Amazon vs. Traditional Healthcare | "Innovating for Wellness" author Robert Longyear

This transcript was generated automatically. Its accuracy may vary.

[00:00:15] Mike Koelzer, Host: Well, hello, Robert. Hey Mike. Good to see you again. 

[00:00:17] Robert Longyear, III: Yeah, I'm uh, I'm glad to be back. It's pretty exciting. Coming for round two on the podcast for our listeners. 

[00:00:22] Mike Koelzer, Host: Robert was on, I don't know, half a year ago or something. And he said he had a book coming out. It did 

[00:00:27] Robert Longyear, III: publish the book. It came out in April. Um, and I'm, uh, glad to be able to, uh, jump back on the podcast with you.

[00:00:34] Mike Koelzer, Host: I was looking at your Facebook page when the book came out, it had to be one of those, like when you were a kid and you found out that there was gonna be new carpeting at home after you got back from school and you couldn't even contain yourself, I was drawn to your knife that you had for that box. do you remember what knife you 

[00:00:55] Robert Longyear, III: used?

Yeah. To, to, uh, to open the. To open 

[00:00:59] Mike Koelzer, Host: the box. That was a big 

[00:01:00] Robert Longyear, III: knife. It was, I did that on purpose, uh, for exactly why you're, you're looking at it. So, um, it was my unboxing video. Um, it took me about a month and a half to get the physical copies of the book shipped from the publisher because of some delays related to COVID.

And, um, so I, I got it and I had to do a dramatic unboxing video. It was something that my publisher told me I needed to do. So I went and found the biggest knife in the drawer and used that to open the 

[00:01:27] Mike Koelzer, Host: box. Now, did the knife have any other purpose if you opened that box and, and something was amiss?

[00:01:32] Robert Longyear, III: Well, I, I, it didn't at the time have any other purpose, it just opened the box. And to be honest with you, I don't have a whole lot of kitchen knives. So it was, uh, the first one on top. And, uh, I, I thought it would be pretty entertaining and I, I guess I was right. That was right. 

[00:01:47] Mike Koelzer, Host: That was great. I wanna cover the two book ends right off the bat.

The first book ended. You opened up your box and I know it's bigger than that, but this was the dramatic part of it. It goes way back the book does, but the dramatic part is the part we caught on camera. What's the last bookend for you? Does this get you as the talking head that we're always going to see on CNN?

That has brought us into the future with technology and health. What's that final book? And that you're looking at with this 

[00:02:24] Robert Longyear, III: book, Mike, you know, I've had a lot of people ask me that question. I actually wrote, uh, an article about why I wrote the book and the, the first answer is the, one of the, the publisher called me and said, do you wanna write a book?

And I said, yes. So that was, that was the primary reason. Um, to, to be honest with you, but what actually went into the book is, is a much longer story in the making. And, um, I, I don't know if I have any particular outcomes that I'm looking for. My publisher asked me the same question. We had like an hour long conversation.

Like why, what do you want to achieve with this book? And it was tough for me to answer because I just wanted to write. 

[00:03:01] Mike Koelzer, Host: I really enjoyed your writing style. It was a story form of technology issues. I think it really does a nice job of getting someone mm-hmm , you know, really into it. Well 

[00:03:16] Robert Longyear, III: done. Well, thanks Mike.

Yeah, I think that's probably one of the best compliments you can give me. Um, I'll do any of the information that's written in the book, except for some of the interviews I did personally, and then some of the research I did. In school. Uh, most of it is taken from other people. So a lot of its research from, from others, from, academics and a lot of its startups that were, were not something I was involved in.

Uh, we do talk about my, my company a little bit, but the, the thing is, is that I, I, the, the biggest compliment you can give me is, is that the, the writing and the way I put it all together was, was really nice. So I definitely appreciate that. But in going back to your original question, I think. I think I don't have any goals of becoming certainly not wealthy from this because book royalties are very small.

So, um, I, you know, if you, you write a book and it gets up there and it's a lot of work and then you figure out how much you get paid when somebody sells the book, it's not very much, so I certainly have no sites on, on making any money from this. Um, and, and the other piece is I, I don't know, If it's really going to, to, to send me to CNN or anything like that.

I think, I think what my, my biggest hopes for it are, you know, I could just get to, to say I wrote a book. I think that's a pretty big, uh, thing for, for me personally, something I wanna do, but I, I do hope that the people that do read it might sort of think differently about healthcare, about where we're going.

And, um, one of the, the core stories I tell when I think about what I wanted to write about is I was sitting in a room with a bunch of researchers that are policy people. So they're health policy researchers, um, some from the university of Chicago, some big names from state Medicaid agencies. And what I, what I learned is that they were, they were trying to build this program that they were working on.

And, um, they, they always kept saying, let's get the data or we'll have data for this. Or we will measure this. And there was nobody in the room that was a health information systems person. There were no digital health people there. There was no. Um, there, there were no, there was nobody else in the room besides policy researchers.

And so they kept saying they were going to do this. And I felt like there was a gap. Between this extremely impressive group of people who work in policy and are trying to further the goals of, of, of us healthcare systems, uh, in general. But there was not this sort of bridge between the people that actually get the information that they need and collect it from patients and build actionable insights from them.

So I, I kind of wrote the book, uh, the, the two major parts of the book one's about health policy and payment innovation, and one's about digital health innovation, and both of. Really coexist nicely together. But, uh, a lot of times I feel like the fields are very separate. Health tech is Silicon valley and Boston and health policies, Washington DC.

And I feel like the groups of people often don't come together very much to try and generate big change. And so I hoped to also be able to break the gap, um, perhaps between the two to sort of weave, uh, an interconnected story between some of the work being done in Silicon valley in Boston, and a lot of the goals of some of the big policy institutions and, and, um, you know, government institutions as well.

So I focus on both of those to 

[00:06:20] Mike Koelzer, Host: bring that to other industries. You'll see complaints about the marketers up here, but the bean counters down here and in pharmacy, you get that with the technology pharmacists working day in and day out with the patient, but you have the boardroom at these big corporations making decisions, but they're not in the meat of it.

