"Telemedicine will become a fundamental aspect of care delivery because of its effectiveness"

Puneet Maheshwari, CEO DocASAP Inc. in conversation with Paddy Padmanabhan, CEO of Damo Consulting on the Big Unlock Podcast – “Telemedicine will become a fundamental aspect of care delivery because of its effectiveness”

PP: Hello again, everyone, and welcome back to my podcast. This is Paddy, and it is my great privilege and honor to introduce my special guest today, Puneet Maheshwari, Founder and CEO of DocASAP. Thank you for setting aside your time to join us on his podcast. Welcome to the show.

PM: Thanks for having me.

PP: Wonderful. So, let’s kick this off Puneet. Why don’t you tell us a little bit about your company and the product platform that you’ve developed over the years.

PM: Sure. DocASAP is an access engagement platform. We are pretty unique in the sense that we were both with the payers and the providers. From the very beginning, the mission of the company has been fairly straightforward, which is to streamline and reduce the friction when it comes to helping the patient find the right provider in the right setting at the right time. And while it sounds cliched over the course of the last several years that we have been doing this, we have come to realize that frictionless patient access is critical for reducing costs and improving health outcomes. What we’ve also realized is that payers and providers both lack meaningful solutions for effectively engaging and navigating patients to optimal care providers. What this results in is decreased quality of care with suboptimal outcomes and increased population risks, increased costs with consumers ending up at suboptimal care providers, and purely from the sense of and the side of the patient, fragmented access, which is uncoordinated, leading to frustrations and suboptimal outcomes overall for all parties involved. With that in mind, we evolved the DocASAP platform to have key three core capabilities. One is what we call navigation and matching. We have only one in the industry who will really go deep to fully understand the clinical and operational intake protocols of the providers. We translate those protocols then into decision trees that can be laid or end to end organization’s delivery model and use those decision trees then to help the consumer navigate to the right provider. Over the course of the last five months, particularly while we supported this before, setting or getting the consumer the right setting has become even more important. And that has been one area where we have doubled down over the course of the last five months. The second part of our platform is around accurate scheduling and the operative word there is accurate. We connect real time to the underlying practice management system and then also take into account all the considerations that the providers put in terms of managing their time and how they want to fill their appointment slots. With that information in real time access to that inventory, we then enable consumers to book their appointments instantaneously across all pathways that they use and trust. And the third part of our platform is what we call actionable engagement. And again, the operative word here is actionable, which is pre, peri, and post of an encounter. How do I enable the consumer to be prepared for that appointment, how do I remind them for that appointment, how do I make it easy for them to reschedule or cancel? And then post appointment how do I engage them for follow up care, which may be pertinent for the last encounter that they just had? And the key really is taking this platform and then touching the consumer across the care journey from when they’re searching for a provider, helping them select the right one, helping them schedule for a timely appointment across all different kinds of care settings that may be pertinent helping them prepare for that appointment and then engaging them for all the follow up care that may be needed from thereon. Where we’ve taken significantly farther is how we deploy this platform, because what they’ve come to realize further is that consumers use diverse and heterogeneous parts for finding care. On one side we power all sorts of digital channels, such as providers owned web and mobile properties or their digital front doors. We work with some of the largest health plans in the country to power their member engagement and doctor finder applications. We power search and social sites like Google, my business pages or embed our capabilities across other social sites. But then we also realized that there are other established pathways that the consumers take which are not digital, such as we enable access centers to have this capability so that they can help the consumer to help them get to the right provider within their health system. The power of similar capabilities for community providers or ambulatory providers so that they can refer patients into a specialty care, radiology lab, et cetera. And then we accentuate our capabilities in acute discharge settings. So, the discharge teams of hospitals or emergency departments can streamline, follow up care for the patients out there getting discharged from the acute settings.

