CareTalk Podcast – Is Virtual Care The Future?

CVS Aetna just announced virtual primary care. Could this be an indication that the future of healthcare is virtual? John and David don’t seem to agree…with each other.

David Williams:

Welcome to CareTalk, America’s home for incisive debate about healthcare, business, and policy. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. David, what do we have up today? What’s trending?

David Williams:

Well, John, what I would say is, you could use a booster and I’m glad everyone’s going to get a booster at the eight month point. President Biden says, “Eight months, booster time.”

John Driscoll:

Do we really think everyone is going to get a booster? We don’t even have everyone getting a first shot. I think we’re north of 50% of the country has two shots and we’re closing on 70% with at least one shot. But, vaccine hesitancy is actually a real thing and a real problem, and is creating a series of opportunities to host the new delta variant. So why are we talking about boosters, at this point?

David Williams:

John, it appears that the vaccines work really well. But then after a while, especially for older people or Immunocompromised people, it starts to become less effective. And just like you get a booster shot for other things like the flu, going to get a booster shot for COVID-19, you’re going to get it a little sooner than a year. And you know what’s nice? When they did the rollout before, it was really difficult… Who was prioritized, and so on? Now, it’s simple. You look at your vaccine card and you’re eligible eight months after you got your second shot.

John Driscoll:

Wait a second. But you haven’t really explained to me, why we’re focusing on boosters when we haven’t got everybody with vaccines, in the first place. And it’s that vaccine in the first place, particularly the Moderna and Pfizer, that create real protective immunity, not just for individuals, but for our country.

David Williams:

John, I think it’s not an, either or, it’s an, everything in there. And there’s plenty of doses, so there’s no shortage of doses, at least in the rich countries. And so the people who have had the two doses, they get a third dose. It’s not hard to persuade them to do it.

Continue working on the first doses. They are working hard on that, John. If you notice, they’re now talking about enforcing it, so that anybody who works in a nursing home needs to be vaccinated. If those nursing homes want to get Medicare and Medicaid funding. I think that’s a jolly good idea.

John Driscoll:

Well, what I’m excited about here, is the early, preliminary information, is that the measures of vaccine effectiveness, [inaudible 00:02:14] the titers of the antibodies in your blood, the measures of the antibodies in your blood that create that protective immunity do appear to decline a little bit faster than we would have expected in the case of folks, particularly over 60, who are more vulnerable. And I think the booster shot makes sense from that perspective. But I would hope that we would not be so focused on boosters, that we would miss the opportunity to keep kind of pushing, really the land war on getting everyone vaccinated with shots that don’t… again, don’t just provide individual immunity, but could really protect us from more mutations of this COVID virus.

David Williams:

Well, John, tighter or looser, I’m glad that we’re doing shots, first shots, second shots, and third shots. Let’s get onto our main topic of the day, which is, that virtual primary care is finally getting real. Some big announcements out there, CVS, Aetna, they just announced a big virtual primary care program. Do you think it’s a big deal?

John Driscoll:

What’s your virtual point here, David?

David Williams:

The point is, that during the pandemic you had tele-health, which is just kind of doing a Zoom conference, essentially, for an in-person appointment that you missed. But there’s a real opportunity to make virtual care the first place that you go. And if you have a primary care physician relationship, actually do it on a virtual basis with a bunch of wraparound services to make things more convenient, more efficient, more effective.

John Driscoll:

I think you’re missing the point, again. The vast majority of primary care relationships actually aren’t that great. I mean, doctors do heal, doctors do an amazing job, but 30 to 50% of all Medicare managed care members don’t even… either don’t have a primary care relationship or don’t know who that relationship is with. And I don’t know what the value of a relationship is, if you don’t even know the name of the person you’re in the relationship with, but that’s another item.

I think that what’s exciting about this, is that you now have technology assisted alternative that’s going to compete and actually force basic primary care to up its game. And I think particularly in the context of value based reimbursement, where you’ve got healthcare on a budget and primary care doctors could, if they are in the right kind of system, leverage technology and, or spend more time with their members. And I also think that it is the… it’s going to… So it’s going to force primary care capacity and primary care doctors and leaders to up their game, I believe. And secondly, it’s going to, I think, draw in and connect a lot of people who, honestly just have a hard time with the inconvenience and complexity of plugging into the medical industrial complex to get the primary care they need, particularly if they’re over the age of 60 or have a chronic condition.

