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- Rick explains his view that technology is the new biology and its influence on personal health and society
- Conversation about the emergence of healthcare delivery in the retail sector and its impact on patient care
- Discussion about the role of technology, convenience, and consumer-centric care in retail settings like Walmart and CVS
- Exploration of Amazon's entry into the healthcare space with Amazon Care and the challenges of licensing and regulation
- Speculation on the potential for a solution to licensing barriers for telehealth practitioners across states
- Overview of Walmart Health's goal to be the provider for rural America and CVS's transformation into health hubs
- Examination of the impact of AI language modeling, such as GPT-3, on healthcare delivery and the need for regulation and avoiding monopolies
- Discussion on the current landscape of capital investment in healthcare and the potential trends to watch in 2023
- Mention of telemedicine, biotech and pharma, analytics, mental health technology, robotic surgery, and wearable technology as attractive areas for growth and innovation in healthcare
- Analysis of the impact of Medicaid redetermination on coverage and healthcare providers, including concerns about access to care and potential strategies to ensure patient enrollment and necessary care
- Emphasis on the importance of communication, intervention, and collaboration to mitigate the risks associated with Medicaid coverage loss
- Conclusion and call to action for audience participation and questions through the podcast's website
- Announcement of a new segment focusing on politics in addition to policy in future podcast episodes
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Creators & Guests
What is Healthcare Nation?
Welcome to Healthcare Nation, the podcast for enthusiasts passionate about the healthcare sector and eager to explore its current state and future trajectory. Join us as we delve into the heart of the healthcare, biotech, and MedTech industries with the help of top thought leaders.
I'm your host, Rick Gannotta, with over four decades of experience in healthcare, spanning from the hospital bedside to the boardroom, C-Suite roles in renowned health systems, advising game-changing startups and established companies, and educating the next generation of healthcare leaders.
In each episode, we'll bring you conversations with distinguished guests, including innovators, scholars, practitioners, and influencers shaping the healthcare landscape. Gain valuable insights from their perspectives and stay updated on the latest developments, trends, and noteworthy news.
Join us on this exciting journey and become a part of the Healthcare Nation community. Subscribe now on Apple Podcasts, Spotify, or your favorite podcast platform to stay in the loop.
healthcare-nation_rick_rick-ya93ksi5e_cfr-synced_2023-jun-02-1721pm-utc-riverside: [00:00:24] Hey, welcome to the show. Here's another postscript with Joe, our producer. And Rick, your host who's on right now. Joe, how you doing [00:00:44] there, buddy? I'm doing good. How are you? I'm doing well. Doing well. Finally stopped raining around our area. That's nice. Stopped raining. Had had a little spell of rain.
We got the sun now. And who knows these weather phenomenon. You know, I'm not gonna get into climate change. That's a, that's a different podcast. Completely. But it is nice to have the sunshine Yeah. Out there.[00:01:04] We don't wanna talk about climate change, but I do wanna talk about technology.
You've, you've often said that technology is, is the new biology, and that's a huge statement. I'm just wondering if you could unpack that a little bit. Yeah. Listen, and that's, by the way, some of these questions are now being sent to us, by the way, which is really great [00:01:24] to, to the healthcare nation podcast.com.
And, and this has gotta be one of the speaks to one of my websites, Washington Square Advisors. And listen what I mean by it Joe, is that not unlike how biology impacts and informs a person's health status? Certainly now I [00:01:44] believe this and in the future, technology will be equally influential. On not only personal health, so an individual's health status, but also even beyond that on the wellness of society.
And I think we're seeing that play out. And the difference between the two I think is scale, [00:02:04] obviously, and, and impact factor. But I. I'm not specifically saying that technology is, is, is a, is a new organism, but what I am saying is it is equally as influential and I think in some ways as impactful as well.
