Telehealth Week
This week is Telehealth awareness week so it was great to catch up with Ann Wood Johnson (@AnnMondJohnson), CEO of the American Telemedicine Association – ATA (@AmericanTelemed), the only organization completely focused on accelerating the adoption of Telehealth. Ann started out focused on early stage companies and joined the ATA before the Pandemic and has seen a tide of change in the space with Telehealth becoming a household term.
As Ann puts it “Telehealth is an expression of health” and in fact one of the drivers for the organization is that it is not ‘Telehealth’ but just ‘Health’ bringing together a large consortium of partners, device, modality and venue agnostic and many with differing and competing priorities all pulling in the same direction ensuring that people get care where and when they need it – meeting people where they are. The pandemic accelerated progress that was already being made and hoped many understand the benefits of Telehealth and some of the relaxation of restrictions (set in place in 1997 14 years before the iPhone appeared in our hands) that separated the practice of medicine and the payment of medicine which are under two very different regulatory controls. Their work made all the more urgent and essential as the Pandemic exposed the lack of available clinical resources to service the patient needs and help solve the already burgeoning demands for brain (aka Mental) health services.
Listen in to hear Ann talk about the acceleration that took place with the Pandemic and the focus of the ATA on solving for the inequities, bias and trust that exist not just in Telehealth but in the delivery of healthcare in general. As Ann describes it
It is not an opportunity but an obligation to address the inequity in healthcare
You can hear some of the solutions that address the broadband limitations and addressing healthcare literacy and how a ‘Pathological optimist’ views the Telehealth Cliff and the future regulatory landscape of healthcare
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
Today I’m delighted to be joined by Ann Monde Johnson, she is the Chief Executive Officer for the American Telemedicine Association. And thanks for joining me today. Thank you so much for having me. So, as I do with all of my guests, tell us a little bit about your background, how you arrived at this point, and, you know, some of the key inflection points as to how you got here.
Ann Mond Johnson
Absolutely. So, my background is in early stage companies, and I’ve done several of those prior to joining the association in the beginning of 2018. All the companies I was with previously focused on healthcare, they all use data. And the last three really focused on helping consumers navigate the healthcare system, using digital apps using decision support tools, so they could basically make better decisions for themselves and their family. And in my experience, I really view viewed telemedicine as an expression of consumerism and health care, which is all about what I’ve done in the last many, many years, my career, which is meeting people where they are. And so when I moved to DC, from Chicago, was recruited to run the APA. And again, this was pre pandemic, so it just seemed like an interesting focus for me at this point.
Nick van Terheyden
I’m gonna guess that this got a whole lot more interesting for you, as the pandemic unfolded,
Ann Mond Johnson
yes, it really did. So when I joined the HCA. And you know, this, Nick, the ataa has been around for over 25 years, telemedicine itself has been around for even longer than that. And depending on what story you believe it’s NASA or Ship to Shore radios off the east coast. In any event, it had been around for a long time. And the organization was really very focused on ensuring that we get reimbursement and focused on issues associated with licensure. And it was the members included the clinicians, the academicians, the the folks who really were pioneers in this industry. And what was clear, though, was that we had to start creating a bigger tent, and a bigger, more compelling why we’re here to get more folks to join. So we created a mission and a vision that we were here to ensure that people get care where and when they need it, and that when they do they know it’s safe, and to get health care where and when they need it, and that when they do they know it’s safe, effective and appropriate, well, enabling clinicians to do more good for more people. So that’s a way of getting people emotionally connected to the vision of the ACA, which was an important step forward. And then we also expanded our membership approach so that today we represent over 400 organizations that are very much engaged in telehealth, including academic medical centers like UC health and Colorado delivery systems like ashburner and inner mountain Avira in South Dakota. And then payers, Humana united. And then we also include the range of players on the solution side, the teladoc, health and amwell. So the world but also organizations that are very focused on asynchronous and chat like Babylon health or asynchronous approaches like ro and hims, and hers and good RX. And then we have some of the more interesting disruptors in our membership, including Walmart, Best Buy health, and folks focused on remote monitoring like vivify. And then some of the, you know, the big, big behemoths, Microsoft, Amazon, HP, Intel, all of whom believes that their their focus is to ensure that higher water floats, more boats. So it’s a very nuanced, very eclectic assortment but very diverse. And so the way that gets expressed in our policy priorities or policy principles, which, incidentally, were crafted before the pandemic, was that we were here to ensure that we were device and modality and venue agnostic. So that includes that telemedicine includes async and synchronous, audio only audio video, as well as remote monitoring. We were also very clear on ensuring that we were using telehealth to eliminate disparities. inequities because pre pandemic we had a problem in the US, right? We had very inconsistent access to health care and very uneven distribution of quality health care. And so we really believe that technology can serve an important role in in eliminating those inequities and effort, disparities. So today, it’s it’s actually a very exciting time for the industry. I think when I first joined in 2018, I thought maybe the American Telemedicine Association was an outdated name. And now telemedicine, of course, is a household word. Everybody’s heard about it. We’ve had such expansion and use of it by both, you know, elderly folks, as well as the Young Invincibles, who grew up with their iPhones or their smartphones. And it’s it’s really just a completely different playing field now.
