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Join us for an insightful conversation with Lyle Berkowitz, a physician executive, as he discusses the growing trend of telehealth and its impact on patient care. With the COVID-19 pandemic accelerating the use of virtual visits, consumers are realizing the value and convenience of telehealth for minor urgent issues, chronic disease management, and mental health services. Dr. Berkowitz will delve into the results of a recent consumer survey that found an overwhelming majority of consumers believe it’s important for their regular doctor and telehealth provider to have access to their health records for sharing critical data. He’ll also discuss the challenges that health systems face in expanding access to telehealth, including the importance of seamless data sharing, partnerships with virtual care providers, and creating a patient-centered experience. Tune in to learn more about the future of telehealth and its role in delivering high-quality care.
Lyle Berkowitz is a physician executive.
He shares his story and discusses his KevinMD article, “What consumers want from telehealth.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Rate and review at KevinMD.com/rate. Subscribe at KevinMD.com/podcast. Today on the show, we have Lyle Berkowitz. He’s a physician executive. His KevinMD article is titled “What consumers want from telehealth.” Lyle, welcome to the show.
Lyle Berkowitz: Thanks, Kevin. Glad to be here.
Kevin Pho: So we’re going to get to your article in a little bit, but first off, briefly share your story and journey to where you are today.
Lyle Berkowitz: You bet. So I studied engineering, became a doctor, added on physician executive, and then became an entrepreneur, which evolved into innovation over the years. But a lot of my career was spent at Northwestern Medicine in internal medicine primary care, practicing part time and working as a physician executive part time. I spent about a decade in classic informatics and IT, rolling out EMRs like Cerner, then Epic, and another 10 years setting up one of the earlier innovation programs. Along the way, I was involved with a lot of digital health companies and got my street MBA.
I left Northwestern five years ago and joined MDLIVE, one of the big telehealth companies, as the number two executive there. I learned a lot, and in 2020 I left there to focus on Healthfinch, a company I’d started in the workflow automation space. I sold that, retired for a second, and then did some consulting. Telehealth became big with COVID, and I wound up starting my new company, KeyCare, which does all the virtual care on Epic. And here we are.
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Kevin Pho: Now, a lot of physicians are interested in that entrepreneurial space, that health technology space or health startup space. How can they do that? What kind of advice do you have for them?
Lyle Berkowitz: You know, I get this a lot: “Hey, how can I do that?” Start small. Be a fractional chief medical officer or an advisor to a startup company. Keep your day job, have some fun, learn, explore, and see if it’s something you want to expand on. And then keep your mind open. One of my favorite quotes is from Louis Pasteur, who said, “Chance favors a prepared mind.” I’m shocked how many times something sort of came my way, and the question is whether you’re willing to take a little chance and take it. And I was lucky to have a supportive family and a great wife who let me try some extra things on top of my day job.
Kevin Pho: Now, you talk about that quote, right? “Chance favors a prepared mind,” or “Fortune favors a prepared mind.” So a lot of doctors, we don’t have a lot of training when it comes to the business aspects, the entrepreneurial aspects. So how can we best, quote-unquote, prepare our minds? Do we need to get MBA degrees? What kind of education do physicians have if they want to enter that space?
Lyle Berkowitz: You know, I was fortunate to have some great mentors on the business side who taught me. Like I said, I got my street MBA. I learned on the job. I had some folks who would help teach me, and by doing it part time, it was easier. And I read a lot of books. I read a lot of management books, and that helped me, you know, all the books about making companies great, etc.
But with that said, a lot of folks are getting these MBAs to help them move into that job. I never wound up doing it, and I don’t think you have to do it. I would say that the more experience you can get on the street, the better. That can also include in your organization: Volunteering for committees and other things within your health care organization is another great way to learn. Because in the end, a lot of business is about politics and being able to work with lots of different people. As a doctor, a lot of times we’re used to being the smartest person in the room, with everyone listening to us. The business world has got to be more collaborative. So the more experience you get like that, the better.
Kevin Pho: What kind of questions can physicians ask themselves to see whether they are suited to that entrepreneurial business world?
