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DANIEL KRAFT: Welcome to Healthy Conversations, an open discussion among health professionals about the latest innovations, what we learned on the frontlines of the pandemic, and how our industry is changing in real time. I'm Dr. Daniel Kraft.

There won't be a specific moment where we can hit the reset button to start to tackle bigger and more systemic health care challenges with a clean slate. But the good news is smaller resets are already happening. Dr. Rushika Fernandopulle joined us to discuss how COVID-19 has accelerated innovation in our industry and what we can learn from venture-backed startups like his.

RUSHIKA FERNANDOPULLE: What you and I do as docs is we tell people what to do. That's mildly interesting. People come to me in my office, and I will say, in my seven-minute visit, you, Dan, should eat less, exercise more, take your medicines. Good luck, sucker. I'll see you in three months.

And you come back in three months, you bad, bad, non-compliant patient. Right? No, we need to help people actually do this. And we've evolved a team model with not just docs but health coaches from the community picked for empathy, hold people's hands when that's the right thing to do, kick them in the behind when that's the right thing to do, integrate behavioral health, interact not just in person but by email and text message and video chat, have patients get together in groups, be reactive and proactive, really, a completely different model.

DANIEL KRAFT: So we're talking here in the fall of 2020. And how has COVID-19 transformed your practice, and what do you think you're going to keep, hopefully, post-COVID-19?

RUSHIKA FERNANDOPULLE: There are a lot of people who've swung as fast as they could back to all in-person. That's not the right thing to do. Individuals have some sets of needs that are better done by a chat bot, some that are better done by video, some that are better done in person in an office. Some, we have to go to their home.

We need people to help engage with consumers. The first and most important thing they do is they build relationships, and now, just being partners with the patient, to then help them on their journey. You've got to think about this long-term. It's been a journey about 16 years. What happens if we started over, built a new model of care that was based on relationships and not transactions, that was really solidly consumer-centric, value-based, and digital? And let's just do it.

DANIEL KRAFT: Let's leap forward to, I don't know, 2030. What might other practitioners do to sort of future-proof things a bit?

RUSHIKA FERNANDOPULLE: I think the key thing that'll change between now and even 10 years from now-- well within our careers-- is real personalized medicine.

So we've built our Chirp, our EHR around what we call the shared care plan, which is where we create a customized plan for each patient, not the average plan every diabetic needs a target of an A1C of seven. I'm like, no, we'll start there. But now let's use all the information we have to create a customized plan.

We do a ton of medicine trial and error at the moment. So I think I need to give you a drug for X. I want to try one, doesn't work, we'll try another and try another. We make recommendations based on 51% of people at the trial having benefited. And we give it to all 100%.

DANIEL KRAFT: As we discussed in earlier episodes, COVID-19 is causing us to rethink and read just how we deliver care, not just now, but from now on. Broader systemic change starts with change within individual systems. To discuss how CVS is changing its own systems to incentivize preventive, personalized care, I spoke with Dr. Dan Knecht and Angie Meoli.

COVID-19 is sort of providing a lens to potentially reshape, or some people say reimagine or reinvent healthcare. The fact that we're now digital and connected and can be much more continuous, how does that piece fit into your time-for-care model, because most of our time we're not interfacing with our primary care docs?

DANIEL KNECHT: Let's talk about the supply side and the demand side. So first of all, what we're seeing now is that it's harder and harder to engage with primary care providers. I'm sure you've heard the right care at the right time at the right place. But I think what does that actually mean? And for us, it's the data we have on our customers, patients, and members to serve up those clinically-impactful insights to them and deliver it in a way that it's trusted and respected.

ANGIE MEOLI: In order to remove any barriers to care, how do we help our members to understand that we want you to get care? Don't let care go aside because there's fear. There are multiple ways for you to engage with your physician. How do we think about next-best actions that a HealthHUB could surround that patient with and help to complement the primary care of that patient is already receiving?

To take care of your patient, they also want to have a business that they can rely on. They want to have partnerships that they trust. We're trying to think about how do we, working together as a partner in a value-based deal, how do you remove some of those inefficiencies that are not just administratively burdensome, but they're a burden to the patient as well?

It's really about building continued relationships that are more than just pushing a payment back and forth across the table. The value to the consumer comes in the fact that they aren't having to go to the hospital. They're home, and they're living their life in a more healthy way than what they were previously.

Through the model that we've worked out with Cleveland Clinic, we are projecting about a 10% savings.

DANIEL KNECHT: And the idea here is to reduce any barriers to accessing preventive and primary care services and investing in more prevention to keep people healthier and avoid chronic conditions or adverse health outcomes.

DANIEL KRAFT: The challenge is often data doesn't translate to actionable information. It can be overwhelming. Are you finding ways to start synthesizing that to make it more actionable?

ANGIE MEOLI: The ability to really, truly connect and fill the gaps in care is completely dependent on open data.

DANIEL KRAFT: One of the most eye-opening impacts of COVID-19 has been the dramatic disparities highlighted in our healthcare system. Let's hear from Dr. Dela Taghipour and Dr. Nadia Abuelezam, who discuss how we can collectively reimagine community health care to address those disparities.

NADIA ABUELEZAM: We can't do good, effective public health work without asking people what it is they need and how it is they need help and support. I hope, and I know you do too, that this leads to some change for disparity work and addressing it in all of our subspecialties in our fields. We're not just talking about health disparities due to the coronavirus. We're talking about the systemic reasons for these disparities. And really, the disparities we're seeing in coronavirus are there because of underlying health care disparities.

DELA TAGHIPOUR: Do you think changing the curriculum in this new healthcare landscape is something that's possible for your students?

NADIA ABUELEZAM: Absolutely, and we are already doing that. I was able to teach students about the process of how to do epidemiology given the background that we knew about coronavirus. But what I'm seeing from my students now is they actually have a desire to sit with their patients, learn about them, get to know them as people. And I do believe that that will make them better healthcare providers, ultimately.

I think the system will have to change to accommodate them and to accommodate their desire to treat the whole person. And so, really, it's systemic change that needs to occur. And we can't view medicine and public health as separate from those political decisions, because in reality, those decisions are what's shaping the health of our patients today.

DANIEL KRAFT: Thanks for watching Healthy Conversations. This is the final episode of our COVID-19 mini series, but we look forward to continuing the conversation with you next month when we discuss how to tackle one of the most challenging chronic conditions, diabetes. Stay tuned.

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