So hopefully that gets to one part of the question. The, the other side, as I, I would say this [00:02:24] certainly for folks moving forward. It's not just about understanding biology as, as we have historically. That's always been a context. I think with technology it's got so many different facets in different ways that it can be applied.
That understanding, that leveraging it, I think has an [00:02:44] upside that has many different dimensions to it and applications Switching topics here, we're, we're still seeing and we continue to see and observe in the retail sector the emergence of healthcare delivery. How is this trend? Reshaping patient care [00:03:04] and the broader healthcare landscape in 2023.
The emergence of, of the retail players, right? Right. In the, in, in the space, meaning the Walmarts, the CVS is and. You know, Amazon clearly a as well. And I, and I would say, let me start with this. I mean, you have, you have a couple young kids, right?
I [00:03:24] do, yeah. Actually today was my oldest. She's not super young. She's 18, but she just graduated high school. Today was the last day. Oh, congratulations. Big milestone. Big milestone. Well, when you think about her experiences and where she will be getting. Care in the future when she needs it she'll probably be much more inclined to a [00:03:44] consumer experience than she will.
What we're seeing now, which is more of a transactional office-based experience with healthcare, telehealth will be much more evolved. If you think about folks who are, who are my age and. And, and a young person 18, growing into that, it's gonna be a different world for them. And I think a [00:04:04] lot of that is gonna be influenced by these consumer models.
So, so I would say that's one piece. This, why is it so attractive? Look, you walk into Walmart and if they have a pharmacy or if they have a healthcare component, I think the average person is going in there. They may pick up their prescription and it costs [00:04:24] X dollars, probably heavily discounted. But at the same time, they're leaving with a bag of groceries or other things where their margins are 30 to 60%.
Right. So there's a big economic uplift on that. And I, I will stop short of saying it's a new model of care, but I think it is definitely one of the [00:04:44] you know, tracks and. Avenues we're going to see more and more of when it comes to where people will be getting their care. Yes. And certainly convenience plays a role too.
Big deal with convenience, right. I mean, that's it. We're, we're, we're in a you know, two things. It's an, it's a attention [00:05:04] economy in some ways. And the other side of it is who can get your attention to come in and how is that experience going to be very efficient and, I think folks, if you take a look at banking for instance, how, how things were revolutionized with ATM machines.
We're, we're seeing consumer, I think based healthcare going in that [00:05:24] direction. Let's talk about Amazon and, and what they've launching Amazon care and what that has done. I think what. What is probably holding back Amazon care and, and I've, I've even been predicted, like Amazon Prime Docs is interoperability between states and I, I do think that there's a lot of reform and regulation that has to be looked at because [00:05:44] if you're a licensed practitioner in one state, you may not be licensed to another.
And I think that might rate limit some of what they're doing. But look we're seeing the acquisition of One Medical and some other Platforms out there that are going to bring a very new, I think, opportunity for an [00:06:04] Amazon out there to reach out. And I think the prime healthcare piece is going to be a big play.
That's a prediction, by the way. Do you think that there's ever gonna be a, a solution for that where you can become licensed for maybe just Teladoc period and be covered in every state? Yeah. Yeah, look, there are compacts. We see nursing certainly has compacts between states. I [00:06:24] think right now there might be, you know 20 states or so that, that will recognize licenses across state lines.
Same thing with, with certain Medical degrees, but it's not ubiquitous. There are still limitations, and aside from licensing, it's also [00:06:44] insurance and reimbursement. That's the other piece of it. Hmm. It's, it's, you know, something that was tackled, and I know we're digressing a little bit during the pandemic the administration had eased the restrictions.
With respect to interoperability across state lines, but that all ended on on May in I think May 11th with the end of [00:07:04] the public health emergency. Yeah. So let's talk a little bit about Walmart. Yeah. Health. Let's look. They've been I, I, I've often said, I think their goal is to be the provider for rural America.
