On January 30th, 2021, Matthew Davidge, CEO and Co-Founder and Brian Yarnell, President and Co-Founder of Bluestream Health met with host Matt Fisher on Podcast Healthcare De Jure to discuss integration of telehealth and technology into the workflow of healthcare to make for seamless experience.
They also discussed the expansive opportunities for enhancing continuum of care along with the future of telehealth policy and technology and moment of opportunity.
Check out the podcast here and read the full transcript below!
Matt Fisher: [00:00:35] Welcome back and thank you for joining as we dive into the hottest topics in health care. I’m your host, Matt Fisher. On the menu today are Matthew Davidge, CEO and co-founder. And Brian, you’re now president and co-founder of Blue Stream Health Matthew. And Brian, welcome. Thank you. So it’s great to have both of you on. And what I always like to do before getting into the main part of the conversation is allow my guests to provide a little bit more of an introduction in terms of who they are and what they do. So, Matthew, would you like to leave us off?
Matthew : [00:01:01] Sure. So I am the the co-founder with Brian of Blue Stream Health. And we our goal is to use technology to help health care systems, small and large, connect their physicians patients together. And Brian, I have been toiling away at this for five years now, right, Brian? That’s right. That’s right.
Brian: [00:01:29] Yeah. So I guess I’d like to say that we we saw the future five years ago and with the chess pieces in place to be there when it came.
Brian: [00:01:36] But I think the reality is both of us had prior exits in health care. We were passionate about, from my standpoint, applying complex workflows to getting care out to patients. Matthew had some background in the education space, in health care, and we got together for a variety of reasons and thought about how do we make the brokering and delivering of remote expertise just easier as a whole for providers, for patients and everybody in that care continuum.
Matt Fisher: [00:02:04] So it sounds like is you’re talking about that remote care. And I think most people recognize that as the broader category of telehealth. So how are the two of you view what telehealth is and how it fits within the broader health care system?
Brian: [00:02:21] That’s a great question. I mean, it’s it’s easy to start off the answer by saying what we think telehealth isn’t, and that’s video conferencing where, you know, we’re connected on a conference call right now. It’s great if you know that Matthew, Matthew and Brian need to be talking at nine o’clock on a Tuesday morning. We are very much more focused on integrating virtual care delivery in a workflow oriented sense across the care continuum as a patient actually moves through it. So wherever that patient is, whatever the level of technological expertise that patient has, if it involves an in-person brick and mortar visit, we want to make sure that you could intercept that patient with a virtual care visit, integrate telehealth into the things doctors are doing every day already, and provide a really flexible platform that isn’t disruptive in the sense that it changes the way you do your job equips you with the tools to move care outside of the hospital as it adapts to what we’re seeing in the environment right now.
Matthew : [00:03:18] I’d also add that telemedicine is a very tired old word that has been used for many, many years. And if you go back five to 10 years ago, its possibilities were endless.
Matthew : [00:03:39] But in the last year, a tremendous amount of telemedicine has been delivered by really straightforward video conferencing systems. And while convenient and a quick Band-Aid really isn’t what is needed over the medium and long term. And what is needed is a true, seamless integration of communication into medical workflow. Really hard to do.
Matt Fisher: [00:04:07] And actually that’s a very interesting observation. You’re pointing out that, as you said, through the course of the pandemic and certainly right at the beginning of it, telehealth really seemed to be just slapping a patch on to an immediate problem without thinking necessarily about all the nuances of how to integrate it into the workflow. So from one perspective, do you think that maybe while it’s great that telehealth has certainly gotten a moment to shine, that it’s almost been a step backwards because you’re seeing a limited view of what telehealth actually has actually is beyond thinking beyond just what the potential could be?