So a lot of different industries will have these two extremes. And in this case with. It's the people that maybe have the final. Numbers, but they're not down in the dirt realizing where these numbers came from and how we got 'em and how consistent they are and these kinds of things. So both of those edges were not talking together.

Is that about right? 

[00:07:09] Robert Longyear, III: Or, yeah, so, uh, I think it's, it's kind of two schools of innovation, I would say. Um, what you're describing I think is part of it. So in healthcare, there's a lot of different stakeholders. So you have the clinicians, the physicians, the nurses, the pharmacists, you have the managers, the administrators of those hospitals and, and outpatient facilities and pharmacies, you have sort of the business people.

And then you have the policy, people that, that deal with government policy and. State policy, federal policy, and you have the health information management people who might also be management, but they're, they're kind of, uh, associated with the, the managers of the healthcare facilities. And then, the insurance companies have their own groups and the PBMs have their own groups.

Yeah. So there's this sort of, uh, different stakeholders with different viewpoints. That you know, does exist in healthcare, exists in every industry, but it's particularly relevant healthcare because you have so many players to be able to deliver these services to patients. But I think what my book is more about is these different schools of innovation, these different levers that are pooled.

So you have the policy, people that pull a lot of payment levers or incentive levers and things like that, to be able to do innovation, to try and encourage certain activities to happen at the patient level. And then you have. Tech entrepreneurs, the health information system companies that are like, look, we can pull, you know, great insights from clinical data and claims data and we can, we can do predictive analytics.

And, you know, I think that those two schools of innovation are extremely, um, complimentary. So. The policy people can make the incentives and set the right environment for these predictive analytics to, to thrive and be successful. And they, they really have to work together. So, um, to use some of the policy terms, we have, uh, value based payment, which incentivizes, uh, healthcare providers, uh, physicians and, and anybody who's actually delivering services to patients to deliver more effective services.

And in the event that they can do that they actually are able to share in the savings. They get it when they provide better services. And so one of the core problems is if we're gonna change those payment incentives to, uh, put those providers at risk or in a value based payment arrangement, then they need the tools to be able to actually improve patient care.

And a lot of times that comes from. Better communication technology, better data use from, from information technology tools and, and digital health tools. So, um, I, I sort of see those two schools of innovation as being very complimentary 

[00:09:31] Mike Koelzer, Host: coming from my pharmacy background. I'm so used to having groups that are bitching at each other, between the PBMs and the pharmacists.

Pharmacy corporate ownership and this and that, but it sounds to me more like this is a positive thing. You've got a lot of groups that are doing really positive innovations, but they may need a language to talk to each other so that they can multiply their efforts where your goal is to help them cooperate even more.

[00:10:02] Robert Longyear, III: Right. So the book is certainly about, you know, positive innovations for patients. So, um, my, my primary driver goal with the book was how can we, uh, have better patient outcomes at a more effective cost point? So, well, the policy people are very concerned with cost because of rising healthcare costs in, in Medicare and rising healthcare across, across the country.

Um, and we were all concerned about the effectiveness of our healthcare services. We want quality healthcare services, and we want patients to actually get better when they seek care. And so, the thing which you identified as correct, both of these spaces are very positive. So. The digital health space with, with a lot of the tech companies and some of these startups, they're trying to improve healthcare services for patients by, um, you know, improving communication between physicians and patients improving real time data collection on conditions like in remote patient monitoring or chronic disease management.

And they, they are really trying to give physicians and, and healthcare providers, the ability to do things that they weren't able to do before. And that's very much needed to, to, um, support the type of innovation that's going on in a policy space. So the policy people are interested in the same outcomes.

They want to improve chronic disease management for diabetes and, and for, for cancers and for hypertension and heart disease. And they're, they're trying to use their levers, which are incentives and. Program funding and things like that, to be able to achieve the same ends as a lot of these companies' technologies.

And so they both are trying to accomplish the same thing. So perhaps maybe it might make sense to do them together. And so that is sort of why I focused on payment innovation, uh, like value based care, accountable care organizations, things like that from a policy perspective and brought in some of these tech companies.

Could really support these programs to make them more effective. 

[00:11:57] Mike Koelzer, Host: Yeah. If you're not talking somewhere in there about money, you've lost the, you know, that's what it, that's what everything revolves around. You always have to keep that in the picture. It seems. Yep. 

[00:12:05] Robert Longyear, III: Absolutely. I mean, we know that payment incentives are extremely, extremely effective at changing the behavior of organizations, um, that deliver healthcare services.

So if you offer to pay more for a type of service, it's gonna get, it's gonna get done more. So we know that if you pay a physician. An extra $10 per patient to, um, you know, write down a care plan and go over that with the patient. Then we know that that's gonna get done more often because of that financial incentive.

And so that's sort of the idea behind value based payment or pay for performance is, is the other term used for it. And so that's one of the, the innovation mechanisms used by policy people quite frequently, but the, and it's a growing movement. I shouldn't say it is quite frequent. But it's growing in popularity and it's being used across the country.

But the problem is, is, um, if you start moving through some of these more complicated mechanisms, those physicians and the healthcare organizations really need support with being able to build new models of care, to more effectively, uh, deliver services to patients. If they don't have these new digital tools, they're gonna have to keep doing what they've been doing for a long time, which we know is not as effective.

Um, as some of these, uh, more comprehensive and, um, advanced models, I should say. And when you 

[00:13:18] Mike Koelzer, Host: say digital tools, you're talking about the chapter on using technology to predict you're talking about those kinds of tools where the person either, either wearing something or they're, they're getting really good data versus just maybe.

Having the customer write it down in a, in a log book or something like that, right? Yeah, 

[00:13:40] Robert Longyear, III: exactly. So when I say digital tools, I say, um, a lot of it's centered around smartphone apps. So we know that, you know, that the popul. You know, most people have smartphones now, uh, there's, there's a new research data set that shows that how many people have smartphones it's around 80% across the population, uh, and that the number's growing as they become more affordable.