Lyle Berkowitz: You know, one is economics. Is this financially something that is going to make sense? Two is how important it is to you to work with a big team, and to understand that you have a job that’s part of a bigger organization. It’s not like in the exam room, where you just get to be the authority. You have to really be collaborative. And of course, I think most of us think about, “Am I going to make a bigger impact?” Because it’s really important that doctors make an impact, and most of the reasons they go into a bigger business are because, I think, they can make a bigger impact that will affect more people.
I do stress, I think it’s important to really get a good baseline as a doctor to be able to have that impact, and that means at least five or 10 years of having some clinical experience before moving over. And again, I’d stress there’s a lot of value we can add part time, and I think it’s fun. We get to be doctors part time and businessmen part time. I’ve spent most of my career doing both of those, and even though I’m essentially a 100 percent business executive now, I still feel very much that after 20-plus years of practicing, I have clinical experience I can bring in that’s still useful.
Kevin Pho: All right, let’s talk about your KevinMD article, titled “What consumers want from telehealth.” Now, how did this article come together?
Lyle Berkowitz: You know, I kept reading these other articles and pundits who were saying, “Oh, telehealth is over. The surge has gone down. We had 80 percent use of telehealth during the height of COVID, and now it’s down to 10 or 15 percent. It’s going away.” I said, “No, no, this is crazy.” I know that patients must want telehealth. The issue is that physicians, I believe, are just getting used to going back to the office. And so the demand is there; the supply isn’t.
So we commissioned a survey of patients, and we asked them two basic things. One is, what would you prefer for your routine issues? Not complex stuff, but routine, whether it’s urgent care, chronic care, etc. What do you prefer, an office visit versus a virtual visit? And over 40 percent preferred a telehealth virtual visit, a little under 40 percent preferred an office visit, and about 20 percent preferred whichever one was first available. And I think it’s important for health systems and doctors to understand that this is not just a maybe but a preference by patients, and that if doctors aren’t willing to be able to provide that in some form or fashion, someone else will.
And the second question we asked, and we talked about in the article, was about how important it is that there’s some continuity of care between these virtual care providers who might be taking care of you and your provider. And again, 79 percent said it was very important that they share the same record, which is essentially what we’re doing with our new company by keeping everyone on Epic, because that data sharing allows for, we believe, higher quality of care and a more seamless experience.
Kevin Pho: So we’re speaking at the beginning of February. What’s the current landscape when it comes to virtual options for care?
Lyle Berkowitz: So what we’re seeing is a lot of health systems and a lot of providers are offering virtual care as an option somewhere in that 10 to 20 percent of the time. It depends on the specialty. Behavioral health is still maybe 80-plus percent of the time, internal medicine maybe closer to 15 or 20, specialists a little less. And most of those are scheduled visits. There’s also a need, an increase in demand, for on-demand urgent care visits, just because our ERs are full, urgent cares are full, or simply patients don’t want to go there. They’ll say, “There are a lot of sick people in those places. I might be a little sick, but I don’t want to go to a place where other people are even more sick.”
And so there’s a huge recognition by providers, who recognize telehealth can work, and by patients, who are like, “This was really easy. This makes sense. I do this in every other aspect of my life. I want to do it more in health care.” During COVID, it was clear it could work. And so I think we’re seeing health systems trying to figure out how they can provide these services, or partner with others who can help them provide it, or recognize that they may be losing it. And they’re starting to get scared that the Amazons and others of the world are out there trying to take those patients at the digital front door.
Kevin Pho: So you say that about 40 percent of patients prefer a virtual visit for routine issues, but only 10 to 15 percent of internal medicine practices offer those. So what’s the bottleneck? Tell me some of the obstacles that are contributing to that gap.
Lyle Berkowitz: I think it’s simply supply. Doctors are optimized for the office in many large health systems and groups. I call them officeologists, Kevin. Just like we had hospitalists rise in the ’90s, I think there’s a distinction between virtualists, who are doing lightweight, routine types of care online, and officeologists, who are focused on what’s going on in the office. I think those should be more complex patients.
