This week I am talking to Lyle Berkowitz, MD (@DrLyleMD), CEO of Keycare (@KeyCareInc) a virtual care platform that connects to the existing infrastructure of health.
Lyle has a long career in medicine and the intersection of business and technology working as a CMIO and clinician at Northwestern Medicine in Chicago and helping form one of the first innovation centers there.
We talk about the growth of these concepts and the emergence of many of these centers in healthcare and how they contribute. As Lyle says – every business including healthcare needs a disruption group:
“I think every company healthcare needs to have at least a small group, thinking about how to disrupt themselves because it’s a classic. If we don’t disrupt ourselves, someone else will.”
We agree – that incremental step is critical to survival unless you want to become a footnote in history like Blockbuster.
We discuss why the world needs another virtual care platform and what makes Keycard different with its flexible staffing model and partnering so that virtual care becomes local care.
Listen in to hear how they have managed to carve out a unique place that is bringing great feedback from Health Systems, Doctors, and patients.
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 Dr. Lyle Berkowitz. He’s the CEO of key care bio. Thanks for joining me today.
Lyle Berkowitz
Hey, thanks for having me, Nick.
Nick van Terheyden
So as I do with all my guests, I think it’s important to get a little bit of context. You’re a physician by training, I think maybe you still practice I’m not sure we’ve known each other for a long time. But if you would share a little bit of the history and how you arrived at this point, because there’s some interesting turns and activities that lead you to this point in your career.
Lyle Berkowitz
Sure, I’ve, I’ve had a fun multifaceted career. Yeah, first and foremost, I am a physician, internal medicine, primary care physician I practice for over 20 years at Northwestern medicine in Chicago, had a clinic as part of the hospital owned Primary Care Group. But I also always split my time between clinical care and being a physician executive. I spent about a decade with a classic informatics role. CMIA Oh, yeah, Director of it, that type of role that rolling out EMRs we did Cerner later epic working on internet strategies, telehealth, etc. And then the second decade of my career at Northwestern was focused more on innovation, how do we bring cool technologies processes, and take advantage of the EMR that we have in place, I set one of the earlier innovation programs in the nation and additionally continued to work on telehealth. And aside from that, my side hustle was that I was also an executive advisor, and founder in some cases of a variety of digital health companies, from technology to consulting type companies, and including starting a company called Health Finch, which was in the physician workflow automation space. So I did all that had a great balance. And five years ago, though, I left Northwestern, in joined MD live one of the larger telehealth companies, help them scale up as an executive, they’re helping with operations, product strategy, etc. By left there in 2020, in part to help with health Finch, and that was sold MD live wound up getting sold the Cigna I was just consulting to a variety of companies and health systems around digital health, virtual care, etc. And with COVID noticed that there was a need for more virtual care support for health systems. And I’ll get to that next. But that’s my history, I was trained as an engineer, worked as a physician, executive and entrepreneur for many years, you know, learned how to really be, I think, a reasonably good operator, and eventually wound up starting a new company in the virtual care space.
Nick van Terheyden
So I mean, as I knew, fascinating, long career that sort of, I’m gonna say me and and I don’t mean that in a pejorative term, you know, meandered, as I think all interesting careers do through different areas. And before we get into the virtual care, and some of that, I want to just go back, if I may, because it’s, it’s quite topical at this point. I’m seeing and I think I hear a lot this, you know, everybody is setting up innovation centers. And given that you were one of the early founders of something, you did it with a healthcare system. I’m curious to get your thoughts about this. Is this good practice? Should more of this be happening? Or has it really tipped too far? Because I’ll be clear, I think it’s just gone a little bit too far everybody’s doing this. But do we really need that much innovation? Don’t we need to focus on the core specifics these days?