And so with a lot of innovations happening around that with mobile devices in that you can collect patient data. More frequently. So why would we not monitor somebody's condition more frequently rather than waiting for them to perhaps get worse or to show up to another in-person appointment? Yeah. So, the digital tools really allow for more frequent touch points with patients to help support them towards better health, rather than waiting for them to show back up again when something goes wrong.

Yeah. So it all, all of this from the policy and payment innovations through the digital health innovation center around this idea, The healthcare system is very reactive. So patients, you know, will get diagnosed, they'll go home, they're left for their own devices. And then they either show up at the emergency department or back in the physician's office because something's not feeling right.

They're going well. And so a lot of the digital health innovation centers center around this idea of being able to. Have more frequent touch points with patients to collect relevant clinical data like blood glucose and blood pressure and, and things like that on a daily basis. So if we notice some things out of what the, when I say we, the healthcare system notices that something is, is, is out of whack or is deteriorating, then they can reach out before something ends up in for the patient ends up in the emergency room.

So the ability to collect real time data. And collecting physiological data in the home has really grown as technology has become able to support this. So we have mobile mobile phones that can connect to wearable devices that can connect to blood glucose meters that can connect to blood pressure cuffs.

And so there's a lot of companies centered around this type of concept. And now that we're able to collect real time data, we can include that with. More rich clinical data that's collected in electronic health records. And now there's a lot more information to go on when you're trying to help patients achieve better health.

You can see what they're doing in real time, and you can see what their medical history is. So for physicians, it just gives them another tool to be able to support patients and to, to be able to help guide them to better health. Um, there's also the communication. So, uh, healthcare is plagued by faxes, and telephone calls.

And so now you can communicate through messaging, you can do video chats and so you can access people a little bit more frequently when you need to alert them to something that might be going wrong. So that's the digital side of things, but in order to make this attractive for people to do, it requires a lot of payment innovation from the policy side.

So you have to incentivize people for. 

[00:16:22] Mike Koelzer, Host: Robert, where does Alexa and so on fit in that picture? I, I forget if you, and I talked about that last time, but where Alexa just throws out a question to somebody , you know, during the day. 

[00:16:33] Robert Longyear, III: Yeah. So this is an area I'm very interested in. So, uh, I just, what I just described with a smartphone app is something that requires somebody to have a smartphone and it requires them to be, you know, actively using that smartphone, but there's a lot of interest in, from healthcare organizations in.

In voice technology like Alexa and like Google, because it's such an engaging natural way to collect information and to talk to patients. So there's a couple different use cases I've seen. Um, one is to just have education. So you're able to have patients ask Alexa healthcare questions, and Alexa can provide, you know, factual information back to help patients understand.

You know, they need to know. Yeah. The other piece is to do some of this remote patient monitoring or virtual care services through Alexa. So, um, Boston children's hospital actually was one of the first to use. They built an Alexa skill and they, uh, for, for children after they have surgery, they go home and they have an Alexa in their home.

And so, uh, after surgery, every day, Alexa will ask, how's your pain level? How are you feeling today? Is there anything you need to get in touch with the care team about, and that data is transmitted back to. That patient's care team, their nurses and their physicians. And so you're able to, you know, reach into the home a little bit more and make sure that for those postoperative procedures, uh, or for patients when they are postoperative, they are home and they're healing correctly and things are going well.

Because that's a pretty risky time for patients. Yeah. So a lot of times they might end up back in the hospital if something's going wrong. So if their pain's too high and it's abnormal, then the care team can recommend they come back in or, uh, make some other recommendations. So it allows for, for data collection, that's really engaging in the home, uh, to be done pretty passively.

So somebody can be making dinner and Alexa can ask, oh, how's your pain level today. Right. And they can say, oh, it's a five. You know, that's a pretty engaging way to engage with patients and it's easy and it's passive and it doesn't require a lot of their time. So that's one piece. Uh, very interesting.

And it's also particularly relevant for aging. Um, so aging in place is a big movement. Yeah. So, uh, we wanna be able to support, uh, older adults who might normally have to go to an assisted living facility to be able to live in their home as long as possible. And so part of that is making sure that they are being checked in with and are able to perform their activities of daily living like eating and going to the bathroom and things like that.

Um, Alexa can be used to support an older group of people because it doesn't require those smartphone skills that are difficult to navigate. Right. It's its voice. So it's pretty easy. Uh, older adults too, um, jump into and be able to use it. And I got my grandma and Alexa and she uses it. She likes it.

And so why not? Yeah. Deliver healthcare services to people through Alexa, um, or Google home. Yeah. And I know there's a lot of applications being built for that purpose 

as well. 

[00:19:22] Mike Koelzer, Host: I played a lot of 20 questions with my youngest son, and we had a lot of battles afterwards. One of 'em was, I had asked.

[00:19:31] Robert Longyear, III: Probably 40 questions by this time are 60. And I got it narrowed down to a dirty piece of metal and through the questions, it's something that cut your head off, you know, and this and that. I got it down to that. I'm like, I'm like drew. I know it's a dirty piece of metal. And finally he's like, no, I'm like, all right, what is it?

He's like, it's scrap. I'm like, yeah, scrap metal. And he said, no, it's scrap. So then we played again. 

[00:19:56] Mike Koelzer, Host: I ask him, I say, draw is the item. You're thinking about being bigger than our dock at the cottage. And he said, Hmm, let me think. Wait , is a school bus bigger than our dock at the cottage? And I said, yeah, it's about the same.

So then my next question was, is it a school bus? And he is like, yeah, it's a school bus. 

[00:20:23] Robert Longyear, III: Now my kids, when we, when I play with him, he's like, what's the category? And I said, that's cheating. You don't have to have the category for 20 questions. If your questions are good enough, you just go. 

[00:20:35] Mike Koelzer, Host: I think with the Alexa things, you'd be surprised at.