David Williams:

John, you’re also starting to see some of these big deals start to play out. We heard about CVS and Aetna merging. We know Amazon has made a lot of moves, and Walmart as well. And now you’re starting to see the chess pieces move around the board. So with C-

John Driscoll:

Wait, wait. But do you really… But, you and your chess analogies. Stop there. I mean, Amazon’s done nothing. It bought PillPack. And as far as I can tell, for three quarters of a billion dollars, it’s had no impact on the pharmacy business. They’ve had a number of unsuccessful stops and starts in the healthcare at work. They had that fantastic success with JP Morgan and Berkshire Hathaway. That’s a complete bust that you were bragging about a few years ago. I mean, I think they’re in the books and soap and convenience business. They’ve done a great job with the cloud. But I think they… in terms of healthcare, they’re kind of like zip and four, as far as I can tell.

David Williams:

Well John, I thought you were one of the last Barnes and Noble guys out there on the planet store. And it’s-

John Driscoll:

It’s a great store. Don’t underestimate it.

David Williams:

But… Well, let’s take a look. So CVS and Aetna, they’ve got the physical locations, they’ve got the insurance company, and so they’re making the most of that. So, they’re combining the minute clinic and the health hub with the CVS pharmacy and with the Aetna insurance, interestingly using Teladoc as a platform, so that’s another player. Now, if you look at what Amazon has been doing, so-

John Driscoll:

But, stop there. Isn’t that the right way to do, to leverage technology, to build on what works? I think the Aetna strategy, as opposed to the Amazon non-strategy, drip, drip, drip, is a really thoughtful one. It’s integrating how things get paid for, how people can get access with an infrastructure that people are using. And adding technology to both reach out into the community to touch and engage patients, and also to accelerate, simplify, and leverage and extend the platforms they’ve already got. That feels like an integrated thought. Amazon’s relationship with healthcare feels like a lot of first dates.

David Williams:

It sounds like a… It sounds really great, John. Yes, I want my insurance company to run exactly how things are going to go. Of course, it makes sense what Aetna and CVS are trying to do, and we should give them credit for that. But I think you’re a little bit… you’re really betting against Amazon and it’s not necessarily going to be the-

John Driscoll:

But wait a second. Wait a sec.

David Williams:

… winning way.

John Driscoll:

Wait a sec. I’m sorry. You don’t like your insurance company, as opposed to the company that has all of your consumer information. That’s listening to your private conversations, that all of your companies are, are, are using as a service, and that doesn’t pay any taxes. I mean, I just… I’m just wanting to understand who you’re betting on, because I-

David Williams:

They have a rocket ship.

John Driscoll:

Oh, that’s right. I forgot about the rocket ship company.

David Williams:

John, the thing is, with Amazon, they’re doing it differently and they’re having a kind of different personality toward it. Now, what they-

John Driscoll:

Well, they’re doing it differently because they haven’t succeeded yet. I mean, Jeff Bezos was on the board of drugstore.com. That didn’t go anywhere. They invested in on-site clinics. That didn’t go anywhere. They spent three quarters of a billion dollars to buy a PillPack. Maybe, that’ll go somewhere. And they did the one night stand with Berkshire Hathaway and JP Morgan and then ended up with no relationships. So I think as of right now, they’re… I mean, maybe they tied one game, but they lost all the other ones. I don’t know why you’re so focused on Amazon. Do you own stock or something?

David Williams:

No. I’m a prime member though. So, Aetna and CVS, they’re doing things in a more traditional way and they’re bringing it into electronic age. But one of the things that Amazon’s going to do is [inaudible 00:08:47] be an on demand service. So you can connect, and in under 60 seconds, you’re going to be connected with a physician or another caregiver. And they’re to have in-app text chatting with the clinicians. They’re going to have the ability to actually go out-

John Driscoll:

[crosstalk 00:09:01] this is great.

David Williams:

… and send somebody out to your-

John Driscoll:

I don’t know [inaudible 00:09:04]… Freeze frame and think about all those crappy urgent centers that were set up a bunch of years ago, that you go in and you have no relationship, but it’s convenient.

David Williams:

Yeah. Called, CVS Minute Clinic, John. Amazon’s also going to be sending people out to your house, if you need it so…

John Driscoll:

Oh, that’s exactly what I’m looking forward to.

