Episode 105- Rich Helppie and Cynthia J. Mark
Brian Kruger 0:00
Welcome to Richard Helppie’s Common Bridge, the fiercely nonpartisan discussion that seeks policy solutions to issues of the day. Rich is a successful entrepreneur in the technology, health, and finance space. He and his wife Leslie are also philanthropists with interest in civic and artistic endeavors, with a primary focus on medically and educationally underserved children.
Richard Helppie 0:23
Hello, and welcome to Richard Helppie’s Common Bridge. I’m your host, Rich Helppie. Today our topic is telehealth/telemedicine and all the benefits that it brings for everyone. And we have as our guest to discuss this topic, Cynthia “CJ” Mark of Kaia Health. And of course, I want to thank all of the listeners and guests that have made the Common Bridge possible. For those of you that have yet to subscribe, please consider that, through your favorite podcast outlet including Apple, Amazon, Buzzsprout, Spotify, and iHeart Radio, and viewers at YouTube TV, and of course register for free at Richard Helppie.com. Today, our guest is CJ Mark. She is the Chief Revenue Officer for Kaia Health, which is the first multinational digital telehealth provider for musculoskeletal issues– issues like your hip, your back, joint pain, something that really affects many Americans and many people around the world, particularly those that are athletic or with a graying population. And through the more than 20 years that she’s worked in healthcare and employee benefits, CJ has been passionate about simplifying access to appropriate health care, lowering costs and improving health outcomes. And that’s what we’re going to hear about today. She has been an early adopter of telehealth, she embedded a telemedicine capability in her disease management program, more than 15 years ago. This was really at the infancy, where we just didn’t have the technology infrastructure that we have today. Since that time, technology and mobile adoption have advanced, making the vision of improved care delivery through virtual access a reality. She continues to be a tireless advocate for using virtual care to transform the healthcare experience. She brings a deep understanding of health care and digital health. And before joining Kaia Health, she was the Chief Commercial Officer for Vida Health, Chief Revenue Officer for Harrington Benefit Services, was Teladoc Health’s U.S. Market Leader, and that’s really a breakthrough company, and the Area President for Gallagher Benefits Services. CJ, thank you for joining us today.
CJ Mark 2:44
Thanks, Rich, it’s a pleasure to be here.
Richard Helppie 2:47
Your full bio is of course going to be posted on our website RichardHelppie.com. Our listeners like to know a little bit about our guests so can you maybe give us a little thumbnail? Where’d you spend your early days, and if there was schooling involved, and what’s your career arc been like?
CJ Mark 3:05
Yeah, so you know, it’s interesting, as you look back over, you know, 20 plus years in an industry and kind of the circuitous route you take over time. So, I’m educated at Miami University, part of the MAC Conference, super proud of that, and from there really had always seen this business trajectory, but hadn’t been focused initially on health care actually became part of a startup HMO, which was called McCauley Health Plan. It was part of the St. Joe hospital system in the day, and became part of what is now Priority Health in Michigan. So that’s really where I began my career in health care and really formed this kind of passion for transforming health care delivery, because those were the early days of HMOs, as we were trying to find a way to really streamline and change the way people were accessing health care at that time, trying to encourage care through primary care, primary care physicians.
Richard Helppie 4:06
Your career has been about cost and quality and access to health care. (CJ: Absolutely. 100%.) Look, the public’s heard a lot about telemedicine of late. What’s generally not known is the extent these technologies actually allow the delivery of diagnostic and treatment services, and the care provider and the patient can be thousands of miles apart. But look, we’re in an interconnected world. We’ve had guests on the Common Bridge talk about telehealth for mental health matters–Judge Milt Mack spoke so eloquently about that, others about how to leverage the availability of doctors to serve an aging population– Brian Peters of the Michigan Health and Hospital Association spoke about that. So today we’re going to just dive right into telehealth. And I know that we’re going to hear some policy ideas and certainly going to get some education. So CJ, most of my listeners are not experts in technology or in health care, so is there a lay definition for what telemedicine is and is that term interchangeable with telehealth?
CJ Mark 5:11
Initially, the terms weren’t interchangeable, but they become interchangeable over time. So people tend to use telehealth and telemedicine as one-in-the-same. Telehealth initially, was really defining a full scope. So it could be anything from interacting with a coach to a physical therapist to a physician to a psychologist to reading images that a radiologist might be reviewing; whereas telemedicine was very specifically, kind of a patient-to-physician encounter. But you hear them used completely interchangeably now, as people talk about the space.
Richard Helppie 5:48
So anytime a provider and a patient are not in the same geography, or two providers that aren’t in the same geography, that could fall under the umbrella of telemedicine, also known as telehealth.