PP: You’re in an interesting space. And by the way my firm, which is a digital transformation advisor firm that works with a lot of health systems and health plans, we are on the other side of the equation. We actually look at patient journeys and we look at all the different digital engagement opportunities or touchpoints and what kind of tools and platforms that are there that can enable that. And clearly the doctor finder is now getting more important than ever because consumers or patients are getting access to care and doing a lot of the things related to that access online and as. So, it’s kind of a mode. We are seeing this gaining importance. Let me ask you a couple quick questions about the landscape you’re in and then we can switch to other topics. When I look at the technology provider landscape for a situation such as yours, firstly, you’ve got the core systems of record, if you will, the big electronic health record platforms and have some of the functionalities that you just talked about. And then you have at least on the health provider side. And then you have the competitive landscape where there’s multiple tools out there that could be competing with your core platform. This is a find a doctor kind of capability. So, when you put yourself in that mix. Do you see your platform as something that complements what EHR systems do on the one hand? Is it a replacement, maybe a better tool compared to what they have native to their platforms? And what else is it that makes you a little bit different and unique? If you could just point out one thing that makes you different and unique.

PM: Let me touch both of those points because those are separate entities in terms of how to think about the overall problems. So, when we think about EHR or electronic practice management systems, what we’re realizing, working with several of our large enterprise healthcare delivery, clients that, EHR systems are built with providers in mind. So, they are more inward facing. And the solutions that have been developed are also developed with an inside out mindset, which tends to have platforms and solutions that do not really work and direct to consumer settings. You really need to apply an outside in mindset when you’re looking at how to engage the consumer and how to really engage the disengaged consumer, if you will. And that has been one big differentiation, that we have been able to bring to our provider clients. Another thing to think about is the space overall. While EHR organizations and practice management organizations by definition are health records or tools for managing practices, they are not really digital tools for enabling access and engagement for the consumers. So, it’s a completely different category in that sense. And some EHR service providers are looking to play in that category. But in most cases, they are still focused on their core business, which is around robust health record systems and robust practice management systems. Now, coming to the competitive landscape that we play in, particularly in the context of that digital front door, I would say that there are two core differentiations that we bring to bear compared to anybody else in the industry. One, we are not a point tool, we are a much broader platform that takes into account the overall patient journey and not just finding the doctor and help the consumer in that journey across all pathways that they use and trust. So, the holistic nature of the platform is one thing which has been a big differentiator for us as we have worked with large health organizations. The second piece, which is highly differentiated for us, is the ecosystem that we have been able to bring together as we solve this complex problem of helping the consumer get to the right provider, right setting the right time. And what I mean by ecosystem in this context is how do you really bring the payer and the providers come together and do and achieve the results in a collaborative way and deliver the coordination that is needed for the patient or the member? Whichever way you look at it, for better outcomes and reduce cost structures. And so, on that side, on one way we work with the large provider groups. But then we also work with large payers and then connect them together through our platforms such that at the end of it, consumers get what they need to get from an access and engagement standpoint. And that ecosystem is a very unique thing that we have been able to bring to bear, both for our provider clients as well as our payer clients.

PP: Very interesting. And that is actually a perfect segue to the next topic that I wanted to explore with you. Your firm recently did a fairly significant survey of consumer attitudes and consumer preferences as it relates to online engagement with their providers. And in the wake of COVID-19, we know that many things have been forced upon us. And I think your report goes into aspects of this new normal that consumers have adapted to very well and some that they have not particularly adapted well to. You want to touch upon some of the highlights of this. What was the driving force for doing this survey and what did you hope to accomplish? Tell us a little bit about some of the key findings from the survey.