Brian: [00:04:48] I think in some cases, yes. I mean, it’s easy to think about in terms of volatility, but everything is accelerated, even the bad habits, so to speak. So there’s a lot of low hanging fruit out there that we’re picking up that are people that are just wanting to do ambulatory one to one visits because it’s a credit card swipe or a reimbursement and it’s X number of dollars and when Matthew talks about this antiquated version of telehealth telemedicine. That’s not how we’d like to paint ourselves and our customers, but it’s still out there. The nice thing we’re seeing is that more and more of these organizations that are involved in, you know, risk based care delivery or value based care delivery, where they do actually look at the holistic cost of care delivery and health care outcomes are integrating these services into what they do. So from your standpoint, I mean, we view that the nuts and bolts swipe your credit card and have a telehealth session as a beachhead to establish that footprint and start expanding horizontally into more of a capitated risk model.
Matthew : [00:05:50] I would say this is the Bryans answer is is absolutely correct. But back in March, when the pandemic hit large complex health systems, we’re not thinking about holistic health care. They were thinking about, oh, my God, I’ve got to deliver thousands and thousands of sessions tomorrow. And so what they did is everybody ran in a different direction. People used Zoom most commonly because everybody knows what it is. People use Skype, people used us. We created a platform. We brought on. How many users do we bring into our rapid response platform?
Brian: [00:06:30] About fifty thousand individual practices.
Matthew : [00:06:33] A thousand. That’s fifty thousand people that signed up to our free tool. But basically, just imagine that a million people within a couple of months chose five hundred different solutions. Three months to four months on, they realize, oh yeah, how do we get that data back to the electronic medical record? Oh, we can’t. Oh, and how do we get that solution inside our ambulatory system? Talk to the talk to that solution, which is in a different advisory system in say, oh, it can’t. And so now you’ve got five hundred embedded systems and a million dissatisfied users.
Matt Fisher: [00:07:14] And kind of as you’re describing, you’re just throwing things at the wall. You think as you’re saying, you kind of got the technological silos, you know. So how how do you see systems or how do you help systems break down those silos, which also feels like a repetitive concept in health care, because it’s talking about breaking down all different forms of silos. You know, kind of going back to what you’re saying. It’s like, how do you get to that stage of truly integrated and seamless transitions between different care modalities?
Brian: [00:07:48] That’s a great question. And I mean, that is the crux of what we do. You know, it’s a it’s a sore point and it’s a point of pride with us that we’re used in literally thousands and thousands of hospitals, major retailers. And most of these people don’t know we exist. And the reason is, is we don’t go in and prescribe this is bluestream. This is what it looks and feels like and how you use it. What we do is we built out a platform that is very much designed to be integrated. So its API based, it has workflows that are built in and patented around this provisioning process. But it’s up to you to define those rules in terms of how we actually connect the patient to a provider. And it’s very quick and easy to make this into existing tools and platforms. Good example. New York City health and hospitals is using this right now for their virtual care off the web. Nobody knows it’s to stream and nobody cares. What they care about is that a patient can literally go to a Web site, click a link that says, I want to talk to a doctor right now. And behind the scenes, we’re tying that into finding the right provider, getting that provider into a call, passing the data back. And those are the important pieces of what it looks and feels like when the patient sees it or what the provider sees it. Those are the pieces where it’s really important to let people do what they’re comfortable with every day.
Matthew : [00:09:04] Also, it’s important as a as a small company to focus on problems that you can solve yourself and partner with other companies that can help solve problems for you. Is that insofar as we need to get data in and out of electronic medical records systems?
Matthew : [00:09:22] We partnered with Redox and they have already developed and built out the integration capability with Epic’s systems, with Cerner systems and many, many others. So by by joining forces with them, we rapidly enabled the transfer of blue stream data in and out of all major EMR systems we partnered, as opposed to solving that problem ourselves.
Matt Fisher: [00:09:54] And I think your description of creating that experience for people, it sounds like both patient users and clinician users don’t have to worry about how is the technology working? Seems to be a great way to describe what would arguably be one of the better system designs, because it’s. I feel like one of the things that is heard often is technology works best when you don’t have to think about it and you don’t know that it’s there.
Brian: [00:10:19] And I think that’s that’s a really great point. Our goal from day one was to be pervasive. And I always say it’s better to be on the platform than the player on the platform.