CJ Mark 6:04
Absolutely. Well, if you think about it, even telehealth/telemedicine, they could be in the same geography. So this week, I’m in New York. So if you think about trying to get from 10 city blocks inside New York, you’re in the same geography, but it can take you an hour in non-COVID times in rush hour to get from point A to point B. And it’s a way to connect people in a much more efficient, effective way.
Richard Helppie 6:28
I see no, that makes a lot of sense. And I know personally I’ve used telehealth/ telemedicine a couple of times for just primary care visits, and it worked great. I never had to leave my desk and they let me know, and I sent images and they had access to my records, and I had a very positive experience. And telehealth has been around for a long time; remote specialists from you know, oncologists to surgeons, the military has used this for the VA system so that veterans don’t have to travel so far and also out literally into the battlefield so that they can be treated. Has your experience been in these areas or something a little more specific than that.
CJ Mark 7:10
So it’s interesting how you end up kind of, you end up with pathways into multiple parts of this. So my pathway has been primarily in the Employer… to the Employer segment, the Health Plans segment, but then circuitously, we ended up embedding this telehealth program that I mentioned previously, over 15 years ago, that was actually embedded in a correctional facility. They were having issues having to transport prisoners out of the prison setting, and how do you get them quality care inside that prison system and we were helping them to facilitate that using telemedicine. So to your point, from whether it’s in the battlefield, you know, in that type of application to just day-to-day, physician-to-physician or from a patient to a physician, multiple applications for it.
Richard Helppie 8:07
And I know there’s been some attempts at some fairly exotic things like robotic surgery, you know, most commonly the robotic surgeries done where the surgeons in the same operating suite, although not looking directly at the patient, but a case could be made, would you rather have a surgeon from New York, highly specialized, or maybe a general practitioner in rural Montana, when you need some kind of life saving treatment? CJ, tell us a little bit who would use the products, and how does what you’re doing today work?
CJ Mark 8:39
Yeah, so it’s interesting. So there is a need in the workplace today to provide better access through employee benefit plans. So if you think about the benefit plans that most employers offer, you usually have a health insurance component of that. And most employers are trying to find better ways to not just contain costs, but improve the quality of care that’s being delivered to their employees — also do that, as I mentioned, in a more cost-efficient way. So I’ve really been in this employee benefits market. So our end buyers are typically large employers who are embedding, you know, as the example of Kaia Health, our MSK solution into their benefit plan offering, in order to improve access for their employees. So if you think about transportation companies, for example, and folks that are lifting boxes all the time and they have to be supremely mobile, and they get injured and they have an MSK issue and they have to still be on the road – (Rich: MSK is musculoskeletal) musculoskeletal, yeah, thank you, Rich, yep..
Richard Helppie 9:46
So if I’m an employee of one of these customers of yours, they could tell me, look, you don’t have to go see the physical therapist or the occupational therapist and wait in the waiting room and be called in and have the physiologist look at you, they’ll just tell me to be available, kind of like a Zoom call and they’ll direct my care and track my care. Am I getting that right?
CJ Mark 10:09
You are. And what’s unique about what Kaia is doing is Kaia has, is using computer vision technology. So literally it scans your body, and as you think about going through a set of exercises for knee pain, for example, the Kaia app is using that computer vision technology to make corrections for the patient without ever having a physical therapist (Rich: oh my) actually there as part of that visit. So it really augments what the physical therapist is doing in brick and mortar settings. And also we’re able to facilitate tele PT visits with a physical therapist as well, so you always have access to human intervention, but you may have worked a 12-hour day and it’s 10 o’clock at night and you say, you know what, I didn’t do that set of exercises I was supposed to do, and if I don’t do them, I’m not going to get better. And you literally can any time 24-7, with that computer vision technology, access this whole set of therapeutic interventions using your own mobile device.
Richard Helppie 11:21
And it will tell me if I’m doing the exercise correctly, as well. (CJ: Exactly.) I’m sure everybody listening to this knows somebody that got through an injury or surgery or what have you, and they were told to do the exercises and either didn’t do them, or did them incorrectly and they wonder why they weren’t getting better.