Almost like 20 questions with an elderly person. How is your pain? It's this it? Well, would you say it's more below the waistline or above, you know, above with 20 questions, you could probably get a lot of detail more than you think mm-hmm . So I think that's fascinating. The, the. You know, the verbal, the verbal 

part of that, that you can do things like that, which are a little bit more diagnostic related.

[00:21:06] Robert Longyear, III: You can do more education stuff like I mentioned, but you can also do things as simple as did you take your medications today, which is extremely impactful towards their health. So if you have an Alexa program, and I know that there's some that exist and that are being built currently, um, that is, did you take your medication today?

Do you have any questions about it? Um, one somebody takes their medications or they forgot they get that reminder verbally and it's right there. That's extremely impactful too, if they have any other questions, well then perhaps they end up getting a phone call from a pharmacist. Yeah. Or from a, uh, from, from a nurse or from a physician that they work with and that have access to that data so that they can make sure that the patient understands how to take their medication.

And a lot of times let's say there's a newly diagnosed diabetic who gets on insulin and insulin a, a complicated thing to, to inject and to prepare and. There's a lot of questions that can be, uh, answered either by Alexa or by a human being. If a patient says, I don't really know what I'm doing here.

Right? So that's another area that is really growing with voice technology. And those types of functions are being done with mobile apps right now as well. Um, but Alexa just makes it a lot easier too. 

[00:22:13] Mike Koelzer, Host: The whole part about payment incentive is mm-hmm. interesting to me because I come from a day where.

Doctors were supposed to have a great handheld and they'd be able to click off on their handheld, what drug was covered on the formulary. And they would know all this stuff. So it would get to the pharmacy with smooth sailing. And I'm back at the pharmacy now more after a few years away. And it's terrible.

How. Time has to go into every prescription, whether it's formulary mm-hmm prior authorization, that kind of thing. So my complaint always is that I think about technology. Either a little bit over people's heads. And so it's no longer the doctor, the doctor's handing this off to a front office, you know, 17 year old who's on her spring break and saying, punch this stuff in.

I'm being a little faceted. I might be taking that a little bit far, but, but I, I think it's always hard to find. The right mechanics for the right people. And the same with pharmacy. It's like, you make something too easy and maybe it's not getting done and too hard. And maybe people aren't doing it, or it's not worth the time even to, you know, fill this and fill that out.

So that's a pretty tricky subject all on its own about setting the reimbursement price, but then. Also testing it out and seeing who's gonna use it and when and how, and you know, all that 

[00:23:54] Robert Longyear, III: kind of stuff. Mm-hmm yeah. It's um, everything obviously has positive and negative outcome effects. Yeah, basically.

So, um, I, I think what, what, what I, I would say about some of the tech tools, there is like a lot of the administrative processes. That occurs are, are still a little archaic and can be automated, um, like prior authorization and, and being able to, to submit formulary requests and. Things like that. I know there's a lot of companies that work in that area specifically, but, um, I, I think that a lot of the administrative functions still have room for improvement and, and that will make things a little bit more seamless.

Um, I think my book covers a little bit more sort of like the clinical realm. So it's less, it's less B2B and a lot more like, what do we do? For patients specifically with technology, but I know that some of those prior authorization systems and formulary management systems and pharmacy prescription management systems are very complicated.

So, um, like the B2B stuff I, I know it certainly has a lot of room to go. Um, And, and so I can't, I, I personally don't work with them, but yeah, I hear you're loved, I've heard horror stories there. Yeah. Um, and, and I know pharmacists have had a really tough time, uh, in the current market as well with all the, the increased in, in challenges associated with drugs and drug pricing and PBMs, and yeah.

Um, I know that pharmacists have really, uh, Gotten a, a, a bad, bad sort of hand that's been dealt with because of a lot of the changes that have occurred. So, um, I think, I think those are gonna start to improve, but it's, uh, it's, it's definitely, I think been tough for the pharmacists in this situation.

The 

[00:25:30] Mike Koelzer, Host: The problem with pharmacy is that. You've got people that want the smoke and mirrors. They want the margin and the mystery mm-hmm because I'm doing X million dollars at my pharmacy. And I could have a sales rep come in and I could say, tell me how much this bottle of such and such cost. How much does that cost?

I don't know until they do all the rebates and fill this out and do this out. And they apparently say they don't know, but somewhere, somewhere they know. And if, if you were treated that way by, uh, By anybody else with the revenue that a pharmacy spends with these wholesalers, it would, it would be, uh, comical, but there's smoke and mirrors on purpose.

There's also smoke and mirrors with the insurers, you know, selling to the patients. If they came out and told them what was really part of these contracts. Yeah. They'd be amazed. So it's really interesting to see your stuff. Really trying to work together. And I think on the other side, they're trying to make it more complicated.

B2B. 

[00:26:36] Robert Longyear, III: Yeah. Yeah. Mike, I mean, I think that there's two, two groups of people in healthcare. You have people that really like the status quo because it's making a lot of businesses. A lot of money. Yeah. Um, and then I think you have the people that are generally approaching this to try and make some, some change.

Yeah. And one of the core themes of the book is that, you know, if you build a really good product that works, um, there's, there's nothing that can, can keep you from being successful. So if you really build something for the patient that achieves phenomenal outcomes or does something cheaper, then there will always be interest in that, in that innovation or that technology.

And. Um, but one of the ways that we can sort of start to chip away at this, this, this sort of archaic healthcare machine is to come up with new things that are more effective and to compete. And eventually then there won't be a choice. So, sure. I think one of the core examples I talk about here is that we all know that Amazon's getting into healthcare.

Right. We know that they purchased PillPack a couple years ago. Yeah. And, um, that's a big pharmacy shipping company. Sure. And. We know that they are launching Amazon care internally. It's sort of a, uh, employee benefits, uh, telehealth solution. Yeah. So they're, they're starting to move into healthcare and we know that Amazon's sort of, uh, Mo and they're, they're sort of operating model for new products as they try it internally, they build something they need, and then they sell it to the larger markets.