And I, I think that's prob that's a prediction. I, I really stick to, and I'll, and I'll stand by. We know that in certain [00:07:24] markets, they have opened centers that. Have, you know, of key healthcare services that go across the board, including some elements of primary care. I think behavioral health services is gonna be next on, on that side of things.
So they're moving a I think pretty quickly on that, and they definitely have scaled to [00:07:44] do that. All right. So cvs? Yeah, cvs, you know don't forget they had the, they made the intentional jump to go from being a pharmacy into the healthcare side of the equation. You know, all in, and they've, Been sequentially [00:08:04] transforming its locations into these health hubs.
You know health clinics, wellness rooms, sometimes they have onsite dieticians. I think they're planning on having more than 1500 stores that have that health hub component out there by the, the mid 2020. So, we'll have to see. And, and certainly this is a, [00:08:24] you know, this just feeds into this broader trend of, of consumer-centric care.
Yeah. All right. Switching gears again, let's talk about AI language modeling chat, G p t 3.54, your favorite subject. All all the fun stuff. Yeah. Yeah. The so the impact, what do you think that these technologies are having on [00:08:44] healthcare in delivery in 2023? Yeah, I thought it was interesting to see Sam Altman testifying recently.
And, you know, it's, it's funny of the. I'll just stop short of saying the inventor of it, getting up there and saying, Hey, we gotta regulate it. Yeah. That, that's, that's kind of strange. It's strange and scary if you wanna let your [00:09:04] your conspiracy theory part of your brain run wearing it a little bit.
Right? Yeah. Like, what does he know? Yeah. Let's, right. He, he knows something we don't apparently, but I also think Look at the end of the day, and I'll go in reverse order. One thing you don't want is you don't want a monopoly in this space. You don't want a few players. I'll [00:09:24] characterize it as that, particularly in healthcare, dominating what we're going to be using, developing the models that mitigate bias, et cetera, in any kind of language modeling system.
Yeah, I have a concern about that. I almost of course I'm, I'm all about standardization in [00:09:44] healthcare, but I do have a concern about monopolies as we, as we go backwards. That said, look, I think today, I think in real time as we speak, I think tomorrow moving forward, the role of, you know, AI chat, G P T, all of the, you know, natural language [00:10:04] modeling.
Systems that are out there, they're going to continue to play a significant role in healthcare. We're gonna see this first, and we talked about this in a, in a previous, I think postscript augmenting what, what clinicians are doing, right? Doctors and nurses, adding value in the patient experience, you know alleviating and, [00:10:24] and unburdening folks that could spend more time with the patient or in nurses you know case at the bedside.
I think that's really. Going to be, you know, a, a really quick lift that could be implemented right away. But the next, I think, bigger opportunity is when you [00:10:44] really get into things like radiology, diagnostics, pathology, clinical trials, looking at big, big data sets and, and having the ability to crunch numbers if the coding behind it is correct, so that you can get some.
You know, novel approaches get further faster on a, on a, on an [00:11:04] equation for an as an example, that really can, can yield some significant results that would've taken a long time. So And I remain bullish on generative ai, its applications in healthcare. The only caution I, and I have said this before, bias, right?
Cuz garbage in, garbage out. Yeah. And, [00:11:24] and the, I'll characterize it as the monopoly thing. So I think we've gotta be, gotta be cautious about that. Right? So, switching gears here, talking about the current landscape of the health sector. There continues to be a lot of buzz about capital investment from private equity venture capital.
So, what trends do you think we should be keeping an eye on [00:11:44] in 2023? Number one, there are phenomenal ideas out there.
Folks have them, they wanna commercialize them. Over the past, let's just say couple of years, going back three years or so, a lot of them were funded. It's much more difficult right now for, for many, many reasons [00:12:04] for a b minus idea to get the kind of funding it needs, whether it's from venture or private equity.
So I think there's much more selectivity and that's important. And it's probably back to where it was in 2019. 2020 or even, even further back than that. So that's just a [00:12:24] characterization from my perspective. But in general, I would say this, I think we're gearing up for very solid growth coming starting out obviously the end of this year and moving on through 2030.