Nick van Terheyden
So, as I listened to that, you know, collection of large organizations, you know, wide and varied. One of the things that strikes me is that a lot of them have different drivers. I mean, some of them are looking at this from a different perspective, maybe not all pulling in the same direction. How have you managed to bring that consortium together successfully? Because clearly you have they’ve all joined in? It can’t all be pandemic related?
Ann Mond Johnson
No, and that’s a great question. I think the issue here is that all of these organizations are united in ensuring that people get care where and when they need it. And so to think that we can perpetuate this one on one physicality, which is what has been defining the American healthcare system for a long time, the members understand that that’s really not possible. It’s, you know, we just don’t have enough clinicians in the US to make that happen. And so what we’ve said is that, by ensuring that we focus on being modality and venue and device agnostic, you create a pretty broad consortium and collection of players who are very much united around these higher principles of fair payment of getting rid of legislation and regulation, that’s outdated. Quite frankly, you know, the telehealth cliff, as we talk about it, is because certain laws and regulations were relaxed during the public health emergency and those are still in place, but that can go away at any time. So our members are very much focused around ensuring that flexibilities stay in place. And then how they execute that from a payment perspective or how they execute that from a coverage perspective. Is is very, you know, it’s varied, as you acknowledged.
Nick van Terheyden
So you bring up the the term the telehealth cliff, help us understand what you mean by that and what the current perspective is, on where we sit and what the potential future might hold.
Ann Mond Johnson
Well, again, another good question. And what’s really important here and what your listeners probably want to understand better is that the the issue of practice of medicine and payment of medicine or health care, at the federal and the state level are different. They’re very unique roles and focuses for both. And so when the pandemic when the public health emergency was announced, really what happened was HHS was given certain authority to relax the restrictions that have been placed before so 1834 is something that was put in place in 1997, which I remind people was 14 years before the iPhone was invented. And what happened is that because of that the restrictions around geography and where someone could actually have telehealth services and get that reimbursed. Previously, it was a Medicare population, but only in rural communities. They had to go somewhere and sort of stand on the right foot and twirl around and it was just very arcane and complicated. And with the public health emergency that went by the wayside, and people have been going in droves to telehealth 40 nearly 45% of all Medicare beneficiaries have used telehealth services. And of those, you know, they were incredibly satisfied 95% of them are satisfied for their sick with these services. Going off the cliff means that ability to access care where and when you need it goes away immediately. That’s what we’re saying cannot happen.
Nick van Terheyden
So you talk about 1834. And it put restrictions in place that I don’t know how to describe them, but anything but economic. They were not clinical base because if you look at the VA system, they’ve been doing telehealth consults across state lines, the concept that medicine changes when you cross from Virginia into Washington DC just doesn’t bear any realistic consideration. We move past that, but they’re temporary. Well, how do we make sure that we don’t step back into the dark ages? What are you doing to ensure that that’s not going to be our future?