So. They're building Amazon care to try and control their own healthcare costs for their own employees. Interesting. By providing better care services, they did this with AWS too. They needed a cloud based system and exactly they built their own cloud internally. And then they're like, oh, we can scale this in order to sell to everybody else.

So that's where sort of AWS came from. And so they're gonna do that with Amazon care as well, probably in the employer market. And so between PillPack, Amazon care and Alexa, that can provide healthcare services. There's also a wearable that I'm hearing about from Amazon. That's aimed at, uh, older adults in the home.

So I, I, I have a feeling that Amazon's very much targeting home based care services. So now they can ship drugs there. They can use Alexa to provide some additional healthcare services and they might be able to provide telehealth services yeah. Um, in the future. And so I feel. They are going to build a product that is so much more consumer friendly, but so much more patient friendly.

And that's so, um, so well built and designed that the traditional healthcare organizations are really gonna struggle with them. And, uh, that's what the tech companies do best. So the tech companies, yes, they have their technology and that's sort of their core operating model, but the way that you go about technology innovation, the way that you build technology products is what you build so well for your.

You learn everything you need to know about your user and you build products around them. And when you do that, it's extremely competitive. And so when they want to come into healthcare and build insurance products or healthcare service products or pharmacy products, then they're gonna build it so well that people are gonna want to use it because it's so convenient and so easy to use.

And it's, it's, it's a good experience. Whereas when you look at traditional healthcare organizations like, uh, like insurance companies, like hospitals, like physicians' offices, Like it has not been a good experience for patients. Patients have not really had a good time. They sit in waiting rooms for a long time.

They don't understand their bills. They get surprise billing from hospitals, right? They, they, they, you know, pay ridiculous prices. Insurance doesn't make any sense to anybody. And so when the tech companies are starting to move into healthcare, They're going to do it better and they're gonna build it for patients.

And so, um, the traditional healthcare organizations are very much at risk of losing a lot of business and customers to different organizations that haven't traditionally been in healthcare. So, um, The, the, like I said, the core of the book is building around the patient building for your end user, um, as a healthcare organization and not necessarily just a tech company, but, um, the, the tech companies are doing this and the startups that are tech companies are doing this as well.

And it's going to build a better patient experience. It's gonna be cheaper and it's gonna be more effective. And we've already seen a lot of examples of that so far. And. I, I think that if, if, if existing hospital systems and physician practices and organizations, don't start to adopt some of these technologies and don't start to change their, their whole patient experience, then they're gonna lose app to some of these other companies take 

[00:30:53] Mike Koelzer, Host: someone like Amazon.

For example, everybody's gotta be very careful with that, including the big insurance companies. PBMs and all this cuz now all of a sudden you go on Amazon and well, you know how it was like years ago when you had to buy, well, maybe you're too young for this. I'm an old fart, but years ago when I had to buy a Dell computer mm-hmm , I'd spend weeks looking at the Dell magazines, you know, and flipping through and comparing.

Stuff and all that. And now you go on Amazon and you say, what's Amazon's choice? All right. I'm gonna snap on that and buy it. And so it's like, it's like one hour compared to like maybe 20 hours of research. Mm-hmm and healthcare's gonna do the same thing. You're gonna be able to go on Amazon and. I want, uh, four units of healthcare.

And do you wanna buy it with one touch or do you wanna buy it by putting it in your cart and then buying it five seconds later? That's gonna be the big decision. Yeah. So it's all the way up that they can disrupt everything with what they're doing for their own company as they did with AWS and so on. 

[00:32:03] Robert Longyear, III: Yeah.

I mean, so imagine Amazon being able to provide telehealth services where you FaceTime with a. That doctor is able to, you know, chat with you about your symptoms and then they write your prescription that gets shipped to you from PillPack. I mean, you can have everything that you need through Amazon right there.

And then they're gonna check up on, uh, on you through Alexa. So, you know, after they deliver those services, then you might get your medication. And Alexa might ask you. You know, how, how's it going with your medications? Do you have any questions? Do you need to set up another appointment or maybe you wanna chat with one of our Amazon care pharmacists to go over your, your, your prescriptions.

And, you know, that type of experience is what healthcare is going to look like in the future. Um, Amazon is probably going to go there. I think they're gonna focus on employers first, so they won't be going directly to consumers, like through their prime members. I do expect something like that to come out of them.

And, uh, a lot of other healthcare organizations are gonna start to adopt and they have to right now due to COVID. So they're starting to adopt telehealth solutions and yeah. Real quickly, um, pharmacy shipping and things like that. Yeah. So, um, you know, we are starting to see some of that effect if you have small startup companies that offer telehealth technologies.

And now because of COVID, it's really accelerated this. You know, they were starting to slowly adopt telehealth tools. So you can deliver some services to patients in the home, because the only reason why a lot of services are delivered, where patients have to come back to the facilities is cuz they get reimbursed more for it.

So if, if you can get reimbursement to be reasonable in telehealth, like it is right now due to COVID. Then a lot of services don't require a patient to come back and, for a patient that was just discharged from the hospital or that, you know, is postoperative or that, you know, doesn't need to spend two hours in a waiting room.

Um, you know, it's, it's a lot more convenient. It's a better experience. And it's nicer for patients. I remember, um, when my mom was sick, we had to go to the. All the time, like three or four times a week after she left the hospital. And it was extremely taxing for her as a patient to make that drive and have to wait in the waiting room and be there all day when she could be in bed at home recovering.

And so, right. You know, some of those services really could have been delivered in the home. Yeah. These are 

[00:34:07] Mike Koelzer, Host: things like how you feel and maybe we'll poke this and do that. And yeah. Those are reimbursed and that's what's gonna keep happening then. Yeah. Getting these people who have just been through major surgeries and who are either sick with cancer or whatever, sitting in a waiting room 

[00:34:20] Robert Longyear, III: for a couple hours.

Yeah. And so it's a, it's, it's much nicer when you can stay in your bed and talk to a doctor if they don't need to do any procedures or don't need to draw blood or don't need to do labs or do anything like that, or do infusions. and a lot of times, if you're just gonna do asking questions, it's much nicer for the patient to do it in the home, and it's probably better for their, their health and their overall wellbeing.