Lyle Berkowitz
But I think every company healthcare needs to have at least a small group, thinking about how to disrupt themselves because it’s a classic. If we don’t disrupt ourselves, someone else will. So you should you what you don’t want is everyone the health system trying to innovate? You want? Yeah, 99% of people in the health system to be focused on the core activity of taking care of patients in a really great way. But you also, you know, I think should have some poor folks who are thinking about what can we do differently? What’s been done differently by others? How do we bring that in? And innovations to find different ways? Yeah, I have a simple definition that says, doing something of value that you weren’t doing before. And I think a lot of people now have created these digital health groups have come out of innovation. Digital Health itself can promote a lot of innovation. I’ve done a lot of the innovation I did was much more about people in process and workflows than about the technology, per se. But now and then there are some really cool interesting technologies using, you know, AI, and in video and other things that can, that can really help promote efficiency and effectiveness and variety of ways. In there, probably about eight different elements of innovation program, and most innovation programs will have two, three, maybe four or five of those elements. Rarely, you’ll see all eight elements. But that’s a whole nother story we can do. But I saw 100% believe we need to have some level of innovation in a large health system, it should not be overwhelming. But if they don’t do it, again, it’s going to be done to them. And I think health systems are incredibly important. They take care of our most complex issues. But sometimes the both simple issues need to be elevated and complex issues need innovation as well. And and what I would say is it doesn’t all have to be technical technology, it can often just be a process change, or new way of looking at something that opens up opportunities that can improve the patient experience in ways much more than a technology camp.
Nick van Terheyden
Yeah, I like that sort of perspective, I think what you highlight for me is and you’ll forgive me, I’m just going to pick on it, it’s an incremental step for every organization is to essentially place in what I would call not innovation hubs, but disruption hubs that essentially go to look and you know, Kodak needed to do it, Blockbuster needed to do it, but didn’t, you know, we’ve seen multiple instances, and, you know, I think healthcare potentially feels a little bit insulated, because everybody needs health care. But it’s not as simple as that. And, you know, there are many opportunities out there. And by the way, we spend way too much money and don’t get the value out of it. So there’s there’s lots to, to derive from that. So I think, you know, good opportunities, good learning points. So now you’ve founded or built a couple of companies, they get spun out, sold off. And you mentioned 2020. And I think most of us, you know, it’s an easy number to remember, let’s be clear, that was right in the pandemic. And you notice the virtual care challenge. I mean, I think people were doing it across really basic systems, FaceTime, Skype, who knows it was all across the board. And, you know, Zoom became a verb. Everybody understood it. So it’s a sort of a normality, but it wasn’t quite smooth, and it’s still not smooth. And you now step into that. Tell us a little bit about the background to your journey there.
Lyle Berkowitz
Yeah, so I was consulting with some health systems, consulting with a couple of technology and other companies. And it was clear, right, we went from health systems doing very little virtual care to to the majority of their care virtually. But that didn’t last we saw this big jump, and then it came down. And it was obvious that patient demand and acceptance of virtual care was high. But also, provider supply was going down. I know providers, I was a provider, they are office ologists. In most health systems, they are very happy and optimize to working in an office. And so when we see these reports that we’re saying, oh, virtual care is going away. It’s decreasing, etc. It’s not because patients no longer want it, it’s because physicians are back to the offices, they don’t have time to do it. And so health systems recognize that if they don’t provide virtual care options, particularly for easy routine type of care, someone else will. And their options are either to take their office based doctors and verte them to virtual office, which is not a good use of those doctors or to work with a third party who has a discontinuous experience in a completely different system. So I want to step in and say, Look, there is a platform out there that is used by over 60% of all health systems in the US, and that’s epic and epic over the past few years has developed a very robust telehealth technology. And so instead of creating a new technology for From scratch in saying that we’re a technology company. Yeah, I said, Look, I talked to my colleagues at Epic. And we agreed it made sense to create a virtual staffing company that’s working on an epic instance. And so we didn’t create new technology, we didn’t integrate with epic, we actually are the first and only virtual care company who has our own instance of epic, upon which we are able to staff these virtual care providers, and then make them easily available to other health systems, particularly using epic because the epic to Epic interoperability is quite profound. It means that data can be transferred easily between the two systems much more robust than general standards. And scheduling can be done across instances so that you can enter the front door of a health system and then have virtualise working on the key care platform available for your patients, where you are not staffing them because it’s you know, out of state after hours or just simply you’re overwhelmed during the day. We’re starting with urgent care but expanding into primary care behavioral health specialty care over time.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Lyle Berkowitz. He’s the CEO of key care. He was just describing key care which I think if I was to pull out the threads of that, essentially a virtual care platform that works within epic and you know, let’s just clarify, it’s only within epic. Is that true?
Lyle Berkowitz
Well, to clarify, so we have our own epic instance, we have we have epics, EMR telehealth functionality, that’s our platform, we don’t sell that platform, you know, to a health system. What we sell or what we partner with health systems on is we provide them access to a group of virtual lists, we’re working on that platform, we can theoretically work with any health system, because since we have epic, that means we’re part of interoperability networks like carry quality. And we can support any other EMR is similarly or better than any other third party vendor. But when we work with other Epic sites, that interoperability is profound, epic has built in significant interoperability that that allows for data transfer, allows for scheduling across the two instances allows even for messaging and orders in various ways. So the most seamless experience would be with another epic site.
Nick van Terheyden
So for for the purposes of our discussion, you know, let’s put to one side, you can work with others. But you know, the, the best instance is working with epic because you’re sitting on an epic platform, just for the benefit of the listeners, because I can hear their voices behind me saying, Yeah, sure. When you’ve seen one epic, you’ve seen one epic, does it really integrate is, is that problem really being solved?
Lyle Berkowitz
Yeah, so epic has a variety of functionalities that allow for really profound interoperability between two epic instances. There’s something called care everywhere, which most epic sites will know. And that means that a data from one epic site that can be transferred, viewed and held in the other Epic instance, as well. So when we see a patient who’s at the hospital XYZ, and they are seen by virtualise, on our platform, they actually have transferred the allergies med problem list in a way that allows them to reconcile, they are able to view labs, notes, vital signs, etc. In our instance, all that is transferred via care everywhere, automatically. And vice versa. Once our note is done, and anything else that we document, it goes automatically back into the originating site, not as a PDF, but a structured note that goes back into the typical workflow, just as if they had been seen in in any office in any epic instance. So it’s a significantly different type of interoperability than you get from one EMR to another. And, additionally, the scheduling integration means that you can go into one hospital site, and when you want to make an appointment with a key care provider, that provider on the key care, you’re able to do that without leaving the originating site that can be done via make sure epics online web portal or it can be done by a scheduling agent at the original site.
Nick van Terheyden
So let’s be clear, we’re two, three years into this whole pandemic, we’ve seen this big shift to virtual care. And you know, you’re right in your description, there’s this sort of pullback and people are office based, in fact, this is going on outside of healthcare. tremendously interesting to watch, let’s say from the sidelines, this push pull of, yes, you must be physically present. And you know, in some instances, that’s true. But I think, certainly for the majority of folks, there’s this sense that virtual, and in the, in the case of healthcare, virtual care is the preferred form. There’s a lot of companies doing this, why do we need another one.
Lyle Berkowitz
So we think we’ve got at least four major differentiations, between what we’ll call third party vendor because we’re on Epic, you know, when we work, particularly with another epic site, you know, we do the following one, so much better patient experience, it’s seamless for the patient, they enter their health systems front door, and they are able to get an appointment without having to create a new login, without having to download anything new, without having to reenter the medical history, all of that is seamless for the patient easier, faster, quicker. And, and then second, it’s better quality, because virtuous on our platform have access to the patient’s data. And when they’re making decisions, that’s important to know, with more certainty, their allergies, and meds, their past medical history, these things are helpful in improving quality and vice versa. The fact that we can send a message in a note in a structured way back to the health system, notify the PCP automatically because of the workflow setup. And if there is additional work to be done, it’s a much easier handoff. And on top of that, Epic is a fully functional meaningful use certified EMR, which is actually rare, most virtual care companies don’t, they build their own software, it’s not a meaningful use certified EMR. And so we have epics 10,000 people, staff, continuing to build decision support tools and other things to improve the quality. Third, it’s overall better economics where, you know, we’re less expensive, because you don’t have to pay us for technology. We want the health systems to continue to use their technology, we don’t want their doctors to use anyone else’s technology, they should use what Epic’s given them already. So it’s a lot cheaper for them. And there’s minimal technology work to implement and maintain. So you don’t have to create new interfaces, all you’re doing is configuring to Epic sites to talk together. And of course, whatever your virtual care service support company will tell you the the bigger the funnel that you can take care of them, the better the downstream revenue. So overall better economics for because we’re on this really deep tech stack, you know, we’re this this robust EMR, we’re able to support a much greater variety of virtual care options from not just urgent care, and behavioral health, but primary care, specialty care, etc. Because we have so many more features and functionalities. And philosophically, as a company, we’re reaching out to other virtual care groups and saying, Hey, come work with us partner with us. And we’ll give you a full stack, full stack EMR, and we’ll make you much more easily available to the health system. So we think this is distinctly different from most of the point solutions that are out there, because we’re really working on the platform to give you an analogy next, it would be like coming into the word processing business and saying, Hey, we are going to create really good services and build in really good novels, Microsoft Word, instead of going out there and saying, we’re going to create a whole new word processor, and then get people to work on that. We are a tech enabled service that is a true partner to health systems. And that’s where we focus. And so I think that there’s Yeah, the time has come for a group like ours, to be able to service those needs and in a different way than what’s traditionally been done in the third party world.
