How Has COVID-19 Changed Patient Care?

[MUSIC PLAYING] Welcome, everyone. You're watching "Coronavirus in Context." I'm Dr. John Whyte, the Chief Medical Officer at WebMD. The COVID pandemic has changed a lot of things. And one of the biggest areas of change is in health care.

So to help provide some insights into how health care is changing, I've asked Joel Theisen. He's the CEO and founder of Lifespark. Joel, thanks for taking the time today.

Hey, thanks for having me, Dr. Whyte. I'm really excited about sharing some stories and some experience in this challenging time that we all have together.

The pandemic really has shifted the focus. The physician isn't so much in charge anymore as the patient. But in many ways, I think the pandemic has accelerated that, and that the patient is now more the focus of how we deliver care. Is that an overstatement? Do you agree with it? Or am I too far ahead of everyone?

No, not too far at all. In fact, I think we're even behind, quite honestly, Dr. Whyte. I think this is something that's been coming for a long time, and especially in the senior sector that we focus on and obviously was hit probably the hardest by the pandemic.

But person-centered services has kind of taken a little bit of a backseat to more of that acute medical, scientific drive in our world. And we've kind of lost the human along the way. So I think consumers, because of access to information and data, et cetera, are really more informed. And they are looking for self well-being and looking for ways to be more in control of their overall experience.

How has the pandemic changed the mindset? Was it from the perspective of, we told people originally not to come to the hospital, not to go to the doctor's office? Is that what kind of changed the mindset, that people started to think, you know what? I want to be able to manage my care at home.

And let's be honest, I still see patients. I wasn't really ever doing telemedicine visits. Now we're all doing it, not as much as a year ago. But how did the mindset change through the pandemic?

Yeah, that's a great point. A couple things. One, I think you said something that's really important. And I think that there's a real trust gap in our-- the coronavirus created a huge trust gap with the health care industry quite frankly because everyone was getting a lot of misinformation throughout the pandemic, as you're well aware.

And I think that created that self-efficacy, that turning in to say, look, I need to know this. I need to own this. I need to be in control. And I need to be accountable to my well-being and my health. And so people are obviously searching in lots of different ways to do that. But it did fracture some of that trust with, I think, the health system in total.

And I think the mindset also is, I think people are looking for a trusted relationship. They are looking for a different type of service that gives them more of an informed decision-maker position versus that patient and do it to me and I'll just accept it sort of mentality. So the mind share and the mind frame is-- that's how I see it.

But how do you want to change it, Joel? So you've been involved in health care for 30 years or so, right? You've seen a lot of things come and go. What do you think is going to be the lasting impact of COVID on the way we deliver health and, as you and I talked about before, how we even think of health and wellness?

I've been pushing against the old architecture of this acute, reactive medical service model, sort of very specialized, but yet we lose that person-centered approach. So how I want to change and how we want to change it at Lifespark is really to bring back that person-centered design and make sure that we create trust around that relationship for not only the physician but also what we call life managers that are nurses and social workers that build that longitudinal, holistic approach.

And then ultimately what really matters and where the big shift is, is that need to be reimbursed for wellness. The society that we live in, we pay for acute reactive services. And so it's a foregone conclusion that we're going to get more acute reactive services because it's a reward.

And I think that the system and the models are changing in managed care to allow service entities to shift to the right side of health care, which is well-being. And so I want to be in the well-being business and get paid for keeping people well and preventive and proactive and predictive, not reactive and acute and myopic in their disease.

But it's also about delivering care in the home, isn't it, or delivering where patients want to receive that care as opposed to the traditional model of, you come to me? You drive, take public transportation, and you wait. And then you do it on my time. You're saying, we need to switch that up in a post-COVID world, aren't you?

Yeah, and again, a perfect example is like Amazon, as it's reframed the industry of retail, right? We want to do that from the standpoint of health services to the population. And again, it's all about access, convenience, and agnostic to environment, right?

I mean, we have a lot of home services. But we also serve a lot of communities and independent living, assisted living, memory care. We need to help people transition through those different acute care events. So it is sort of that holistic, but coming from that home community, as you said, because that's where people live. I mean, that's where they're healthiest. That's where they want to be.