But I tell you, our fellow doctors, we’re optimized for the office. When we have our own office, right, it’s nice. Everything’s prepared for us. Our assistants take care of everything. Everything is prepped. We’ve been doing it for years. We’re used to it. We know we’re going to get paid a certain way for it. And so for doctors, there’s not a big reason, if they’re in the office and have an office, to do a lot of virtual care, whereas a whole new crowd of virtualists is rising up who are much more amenable to and optimized for being virtualists, working from their home, focusing on lightweight issues. And I think we have to recognize there’s a distinction. For doctors, jumping back and forth between office and virtual care is a discontinuous experience, and one that often doesn’t pay as well, additionally.
Kevin Pho: So you mentioned the payment piece, right? During the pandemic, there were a lot of insurers and Medicare that paid for virtual visits, but that’s going away as the pandemic progresses. So talk about the current landscape when it comes to payment for virtual visits. Are they mostly reimbursed?
Lyle Berkowitz: Yeah, so these days, I think video visits in general are reimbursed at parity. The recent omnibus bill extended CMS payment for video and virtual visits for the next two years, even though the emergency order is coming to an end in May. We still have an extension. I do think Congress is eventually, more likely, going to formalize some level of reimbursement. Virtual care is here; it’s not going away. I think most insurance companies recognize it makes sense. The question will be, will it be paid at parity? You’ve got video, phone, and asynchronous.
From a fee-for-service perspective, I think there are still a lot of payment options, but I think we’re also seeing that value-based care, capitated models, etc. make a lot of sense for virtual care. It’s also where you can bring in asynchronous models and automation to really help manage a population in a much more efficient and cost-effective way.
Kevin Pho: Now, you mentioned technology companies like Amazon going into primary care and virtual care. So what’s the status there? Tell us more about that.
Lyle Berkowitz: Well, everyone who can seems to be going into it, right? We’re seeing the major tech companies, we’re seeing Amazon, and we’re seeing independent third parties offering these lightweight, easy types of care, particularly for mild urgent care issues. And for patients, it’s an easy option. But the problem is, they recognize at some point that it’s discontinuous from their base primary care physician, health system, etc. And the result is that the decisions, the quality, might not be as great, because they don’t have all the information, and if anything serious happens, that information may be lost.
But with that said, consumers are looking for easy options here, and my big advice to health systems is, if you’re not going to offer those easy options, someone else will, and someone will disrupt you. And so that, to me, is a big message to be heard. Health systems have an opportunity right now to compete with these third parties. If they don’t, they’re going to get some of their lunch eaten.
Kevin Pho: We’re talking to Lyle Berkowitz. He’s a physician executive. His KevinMD article is titled “What consumers want from telehealth.” So, Lyle, look into your proverbial crystal ball. What do you anticipate the future of telehealth will be over the next six to 12 months?
Lyle Berkowitz: Six to 12 months, I think we’re just going to see a continued increase in utilization. A lot of it, though, is going to depend on financial incentives, so the question is who’s paying for it: insurers, employers, health systems, etc. I think we’re going to see places that really figure out how to maximize this. A lot of the country is still going to be watching, but what we’re going to see over the next six to 12 months is hopefully more and more places really becoming expert at it, and they will set the trend. It’s sort of like the four-minute mile, Kevin. Once it’s been broken, then others will go.
And right now, I think we’re looking to see who’s going to break that four-minute mile and really, as a health system in particular, figure out how to optimize and provide the best level of virtual care, so that they can shift more of the routine care online and the health system can then focus on more complex patients. And as a whole, they can manage a larger population, because if they can increase panel size by using a virtual care workforce, we start to solve a lot of these issues that we have. It’s not going to happen overnight, but I think we’ll see some oases in the desert happening over the next year.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Lyle Berkowitz: You know, to the doctors out there, be able to combine your passions outside of health care with your knowledge in health care. And again, volunteer and do whatever you can fractionally to sort of help and do some of these interesting business activities you might be looking at exploring, and see where that goes. And to the health systems and large groups, remember, if you don’t disrupt yourselves, someone else will.
Kevin Pho: Lyle, thank you so much for sharing your time and insight. Thanks again for being on the show.
Lyle Berkowitz: Thanks, Kevin.
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