Ann Mond Johnson
So we are working with our members it a couple of dimensions. One is I mentioned the telehealth cliff. And that is a effort that involves policy and some advocacy at the federal and the state level. So just really communicating with Hill staff on the importance of telehealth and how well accepted it’s been the quality of care, it’s providing that it is really something that has been broadly accepted by both physicians and consumers. The second thing that we’ve done is we announced telehealth Awareness Week, which is September 19, through 25th. And not only do we have our members engaged in this, but we also have patient groups that are very much behind this. So for example, the Muscular Dystrophy Association, Susan G. Komen, a number of patient organizations who can point to the fact that their communities have really benefited from access. So it’s it’s messaging and work in both legislatures, as well as regulators, and then messaging to the public as well. Because I don’t think people understand how vulnerable we are to having this all go away. And that’s our job is to let them know that I can’t.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to and Monde Johnson, she is the CEO of the American Telemedicine Association, we were just talking about the history of telemedicine, you know, where it came from, but more importantly, the acceleration, I want to call it that from the pandemic that really sort of pushed us forward. bringing along folks that I guess, didn’t buy into the concept, along with all of those that said, yes, this makes sense, but really pushed us into that. If we had not had the pandemic, do you think we would be in the circumstance now? Or will we still be talking about the same things previously?
Ann Mond Johnson
Well, certainly, the pandemic afforded this incredible experiment in a very short period of time and the acceleration that you mentioned. But again, think about pre pandemic neck that we had an inadequate number of clinicians to deal with are increasingly aging, and in many instances, Ill population. So that that was something that was clearly in place. And again, the idea that if you want to address access and provide broader access, you have to use telehealth you have to use technology. And the best instance in describing that was in mental health services, which pre pandemic I think it’s 50% of counties in the US did not have access to mental health services. And one out of five Americans had some mental health issue that required attention. So if you just look at that particular use case, what happened then is that people, you know, realize the benefit of accessing apps and accessing other services, again, using technology using telehealth. So would it have happened as quickly? Probably not, but at the same time, I think that we should take advantage of what has been clear natural experiment and and really demonstrate both satisfaction, high quality services, that this is not costly, or more costly than health care. And in very many instances, it’s less expensive. And that it’s not, you know, it’s just another modality of care. So that’s why we talk about telehealth is health.
Nick van Terheyden
So, one of the things that always stands out to me in telehealth is the the inequity that existed irrespective of telehealth, right, because with the technology and in some respects is actually pretend worse because the folks that have or lack access to regular health care services, struggle with the same technology. And some of the stories that I’ve heard through the pandemic, you know, mental health, you mentioned that huge increase even more you talk one in five, I imagine it’s way more than way more than that. Yeah. And, you know, this is clearly on the pathway. How do we, I, you know, I know, this is not the responsibility, but it must be part of the sort of the solution set is resolving that inequity, that ties back to both access, so internet access, technology access, but also one of the things that just doesn’t occur to you if you don’t experience it, the privacy for a parent who lives in a very small apartment. I’ve heard stories of folks going into the car to have an interaction. What are your thoughts around that? How do we address that? Because it’s essential for the persistence of this right.
Ann Mond Johnson
Right. I could not agree more. And what we say at the eta is that we have not only an opportunity, but an obligation to ensure that telehealth is used to eliminate disparities and inequities in health care. Again, if you look at access, you’re not going to solve for that without using telehealth. But the other way we look at it, it from our point of view is that there are many levers that have to be played or pulled in order to ensure that we address inequities and disparities, which as you pointed out, have been around for quite some time, unfortunately. So connectivity is the one that people talk about the most, right, the ability to access services, broadband connectivity. And I would submit that that’s probably the easiest thing to solve for. Because once you have that, you still have other issues in place, impediments in place, one is access to the devices themselves. Another is access to plans that are affordable. So if you use up all your data, and communication in a session of some kind, you have a problem. So we have to address that also. And to your point earlier, the way the VA did that was through negotiating deals with T Mobile, and so other carriers that are zero rating. So when a veteran uses a particular app through the VA platform, that is not counted against their data plan. I think that’s marvelous. And I would like to see more of that happen. Another issue that we have that we have to address is the whole notion of literacy of digital and health and technical literacy. Again, thinking on some of the challenges that people had in using telehealth, there was a significant portion of the population that couldn’t figure out how to use it. Now, why is that because it can be hard, it shouldn’t be hard. So it’s not up to the consumer, the patient to be literate, it’s up to us to make it easier for them. And then finally, there’s this whole notion of bias and trust. So you can have all the connectivity in the world, you can have the slickest equipment you can have, you know, you may know how to use it. But if you don’t fundamentally trust your provider, or if you feel you’re being judged because your of your race or your ethnicity, or your sexual orientation, that’s a problem. And so that’s something that we have to address as well. So lots of different things that we have to focus on. And to that we’ve organized a group within the HTA and advisory group of members and non members that is addressing this. And again, during telehealth Awareness Week, which is September 19, through 25th, we’ll be announcing the first of our deliverables and the first of our findings on this. And it’s very exciting because, again, we have an opportunity, but we also have an obligation to make sure this happens.