Nick van Terheyden
I thought for sure you were going to date yourself and say, build it on WordPerfect. But okay, any brand new word. I think we all were at one point it sort of disappeared out and got overwhelmed by, you know, replacement standardized technology, even though it was interoperable in many respects. So, as I think about this, what are the challenges, you know, so you’re essentially virtualizing staff, you’re allowing for this local access. But one of the challenges of that is obviously, the flexing of staff the availability and in this, I’m sorry, bizarro nation that we live in. It doesn’t matter if you’re licensed in Idaho, you can’t treat outside of Idaho unless you’ve got licensure. And how do you handle all of that.
Lyle Berkowitz
So, like I said, part of our philosophy is we work with virtual care groups. And one of the groups that we work with, is staffed with, you know, plenty of 1000s of physicians and in many of those are multi license. So they are set to provide that 24 by 750 state coverage. And so we contract with them to provide our coverage and do it on our epic instance. So again, we therefore really are set up to, you know, support all of this, we ourselves don’t have to go out in employee each of these providers. But we do need to find really good partners to do that. And that’s what we’ve done in the urgent care space and the specialty space. We’ve also found a number of specialty NICs providers that similarly will multi license their doctors. In the long run, though, what we also want to do is layer on more technology to make it make these virtuous more efficient. If all we did was replace a 15 minute office visit with a 15 minute video visit, that’s a nice to have, but it’s not really solving the big picture of access and efficiency. So you know, we’re layering planning to layer in automation, a synchronous care in a variety of technology improvements, to make these virtual lists much more efficient. And in delegate as much as possible, like two different levels, there’s doctors, there’s NPS, there’s nurses, there’s coaches, dieticians, and a variety of other types of people that make up a virtual care team that can help a health system better manage a large population.
Nick van Terheyden
So as you think about this, what’s what’s been the response? I mean, have you had your I want to say still relatively new, how is the experience been from a physician perspective? How has the experience been from a patient perspective? What what what, what’s the feedback that you’re getting?
Lyle Berkowitz
Well, first of all, we we’ve gotten great feedback from health systems who’ve said, Yes, this is what we’ve been waiting for, we need to provide more care, we, we don’t have enough staff internally, we don’t like using third party vendors that work on a completely different system. So there is what we would call in the in the biz, a good product market fit, we have really done very little marketing. And yet, all these health systems have come to us. And we’re very quickly contracting and implementing, we just really came out of stealth mode in the in August. And we’re going live with multiple health systems this quarter, and have a backlog through through the next several quarters of health systems who want to go live, I’d say the patients, of course, you know, look at this as something now they can get done through their health system, and would seem to appreciate that. It’s something that allows them to stick with their health system and know that their primary care doctor will be aware of what’s going on, but mostly what they’re looking for. It’s just that you know, that easy access to care, a lot of what we do is essentially a commodity to a patient, they’ve got an urgent care need, and they want something taken care of. And we believe that they see the benefit of doing it with their health system because of the ability to share the data. But we’re adding on more and more functionality to allow for expanded coverage from adults to peds to allow for a easier experience to allow for better billing experience. And ultimately, like I said to add on more than urgent care. And so in the end, we want our health systems to be able to tell their patients look, whatever your need is urgent care to super complex need, come to us our website or call center etc. And we will figure it out. Whether it’s you need a virtual or On Demand virtual care provider, a scheduled virtual care provider, an office visit, just come to us and we will figure it all out for you. And we’ll do it on the same platform in a continuous way so that your data is not lost. So you don’t have to fill out Another form, etc. So we, we believe that that seems to be what the health systems and their patients really enjoy and want. When we, when we’ve asked patients and we did a poll, we asked a couple things one was asked, What if you want your virtual care provider to have access to your base medical information from your EMR and vice versa? And of course, the overwhelming number of patients said yes, they absolutely love that idea. When we ask them, Do you want to do virtual care for routine, urgent and chronic care issues? You know, 40% of them said they prefer virtual 40% prefer the office 20% will take whichever is first. So yes, we see a lot of need for that.
Nick van Terheyden
Fantastic, unfortunately, as we do each and every week, we’ve run out of time, so just remains for me too. Thank you for joining us. Lol. Thanks for joining us.
Lyle Berkowitz
Thanks, Nick. I appreciate you letting us get the word out.