CJ Mark 11:39
Yeah, exactly. So the precision, it’s actually so precise. The technology is so precise, we had to kind of, I don’t want to say dumb it down. It was so precise that it was… correcting like to the minutia, and we had to loosen up that a little bit so that it’s more forgiving, so that a normal person like myself, can actually get through a round of exercises, still very safely. But it’s it’s literally able to correct you as you go, which is fantastic if you think about it in our busy days, our busy schedules to have that at your fingertips, increases adherence significantly, because part of the issue you have with a lot of programs are adherence rates. And people just fall off, they they do a couple sessions, and then they don’t continue to therapy because it’s not convenient enough, or it’s too high cost, or they don’t have the time. So it increases the completion rate of the program. So if you look at our completion rate, we’re running about 86% right now completion rate of the program, as compared with brick and mortar, which is running in the 30 to 40% range depending upon the therapeutic intervention.
Richard Helppie 12:52
So it’s a double in quality, it’s a double in convenience, and and also in costs. So during the pandemic, there was a lot more telemedicine — primary care doctors, mental health, oncologists, looking into this, I was wondering, what do you think will continue? Will we still benefit from this or are there headwinds that are going to prevent telemedicine from reaching its full potential?
CJ Mark 13:20
Well, so my experience having done this now for more than a decade is that once people have used telemedicine, (I think it’s similar to your experience Rich,) where you say, wow, this is very, very convenient. The physicians that are using it, love it as well, because it gives them an opportunity to increase the reach of their practice., for us with our physical therapist, it gives our physical therapists a way to more proactively reach out and engage with their patients. So it’s really a win-win-win for all of the stakeholders that are in the ecosystem, from the patient, to the providers, to those folks that are paying the bill, because you see better outcomes, better quality, better adherence rates. So people use it, and they love it, and they continue to use it ongoing and that’s what we see in the data.
Richard Helppie 14:12
And we’ve had guests on the program–so, Dr. Rick Geddes talked about the need for infrastructure, particularly broadband and for devices. And I think this is essential to making sure that we do have universal access to care, so that we have people that are not unnecessarily in pain. Dan Dodson, who was a recent guest talking about artificial intelligence and machine learning, just clearly baked in and the need to make sure that the networks are protected because of all that sensitive patient data. And then from a policy level, Brian Peters talking about what can be done legislatively, so that, for example, cross-state licensing that a physical therapist, you know, living in Idaho, why couldn’t that physical therapist consult to somebody living in Nebraska and maybe getting a more talented therapist? Are their bills moving through at the federal or state level that you’re aware of that are going to help or hinder the expansion of telehealth?
CJ Mark 15:13
So one of the big question marks is whether the Cures Act, whether the components that were passed, that made it more easy for providers to provide care across state lines, you know, what will happen with that. There are some tailwinds right now, because I think it’s become very clear that it’s beneficial for multiple folks inside not only just health care delivery, but in terms of lowering health care costs overall. And then it also puts more tools at the disposal of providers that are providing that care. So when we’re looking at the legislative piece, I think we’re seeing tailwinds, in terms of that piece, but stay tuned, you never know what’s going to happen, ultimately. But that will make a big difference. And I will say that when I started in this digital healthcare space 15 years ago, and it was a patchwork quilt of regulation from state to state, so you literally had to operate differently depending upon the state– that’s changing. There’s more commonality from state to state, which has helped considerably, there’s still some nuances, but that’s made it much easier for providers to be able to operate because they’re not operating with separate regulations as they’re trying to cross state lines to provide care. So those things I find very, very encouraging. Are there additional things that have to happen, absolutely democratizing access to broadband. The good news is that many of the things can be delivered today through a mobile phone. And if you look at the latest Pew Research, you know, 87% of Americans now have a smartphone. So the more superior patient experiences should be able to be delivered through a smartphone. So that now means that 87% of Americans, regardless of whether they’re in a broadband area or not, can access telehealth solutions or telemedicine solutions just from the convenience of their cell phone. So that really is the great democratizer in terms of healthcare access, which is the mobile phone.
Richard Helppie 17:20
How about billing from the you know, the big insurers, Medicare, Medicaid, and some of the large private plans? Are they on board with this or are they still of the old model -we want the patient to come into a facility, otherwise, we’re not paying for it? Where do they stand today?
CJ Mark 17:37
Yeah, so I wouldn’t say it’s 100% of all the payers in the country, but it’s close to 100% of the payors today have telehealth solutions embedded into their offering. And they’re expanding that, so they started with the primary care physician model that you mentioned before, Rich and they’re expanding that to other things– diabetes management, musculoskeletal– so that expansion is continuing through payers, and payers recognizing those solutions as in-network benefits, so that the patient responsibility component of that doesn’t make it financially difficult for people to be able to afford that access. So we’ve seen that occur as well. And then when you look at basic primary care access through telemedicine, 99% of all employers now in the US are offering some form of primary care-based telemedicine. So if you look at where we were a decade ago, and where we are today, where literally a decade ago, they were- folks were still saying, “What is this? Is this even legal? Can you even do this?” to you know, we have, you’re close – it’s like 99.8% of employers now saying, you know, we have this embedded as part of our standard benefits plan offering, which is remarkable.