Brian: [00:10:30] And the best way to do that is, you know, really make this thing open and flexible so anybody can show up and bring their own tools. And what’s really surprised us is that big enterprise health systems have started using our API to directly tie this into their own portals in lieu of and sometimes in addition to using some of the portals provided by the EMRs. And I’m sure all of you listening have using the EMR and try to get your patient records. And it’s not something I would want my mother to try to do.
Matthew : [00:10:58] No matter what we do, no matter what we do is a job. We all have a touch screen, cell phone in our hand all day, every day.
Matthew : [00:11:09] And when we put our finger on it, it works. Right. And so the expectation now is that everything should be that way. There’s an icon. I touch it and it works. If not, I think ah I think ah our frustration level goes spikes after about one to one, one to two seconds and we throw the phone against the wall if it doesn’t work four to five seconds. So we have this consumer expectation that this ought to be easy, this ought to work.
Matt Fisher: [00:11:41] I just touch it and it works in thinking about, as you said, everyone, everyone expects systems to work really easily and very readily, kind of. Have you seen challenges in getting systems to appropriately adopt or appropriately implement the technology? Because, you know, sometimes what I see, especially because I work with companies on the outside that are contracting with systems, is a system might try to pigeonhole a solution into a particular area without fully appreciating all of the capabilities. You know, how do you overcome some of those challenges?
Brian: [00:12:17] It’s a great point. And it happens. I mean, you mentioned this idea that people stand up these own little systems. We call them shadow systems.
Brian: [00:12:24] We make it really easy to do that if that’s the direction you want to go, which is great, because we can sell a deal, get it implemented and be up and running in two weeks. But we really do invite people to bring their I.T. departments, their clinical informatics, the security and compliance folks to the table and look under the covers. And this is worked out really well for us because at first they’re a bit indignant. They’re like, what is this thing? And why didn’t you get my approval to use it? And they look at the details. And for us, it’s worked out well because they they get under the covers and they say, jeez, there’s a lot I could be doing with this. And that’s how we move up the food chain in terms of value in the system. So it’s not for us. I mean, we definitely see it and we can kind of look at it like a Trojan horse from our standpoint.
Matt Fisher: [00:13:03] And for those of you just joining us, I’m talking with Matthew Davidge. And Brian, you’re now from Blue Stream Health. And we’ve been talking about, you know, the the use and expansion of telehealth through the course of the pandemic. And what I’d like to do now is actually take a little bit of a pivot and start looking to the future. Know we’re recording this in early December. So we we have a clear picture that there’s going to be a change of administration on top of a lot of discussion as the pandemic has worn on of needing to make a lot of that, some or many of the changes around telehealth permanent through either legislative and or regulatory change. So kind of thinking about that landscape, it would be great to get your both of your perspectives in terms of where do you think the opportunities lie? What do you think might be likely and what should be considered in the development of those policies?
Brian: [00:13:55] So I’ll talk about it in terms of where I see the the technology heading.
Brian: [00:13:59] And then, Matthew, we’ll probably talk more on the policy side. I think covid has been a great accelerator of telehealth adoption. Even when it goes away, people are going to still maintain that comfort level with telehealth. And the big advantage there are the big change in the industry is not about incremental reimbursements. It’s got to be about moving towards these value based and outcomes based care models and using that comfort with telehealth to do it. And, you know, this is where we see our more strategic and more sophisticated customers already looking. And they’re looking on the horizon and seeing that the real wave coming is how do you make health care delivery pervasive and inexpensive so that you don’t think twice about having a telehealth session with someone wondering, am I going to get reimbursed? You’re thinking, how do I get this patient engaged in actual health care? And telehealth is a great tool to do it. And that’s where we want to be. And we think that the industry is headed there.
Matthew : [00:14:56] I think that to a large extent leaders that direction. Joe Biden talks explicitly about telehealth in his books and technology. Of course, he. The last administration, the last Democratic administration between 2000 and eight in 2016 spent 20 billion dollars on upgrading EMR systems, and during that time, then Vice President Biden suffered the tragedy of losing his son, Beau. And he talks specifically about these ingenious corporations that had proprietary technology. But the systems couldn’t talk to each other. You couldn’t get a scan from A to B and the frustration that came from that. So I think that this is is top of mind for him. And he will help certain environment where. Accountable, affordable care and interconnectivity is important, and I think it will flow from the top down.