David Williams:

They’re at your house everyday anyway, John. They could take your blood while you’re there. I have to understand what you’re selling against Amazon. What did they-

John Driscoll:

They’re sucking the blood out of the economy.

David Williams:

Are you one of those guys, John, that they banned for doing too many returns? Is that your problem? Yeah. Going to return your blood sample.

John Driscoll:

I think one of the challenges that people in technology continuously run into… And Amazon has done an amazing job in the things that they’re really good at, which is, on demand retail. They’re only doing okay in the supermarket business, which is a very different business. They’re doing an incredible job with the cloud, and hopefully they will shoot more of their executives into space soon. But one of the challenges, whether it’s Facebook, Amazon, or Google, or maybe Netflix, we’ll throw all the fangs in there, is they tend to think technology first, as opposed to building on what’s already working, whether well or ill that people are engaging in.

And you visit your pharmacy four to 12 times a year, you leverage your insurance company to pay for your needs, when you really have got a crisis. Both of the insurance company and CVS build, off of and leverage, doctors and hospital systems that people are leveraging today. Adding technology to that makes a lot of sense to me. Coming in and trying to have some slick app that’s going to solve all your healthcare problems, well, Dave, you go along on that. I’m going to stick with my doctors and infrastructure who know how to use Zoom [crosstalk 00:10:51].

David Williams:

All right, fine. Now, John, how about Walmart? Okay? Facebook, you scared me there. I don’t think anybody talks seriously about Facebook getting into primary care. I can just imagine what it would be like. I don’t think they would even tell you-

John Driscoll:

Oh, no. Facebook’s-

David Williams:

… the results.

John Driscoll:

No, Facebook’s got a chief medical officer and they’re doing stuff. And Amazon… I mean, and Google, I think, is the sleeping giant there, in terms of really being able to potentially make technology. And really their data, their technology asset’s relevant for all the disconnected data. And hit the pause button on that one, David, because I think Google is going to come back strong there.

But I think that the key thing about virtual care is, it is very exciting. The fact that… The healthcare system doesn’t really understand how desperately and convenient it is for a consumer facing system to waste your time refilling in forms that you’ve already filled in, and then telling you when they’re available to meet your urgent need. I mean, that just is a recipe for failure. And technology can really solve for and help kind of gap that in a meaningful way. But we have to build on what we’ve got. And I think the notion that getting some slick application and some cloud-based platform’s going to cure my mother’s cancer, is crazy.

David Williams:

I had been ruminating there, John, on your Facebook comment, because I think the way Facebook would work, is that, you’ll do a visit with them and they won’t bother to tell you your diagnosis, but they’ll sell it to a few different people that are out there. But John, what about Walmart? How about Walmart? They’re not a tech company. They don’t have an insurance company.

John Driscoll:

Again, I’m very optimistic, although they’ve not really leaned in. They have physical infrastructure, a quarter of the country visits a Walmart store every week. They’re connected to the community. They’re in rural areas that are desperately underserved by primary and specialist care.

They’ve actually come up with some real innovations that have changed the industry. They came up with these $4 generics for 400 different NDCs. There’re specific drugs that fundamentally changed the way drug pricing for those categories. They have the ability to really move the needle. I mean, they’ve just… I mean, they have over a million employees in the United States. And you figure, an average family size of two and a half, they’re the size of, just their employee base, is the size of a regional size healthcare plan.

Now I think Walmart, the question is, whether they’re serious about healthcare. If they were, then they have the access, the traffic, and the credibility, I think, to do something quite remarkable. And they’ve got a commitment to low price, which makes them kind of unique in healthcare. Which is, where all the reimbursement is up and to the right, or the prices are up into the right, which is one of the reasons why so much of this is hard. And if they got in and came in low with priced alternatives, I think it could be a game changer.

David Williams:

No, I think they’re being careful about it, because it’s tough, because they got to fight everybody else.

John Driscoll:

We;;, they’re careful they haven’t made up their mind. I mean-

David Williams:

Yeah.

John Driscoll:

… there’s careful and there’s sort of lost. And I think they’ve been stuck for a long time-

David Williams:

Yeah.

John Driscoll:

… expressing it as a priority. But frankly, they’ve done a really nice job, for example, at recovering a lot of ground in online retail, by making very aggressive acquisitions. They’ve got a wonderful, new, talented leader in Cheryl Pegas. Hopefully, we’ll get her on the show.

