we take for granted, electricity, water, et cetera, how much is this an essential service that we’ll do a better job providing across the nation in areas where it doesn't exist very effectively now. And then as I said, how do we help people learn? And what are the particular cultural competencies required for trainers? What are the different uses that people want? This gets back to being person-centered and engaging the people that will be the end-user users and understanding what's most effective for them.
There are still a fairly large proportion of older adults who don't have access to any sort of computer; some have smartphones. And there is this notion, I guess, if we build it, they will come. Or if we give it to them, they'll use it, it would be the way of talking about that. But there's a variety of barriers. And if you hand somebody a box with a computer in it and say, ‘There you go, you're now going to go on the other side, the right side of the digital divide.’ They're not. So what can we learn about how to help people use technology in a way that is useful for them effective, meaningful?”
On telehealth
“So this will be a time saver. I think that's pretty clear, but the nursing facilities have to invest in it. The staff have to invest in it. They have to learn how to do it. And one of the things we're seeing is they thought the residents would be the most resistant and they're not. They're like, ’Okay, if I can see my doctor this way, fine.’ But I think the question is, how is it used, where is it most effective and where is it not a good replacement for a physician coming to the facility? So, there's a fair amount of literature developing on this, but I think there's so many exciting innovations that are rolling out and we need to build on what we're learning and make them better and be more effective in the next generation of telehealth and facilities and helping people on the digital divide connect. So all these things are really exciting opportunities to learn how to connect.”
On person-centered care
“So the idea behind person-centered care is that people have different needs. Of course, they also have different preferences, different preferences for care and for services and for supports and for contributing and giving back and primarily and mostly as with all of us, for controlling their lives and the decisions that are made. So person-centered care recognizes that the power should live with the individual in terms of the ability to make decisions about care informed decisions. But I think sometimes, we, as professionals can see, oh, this would be best for this person. And professionals are extremely busy also. And so it kind of overlooks sometimes the person's needs and preferences and working in areas like elder mistreatment and elder self-neglect. A lot of times people have legitimate reasons for wanting things that we don't necessarily think would be the best choice, but person-centered care asks us to really get in touch with what's behind those preferences. And to what extent can we ethically honor them and this is something I see the field doing a much better job thinking about and working on and great things have been written. And the American Geriatric Society a few years ago had an expert panel come together and develop a definition and sort of protocols for this. And I think that's really moving the field.
One more thing I'll say is that ageism contributes here. So we make assumptions about older people that they can't express their preferences adequately. And providers talk to the caregiver, not the older person. Or they say this is what needs to be done. So I think there's also a culture change of recognizing that it's about the older person. And we start with the older person, and that's not to say that there aren't age-related increased likelihoods, but not inevitabilities of memory issues and things of that kind. And so we need to be clear that the person has the capacity to express their preferences, but we start with person-centered. The elder is the person who whatever is happening is happening on behalf of, or for, or with. And that's where we start.”
On students
“That's our future. … Our legacy is you see the students that go through our program and they're very excited about learning and they bring innovation and enthusiasm, and then they go out and do wonderful things and they become the leaders of the field. And you could see that across the board in so many areas.”
Mounting a Data-Driven Response to COVID-19 (Part 1)
As the economy and businesses race to reopen, COVID-19 continues to bring unprecedented challenges to our nation’s leaders and communities alike, threatening lives and livelihoods. In this two-part special episode, Mike Alkire (@AlkirePremier), President of Premier, Inc. and Dr. Mark McClellan, former FDA and CMS chief, and the Director of the Duke Margolis Center for Health Policy, explore how big data is helping provide an early-warning system for the pandemic and protecting communities from the risk of COVID-19 resurgence.
EP274: COVID-19—What Telehealth Means After the Pandemic, With Jonathan Thierman, MD, PhD, From LifeBridge Health System
Everybody’s talking about the surge in telehealth usage. I wanted to talk to someone who has been ramping up their telehealth capabilities for a while to get a sense of what it takes to do it well. And, as has been said by many, doing telehealth isn’t just about technology. It’s about training clinicians, patients, and accounts receivable and other staff. It’s about rearranging workflows and processes. So, I was super pleased to have had the opportunity to speak with Jonathan Thierman, MD, PhD. Dr. Thierman is an ER doctor. He’s also the chief medical information officer for LifeBridge Health systems and medical director of the LifeBridge Health Virtual Hospital.