Matt Fisher: [00:16:05] You know, I think your point about the personal experience of leaders being a driver for change is a very good one, because then, as you said, it makes it personal and makes those leaders invested in making sure that the follow through occurs. Kind of hearing what both of you are saying, though, it really sounds like it’s not necessarily calling for a sea change, but really just calling for continued consider and measure progress that we’ve been seeing over probably the past about 12 years or so over over the last two administrations.
Matthew : [00:16:38] Well, I guess so. Revolution or revolution? So everybody revolutions. A great headline. Let’s just throw the old out. Let’s do something brand new that doesn’t work so well in health care across five thousand hospitals is that the bottom line is shoulder to the Bolgar and push, push and push with federal leadership, though, to allow the states to do things piecemeal and for certain states to do certain things and other states do other.
Matthew : [00:17:11] It would be better if clear guidance were given and the federal government helped adopt a common framework by which companies like ours and others and electronic medical records company all pushed to help make this ubiquitous.
Brian: [00:17:29] I think it’s I think it’s a great point. And I mean, the one thing I’ll say on the subject is I often say that it ought to be called the Accountable Care Act.
Brian: [00:17:38] And from my standpoint, especially somebody that provides solutions for getting health care out into the community, I really think this continued push to holding health care delivery systems and payers and all the affiliated folks accountable for delivering health outcomes is is going to be good for consumers patients. And it’s going to be good for people like us that are providing that infrastructure technology to make this type of care ubiquitous.
Matt Fisher: [00:18:03] It kind of is. You guys are saying, you know, it’s really enhancing and moving the value based care model forward. You know, thinking about those aspects, if you had the power to and were in charge of what changes or what policies would you put in place to help continue that drive forward? And I’m going to hazard a guess that part of it would be standardization, as opposed to allowing a bunch of different measurement systems to be put in place, depending on which program you’re looking at.
Brian: [00:18:37] Yeah, I think that’s a great point.
Brian: [00:18:38] I mean, if you look at some of these things like like S.J or knee surgery, I think that’s a good proof point for looking at setting up a standard in terms of what is in operation like this really cost one of the things you do after the operation and people have stepped up and said, I will take accountability, responsibility for staying within those guardrails. But that’s just one piece. I mean, if you look at how many ICD codes there are out there, I love the idea of trying to get to a standardized care delivery, standardized reimbursements for it all. But I think it’s a long road before we get there again.
Matthew : [00:19:15] I think a lot of this gets lost to consumers who simply don’t understand that in a in a fee for service world.
Matthew : [00:19:27] When you go in for treatment, you’re going to get a lot of service and people are going to be charged a lot of fees for service world, and we and it is a it is a complete sea change to move towards accountable care.
Matthew : [00:19:42] That’s the boulder that we all need to push. Doesn’t sound very sexy and is a tremendous amount of work, but that’s what we all need to push.
Matt Fisher: [00:19:52] And it kind of as you said, it definitely is a boulder because it’s fundamentally changing the approach of systems, as you’re saying, to how they deliver care, because it’s you know, now you’re not just trying to churn through a high volume because, as you said, in fee for service, every single service that you provide, that that’s more money in the till now. It’s you’re trying to be more strategic around what you’re doing. And arguably, you’re focused more on health as opposed to issues fighting an issue addressing. And it seems like it’s kind of helps to bring the conversation full circle of saying, you know, if you’re focused on that, then you need to have the right tools in place that enable a comprehensive ability to not only review what’s happening with the patient, but also to interact with that patient. So that way you can get the patient into the appropriate care delivery setting.
Brian: [00:20:45] Absolutely. And that’s where we see right now. It’s the tip of the iceberg. But we’re signing up for organizations that ACOs and other kind of managed care groups.
Brian: [00:20:56] We’re seeing things like the three program that make a big impact on the health of the community as a whole by people like New York City are doing it because they are the biggest public health organization in the country. And to them, it’s the right thing to do. But we also see people that are doing it because there’s a financial incentive and we’re totally OK with that because we think it’s the right thing to do for the community as well.
Matt Fisher: [00:21:18] Yeah, kind of. You know, as I said, you know, financial incentives are an amazing things. It’s there’s a reason there’s the old saying of money talks because it’s you know, you can’t just expect a change in behavior to happen because it’s going to be a public good while that ideally you would love to see that, you know, at the same time, even if you’re no matter if you’re talking about a for profit or non-profit health care organization, it still needs to be bringing money in the door to continue operations.
Matthew : [00:21:47] But I mean, change is always hard to change for a change for a small company is hard. Change for a large company is very difficult. To change for a nation is almost impossible. And that’s why we need we need people at the at the government level, at the health system level and companies like us to all push together because what comes of it is better efficiency and better outcomes. Painful push the.
Matt Fisher: [00:22:22] Yeah, and it kind of goes back to what you said a little bit ago, Matthew, of it’s evolution, not revolution, you know, because you said it’s a painful push. And that’s where I think having consistency and a common vision as opposed to continually zigzagging back and forth or yoyo going back and forth to different visions, will in the end be beneficial for the for health care, because it’s you know, you’re allowed to keep progressing step by step. And it helps to hopefully remove the, you know, likely unrealistic expectation that you’re going to see this gigantic leap all of a sudden, that you’ve one day you go from one system and the next day or in the next. Whereas it’s you know, if we kind of look at what’s been happening over the past, however many years, the system is completely different from how it operated, say, 10 years ago. But because it’s happened, you know, with, you know, your constant analogy of by pushing the boulder and going through the hard work, maybe you don’t appreciate how much it’s changed because you’ve been living it day to day and it’s been small steps. Whereas if someone from the outside were to come in and do a comparison, you know, their eyes would go wide, realizing just how much has fundamentally changed.
Matthew : [00:23:40] The great thing about health care, though, is that people have common purpose is that ultimately the industry is there to serve the patients. So we ought to be able to find common standards and we ought to be able to push together. And certainly the way we try and run our system, Brian, is that we we are always looking for partners to connect with, offering our video as part of their solution, accepting their video as part of our solution. So in a small way, we are doing what we can to make the conversation open and cooperating. And health care as a whole, I think is a cooperative. Problem-Solving field, there’s there’s just a lot of inertia and a lot of pushing that you need to do it.
Matt Fisher: [00:24:34] No, I think that’s a great point. And believe it or not, we’re already extremely close to the end of our time. So what I’d like to do is allow both of you to make a prediction of what change do you think we’re going to see when it comes to telehealth or health care over the coming year? Said Brian.
Brian: [00:24:54] You want to take the first pass at that one over the next year? I think what you’re going to see is that there’s going to be a big focus of moving telehealth away from simply ambulatory type of visits as a replacement for in person due to COVID and thinking about how do you integrate this into general wellness, general health care delivery.
Brian: [00:25:15] And I think patients in particular need to get used to the idea that not every telehealth session is to diagnosis, sniffle or to to deal with an ongoing condition. But these are really important aspects of their journey through the care continuum. And I think it’s going to be incumbent on the patient and the providers to embrace that. And I think you’ll start to see that probably towards the end of next year to improve.
Matthew : [00:25:39] I think I think people’s memories are short and getting shorter, and in a year’s time they will have forgotten what health care delivery was like before the pandemic. Now it’s now it’s it’s delivered remotely. That will be the delivery method. And the providers are going to have to hurry, hurry, hurry up behind the scenes to keep the delivery of health care, to keep remote delivery of health care rising and delivering value. So it’s only going to get faster, in my opinion.
Matt Fisher: [00:26:16] Yeah. And I think you’re both right. It’s you know, things have changed so much. And once once people adapt to something new, it’s hard to remember how it was before. But as I mentioned, believe it or not, we are already out of time. I want to thank my guests, Matthew Davidge Brian Yarnell, for a great conversation today. Thank you, Matt. Thank you. And thank you to everyone listening. Keep the dialogue going and connect with me at hashtag h c d e j u r e. I’m Matt Fisher. Until next time.