Richard Helppie 18:57
But no, that’s outstanding. What about malpractice issues and malpractice insurance? That’s got to be a factor here.
CJ Mark 19:04
Yeah, so the good telehealth providers today have significant clinical oversight as part of their program, and some sort of medical malpractice oversight as part of the program, too. So the very strong programs like Kaia Health, for example, our algorithms on the front end do screenings for patients that may not be appropriate for a telehealth visit or a Kaia visit, and so we screen on the front end of that because we want to make sure that they’re accessing care appropriately and safely. So patient safety should always be number one, paramount in part of every single solution that you would look at. And we’re seeing that more and more out there. So and as part of that, there should always be an escalation process, so that you have physician oversight for the things that are more complex in nature, and that helps in terms of care delivery too, for folks that are operating inside the network and helps lessen their liability, but it’s again, it’s all about patient safety. That should be number one.
Richard Helppie 20:07
Are there places or parts of the profession that telehealth or telemedicine just doesn’t make sense, or maybe something that’s been tried and, you know, we’re not going to do it in that area?
CJ Mark 20:18
Absolutely. So early on, when I would go to talk to groups early on and explain the concept, I’d say, “so if you break your arm this weekend, we’re not a good solution for you.” We can’t set your arm remotely, you’d have to go to brick and mortar for that. For musculoskeletal, there are still things that you want to be in your PT’s office, you want to be in your Physical Therapist’s office, because we can’t actually help stretch your muscles and do all the manipulations that a physical therapist can do. So the telemedicine/telehealth is not a replacement for brick and mortar– never will be a replacement for that. It should augment what happens in brick and mortar and provide additional tools for the providers that are delivering that care. So if we provide more diagnostic tools, more consistency, and in terms of the clinical care protocols in this computer technology that we’re putting at the fingertips of both the patient and the provider, helps both of them– the patient in terms of appearance, and the provider because they have more diagnostic tools and more information at their fingertips, as they’re diagnosing and working with patients.
Richard Helppie 21:29
That’s very fascinating. And sometimes things you wouldn’t think would lend itself to telemedicine, do and I’ve read up on the military, of course, the VA system, and one of the things, you know, members of the armed services, they get transferred a lot, but they might have family members that need care. Well guess what that care is on a continuum, because they’re getting the available services that make sense by telehealth. And also there was a case of a corpsman on a navy ship taking direction from a surgeon in San Diego to actually cut a tracheotomy for a breathing tube under that direction. So there’s there’s some amazing things that can happen. I just kind of feel like we’re just on the forefront of this. And I really applaud what you’re doing. You’ve been very generous with your time and I know it’s been limited today, but is there anything that we didn’t cover that we should have?
CJ Mark 22:22
Well, I think for me, what is really exciting right now is the convergence that is occurring. So if you think about mental health, the mental and the physical coming together, from a telehealth perspective, this ability to be able to bring those components together in a way that you might not have been able to in brick and mortar previously, through greater data, better diagnostic tools, in some instances. And in some instances, being able to take the better diagnostic tools that you have in brick and mortar and bring that into a virtual care visit — this convergence that is occurring is very, very exciting. And to your point, Rich, we really are at the tip of the iceberg. When you look at the total addressable market in virtual care today, we literally are at the tip of the iceberg. So when you look at the number of mental health visits, for example, that are being delivered today, it’s a tiny sliver. And it’s estimated that close to 95% of those could be delivered through virtual care visits. And we’re just starting to see this explosion in telebehavioral/telemental health visits. So again, I’m very excited about that and how this is emerging and how it changes literally overnight as technology changes. The one other thing I would close with is if you think about your mobile device, and how your mobile device, every iteration that you see has greater technology in it. That is a diagnostic tool that you’re walking around with. It’s in your hand almost every single day, every hour of the day at some point and you have this incredibly powerful diagnostic tool now that you’re carrying around with you and it will only get better over time. So that’s super exciting as well.
Richard Helppie 24:11
That it is and that is a great closing note. We’ve been talking today with CJ Mark about telemedicine and telehealth. This is Rich Helppie on the Common Bridge, please register for free at RichardHelppie.com, subscribe on your podcast provider and on YouTube TV and please rate us, rate us high please, that would be great. And please continue to send in your questions and ideas for topics and for guests. This is Rich Helppie with our guest CJ Mark signing off on the Common Bridge.
Brian Kruger 24:45
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