And the world's caught up, I mean, from a technology-- as you know, a lot of this, we couldn't really perform this efficiently and at scale before without good technology, good data. Like you said, you mentioned telehealth is an example of one part of that that creates opportunity and access. So home and community is where we think health and well-being sprouts from and where it needs to be delivered.

So I'm right on with you. And I think that is absolutely going to be not only the trend today but for the future. And I think that clinics and hospitals are going to have to really shift that architecture and really deliver in the home and community-based setting.

And you've talked about this concept that I love, is total-total cost. So [LAUGHS] I'm not repeating words by accident. But we didn't think about that pre-pandemic as much as we should. So what's this concept of total-total cost that we need to be focused on as we start to emerge from the pandemic, hopefully soon, and rethink how health care is delivered?

I think most people, when they think of health services, they think of medical care and acute care and what's reimbursed, right? So what we reimburse through Medicare and Medicaid, on a governmental program side, is that insurance for that acute reactive care.

And what's missed, from an industry perspective, we say total cost of care is really claims data, claims history on the cost of care. And the total-total-- and again, that may not be the exact right words; but what we're working on-- the total-total, so the other total, is what sometimes we miss and I think the industry misses, is that if I'm a son or daughter or I'm an elderly person or I'm a person out in the community and I have to enter into an assisted living environment or a long-term care, that's not free. I'm paying out of pocket.

So the total on the other side is, there's government programs on one side, which is funded through your earned benefits and your insurance products. But then there's all the out of pocket. And as you are very familiar, when someone goes into a memory care unit or an assisted, that can be $3,000, $4,000, $5,000, $6,000 a month.

And so as an example, people don't "count" that in the total cost of care. And obviously drug costs and other out-of-pocket expenses. And when you degradate your capabilities as a human, obviously you have more out-of-pocket costs.

And so what we want to do as a company is to really look at both sides of the equation because that's how a person looks at it. And so we want to not just take the cost of care-- we want to understand that; claims history-- and tie that to, how does a consumer have to spend their money on a daily basis for food, drugs, lifestyle, travel, et cetera, and look at that as a total-total cost of care.

But is care going to look different? Are we going to focus more on social determinants of health, address that? Are we going to deliver more care in the homes? They won't have to come in to clinic as often. I mean, you've been promoting all of these changes in terms of how we're going to think about health. And that includes disease states. Is that a fundamental shift?

Absolutely, absolutely. And again, that's that holistic, looking at helping people with their life plan-- not a care plan, not a disease plan, not a medical plan--

A life plan.

--but a life plan, right? And that's what people need. We all should be surrounding ourselves, our loved ones with what's driving out of their purpose, their passion, their life plan, and then supporting that. And that gets to what you're talking about as far as what really matters. And also, those are the core root causes. When those aren't well, those are the root causes for many of the medical conditions that people face.

You know, obviously people have-- again, not to look at one, but diabetes. You talked about the pandemic. We eat a lot more when we're depressed and socially isolated, right? I mean, we want to walk and be with our friends and be with our family and be with our grandkids. We want to be healthy because we want to do those things.

So I think it is moving in. And allowing that access and designing, right? Designing the architecture is going to be really important for service providers like us to make that available to people. Like you said, hospital at home, acute care at home, bringing telehealth, bringing that life planning into the spirit of the relationship with those that trust us.

And we have to work out the payment structures and payment plans, as you've talked about, in terms of addressing what are some of those financial incentives that encourage a certain type of care and discourage what you and I are talking about, this concept of wellness in care and the home. But I want to end with asking you, what word would you use to describe the lasting impact of the COVID pandemic on health and health care?

The thing that comes to mind to me is trust. Trust and access are critical to pivoting our experience as a human race. I think that we have to have trust and access to that information so we can create informed decision makers.

So I think the pandemic created this real step back and real pivot for us to hopefully slow down and get really clear about the importance of us going forward in the right direction and not just going back, as you said, to the old kind of ways. So we have to slow down and get very clear and intentional about the redesign for health care in America.

I want to thank you for taking the time today and really poking us a little to think about how we have to change how we deliver care. This really a once-in-a-lifetime opportunity to really make these changes and sustain them for the future. So thanks for all you're doing.

Thank you for the opportunity. I really appreciate it. And let's make this happen. Let's keep that momentum rolling. And appreciate the time today with you, Dr. Whyte.

If you have questions for Joel or me, feel free to drop me a line. You can email me at [email protected]. Thanks for watching.