So I think, yeah, we're gonna start to see what's happening in telehealth is going to be, first of all, all the healthcare, I shouldn't say all, cuz that's a blanket statement, but many healthcare systems and facilities are having to adopt te. During COVID because they can't have patients coming into their facility.

Right. So that's number one. What we're gonna start to see is what types of services can be delivered through telehealth and what cannot. Yeah. So there's gonna be a mix between the two now going back to payment, which is why it's so important. If they, if, if we continue to see lower reimbursement for telehealth, then we're still gonna return back to an in person model.

Sure. But, um, if we're able to get the telehealth reimbursement rates to be on par with facility rates, then. I think that that's going to be extremely beneficial and we're gonna be able to deliver a lot of services, uh, more, more, I guess, comfortably for patients more conveniently for patients. So, um, I think that that's gonna be good.

The state 

of 

[00:35:33] Mike Koelzer, Host: Michigan is suing me for like a thousand bucks or something and, and I'm not going to settle with them. Cause I don't agree with what. Saying I owe that money for, and so I spent a whole day, you know, going down to court just to sit there and have the attorneys say, all right, here's an update.

Mm-hmm that stuff's only happening. Mm-hmm because everybody's getting paid to do it. Mm-hmm and you take that money away from 'em and that would've happened in, you 

[00:35:59] Robert Longyear, III: now, five minutes. Yeah, exactly. So, you know, a lot of stuff, people come back into the office for it's like, oh, by the way, your lab results came in and this is what we saw.

It's like, you know, you, you could have just, you could text me if you want to send me an email. Yeah. It's like, I don't need to be spending several hours in your waiting room, just come in here and have you tell me this? So those types of services can be moved to telehealth. And I think that they will, because it's a better experience and, and what's gonna end up happening is for the facilities and the physician practices and clinics that don't offer telehealth.

There's gonna be a lot of patients that are gonna want to go to other facilities that do. And so it's becoming a competitive thing for healthcare facilities. Uh, as we move forward where, you know, If my, if I go see a doctor and they offer telehealth, I'll be pretty happy with that. So I can, I can get care services I need, um, without having to go to the facility sometimes.

But you know, if, if I'm at a physician's office that doesn't offer telehealth and I know the one next door does, I might be more likely to go and, and, and, you know, join that practice and. And, you know, receive care from them. If I can, you know, FaceTime my doctor after work sometime and, um, you know, get the prescription I need because you know, it ran out instead of having to go into the office or, um, having to, you know, right.

So I think that. I think that's something that's gonna be happening, which is really interesting. And, um, it's very much driven by the acceleration it's, it's, it's been around for a while, but the acceleration's been driven by COVID and, uh, people not being able to go into, you know, physical locations. So, yeah, that's, it's been very interesting.

[00:37:22] Mike Koelzer, Host: So Robert, you got a dozen people out in, out in a lobby, let's say, and there's doctors and attorneys and students and people who just like to read and there's pharmacists and so on. And you can get a few of 'em into a huddle and give them, oh, maybe almost like a pep talk mm-hmm who would be in that room with you.

And what would 

[00:37:42] Robert Longyear, III: Are you telling them? I think I'd like to talk to, uh, a lot of the politicians, to be honest with you. I think if I could pull them, you're a glut for punishment. I know. I know. I know. Well, the thing is, is that like, if you, if I were to say a bunch of physicians, like they, they know a lot of the stuff that I'm talking about.

So I see, um, I, I, I feel like if I, I, I perhaps they may be new to remote patient monitoring or they may be skeptical of remote patient monitoring. So let me do this. Let me give you an example for, for the physicians. Yes. And let me do the politicians. So I would pull in some of the clinicians, the nurses and the clinicians, and I would say, look.

Here's the evidence we have for the effectiveness of remote patient monitoring, and telehealth. And, you know, I think this is really important for being able to improve access to care and to be able to improve quality of services for, uh, patients with chronic illness. So they can get more touch points so we can collect more data from them.

And we can sort of change the way that healthcare has worked to be more of an outbound system to be more proactive. And so I would, I would ask them to, uh, perhaps, you know, join me. On, uh, you know, promoting this and, and working towards something that, that may actually become more proactive for patients that can help them attain better health, which is the ultimate goal.

More 

[00:38:54] Mike Koelzer, Host: of that prediction. Technology, right? Yeah. Wearing things or introducing monitors to them and, and getting people involved and so on. 

[00:39:03] Robert Longyear, III: Yeah. So Mike, I gotta tell you, it's going that way. It will be there. It might take a decade for it to become common practice, but it is going that direction. And you know, that is extremely helpful.

And as we get more research and more evidence and more people using this, we're gonna probably find that this works pretty, pretty well. Sure. And we're gonna be able to care for patients more effectively. What I would say to the politicians is, healthcare impacts. Everything else, the economy, impacts productivity.

It impacts, you know, so much in the country. If we were to think of everything as health policy, we might be able to attain a lot more productivity in a growing GDP. So, um, one of the things I like to talk about is that like a good society, a healthier society is more productive. They're more innovative, they're more effective.

And, you know, that is something that we should always be thinking about in our policies. How is this going to impact the well-being of our country and our society? Because health is a renewable resource. I mean, if we're able to get everybody to a certain level of health and be able to promote health overall, then it allows people to work longer to, to, you know, To do different things to innovate, to, um, to, to participate in the workforce.

Moreover, it can, it can really raise all boats. And so health is such a basic human need that it's something that I think we should pay a lot more attention to in the policy space and in, in government. Yeah. Uh, in politics as well, because it's not just health insurance coverage. It's so much more than that.

There's a lot more investment we can make in health education. There's a lot more investment we can make in, um, in, in improving housing, affordable housing for people. If you don't have a house, you can't obtain health. If you're living on the street or you don't have stable housing. So what that costs a lot of money downstream as.

