COVID-19 has been pretty much like an atomic bomb.
In the five years or six years since we founded
there were big changes.
We had to serve 10 times as many patients
and we had to do that at warp speed.
There is a real value in making change slowly
and maybe in particular in healthcare.
And when we make changes slowly, we can slowly iterate
until we get to that best solution.
Sometimes when we make changes very rapidly
we sometimes will go to solutions that may not be ideal
When COVID-19 struck our country,
we had to shut a lot of things down
and it was dangerous and difficult
for people to get to doctor's visits in person.
So we had to have access to healthcare
and one way that we knew was available
was through Telehealth.
[Narrator] What is Telehealth?
In short, it's healthcare over the internet.
Healthcare providers realized
that the majority of doctor's visits
consist of a doctor and a patient well, talking.
So more and more providers realized
that they can do these consultations online.
But a lot of our laws kept them from doing that.
In light of the pandemic though, regulations were adjusted
to let people have continued access to healthcare
from the safety of their homes.
One company that was affected by the shift to Telehealth
is a company called Emocha Mobile Health.
Emocha uses video and human engagement
to help patients take every dose of their medication.
So patients video record themselves at every dose
taking their medication and we would receive that video,
assess it and then engage back with them and support them
to take their next dose of medication.
Now this is actually a practice called
Directly Observed Therapy
and it's been the standard of care for some diseases
since the 80s.
Even in situations where for medication adherence monitoring
we had to monitor thousands of people,
the pressure to do so was nothing
compared to what we experience now during the pandemic.
So we had to roll out within days
to thousands of people at a time
and that forced our business to adjust
and to adjust on the fly.
We had to enhance the technology to handle scale.
Doctors and hospitals and health systems
didn't necessarily have the equipment in place
and their staff was not trained
in how to deliver Telehealth services.
This seems crazy right?
Because Telehealth has been around forever.
But it is the reality that we were really caught flat footed
at the beginning of COVID
and that was because of the barriers to adoption
from the regulatory and legislative infrastructure.
We have to be prepared to deal with crises like COVID-19
and the technology is there, the apps are there,
but sometimes we can't get them out to the market
and into use by patients
because of the regulatory constraints
that are still in place.
The way that the regulatory bodies
viewed technologies started to change.
Between February and June
we saw about five to 10 years of regulatory progression.
Something that we couldn't have done 10 years ago
or 20 years ago now suddenly it was available.
Medicare said everyone in the United States
could have a Telemedicine visit within their home.
Previously, they had limited Telemedicine
to some select populations.
If I as a physician wanna take care of a patient
in another state, I have to be licensed in the state
in which the patient is located.
In the context of the pandemic a bunch of states said,
"you know what?
"If you have you're license anywhere in the United States,
"you can take care of patients."
That changed things.
As well as a lot of nitty gritty details of codes
and what you could prescribe et cetera,
those all have changed things.
And I think I go back to that same idea
that we need to be very careful in healthcare
and move in a slower way than it might happen
if you're in the gaming world
or the you know, search engine world
or whatever other application that you have.
It makes a ton of sense
that you need to move a little bit more slowly
and more carefully when it comes to healthcare
and emphasize that you need to have the evidence
that this works.
[Narrator] In light of the rapid evolution
of remote monitoring, people started asking more questions
about Telehealth.
Of course, some people have been skeptical of it all along
but the pandemic brought these concerns to the forefront
and fueled disagreements
about the role regulation should play.
So every year CMS goes through a process
where they decide what types of services
are gonna be reimbursed for physicians
and what types of services are not gonna be reimbursed
and under what conditions.
What CMS has proposed in July of 2021
are some different interpretations
of remote patient monitoring and some of the constraints
that had been kind of opened up during COVID
may not be made permanent
and that's gonna be a problem for the industry.
The challenge for us is that
regulation could pick new winners
and while we have an excellent product
that can help a ton of people get better faster,
we may be excluded from being one of those winners
by regulation alone.
While regulation is opening up in a lot of ways,
the challenge for Emocha is that it's obvious
that technology is needed to improve patient care right now
especially in the middle of a pandemic.
When we've done some evaluations
of some direct to consumer,
these apps that you can get to do a video visit,
we find the vast majority of the visits that are happen
do not replace an office visit or an ED visit
but the vast majority are new utilization
and in net it increases healthcare spending.
And we all know in the US Healthcare System
that healthcare spending is a huge problem
and I think from my perspective in many cases
a drain on our society is really holding us back
and not improving health the way we want.
And you know, a lot of people again
are looking to Telehealth as a way to improve it.
I think we need to be quite skeptical of that claim
unfortunately.
If you look so at the overall trajectory
of you know, Telehealth and the long view,
providing access to Telehealth services
actually reduces the overall cost of care
in a longitudinal sort of way over time.
The other fundamental issue is
if we introduce a Telehealth application
and only those who are wealthy
and therefore have the smartphone,
know how to use Zoom et cetera, they can access it.
That might be helpful for them.
It may improve their health
but it actually could widen those disparities
because those disadvantaged populations
don't have access to the technology.
The FCC is doing a lot to support better connectivity
in rural areas.
They recently designated $200 million
to institutions who serve rural patients
to help them provide better connectivity to their patients.
All of that $200 million was grabbed up
as soon as it was put out there.
[Narrator] With so much uncertainty to date
regulators, business owners and legal experts alike
agree that more regulatory clarity is needed.
Being a healthcare entrepreneur is very satisfying
because you can be involved in helping a patient
but the challenging part is that providing a quality outcome
or improving the quality of care
is not necessarily recognized
by our antiquated regulatory schemes.
So just because you improve care
does not mean that the provider is going take it up
unless they're compensated for it.
To have the ability to sort of pivot
in a situation where it calls for a little bit of a change
and to be able to do that in a creative way
is really something that we should be fostering
in the healthcare system as a whole.
We don't wanna overly constrain these companies
to the point where there's something really interesting
and great that they could do but they just can't
because of the regulatory infrastructure.
When we talked to a lot of doctors they'll tell us,
"these the great things.
"I'm so glad that Telehealth was available
"during the pandemic."
And then we asked them, "are you gonna go back to...
"Are you gonna continue using Telehealth afterwards?"
They're like, "no, probably I'll go back to in-person care.
"I feel it's better healthcare."
Telehealth is kind of like a drug and it has its benefits
and it has its side effects.
And we...
That's just the nature of healthcare.
I think instead of criticizing doctors for being skeptical
I think we should applaud doctors for being skeptical.
It's a good way to practice medicine is to be skeptical
and cautious with new things that are coming up.