And I'll, I'll get into some, some specifics with this. First, I really think that It's [00:12:44] fueled primarily by a demand from folks who want to look at improving efficiency and tackle the big issues that are associated with labor shortages that are, that are out there now. We speak a lot about models of care.
I think we've gotta crack the code on that. Across the board. And that's gonna take [00:13:04] agreement from hospitals, health systems, et cetera, on what it looks like because there's a lot of implications when you look at licensed professionals, et cetera. But I think augmenting the workforce to mitigate issues with shortages by leveraging artificial intelligence is going to be a.
An area of focus and investment moving [00:13:24] forward. So that's just one prediction, but I think it goes into a lot of other areas. Preauthorization would be one of them. We talked about the clinical applications, et cetera. The second area, I think is just that. There's such speed and velocity with the acceleration of different software and [00:13:44] platforms that will support so many aspects of healthcare, that that's an area also that we're gonna see a lot of, I think, exciting investment opportunities at the end of the day.
Do you think that advancement is what's making private investors and people so excited is like, oh, have we applied this new, new shiny thing yet to this. Existing [00:14:04] problem. Yeah. I think, I think that's part of it. I I would say this also, you know, it's also who's investing right in it? , I think the attraction right now for private equity really goes into those folks who have ideas that are gonna impact efficiency, the patient experience, the model of care, much more tactical, if I could. [00:14:24] If I could characterize it that way.
Yeah. Applications that are out there. On the flip side of that, I think that leveraging, and we talk about this many times, as I said, generative AI into so many of those other areas, including things like protein folding and basic sciences and clinical trials. [00:14:44] That's the other side of the equation.
Mm-hmm. So I think that there's enough ideas out there, and again, I, I think that it's going to be a very good You know, time for investment in, in the health sector. So picking up on that, in the health sector, what are the areas that are particularly [00:15:04] attractive due to their growth potential, innovative capacity and ability to provide solutions to pressing healthcare issues?
Yeah. Okay. So no particular order, but at, I would say, you know, again, telemedicine digital health. Real strong growth there. We saw the difference it could make during the [00:15:24] pandemic. We are seeing what it can do now with, with mental health apps, et cetera. So I think really, really strong there.
Second would be you know, biotech and pharma. I, I've remained a big supporter of advances in certainly the pharma space. Others have not, I don't think the growth is gonna be as strong [00:15:44] as it, it has historically, but that's another space. Everything analytic, you know, there's so much data out there.
Not only. Clinical data, meaning parametric, you know individual data, but also how we're gonna take consumer data and kind of fuse that together as a, gonna be a, an incredible opportunity. With, with, [00:16:04] with that, you know, mental health, I just mentioned mental health apps. I think a lot of the issue with.
With mental health access has been so many of the providers don't take insurance. But now, when you have some of these real novel and exciting, innovative mental health platforms coming [00:16:24] along and saying, look we'll make it. Easy for the clinicians, the providers, the mental health therapists to take insurance because we could negotiate at scale for them.
What that that does is it increases access and that that is a big deal, right? Because this is a, this is a problem. So I'm very bullish on, on the mental health side [00:16:44] of technology with respect to it being, you know, access through apps and also coming at a time where the stigma for mental health treatment has really been lowered, it seems.
Absolutely. Yeah. I mean, we see this as, as you know, it's never been on parody with You know, chronic illnesses like you know, heart failure, things [00:17:04] like that, you know, to round it out, look, robotic surgery. I think that the advances that we're seeing across the board in robotics, obviously in general surgery, but also moving into the orthopedic space that's, that's moving fast.
Wearable technology, you know, not only what we've seen, On the watch [00:17:24] side, which has been really impressive. Yeah. With, with the data that's being acquired through that, but also what, what we'll we we'll see in the future I think is gonna be very, very excited. So, you know, that's, that's my kind of short list.