Food insecurity. Those types of programs can be very effective at reducing overall healthcare costs and improving the health of people as well. Yeah. So there's a lot of things that I think are low hanging fruit that I would tell the politicians that like, if you want to actually improve the economy, you wanna improve our, our overall well being.

Right? You wanna improve our society. Then let's start thinking about things that, um, are, are impactful to health, like housing, like food insecurity. It's not just healthcare insurance coverage. It's not just Medicare for. If you wanna make a dent in, in, in healthcare services and saving money in healthcare, start with those, those basic needs that people, um, that they need.

So we, we, we have bad housing instability in this country, so let's do some policies and promote some policies that affect affordable housing and things like that to actually improve. Patient health from a very basic level. Um, it'll probably save us money in the healthcare system in, in general, Medicare and Medicaid.

Yeah. But, um, you know, it's not just health insurance coverage. Um, there's, there's more there. So that's something I touch on the book a little bit as well. And, um, that's what I would say to the politicians, um, I think that a rising healthcare tide lifts all those. Yeah. Um, it can help a lot of people and it's something that we should focus on more, more, uh, intentionally.

[00:42:05] Mike Koelzer, Host: I think so Robert, with the current system set up, the pharmacist has more touch points arguably than a doctor. I know that can change as far as telehealth and when more stuff goes, mail order and so on. Where does the pharmacist either fit into this or where might. A pharmacist find interest in 

[00:42:25] Robert Longyear, III: this.

I think pharmacists are extremely, uh, you know, well trained healthcare providers. And I think that there's a lot of frustration I've heard from, from the pharmacist community in that they went through, you know, years of pharmacy school and. They know a lot about this stuff, but they're stuck behind a retail counter or something like that.

And they're not able to, to use the, the full scope of their knowledge. And so sure. What I, what I think is happening and what I've seen in some different companies are, are pharmacists are starting to be able to deliver chronic disease management. Uh, services. So they're able to start doing motivational interviewing interventions to try and help patients, uh, be more adherent to their medications, to be adherent to their care plan and to, uh, also work with that medication list.

So pharmacists do have more touchpoints. So if they do work in a retail clinic, they're able to sort of counsel patients on. On various services. Um, so that's, that's sort of one, one thing I think is, is, is going to be happening quite a bit. So if, if a patient has, if you have a polypharmacy patient with a whole bunch of different medications, I think there's a lot that can be done for prescribing deprescribing suggestions and things like that for, um, what patient should look for as well as looking for potential, um, adverse interactions and, um, you know, contraindications and things like.

So I think, uh, pharmacists are gonna continue to find their way into sort of the primary care space as well. So being able to do medication therapy, management reviews with primary care physicians, and patients. So, um, after you see your primary care doctor, maybe you go talk to the pharmacist for 20 minutes and, um, that pharmacist is able to, uh, sort of walk through your medications.

and to, um, sort of work with you on, on, on making sure that they're a good fit and then you know how to take them and all that information. So, um, that model is starting to become more interesting to a lot of primary care physicians and CMS, chronic care management codes and remote patient monitoring codes also allow for pharmacists to deliver those types of services as well.

So, uh, that's, that's another area that's growing quite a bit, I believe so. Um, because pharmacists have such medication. Understanding and focus, um, and that's their full, their, their skills. Um, you know, as we start to use more medications to deliver, you know, chronic disease treatment, then you're gonna see a bigger need for pharmacist services actually in the clinical environment.

Um, and not just in the pharmacy. So I think that that's gonna be happening quite a bit more. I think one of the core pieces of this as, as you know, Um, is there's been so many new drug approvals that come onto the market who are getting better at making drugs for new indications and, and the biotechnology medical device and pharmaceutical space research is so effective, um, that there's so many drugs to treat different conditions, that finding the right one and, and the right mix of drugs for patients I think is gonna become more important.

So I think the pharmacists are gonna start to find a really strong role there. Um, working alongside physicians because physicians just have to learn so much more, more, more about physiology and things in terms of, um, you know, their specialty that they, they probably don't have time to keep up with a lot of the, uh, the new pharmacy, um, innovations, the new drugs that are on the market, things like that.

So I think pharmacists are certainly gonna start to carve out their own space as a healthcare provider. Um, and I know some states, I know the national pharmacy association. Um, I can't remember what they're called by the American pharmacy association. um, they are really advocating for pharmacists to become healthcare providers in a lot of states, um, so that they can actually bill for their own services.

Um, I know pharmacists, I believe, uh, CMS during COVID 19 has allowed pharmacists to start delivering telehealth care or telehealth services. So, um, I think that that might stick around if we find that that's effective. So. Um, my hope is that pharmacists are able to start, um, using all that great knowledge to, um, actually start to impact patient care directly and to be able to provide services for patients going forward.

This 

[00:46:07] Mike Koelzer, Host: might give a little glimpse of the 

[00:46:09] Robert Longyear, III: future. Yeah. I like to think I've, I've kind of branded it as, okay. These are important innovations that are occurring right now that are going to affect what healthcare looks like in the next 10 years. So if you want to kind of get a sense for. Um, what is changing, what does it mean for the patient for healthcare?

Um, I think it's a good overview of that. I'm biased cuz I wrote the book, but I think if you wanna get a handle on where things are going from technology and policy and sort of the overall healthcare ecosystem, it's a good resource for that. It's all evidence based. Everything's from clinical literature, from policy research or from, um, directly from stories that form, from startups and professors and things like that.

So it's a pretty factual Facebook. It has some personal stories in it. It's basically just an overview. Of where I think innovation's going in healthcare, which will, will impact it. 

[00:46:56] Mike Koelzer, Host: As you mentioned, everybody works through a personal story. You might not even realize it, but all of our dealings have a lot of our history involved with 

[00:47:06] Robert Longyear, III: it.

Mm-hmm I think one of the last things I leave, uh, in the last chapter of the book is I try to start a hopeful tone. So I did lose my mom to, uh, to leukemia. And it really did spark, uh, a, a big interest in, in, in, in me to be able to sort of improve the patient experience with healthcare. And she had great services from her healthcare providers and the care was very good, but, um, you know, there were still a lot of things that happened that, you know, I didn't feel like were, should happen in, in this day and age.

