How remote patient monitoring can deliver better health outcomes for patients
A star-studded panel featuring top healthcare executives, policymakers, and physicians sat down with Cadence Founder and CEO Chris Altchek to discuss the future of remote patient monitoring (RPM) and how health systems can leverage RPM technology to deliver better care to patients.
The conversation, which took place during a recent event hosted by Cadence in Nashville, Tennessee, was recorded and released as an episode of Cadence Conversations, a new podcast from Cadence featuring prominent physicians, healthcare leaders, and tech entrepreneurs discussing their experiences driving innovation and progress within the healthcare system.
The discussion featured Dr. Toby Cosgrove, former president and chief executive officer of the Cleveland Clinic; Dr. David Shulkin, 9th Secretary, U.S. Department of Veteran Affairs; David Dill, the chairman and chief executive officer at LifePoint Health; and Dr. Lynn Simon, president, clinical operations and chief medical officer at Community Health Systems.
CHS recently announced a partnership with Cadence to bring RPM technology to patients across the country, and during the conversation, Simon highlighted why she and her team are so enthusiastic about RPM technology and the impact it can have on patients.
"We're excited with the message around remote patient monitoring, because it's great for the clinicians, because they can really have a tool, and a care team, and make it easier for them to take care of their patients," Simon said. "It's great for the patient. It's great for everyone. So it's really a win-win all around."
"At the end of the day, it's really about the patient and driving better outcomes," she continued.
LifePoint Health also recently partnered with Cadence to deploy RPM technology across the country to help manage patients with chronic conditions, and Dill explained how the health system's relationship with Cadence fits into its broader strategy of partnering with outside organizations to deliver better care for patients.
"When I think about partnering, I think about the relationship that we have with Cadence. To bring new capabilities to smaller communities around the country, to bring capabilities and allow doctors to take care of patients in a different way and make that small community feel bigger than they were on their own… I think that's the role that we play in innovation at scale around the country."
Throughout the conversation, Cosgrove, who formerly served as chief executive officer of the Cleveland Clinic, also celebrated the merits of RPM technology as one of the tools that health systems can use to deliver high quality care at scale to patients as the delivery of care changes in the future.
"Everything is going to change as we go forward. The patients are going [to change], the diseases are going to change. There are going to be more chronic diseases. The places that [patients] are going to get taken care of, they're going to change. The people who are looking after them are going to change. And the treatments are going to change," Cosgrove said.
"All of these things are going to change, but the technology is, and the new approach to healthcare delivery, is going to be fundamental to all of those needs," he continued.
Meanwhile, Shulkin shared his view that RPM technology can help to drive health equity and ensure that health outcomes are not determined by where patients live.
"What are the problems that I think that Cadence or new infrastructure can solve? First of all, we still live in a time where the biggest predictor of health outcomes is your zip code. And it just shouldn't, it shouldn't be that way. And so I see technology, remote monitoring, as really an equalizer that can provide a level of care, no matter where you live, what your zip code is."
Listen above to the entire conversation and be sure to subscribe to Cadence Conversations wherever you get your podcasts in order to listen to future episodes.
Also read the full transcript of the conversation below:
Transcript for Ep 02: How to deliver better care to patients, a live Cadence Conversation
Table of Contents:
- Challenges of Reforming Health Systems in America
- Rapid Transformation in Healthcare Delivery
- Health Tech Incubator and Innovation Strategy
- Scaling Healthcare for Large Patient Populations with Chronic Conditions
- Embracing Remote Monitoring for Chronic Disease Management
- Technology’s Role in Healthcare Infrastructure
- Healthcare Leaders’ Vision for Transformation and Innovation
Welcome to Cadence Conversations, where we're talking with prominent physicians, healthcare leaders, and tech entrepreneurs about their experiences driving innovation and progress. This week, we're coming to you from Nashville, Tennessee, where Cadence recently hosted a thought-leader roundtable featuring Dr. Toby Cosgrove, former president and chief executive officer of the Cleveland Clinic; Dr. David Shulkin, 9th Secretary, U.S. Department of Veteran Affairs; David Dill, the chairman and chief executive officer at LifePoint Health; and Dr. Lynn Simon, president, clinical operations and chief medical officer at Community Health Systems. They joined Chris Altchek, founder and CEO of Cadence, to explore how health systems can use technology to deliver better care to their patients. So let's get to this week's Cadence Conversation.