Nick van Terheyden
I think it’s important to highlight that I mean, you know, it’s nice to talk about opportunities, but I think referencing this as an obligation is a critical element to putting the ataa at front and center and helping solve this problem. You know, I’m gonna go backwards because I heard something just recently that I thought highly relevant to this. When you talk about trust, and many of these communities move at the pace of trust that was the mayor of Jacksonville, Mississippi, and I thought, you know, absolutely, if we don’t engender trust through this, we really are failing in our delivery of solutions. We’d have to build that trust back up, I think at this point relative to the plants, one of the things that really struck me through tea, the pandemics, something else that sort of unfolded was the, oh, we don’t have data caps anymore. There’s no need to worry about that. But they’ve now all slowly been reintroduced to your point of the telehealth cliff, it feels like there’s a data cliff, that has been restored. Because in none of those instances, I think there was any technical reason to limit people’s access. We’re doing that for economic reasons. So we have to address those elements, you know, as part of it, so it sounds like the ACA has got that all front and center. As you think about the future, we’ve we’ve, you know, we’ve progressed tremendously. What are you excited about? What are you concerned about? Where’s your focus in, you know, coming weeks and months?
Ann Mond Johnson
So I would say that. The first is this work on using telehealth to eliminate disparities and inequities in health care, I think that’s front and center. That’s an important focus of our, our membership of mine of the boards. And so we will continue down this path. And I think we’re going to get results, I’m encouraged by the amount of conversation that has happened around systemic racism in healthcare in the last several months. So it’s been around for a long time, as you know, your geography is your healthcare destiny. But now we’re finally getting some attention on this. So that’s going to be front and center for us. The second is to ensure that we drive the conversation around what hybrid care looks like, we know as fabulous as telehealth is, it’s not for everyone, it’s not for every situation. And so if we believe which we do that virtual is a modality that should be used by clinicians at their discretion along with consultation with their patient, then we have to drive what that looks like. So it’s Think of it as almost next generation guidelines that we’ll put together. So the HCA historically had a number of guidelines around different specialties. And now as you think about, you know, what does it look like for dermatology for me to interact with my clinician when I find a new bump on my arm. So those are important because you can take a photo and send it in, but then you may have to come in and have a biopsy as well. So having those kind of conversations around hybrid, and then, you know, just generally expanding the focus of telehealth because it’s become much more prevalent. We’ve recently launched a decentralized clinical trial special interest group within our membership that’s chaired by Jim malt, who’s the CEO of bio IntelliSense. We’re looking at a new special interest group on at home testing. We have another one that launched under the leadership of Matt Levi from common spirit on digital transformation. So a lot of conversations and different efforts of harnessing the collective genius and experiment of our experience with our members.
Nick van Terheyden
So exciting times, you know, obviously challenging from a policy standpoint, there’s, you know, real risks with the telehealth, Cliff as you do. I’m gonna put you on the spot, the spot and say, what’s your prediction? Do you think we’re going to hold the line and maintain the value proposition and not be not returned to the dark ages of health delivering?
Ann Mond Johnson
So I’m, I’m pathologically optimistic. That’s what happens when you’re an entrepreneur, entrepreneur, you have to be that way. So I would say that as I look to the future, what I really believe in is that the consumers and clinicians alike have so profoundly benefited from using telehealth that I don’t see it going away. And I think that message is going to get to Congress. It’s already a Congress. It’s already an over 25 state legislatures that have put together favorable legislation supporting telehealth. So yes, I’m very optimistic. It’s a way that many people and more Americans will be able to get care going forward.
Nick van Terheyden
no better way to finish an interview with that level of optimism. I’m with you. I think we cannot step back. There’s no pathway to step back that genie is out of the bottle. And I’m excited with the progress that’s been made and grateful for all the work that’s being done by the ACA just remains for me to thank you for joining me on the show. And thanks for joining me.
Ann Mond Johnson
Well, thank you so much for having me. And again, very excited about the future. and encouraged people to join us in this work.