Maybe it's not short at all, but, but some of that predictions in there. Yeah. All right, so according to a [00:17:44] new analysis from K F F, yeah, so it says half a million people in 11 states have already been removed from Medicaid rules since redetermination started. The numbers vary by state will Florida leading the way with nearly 250,000 dis enrollments these early figures confirm previous notions that the end of continuous enrollment could [00:18:04] result in a significant portion of the population losing their coverage. Health experts have estimated that by the end of the redetermination, a staggering 17 million individuals could be taken off of Medicare nationwide.
This has. Cause concern among healthcare providers who fear that the potential impact on clinics and [00:18:24] hospitals that heavily rely on Medicare patients. Additionally, doctors worry that patients may miss out on essential care leading to a setback in managing chronic conditions. So given this situation, Rick, what are your thoughts on the impact of redetermination and the potential strategies that healthcare providers [00:18:44] can employ to ensure patients remain enrolled?
And receive the necessary care. Wow. Was that a question that was sent in? I've just gotta ask that because that's that's a, it wasn't one of mine That was a page fold. Listen, I'll, I'll, I'll, I'll try to tackle it with the level of, of [00:19:04] information and expertise that I, that I have it. Had a hand at the moment.
Number one, look Medicaid coverage is essential to so many. Any kind of rollback or a redetermination would be, you know, very concerning and consequential for so many folks. Number one, the [00:19:24] patients and the individuals who rely on it, but also healthcare providers as a. You know, a as part of how they also get their reimbursement and, and you know, fund their practice or, or even the economics across the board of, of healthcare delivery and it's, and the role Medicaid plays.
So [00:19:44] that's one. I think your second part was what could we. What could we do to kind of mitigate this issue? I, I think there's a couple of strategies. One is communication, right? You don't want folks to lose this. So any, any individual would be at risk for losing their coverage. Can we get in touch with them and.
[00:20:04] Somehow guide them through the necessary process so that they could maintain their, their enrollment. Sure. The second is folks who are seeking care, who are at risk for losing it or have lost it. And, and they're I would tell you, New York City Health and Hospitals did a great job at this years back with [00:20:24] enrolling folks on Medicaid.
And I'm using them as an example. A very positive example, you know, if institutions, hospitals could adopt a. Some check-in, you know, methodology where they could enroll or identify folks who are at risk for losing their coverage. I think that's a, that's a big part of it. Right? And then the next is just [00:20:44] collaboration and communication.
I think that is really, really Important. At the end of the day, it's gotta be a, a multifaceted approach. I think all of that, you know, the, the communication for folks who are at risk at losing the intervention of, of speaking to folks who are coming, say into an ED and identifying [00:21:04] that, and then making sure that folks work together to close any gaps that are out there so that no one goes without coverage.
All right. I, I always enjoy these, these recap episodes. We we're making this part of what we do at the beginning of, of each month. Hopefully our audience finds. Value to what we share here [00:21:24] with them.
And I think you mentioned it earlier at least half of the questions that that you asked me today came in through our website. So I encourage folks, if you have questions, please go to healthcare nation podcast.com and there's a form there you could send your questions in and Joe will.
Be happy [00:21:44] to put them on for our next postscript. I think the, the rest of them you curate yourself through Kaiser Family Foundation and Politico and some other sites. Am I correct on that, Joe? Yep. Yeah, so really appreciate that too. Yeah, absolutely. So one thing for our audience, we're, we're gonna be moving into a new [00:22:04] segment now in the Healthcare Nation Podcast.
We're gonna get into we, we've covered policy. Now we're gonna get into politics. So we're hoping to have some of our, our leading politicians on the show. So we'll see who responds to our invitations. Thanks for tuning into the Healthcare Nation Podcast. We appreciate it. As we said, send your questions in via the [00:22:24] healthcare nation podcast.com and continue to listen to us on. Your favorite podcast platform?