Chris Altchek (CA): Without further ado, I'm going to let everyone on this panel give a brief introduction. Don't be humble. We know you're an incredibly accomplished group. But I'll start with you, Dr. Simon, if you don't mind.
Dr. Lynn Simon (LS): Well, I appreciate being invited here, and looking forward to working with Cadence. I'm Dr. Lynn Simon. I'm the chief medical officer, president of clinical operations for Community Health Systems. I've been with Community Health Systems for 12 years. I'm a neurologist by background and really excited to kick off our Cadence relationship. I think we launched right at the beginning of April.
CA: Welcome.
LS: Thank you.
Dr. Toby Cosgrove (TC): Hi, I'm Toby Cosgrove, a recovering heart surgeon and formerly CEO of the Cleveland Clinic.
Dr. David Shulkin (DS): I'm going to steal from Toby as I usually do. I'm David Shulkin. I'm a recovering member of the Trump administration, but you look better than me, Toby. And I had a chance to, as we'll talk about, to lead the U.S. Department of Veteran Affairs.
David Dill (DD): My name's David Dill, and I'm the CEO at LifePoint Health. It's great to be up here with three doctors. I'm outnumbered. So Marty and Tim in particular, if I need some help, I may call for some help up here in a little bit. I've been in Nashville for 31 years, and last time I saw three doctors together on a stage like this, they were singing a song, and Toby said, in addition to singing, he could also tap dance.
TC: Absolutely.
DD: So maybe at the end of this, we could see both of those tonight.
Challenges of Reforming Health Systems in America
CA: Awesome. So maybe we'll start with you, Dr. Shulkin. Can you help set the stage for this conversation as leader of, both in the private sector and as the former Secretary of the VA, you're very familiar with gigantic opportunities, as well as the monumental challenges when it comes to reforming health systems in this country. Can you share some of your lessons learned in your time in government about both these opportunities and challenges?
DS: Sure. Thanks, Chris. I think that there are four lessons that I learned that I like to share from my time in government. But before that, let me just quickly set the stage. I was running a hospital system as the CEO, and President Obama called me and said, "We want you to come to VA to help fix the VA." And I said, "Mr. President, I don't have any government experience. I haven't been in the VA since I was a medical student. I can't really help you." And he said, "No, that's precisely why we want you, because you have private sector experience." So I figured, well, how hard could this be? You know, I mean, I know healthcare.
So my experience when I got to Washington was, I don't know how many of you ever watch Seinfeld, but there was this episode with George, and George's life was going really bad. So he decided...It's called the opposite day episode. He decided whenever he was going to say yes to something, he would say no. Whenever he was going to say no to something, he would say yes, and his life worked out. That's the way the government was. It made no sense to me at all, and I couldn't rely upon my instincts, my past experience, because it was filled with these archaic rules.
So basically from that, though, I learned four things. The first is that the job of a leader of a big system, maybe even a small startup, is to prioritize. When you go into these organizations, and remember, the VA is the second-largest government organization, $260 billion a year, 450,000 employees, you have to prioritize. And everybody knew when I went around to visit, they knew my top four priorities, and that's all I ever talked about, and that's what I messaged.
The second lesson was, interestingly, like George in opposite day, it was actually easier to get big things done, not incremental change. Incremental change in Washington is impossible. So let me give you an example. I entered the VA during the wait time crisis when veterans couldn't get care, and the average wait for an appointment was 70 days. So my staff said, "Let's go to 50 days," right? 70 to 50. Then that will be progress. I said, "No, we're going to go to same day, same day appointments," because that was the only way I knew how to assure a veteran wouldn't wait for care, is same day. By December of 2016, I was able to tell President Obama we had implemented same-day appointments across the entire VA at every VA medical center across the country. And it was because big change was actually easier for employees to understand what it was. How could they manage to 50 days when that didn't mean anything? But they knew what same-day appointments were.
The third issue was, again, opposite day, do not manage by consensus. A lot of people, you hear healthcare CEOs, they say, "Well, I want to listen to everybody and hear their point and make sure I get everybody's input." I didn't do things by consensus. I decided what I wanted to get done, and then I announced it. So I went before Congress one day and I said, "I want to eliminate hepatitis in every veteran in this country." And I knew the senators would cheer for it and say that was a great thing. And then I said, after they publicly said it's the right thing to do, "I need a billion and a half dollars from you." And they gave it to me. And today, there would be less than 10,000 veterans in this country who have hepatitis C.
The same thing with the electronic health record, and Toby was involved in this behind the scenes. I did not tell anybody at VA that I was switching from their beloved homegrown system to a commercial system. Cerner didn't even know I was doing this. We just announced it because we had done the work and thought it was the right thing to do, but I wasn't leading by consensus.
And the fourth lesson, Chris, and then I'll shut up, is that what I learned in government was when you work, especially at the Cabinet level, you serve at the pleasure of the President. I didn't even know when I took the job it would be possible to be fired by tweet, but I was. So I took every day as a day that I had to get something done. I had to fix this system for our veterans. Every day was a day that if you didn't accomplish something, it wasn't worthwhile because you never knew that you'd have another day after that, as I found out. And that has still stayed with me, that, get something done of value every day.
Rapid Transformation in Healthcare Delivery
CA: Love it, love it. And then Dr. Cosgrove, let's turn to you and discuss what this looks like at the health system level. You've witnessed the rapid transformation and driven the rapid transformation in healthcare from when you took over leading the Cleveland Clinic to some of your work afterwards. Can you describe what things were like back then versus today, and what some of the most notable changes that have taken place in care delivery for very large systems?
TC: Well, not to be outdone. I've also been fired by the President by tweets, so you're not alone. But I think when I took over, and this was 2004, healthcare systems were not mature. And just to give you an example of the Cleveland Clinic, it had 10 hospitals in Cleveland. They all had separate governance. They had separate hiring practices. They had separate purchasing practices. They had separate mission statements. And there was no coordination between them. They all competed with each other. And it was a long process to bring them together in a coordinated fashion.
And I think that one of the things that we started with was doing administrative sort of things, things like HR and finance and marketing, et cetera, and that was relatively easy. And then we got around to beginning to integrate the physicians and the nurses. The nurses came first. That was hard, and then subsequently even harder was bringing the physicians together in an organized sort of way.
So I think healthcare systems across the entire organization of the entire country have begun to do that, and the ones that have been most successful have done it the best. And I think one of the things that has driven it is understanding the importance of data. And the more you bring the data together, you can begin to drive these changes. And there are only a very few things that change doctors, and that's one of the things that changes them, is data. And what you do is you'll present them the data and they'll say, "Well, that doesn't apply to me. My patients are different." That takes six months. And then they'll say, "Well, the data's wrong," and that takes another six months. So a year later, they've begun to believe the data and you for the first time begin to see the change. So I think that healthcare systems that have done it well and have come together as integrated, functioning healthcare systems have used data.
The second thing I think that is incredibly important in bringing a healthcare system together is communication. And it is impossible to communicate enough, whether you do it twice a day, by email, by television, by in person, there's always somebody that doesn't get the message. After I finally thought that I'd finally had people understanding and I'm walking through the halls one day, and after I've talked to them about this incessantly, somebody stops me and says, "What's that building that's going up over there?" That was a new cancer center that had been three years in the process of being built. So it's impossible to get the message out to everybody. And so if you're going to have a coordinated team effort, I think you have to have data and you have
Health Tech Incubator and Innovation Strategy
CA: Love it. Love it. And David, turning to you, tell us about LifePoint's broader innovation strategy and your company's new health tech incubator, 25madison. And how do you see technology startups playing a role in improving care delivery for systems like LifePoint?
DD: Perfect. Thank you for that, Chris. And Lynn, for you and I, it's great that we have not been fired through a tweet by the President. That's good.
DS: Not yet.
DD: Or at least I haven't.
DS: Yeah.
LS: No, I haven't. I'm still waiting for that. And luckily I don't think Tim tweets, so maybe. I don't know. Hoping.