Yeah. There's a lot of technologies we can use to improve things. And so that really sparked my personal interest, but I leave the book with. There's always this sort of big, scary black box of healthcare that, um, is tough to understand is very complicated. And there's a lot of parties that just want to maintain the status quo.

But there's also a lot of people out there. Like the stories I tell in the book of the interviews I did and things like that that I am really, really trying to do. Good. Yeah. And so I, I, I think one of the last things I leave the reader with is, you know, there are people out there that care about this and that are working to try and make this, that healthcare experience thing, a lot more effective, a lot safer and a lot cheaper.

And. You know, those people are working very hard for it. And I, I like to think that because they're coming from a place that is personal experience, so a lot of them have told me a personal story. Like one of the people I interviewed, was diagnosed with cancer. And one of the people I interviewed who was very close with his, his, uh, grandfather who passed away from falling down the stairs, you know, wanted to pursue helping older people live at home.

Yeah. And so those people come from personal stories and so it's very, their work in this space is very much driven. You know, I want to make this better for people, so nobody else has to experience this. And so I think that there are a lot of really good people that are innovating in space and that are working to make things better.

And so I, I hope that I strike sort of a hopeful ending to the book where it's like, look, I lost my mom, but I'm, I'm gonna keep working at this until we get something. Right. Yeah. And I know, you know, Jerry, who's the CEO or C of care, predicts who I interview in the technology section of the book. Um, you know, he.

He told me a very impactful story about how he got set on his path. And he keeps working towards it sort of out of that personal experience as well. And so I know that there's the, most of the people I talked to when I was sort of interviewing people over the book were like, look, I. Had this horrible thing happen to me.

And that's why I just wanna keep working at this. And I think that that's one of the most powerful ways to bring about change. And I know that people are extremely frustrated and have horrible experiences in healthcare. And, um, I like to think that we are working towards something better in the future.

and, uh, the, the good side will, will hopefully 

[00:49:42] Mike Koelzer, Host: win out. There's too many books that end with, well, yep. There we are. We're all divided. And so I just had to tell everybody that yeah. Writing and finishing a book, I know, was a pain in the ass, but just like a marathon runner or, or your wives after childbirth, eventually that pain goes away.

And do you have another book inside you? 

[00:50:02] Robert Longyear, III: I do. So it's funny, Mike, as you asked that, um, we, I do have another one in the works. Um, it's more focused on technology though. I, I can't say much about it, but, um, I, I did end up having a conversation with a, um, another group and, um, I maybe coming out with a, another book in the next year, um, that's a, a little bit more, uh, focused on the, the digital health side.

It's gonna be somewhat related to COVID. Um, as it sort of accelerated the industry. So, um, I might have another book in me, writing a book is a challenge. But if you commit to it and you sit there and you do it, and my publisher was great because they were like, you're gonna meet these deadlines or we're kicking you out of the program.

And, uh, so it was, it was good to have some motivation and they were also very helpful. So I am very supportive. Yeah. And like, you know, gave me a lot of resources and read all the materials and gave me comments and things like that. So I walked through the whole process. You know, it was a lot of nights and, uh, a lot of Saturdays spent writing.

Yeah. Um, it was something I wanted to do and I really learned that I enjoyed doing it. So if you don't like writing, don't, don't write a book. Um, it's not a good experience, but I really like sitting there writing. It helps me sort of solidify what I think. I know, but the biggest thing that I learned from this, and I, I did a, um, a brief, uh, live stream with one of the, uh, one of, one of my previous professors at one point.

But the biggest thing I learned is. There's a lot to learn out there. And yeah, when you put it all down on paper, you learn how much you, you don't know when you gotta 

[00:51:28] Mike Koelzer, Host: fill all the blanks in and all the paragraphs 

[00:51:30] Robert Longyear, III: in. And so you learn that there's a lot of gaps in what, you know, you learn that there's a lot of, sort of like, uh, intersections, a lot of offshoots.

And you know, there's a lot of ways to go with things. It's very tough to keep your scope and it's, uh, also very tough too. To feel like, you know, things. So I feel like, I, I felt like when I started writing the book, I felt like I knew more than I do now. So now that I wrote the book, I feel like I'm, I feel like I know a lot less than I thought I did at the beginning.

And, um, it's a very humbling process to go through. And, uh, you know, like, I, I. I'm publishing an article about why I read the book soon and you know, one of the things I say is like, I, I don't feel. I don't really feel like I know that much, to be honest with you. Um, and, and I think people sort of expect that feeling.

Sure. I also expected that I was going to have this eternal sense of accomplishment. So I, I felt like I, I was gonna get to a point where I just like, was like, constantly very happy that I wrote this book, but, um, I think it's just yet another lesson in sort of this whole growth mindset that the journey is sort of the, the destination, which I, I know is pretty cliche, but, um, truthfully I was, I hit publish, um, with, with my publisher when they got everything set up on, on some of the digital publishing sites and they were like, how do you feel now?

And I was like, I was like, I feel pretty good about it. And then, you know, the next day I was like, well, that's over. Yeah. So, um, it was, it was, it's something I sort of expected to be very excited about forever, but to be honest with you, I just, uh, it was, it was very exciting and it was, the process was fun and I honestly missed writing.

So I'm going to the next one, but, um, it was. it. Wasn't what I was, it was a fleeting moment of excitement. I 

[00:53:09] Mike Koelzer, Host: spent some time making some blog posts for the pharmacy and it ended up at about half of 'em. I said I was gonna do a hundred and about half of 'em were about me and my family and my kids and half were about business.

So I split 'em into two different, two different books, and I just have Kindle, uh, little Kindle books of those. And there might not be. Consistent like joy from it, all the tweets and blog posts. And when, when you can look back and say that is a book there's accomplishment, it might not be the joy and the excitement, but you'll always look back at, you know, that accomplishment.

Mm-hmm we wish you all the best.