David Williams:

Yeah.

John Driscoll:

Who’s a doc, who really gets folks with chronic conditions. And also… And they’ve got incredibly talented people. They’re very innovative from a from an employee benefit perspective. They leveraged technology very aggressively on the retail side and on online. I think they’re the player to be named later that could really change the topography of healthcare, if they chose to.

David Williams:

Well, John, I think what I’m learning from this is, that you love everybody except for Amazon. How about Dollar General? They’re even more rural.

John Driscoll:

Why you bringing up Amazon? Why are you bringing up Amazon again?

David Williams:

Dollar General… Dollar General-

John Driscoll:

You want to hear more about Amazon?

David Williams:

Dollar General is even more rural and cheaper than Walmart. And they just named a chief medical officer. We should have them on the show too.

John Driscoll:

Amazon gets way too much credit for things they haven’t done and might do. And they don’t get any blame or shame associated with, failed at drugstore.com, failed at an in-store clinics, failed basic questions around privacy and personal information, which is a very high… a hot issue for most consumers, who, if they got any healthcare needs. And increasingly, they are alienating their consumers. So, I think if you want to solve a healthcare problem, you have to have the resources to do it, and you have to have a trusted relationship with the consumer. And I think they’re botching that second piece.

David Williams:

I want to talk now, about the impact this has, and kind of the overlay with the shift of care to the home, which we’ve talked about quite a bit on the show, and which is obviously top of mind for you. What does it mean to have virtual primary care? Does that help to enable the home? Does it compete with some of the other things that are done in the home? What does it mean for the consumer?

John Driscoll:

Yeah. No, I’m actually really, with the exception of the fact that you associated Amazon with it, I’m really excited about virtual primary care and virtual specialist care. I think that, again, if you can… We can leverage technology right now with data to make healthcare a lot more convenient. And solve a lot more problems faster by directly connecting clinicians and knowledgeable resources and support with technology tools to tighten the cycle time between, “Hey, I think I’ve got a problem.” to, “I’ve got a solution, or I should go to the hospital.”

And by creating a web of remote patient monitoring, [inaudible 00:16:42] that information where you either got a wearable or an activity monitor, or a tablet that’s feeding information back and forth between the family, the caregiver, the patient, and the health care oversight. It could be a doctorate, could be a service, could be a hospital. We can shift a lot of the low acuity cases out of hospitals, out of nursing homes. And you’re starting to hear about it. You’re starting to hear about experiments about hospital at home, experiments about [inaudible 00:17:09] at home.

Increasingly hospitals and nursing homes are some of the most dangerous places to be, not just because of COVID, but from a risk of death perspective, for people who don’t need to be institutionalized who are medically vulnerable. And if we can bring them home and leverage virtual primary care and specialist care and technology assisted monitoring, I think you’re going to see us empty a third of the [inaudible 00:17:35] hospital beds, and really provide more care. And actually, which creates the opportunity for, frankly, more healing, because everybody would much prefer, if they’ve got the option and it’s safe, to heal at home, as opposed to within the four walls of a hospital.

David Williams:

I think it’s good, John. I think it actually is exciting times. And it is interesting to see, in particular for me, what CVS and Aetna were doing. They’re really trying to bring things together. I know they’ve been thoughtful about it. It’s hard to actually unite multiple big companies, as they’ve done. And they’ve got the timing right, both from their own integration and where we are in the pandemic.

And they’re going to force a competitive response among a lot of other players. I think it will be also interesting to see what happens with your traditional primary care physicians and how the hospital systems react. But as far as I’m concerned, better care, more convenient care, safer care, less expensive care is where we’re headed here. And it’s all good.

John Driscoll:

If we can take the time out of, I’ve got a problem, I need a solution. If we can provide instant access, particularly for folks, again, that 30 to 40% of people who don’t even have a relationship with a doctor, to start to build one virtually that’s a game changer. I think… I’m thoroughly excited about virtual primary care and virtual care in general, as long as it’s integrated into a care system that can take care of all the needs of vulnerable patients.

David Williams:

Well, John, before we get even more optimistic and utopian, I say, let’s call it quits today, and say, that’s it for yet another edition of CareTalk. I’m David Williams, President of Health Business Group.

John Driscoll:

And I’m John Driscoll, the CEO of CareCentrix. We’d love to hear from you, please subscribe.