DD: So that feels good. So LifePoint has 65 hospitals around the country. We're in smaller communities. We have 50,000 employees. I grew up in a small town. It's one of the things that drew me to the company many years ago. So as we think about innovation, innovation is core to our success as an organization. I have a painting in my office. And a few of our team members that are here have had to listen to me tell the story. And I won't bore everybody with the story, but in the painting that I had made, there's pictures of old barns and there's pictures of new storage silos. And it's a picture for me every day when I walk into my office, how important it is to be thinking about the future, not just to build shiny new barns, but to build technologies and capabilities that make the existing barns stronger with a new roof and a new floor that can stand the test of time.
And COVID, and this pandemic taught us a lot of things, taught me a lot of things, but leaning into innovation. So we branded our own innovation strategy called LifePoint Forward. It's a nod to the history of LifePoint over 25 years, but also the forward notion of thinking into the future. And we break our work up into three ways, partnering, building, and buying. And when I think about partnering, I think about the relationship that we have with Cadence. There's technologies that are out there that come across all of our desks every day. And we had a chance to visit with you and your team early on. It was great to be able to form a relationship with you where it fell into that partner bucket, to bring new capabilities to smaller communities around the country. To bring capabilities and allow doctors to take care of patients in a different way, and make that small community feel bigger than they were on their own. I think that's the role that we play in innovation at scale around the country.
The second bucket is building companies. And through our 25madison health incubator, it's a venture studio. We will build two to three companies a year. So while it's kind of part of the company, it's separate from the company. We didn't want to make it part of our day to day hospital operations. So we'll be hiring a fantastic team. We have a couple of our team members in here tonight. We'll build two to three companies a year. And over time, my guess is one or two of those companies, we may like it so much that we just keep it to ourselves. We may be a little jealous and say, we want to hold onto that. That becomes a little bit of the secret sauce of the company. I don't know if we'll find those or develop those, but it's very possible.
Most of them will be commercialized businesses that we could then sell into the market to solve real problems. Not just listening to people coming in from other parts of the country to say, here's what you need to do. But having a team that's listening to our own caregivers around the country and listening to what their needs are and then bringing real solutions. And then finally there may be companies that are at an early stage that we want to invest capital in and buy. And so each of those threads are where we'll lean into to really bring new capabilities, to take those new shiny storage containers, make them bigger and better, but also make the barns on the other side of the street stronger to endure the next pandemic and the next 20 years.
Scaling Healthcare for Large Patient Populations with Chronic Conditions
CA: It's awesome. And the partnership has been incredible. And what your team is doing is so impressive. So impressive. Dr. Simon, I'd love to talk about virtual care and remote monitoring. And as the chief medical officer of Community Health Systems, you're familiar with managing care for very large patient populations with chronic conditions. Can you tell us about some of the challenges with this type of care today and how you think remote monitoring can help both physicians and patients?
LS: Yup. Oh, sure. I think kind of, this is where more of the rubber meets the road. So you mentioned it when you started out. And I think some of the challenge is really with that patient engagement piece. Because as a sort of setup, we have over 40 markets and over 80 hospitals and each one of those markets has an ACO. So obviously their patients engage in those ACOs, but they don't really know that. And then we have care teams. And we have networks that we build out. And we try to use those networks and those care teams to navigate patients and the care needs.
But I think where remote patient monitoring comes in is really to tie all that together. So it really gives, for maybe one of the first times, our care teams in our networks, a really tangible tool to engage the patients in those cares and become connected. We call that Connected Care. And so that's how we sort of try to tie everything together and with our networks of care. So we're really excited to give a tool to our physicians, to our clinicians, to our patients, to engage them. So we can kind of build out the ACOs to build out the care that is higher quality and lower cost.
CA: And then we've learned a lot from your team on this. As you think about deploying these programs at scale, what have you learned? What are you keeping in the back of your mind as you're sort of trying to bring this to 20 plus, 15 plus states?
LS: Yeah. So we always do better starting with pilots. So we start with small testing.
CA: We don't use that. We don't use that word.
LS: Yeah. Well, but we move very quickly. So we do better when we, and Toby talked about communication. So a lot of the communication, the good thing about this is it's really we've created a lot of disruption over the last couple years. So we've really focused on the consumer, focused on patient access, but we've done that somewhat by sort of rocking the world of some of our clinicians.