PM: Yes. COVID-19 has been a very high impact phenomena for the healthcare industry and Paddy you are seeing this from your vantage point. And we are definitely seeing it from ours. I would say we are seeing close to five years’ worth of innovation acceleration happening in three to five months. And that is creating a significant disruption, if you will, at a pace that has otherwise not been experienced by the healthcare industry. And that brings me to the survey that we did and why we did that. As we were seeing that disruption happening. It was important for us to start understanding the underlying themes that were driving that disruption. And where should we then expect the new normal to fall was equally important for us to understand. The underlying themes essentially fell in three broad categories. One was around contactless access, and that theme was there before the pandemic and which got dramatically accelerated during the pandemic. I think we were already on that journey. But as I said, we saw that five years’ worth of acceleration in three months. The second piece that we wanted to understand was how this is really affecting consumer behavior and provider behavior overall. And the third piece was around looking at what are the foundational pieces that would need to be put in place to help our customers be the payers or the providers aligned better to those major trends that will be coming out of this pandemic. So that was the fundamental premise for doing the survey in the first place. So, we did survey around thousands U.S. adults those who had used healthcare provider in the last 12 months. And the learnings are pretty interesting. So, one no surprise there was this massive utilization of telemedicine beyond what it was. And the adoption was kind of increasing 92 percent of our respondents who have had a telehealth appointment said that they were satisfied, and their overall telehealth appointment experience was positive. When asked to describe their telehealth appointment experience, the top three descriptors were easy, efficient, and convenient, if you will. And those are fundamental themes, again, that we have to understand to say ‘Ok where the pick is going to be. Eventually, consumers, stations, members are looking for convenience, efficiency, and ease. And as a healthcare solution provider helping the healthcare providers overall. We need to think through what will help the consumers get that ease, efficiency, and convenience. But what was also very evident was the anxiety where in-person visits, at least in the short term. We heard loud and clear that respondents were not comfortable going back to see a health care provider in person until at least the fall. And there was a proportionate number that said they are not comfortable going back to a doctor’s office until early 2021. It’s pretty amazing when you start comparing the results and see that the respondents felt safe for going to a grocery store or a hospital or a doctor’s office and in a doctor’s office or somewhere around 26 percent compared to a grocery store, which was 42 percent. And those things are pretty eye-opening as you start thinking about how we going to go back to normal and how will we convince these consumers around the safety of the care that can be delivered within in-person premise. And as we started kind of taking that and talking to our customers, we started realizing that telemedicine is here to stay. And if you look at, you know, secondary searches done by firms like McKinsey, you’re seeing a massive shift of care delivery dollars going through telemedicine. But there’s also a realization that you cannot think of telemedicine in a silo. It’s not just about, you know, on-demand acute care. It’s about how do we blend telemedicine into the overall care delivery continuum. And how do we then make sure that the consumer, based on their specific needs, is navigated to the right care settings? So, if it’s a first appointment, which requires an in-person visit and you’re helping them get that in-person visit. But if it’s a follow-up, which can be done remotely through a video visit or a phone call. The consumer’s navigator to that. And enabling that streamlined, flow of care delivery across those different care settings is one foundational piece that has to be solved by the care providers as we move forward. I would say the biggest takeaway, which shouldn’t be any surprise to anybody, was that telemedicine is opening the digital front door to the digital practice now. So, the world is moving to digital-first when it comes to health care. And you would see a massive acceleration towards that mindset both from the consumers as well as the providers as we get out of the pandemic and start thinking about what the new normal is going to look like.

PP: Yeah, everything that you said makes a lot of sense, especially in the immediate wake of the pandemic. I want to unpack that a little bit. So, what I do like about your earlier comments is the B2C focus that’s never been part of how healthcare operates in the past, at least. And now, in fact, my latest book, which of healthcare digital transmission, the subtext to the title as how consumerism, technology and pandemic are accelerating the future. We already covered two of them. Consumerism and pandemic and of course, we are in this podcast is all about technology and how it is driving transformation in healthcare. The consumerism aspect of it is the unfinished business. It’s still in early stages. We found the same thing that you talked about, which is that yours were the transformation effort has now been compressed into a matter of months and is putting an enormous amount of strain on organizations while dramatically altering the ways in which healthcare is access to consume. At the same time, the more recent data that’s based on our research, it tells us that we swung a little too far to one extreme in terms of virtual care models, telehealth, telemedicine, real time, virtual consult things like that. In the immediate wake of the pandemic because there was no option. But now it’s all pulling back a little bit. And, you know, there’s some kind of a variety of reasons, some kind of care cannot be done remotely, whether you want to or not, whether the technology is available or not. And then, of course, there’s a question of all of the revenue dollars. And in healthcare, you know, everything you need to follow the money right. Now, where the reimbursement is coming from, what are the puts and takes in terms of lost revenue versus what you can gain from telehealth visits and so on? So my question is, do you feel like you’ve reached some kind of an equilibrium? And if not, how long do you think if you were to look out a little bit, how long do you think, before we get to a point where we say, you know what, this is going to be a 60-40 split for all primary care visits between telehealth and in-person visits. Something like that. Can you share your thoughts on that?