This show has two parts. This is the second part—episode 274. In this health care podcast, we’ll get into some of the operational aspects of telehealth, like what EHR integration actually means and looks like. We talk about whether laws governing telehealth that were relaxed get stringent again. We talk about natural language processing and artificial intelligence and how they fold into the telehealth answer. I also ask Dr. Thierman for his advice to those potentially more new at the telehealth thing—what lessons he’s learned, what critical success factors might be.
One last point: In episode 273 (and you probably don’t need to listen to these in order), which is the first part of this two-part series, Dr. Thierman and I discuss what telehealth can accomplish, maybe better than a face-to-face patient encounter, and what it’s not so good at. One thing that dawned on me as we were talking is that technology isn’t just a video system. There’s apps, there’s AI, there’s minivans full of lab equipment … there are other innovations that expand the capacity of a remote patient visit.
You can learn more at lifebridgehealth.org. You can also follow Dr. Thierman on Twitter at @techie_doc or connect with him on LinkedIn.
Jonathan Thierman, MD, PhD, is physician executive in the LifeBridge Health system and president of the medical staff at Northwest Hospital. He started his career as an engineer and inventor, earning his PhD at MIT and then training in emergency medicine at Harvard Medical School and Johns Hopkins Hospital. In the past, he has worked to bring real-world clinical experience to the engineering and design of medical devices.
Currently, he is the chief medical information officer for the LifeBridge Health system in Baltimore, where he leads a team of physician informaticists to interface between the 180+-person IT department and the 3000+ affiliated physicians across five hospitals and in community practices on matters of the EMR, CPOE, and other health IT systems.
Dr. Thierman is passionate about applying technology to improve health and outcomes. To this end, he helped to establish the LifeBridge Health Virtual Hospital, with affiliated clinical call centers in Jerusalem and the Philippines, to provide telemedicine services across the continuum. He also created the LifeBridge Techbar to offer in-person IS assistance to LifeBridge providers. In addition, he developed a patient “Digital Front Door” to help direct patients to the right care center with the least wait time, improving patient experience and load-balancing the emergency departments and urgent care centers in the LifeBridge Health system.
03:15 The net effect of adopting telemedicine during the pandemic.
06:42 “Data is key.”
09:20 “There’s a lot more communication going on now between health care providers and their patients than there was before.”
09:40 “Even now, we’re still scratching the surface of what insights we can gain from the data.”
12:42 EP251 with Dr. Kimberly Noel and training doctors in webside manner.
13:00 How telehealth and EHR systems align.
14:02 The telehealth value points that are coming.
17:23 The necessity of training for clinicians embarking on this telehealth adaptation.
18:50 “Jump in, because it’s … here to stay.”
19:30 “It doesn’t have to be as expensive as you think.”
You can learn more at lifebridgehealth.org. You can also follow Dr. Thierman on Twitter at @techie_doc or connect with him on LinkedIn.
Check out our second part #healthcarepodcast with @techie_doc as he discusses #telehealth post-#pandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19
What’s the net effect of adopting #telemedicine during the #pandemic? @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
“Data is key.” @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
“There’s a lot more communication going on now between health care providers and their patients than there was before.” @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
“Even now, we’re still scratching the surface of what insights we can gain from the data.” @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
How do #telemedicine and #EHR systems align? @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
How will the value of #telemedicine change in the future? @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
Is training for #clinicians necessary for moving forward with #telemedicine? @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
“Jump in, because it’s … here to stay.” @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
“It doesn’t have to be as expensive as you think.” @techie_doc discusses #telehealth #postpandemic. #healthcare #podcast #digitalhealth #coronavirus #covid19 #healthcarepodcast
Addressing Recovery Disparities in 2020 & Beyond
Valeria Chambers and Keith Murphy discuss strategies for supporting recovery, mental health, and wellness for marginalized communities during these times of COVID-19 and racial strife with host Kristen Harper.
Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact.
Learn More
Valeria Chambers, Black Voices in Recovery
Keith Murphy, Rutgers Student Health
Behavioral Health and Recovery at C4 Innovations
Access a transcript of Addressing Recovery Disparities in 2020 & Beyond
EP283: Your Telehealth Success May Be a Launchpad for Health System Innovation and Human-centered Health Care, With Sylvia Romm, MD, MPH, Chief Innovation Officer at Atlantic Health System
At the end of the day, health care should be about helping patients find their way to health while doctors, nurses, and other clinicians don’t burn out in the process. It’s becoming increasingly indisputable that the way to get to this North Star efficiently is through human-centered health care.
Human-centered health care is a term coined by Dr. Sylvia Romm, and it’s a play on the term customer-centered design. How do we innovate? How do we use technology to intensify the human experience for both provider and patient? How do we rid ourselves of friction points and create a continuum of care that is sticky and makes getting healthy as enjoyable as Instagram?
In this health care podcast, I speak with Sylvia Romm. She’s an MD and an MPH with a background as a researcher and a telemedicine entrepreneur prior to coming to Atlantic Health System as their chief innovation officer. We talk in this podcast about human-centered health care—what this means, what the success factors are, and how to make it happen. We also take into account the assorted challenges to overcome on the way there.
This interview was recorded moments before COVID-19, and I say that as a good thing. Dr. Romm brings up telehealth as, let’s just say, a first step toward actuating human-centered design in health care. Clearly in the past, that was quite a hurdle. No longer.
So, those health systems or you other stakeholders in the mix who have gotten the telehealth thing nailed, listen on for ways that you can leverage your success. And for those of you who haven’t, well, here’s a little extra motivation.
You can learn more by connecting with Dr. Romm on Twitter at @sylvia_romm.
Sylvia Romm, MD, MPH, is driven by a passion for transforming health care delivery to patients and communities. She brings her background and expertise as a clinician and an entrepreneur to her role as chief innovation officer for Atlantic Health System. Firmly believing that a patient-centered focus is vital to health care innovation, Dr. Romm works with Atlantic Health System’s team members and physicians to find new ways to improve access to high-quality, affordable care. She also forges relationships with local and national innovation partners and works to expand the organization’s research profile.
Dr. Romm is an avid author and speaker in the areas of health care, technology, and health information technology (IT) policy. She has written articles for various publications—including NEJM Catalyst, Forbes, KevinMD, and the Huffington Post—and was named one of Fierce Healthcare’s 8 Influential Women Reshaping Health IT and Becker’s Women in Health IT to Watch in 2020.
A board-certified pediatrician, Dr. Romm has served in a variety of clinical leadership roles throughout her residency and as a hospitalist. Before joining Atlantic Health System, she was vice president of clinical transformation for American Well, the largest video-based telemedicine company in the United States. In addition, she was the founder of MilkOnTap, the nation’s first telehealth company focused on the needs of nursing mothers and lactation support. Dr. Romm earned her Master of Public Health in global health from Harvard TH Chan School of Public Health. She holds a medical degree from the University of Arizona College of Medicine and completed her residency in pediatrics at Massachusetts General Hospital.
02:18 How Dr. Romm’s background in research, public policy, and being a pediatric hospitalist intertwine to create great innovation strategies.
03:22 “How do we look at populations?”
03:31 “It’s really about affecting the system in its entirety.”
04:33 What human-centered health care means.
06:36 “You’re only as effective as the rapport that you build with [this] person.”
08:05 “What do people really need … but also, what do they find valuable?”
09:42 How data are folded into human-centered health care.
11:55 “The endgame is to figure out … how to have a better experience.”
12:39 How this fits into the quadruple aim.
17:19 “We are going to have to earn and learn agility.”
19:38 What has the most promise in deepening the connection between patients and providers.
20:32 “Is this about you, and how do we know … how people outside feel about creating a relationship?”
23:29 Is there a best practice for furthering the patient/doctor relationship from afar?
24:24 The need for a variety of approaches to patient/doctor connections.
27:30 What innovation initiatives need to be successful.
28:07 “People have to understand the ‘why.’”
29:38 The classic tenets of change management.
30:02 A challenge Dr. Romm is proud of having solved.
31:56 Secret weapon: collaboration.
You can learn more by connecting with Dr. Romm on Twitter at @sylvia_romm.
Check out our newest #healthcarepodcast with @sylvia_romm of @SonderHealth and @AtlanticHealth as she discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation
“How do we look at populations?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
“It’s really about affecting the system in its entirety.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
What does human-centered #healthcare mean? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
“You’re only as effective as the rapport that you build with [this] person.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
“What do people really need … but also, what do they find valuable?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
How are data folded into human-centered #healthcare? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
“The endgame is to figure out … how to have a better experience.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
“We are going to have to earn and learn agility.” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
“Is this about you, and how do we know … how people outside feel about creating a relationship?” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
What do innovation initiatives need to be successful? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
“People have to understand the ‘why.’” @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
What are the classic tenets of change management? @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast
Why collaboration is the secret weapon to innovation in health care. @sylvia_romm of @SonderHealth and @AtlanticHealth discusses human-centered #healthcare. #podcast #digitalhealth #healthtech #healthinnovation #healthcarepodcast