So we've done centralized scheduling and online scheduling. It's been great for the patients, but for the clinicians it's really been difficult. So we're excited with the message around remote patient monitoring, because it's great for the clinicians because they can really have a tool, and a care team, and make it easier for them to take care of their patients. It's great for the patient. It's great for everyone. So it's really a win-win all around, which is a different message than maybe we've had, to communicate along the way. So I think we've done some hopeful things for the patients, but again, this is something that I think we have a great communication around, a great message, that it really be a win to everybody. And at the end of the day, it's really about the patient and driving better outcomes. And that's what the doctors want anyway.
Embracing Remote Monitoring for Chronic Disease Management
CA: That's awesome. That's awesome. And Dr. Cosgrove, what gets you excited about this next phase of technology and remote monitoring and data? You spent time with some of the biggest technology companies in the world. Why does this interest you?
TC: Well, first of all, I think that everything is going to change as we go forward. The patients are going, the diseases are going to change. They're going to be more chronic diseases. The places that are going to get taken care of, they're going to change. It's going to be more outpatient. The people who are looking after them are going to change, and they're going to be more techs looking after people, and less nurses and physicians. And the treatments are going to change. And they're going to get more sophisticated, more sophisticated as we go along.
So you are going to have to embrace the technology for a couple reasons. In order to make those things happen, you have to have technology taking away the work of the people who are currently trying to do it in an algorithm, in a not an algorithmic sort of way. And you're also going to have to meet them, patients, where they're going to be, which is hopefully out of the hospital. And you're also going to have to begin to deal with the chronic diseases. And so those are all knitted together in the embrace of technology as it comes along. And we're seeing it in terms of device technology, in terms of organizational capabilities, in terms of the use of artificial intelligence, to begin to understand this. And again, all of these things are going to change, but the technology is, and the new approach to healthcare delivery is going to be fundamental to all of those needs.
Technology’s Role in Healthcare Infrastructure
CA: That's awesome. And Dr. Shulkin, you've used an analogy to me that what bridges did for cities and for the infrastructure, companies like Cadence can do for healthcare. What do you see as the biggest gaps that need to be built around the infrastructure for healthcare in this country and what role can new technology play to really close those gaps?
DS: Well, so first of all, I should say, I drive a 2010 car because it gets me where I want to go. So I'm not in favor of technology for the sake of technology, or for infrastructure for the sake of it. It's got to solve a problem. So what are the problems that I think that Cadence or new infrastructure can solve? First of all, we still live in a time where the biggest predictor of health outcomes is your zip code. And it just shouldn't, it shouldn't be that way. And so I see technology, remote monitoring as really an equalizer that can provide a level of care, no matter where you live, what your zip code is.
Secondly, what's the problem that every healthcare CEO, David, I'm sure you're included, Lynn, you included, are talking about today? And it's workforce. And it's the fact that we can't, there's not enough healthcare professionals. And so if you can use technology to leverage and to help the workforce do their job easier and better and to improve labor productivity, that's the future.
The third factor I think, is the mal-distribution of our workforce. So I got very interested in rural healthcare at VA because 45% of veterans live in rural areas. And we didn't have psychiatrists who live in rural areas and we didn't have specialists like Toby, a heart surgeon, that would live in rural areas. So being able to use remote technology to reach out to those people is important.
And then last is behavior change and compliance with what we know works, like what Toby was saying with chronic diseases. And I do think that if you can engage with the patient in these technologies themselves, you will have a bigger impact on behavior change and compliance.
Healthcare Leaders’ Vision for Transformation and Innovation
CA: Love it. Okay. And before we conclude, I just want to give each of you a chance to discuss your vision for the future. And David will start with you. How do you see LifePoint leveraging tech and partnerships to better serve patients in the future? What are you most excited about? And what can we expect LifePoint to look like in 10 years?
DD: Yeah. I'm really excited about the work that we're doing together. I can spend a lot of time talking about it, but I think where we're starting is not anywhere near where we'll end up. So partnerships to me are the key theme. Some of those are economic partnerships and some of them might not be economic partnerships. But we have embraced, at our company, the understanding that we cannot do it all by ourselves and we need great partners to come alongside. And so partnerships will be the key to our success. Making smart investments to make our communities feel more durable than they are today.
This exposed, the last two years have exposed, a lot of things that were coming our way anyway. And the whole workforce challenges that you talked about, we knew these workforce challenges were coming. This just accelerated that. So everything that we do has to be centered around, it's got to be good for quality. And we start with that every day. So that's table stakes. Has to improve the experience of the patients and families and providers that use our network of hospitals each and every day. And it's got to help us grow as an organization. And if we can check those three boxes through partnerships, leaning into technology, I think we'll be very successful over the next five to 10 years, regardless of what happens on the reimbursement front over time.
CA: And Dr. Simon, with healthcare transformation, what are you most excited about?
LS: Two things. And I think we've touched on them a little bit. I think the movement of care to the home. So we used to think about getting healthcare and we had to go to a brick and mortar place, and it was all about I got to go to the hospital for my care. And then it was well, not quite that sick, so I'll just have to go to urgent care. And then now it's, I'm really not that sick, I can get telemedicine. And now there's this care moving to the home and whether it's remote patient monitoring, even hospital at home, I'm very excited about that particular shift. I think the other shift is, and we've mentioned it here, is technology and support of our care teams. So we're uber focused on how do we use technology and how do we create a different care team model in the hospital to support our caregivers, because that model has to change. We just don't have the workforce going into the future. And how do we leverage the technology and support to do things differently going forward?
CA: And Dr. Cosgrove?
TC: Yeah, one of the things that really excites me is the fact that for the first time private industry has taken notice of healthcare. And you see it now with hundreds of startups all over the place, whether it be pharmaceuticals or whether it be IT or whether it be devices or that... All kinds of new startups are happening. And frankly we as an organization are at our best when we're taking care of patients. We're not changing the model. And I think that the model has got to, the changes have got to come from outside of the healthcare delivery system. And I would encourage the healthcare system to embrace the new ideas that are coming from outside rather than just to try and do it all themselves. Because our job basically is looking after patients. It's not innovating. It's much like you all are the Skunk Works for a big industry and we need to embrace those ideas and help you develop them. Some of them will be great. Some of them will not work. But nonetheless we'll be better for the collaboration.
CA: Appreciate it. And Dr. Shulkin, maybe we'll end on a harder question, but from a policy perspective, the government played a huge role during the pandemic in ushering the explosive growth of virtual care, both in terms of reimbursement and enabling care across borders. As we move to a post-COVID world, what do you want to see from policymakers to keep the foot on the gas on the innovation front?
DS: Yeah. Well, first of all, the role of government, which we saw in the pandemic is to protect its citizens. Its primary goal, defense of the country and protect its citizens in times of crisis, like a pandemic. I think in many ways our government let us down and we're going to learn from that. We're going to learn to get better as a public government to be able to be better prepared. The pandemic, I think, as David said, took things that many of us in healthcare knew were deficient and were barriers, but it made it visible to everybody. So supply chain issues are extremely scary. We saw capacity issues. And really during those first, in March and April of 2020, for those of you that were close to New York, those hospitals were really on the verge. We just barely got through, through basically the hard work of the workforce, quite frankly. But I think the successes that have come out of this pandemic are clearly the ones that Toby mentioned, the public-private partnerships. Operation Warp Speed, I think, was a tremendous success.
And we have to build upon those types of partnerships. I also think that there's one other lesson that should come out of this. And that essentially ties into the question about what I am most excited about. And that is the need to break down the silos in healthcare. We are the most siloed industry around whether you talk about payers, providers, patients. But if you think about the silos that I think the pandemic has shown us, the need to break down between physical health and behavioral health and pharmaceutical health. And these three have not talked to each other for decades. And the ability to bring those silos down, and to create something around patients that really change and make a difference in people's lives, I think is an exciting vision. And I think that the government is going to have to be part of doing that.
CA: Great. Well, look, I'll just conclude by saying, I think this is the most exciting time we could possibly be working on these issues. There's so much change happening so quickly and so many incredible people working on these issues. So we feel a deep privilege and responsibility to be working on this together. And so thank you all for your time tonight.
Thanks again to that panel of health technology allstars, who came out to see us in Nashville. To make sure you get updates on our future conversations, please subscribe to Cadence Conversations wherever you listen to podcasts. And for more information about Cadence and how to get involved, visit cadence.care. At Cadence, we believe that everyone deserves the best healthcare possible and we won't stop working until that vision becomes reality.