PM: I don’t think we have gotten to an equilibrium right now. I think we are still in the middle of the pandemic. The surges are still happening, and members are still kind of going back and forth in terms of our level of comfort around whether it’s behind us or not. So, till the time that’s going on, I don’t think there’s going to be a very meaningful equilibrium that is reached. Having said that, there is an equilibrium eventually. And when I think about that, I think in two big parameters, if you will, one parameter is the disruption that is happening. And if you look at the new normal, I see the disruptions happening both on the business model side as well as on the technology side. And, you know, it’s easy to manage one disruption when it’s happening. And this is a bit of a perfect storm of sorts where we are having these still disruptions happening at the same time, which means that there will be winners and losers and organizations will have to really embrace these disruptions and navigate through them with the nimbleness and ingenuity. The second piece is around, you know, what are these disruptions really driving? And in my mind, the reason why telemedicine is here to stay and become a fundamental aspect of care delivery, if not the preferred health care delivery, is the efficiency and effectiveness aspect of delivering care to that pathway. And you touch the effectiveness part of it by highlighting how certain aspects of the care cannot be delivered in a virtual setting. But I think that’s a moving target in my mind. I think what we have come to realize is that more and more care can be done in a remote setting that doesn’t always mean that it has to be over a video call or a phone call. It couldn’t be through remote monitoring. It could be through shipping diskettes to individuals so that they don’t have to come to a lab and get exposed to other kinds of infections. It could be about augmented reality in future. I think the theme has to be consistent and till the time theme is consistent. The technology will catch up to that and one way or the other. And the theme really is that when you deliver care in a virtual setting or in a setting which is at home for the consumers, more efficient for the consumer and the provider. It’s more cost-effective. It’s less risky. And those three points are critical as you think about delivering ambulatory care of the future. So, in my mind, the world is moving to digital-first care delivery. The pandemic was a very strong impetus to push us in that direction. And you’re right, we probably swung a little too far on that side. But what it has also done is it has opened the eyes of the consumer and the providers, I would say, on the benefits that come out of it around efficiency, around cost, around the overall risks. And what that means is now the technology is going to be following that trend and we’ll be solving things that we haven’t seen solved till now. And you and I will both be very surprised end of 2021 on the amount of care that can be delivered in a home setting.

PP: Yeah, I think I agree with you there. What are you seeing in terms of the demand environment coming down to the real situation on the ground, if you will, for one of your own products and services? But in general, for digital health capabilities and the kind of tools and platforms that health systems in particular have to invest in order to prepare for this new normal or next normal and really position themselves for the inevitable digital future that you just talked about.

PM: Yeah. So, again, I would put it in, you know, two horizons. One is the immediate horizon. Another is the more midterm horizon. The immediate horizon is about helping our customers in my mind. Many of our customers are really struggling financially, given what the pandemic threw at them. Ambulatory visits dropped almost 50 percent for several of the providers across the country. And when the pie shrinks, you can only a vendor. You have to be a partner. And that is the approach that we are taking. What we are also realizing is the opportunity that this crisis is creating for our customers and for ourselves, which means that we have to double down in the investments that we are making for that midterm to long term growth that we can expect in the digital capabilities that are going to be used in the market. So, till the time we keep that set of horizon and mind, I would say at this point in time, yes, we are seeing a lot of demand in terms of providers realizing that they are behind the curve on some of these capabilities. But we also understand that they themselves are struggling financially. So, we are approaching it a very partner-oriented mindset. And then we also realize that nobody really knows where technology is going to be in two years, three years from now. And the companies that are going to be successful or companies who make their investments listen to their customers, keep their ears to the ground and execute. So those are the two ways we’re looking at the market and we believe that we are pretty strongly position with partners and customers that we have. We have been able to associate ourselves over the course of the last several years, and it’s going to be a very exciting ride as we move forward. I wish we didn’t need a pandemic for all of this to happen. We all would have been happier without it, I’m sure. But if there is a silver lining to any of this is the fact that we all are becoming more open to change and change is the name of the game if we want to move the needle on cost and quality in the U.S. Healthcare.

PP: Right. Never waste a crisis, as a wise man said. Well Puneet, it’s been a fantastic conversation. I’m afraid we’re going to have to leave it there. We’re coming up to the end of a time. But I wish you and your company and all the very best. You guys are in the right place at the right time. It looks like and I look forward following your company and the progress that you make. Thank you again for coming on the show.

PM: Thank you so much for having me, Paddy. It has been a pleasure.

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity