BTO_Meg Barron: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.
Emmanuel Fombu:
Welcome to Bite the Orange. Through our conversations, we create a roadmap for the future of health with the most impactful leaders in the space. This is your host, Dr. Manny Fombu. Let's make the future of healthcare a reality together.
Emmanuel Fombu:
Good morning, good afternoon, good evening, ladies and gentlemen. Welcome to another episode of Bite the Orange. And today, we have a very special guest that comes all the way from the American Medical Association. And if you know her, then you're lucky, and if you don't know her, then you're about to get to meet her. And that person is none other than Meg Barron with the AMA. Welcome to the show, Meg.
Meg Barron:
And thank you so much, Manny. It's a pleasure to be here.
Emmanuel Fombu:
Thank you. So why don't we start out, first of all, for anyone that does not know Meg, or for those that know Meg, who's Meg? How should we know you? You're based in the Midwest right now, but what's your story?
Meg Barron:
I'm based in the Midwest, yep. So I have the pleasure of serving as the Vice President of Digital Health and Innovation for American Medical Association. For those that aren't as familiar with American Medical Association, it's the largest organization of physicians in the country. So AMA, we represent physicians in every state, every specialty, all practice settings across the country. My team and my team's role is really focused on how do we help to make technology an asset and not one more thing or one more burden on patients, and physicians, and clinicians. So we focus primarily on research. We focus primarily on resources based on gaps and opportunity areas from that research where we can help to scale evidence-based technology and innovations in market.
Emmanuel Fombu:
Which is quite interesting. So how do you get such a role? It's quite interesting. It's an amazing role, first of all, amazing title. Absolutely. I'm sure it's one of those roles that just one that just pops up, and then Meg comes out of nowhere and just like, yeah, comes in and scoops it up, right?
Meg Barron:
... Yep. So yeah, my background actually, I started my career at a place called Smithbucklin Organization Corporation, which ironically is in AMA's headquarter buildings in Chicago. Now, they ended up moving over there but worked with business and healthcare clients and largely in more of an agency setting of sorts, ended up going to Capgemini, a global consulting firm for a bit, and then made my way to AMA, which has been really exciting to see both my own personal progression there, but also the progression of the organization. So I started more in a segment manager role where I was helping from both a membership marketing standpoint as well as how do you go about identifying the right resources and research and initiatives for different segments of physicians. So think, for young physicians, for International Medical, Graduate Physicians, for employed, Physicians for Women Physicians. So that taught me a lot about the space in general and also the both needs and value propositions that physicians in all different practice settings were really looking for. From that work, it really led into a new product development and portfolio management role, and this was a net new division for the AMA, and it was really also a recognition at the time for the AMA that we had a new CEO, or new-ish CEO, I should say, at the time, Dr. Madera, who's our existing CEO, who had a great vision as well as helped us really land on three major initiatives for the organization. And those three major initiatives are around reimagining medical education and lifelong learning for physicians. And so if you think about it, historically, for 100-plus years, right, medical education really hadn't been reimagined or disrupted that much. So this initiative helped to work with medical schools, and now it's moved on to also include residency programs across the country to help them do just that. So I think for the business side of medicine or for technology, what new education, or really, curriculums are needed to be able to really face the realities of today and really help to make physicians feel empowered for the realities of today. The second is around improving health outcomes, and that's where we have a focus on hypertension and prediabetes and helping to really improve the health of the nation, particularly around those two key areas. So I can get to that in a minute of where, of course, technology has a role to play there. And the third kind of umbrella initiative is around improving physician satisfaction and practice sustainability. So a long way to say, how do we address a lot of the administrative burdens? So think prior authorization, think around EHR and frustrations with the EHRs, and really anything that's taking away face time, and that could be in-person face time, or virtual face time, between a physician and a patient. And the reason you know well, Manny, right? That's why you got into medicine to begin with, and then you've got all this kind of red tape and administrative issues surrounding that. My team, while we cut across those strategic initiatives, we technically sit within that third one with the goal of how can technology help to really address a lot of these administrative issues or burdens in a nutshell, really help to make improvements that, again, right now can be really wrong with just a lot of administrative red tape. And I say all that because from that role had the opportunity to really work with a number of different departments across the AMA to figure out what products and solutions are and were at the time being most impactful and then where we could re-orientate some energy to have even more impact overall. And that led us down a path to start working with because this was about six, seven years ago at the time to start working with some different health tech accelerators and incubators that were just popping up, especially for anything related to new product development. Of course, there's things that we could develop just in-house, but then there's also the recognition of where we could be moving faster or again have more impact if we're partnering or collaborating with some companies or even emerging technologies and solutions. This is a winded journey of how I got involved in some of these health tech accelerators and incubators, such as MATTER, which is in Chicago, and the Merchandise Mart in our own backyard of AMA. Dr. Madera sits on the board of MATTER. I sit on the advisory board of MATTER. It's home alone to over 200 healthcare startups and really two main facets here. One, we were getting involved because we wanted to identify where there were any solutions we could partner or collaborate with. But then two, it was how do we help to ensure that as much physician and patient feedback and involvement is getting included into these new solutions as early stage as possible and really as often as possible. So now there's these health tech accelerators, incubators, and pretty much every major market where we've got either formal or informal relationships. And that's really been my entree into digital health because, at the time, it was being referred to more as just health tech or technology and healthcare or health IT, information technology, and mostly around interoperability and EHRs, and digital health was this, at the time, somewhat nascent-ish space of, All right, we know and recognize there's all these emerging different solutions, but how do we help to start this off on the right foot, especially with lessons learned from the electronic health record? So I'll stop there, but yeah, that's been my journey into the digital health, both area, as well as the development of the team at the AMA.
Emmanuel Fombu:
Meg, that's the most, actually most comprehensive and thorough definition of digital health I've ever heard, because I had roles where I've worked in medical education as one side of it, right? Which today, if you go to most conferences, either they focus on clinical trial recruitment, right? Or if you go to other conferences, like EHR conversations, right? And the very few people actually focused on that side of medical education as well, right? So looking at curriculum development. So I think probably that definition, with your experience, you actually covered multiple facets of this thing. So with that being said, if I was to ask you to define what digital health is, what would you say?
Meg Barron:
From my lens, personally, it's technology that can help to be, again, an asset versus a burden for healthcare overall.
Emmanuel Fombu:
Perfect. And I think that's a much proper way to define it, right? And it could be across the entire healthcare spectrum. With that being said, you have a pretty unique perspective. Most companies in the digital health space or vendors, they're trying to approach clinicians, and many clinicians as well that also develop solutions, they're trying to get out in the market, and some of them go to these incubators and accelerators like MATTER, for example, that you talked about. So with that being said, what are some of the key challenges that you've identified so far with actually making progress in this particular field? And after that, I'll go into telemedicine. But in general, what are some of the challenges that you face so far?
Meg Barron:
Yeah, it's exciting because there's always work to do, as you know well. But I would say right from the get-go, we were recognizing that, how do we scale getting more physician, more patient, more clinician feedback into all of these emerging technology solutions, right? And I mentioned previously just lessons learned from the electronic health record and the fact that that became such a frustration point for physicians. And a lot of that had to do with not of a lot of physician involvement in the product development of those solutions and technologies. As such, when we started getting more involved in a lot of these health tech accelerators and incubators, that led us to start playing a lot of manual matchmaker as well between companies saying, Hey, we get it. We want more physician involvement in what we're building. Or for us to have a pulse check if we're on the right track, or we want a physician advisor, or a board member, or even a full or part-time chief medical information officer to get involved in our company. So we were playing a lot of manual matchmaker, right? Helping find physicians who had an interest in this space, which again, remember, was quite nascent at this time, as well as for companies to help find the right fit for them to get the proper feedback and involvement early stage. So we ended up building a platform called AMA Physician Innovation Network. And really, you can think of this as a Match.com to help connect physicians, health tech companies, and then really, others in the industry that have an interest or lean or are utilizing digital health to some degree. And this is 100% mission-driven, it is free for any company of any size to join and to put an opportunity for a physician to get involved, and those opportunities could either be paid or unpaid opportunities. Of course, I think the paid opportunities, because of how busy everyone is, if possible, that's always helpful to get the right feedback and involvement. But now we have over 19,000 users on the platform, and I'd say about a third of them are physicians, and the rest are either startups, companies, organizations looking to get involvement and feedback from the physician community as well as other stakeholder groups like large employers, payers, VCs, right, that are looking to better understand what emerging solutions are there, as well as how to get the proper physician feedback included in what they're doing.
Emmanuel Fombu:
And that's quite fascinating, actually. I'm a member of the network actually myself, and I'd be quite impressed even with some of the working documents that you created, right?
Meg Barron:
That's great.
Emmanuel Fombu:
They're pretty detailed in terms of how to give backgrounds, they actually give clinicians kind of the framework in how to identify solutions, right? And I think it's a place people come to get to gain confidence about this. So that may be, because one of the frameworks I actually liked a lot was the one around telemedicine, for example, right?
Meg Barron:
Okay. Yeah.
Emmanuel Fombu:
And this is like pre-COVID and then COVID getting in and how you adopt the best solutions, evaluate solution, and select them. So tell me about that process of how this worked, because there's a lot of confidence in this, right? AMA, of course, right? You have clinicians believe, members. So tell me how that process works in general.
Meg Barron:
Yeah, great question, and I'm so glad that you're utilizing those resources as well, and we've heard similar things, which is great. And maybe I'll take one step back. So in 2016, when we initiated the Digital Health division at the AMA, we really wanted to get a pulse check of what physicians were utilizing in practice in 2016. And this is outside of or taken as a given that they're utilizing an EHR at this point in time, right? But what in 2016, as it relates to, think telehealth and e-visits and remote patient monitoring and clinical decision support tools, what physicians were using in 2016, what they were excited or enthusiastic about utilizing the potential of, and then what their key requirements for adoption were before utilizing or ending up adopting any of these technologies. And what we found was, and we're pleasantly surprised that physicians, and again, even this is 2016, were quite enthusiastic about digital technology, and that enthusiasm was directly tied to solution's ability to help them take better care of patients and help them get more face time with patients. And instead of having their back to the patient just plugging into the EHR, what can help save them time or help deliver better quality care? And then the other components that we learned as part of the top line from that research were that they were anticipating to use more of these technologies. They weren't so much at the time utilizing many things like telehealth, remote patient monitoring, even, to some degree, yes, clinical decision support tools. But what we heard loud and clear were what the key requirements for adoption were, which really fall into four key buckets around, prove to me this works and has an evidence base proper evidence base to it. Prove to me that there is a fair payment pathway or reimbursement structure if I'm going to use this or prescribe this to a patient. The third is around liability. So who's going to be liable if I use this, or again, end up prescribing this to a patient? Who holds the liability for that? And then lastly, and this is where we spend a lot of time, and this gets to the telehealth playbook that you're mentioning, Manny, which is the change management aspect of introducing one more thing into a very overburdened workflow already. So people often think, or often with the companies or startups that I'm talking with, well, it's just two more clicks, or if you just go to this portal instead of this portal or, and this portal, then you know, easy peasy. And when you've got an average physician that has 4000 clicks a day in an EHR asking them to add 2 to 3 more clicks to something just often is not going to work, right, and be a nonstarter from from the beginning, versus something that could potentially help save them 100 clicks a day or give them back two minutes of time a day and thinking really comprehensively on how, right, the integration and adoption pieces of that have to be there not only for them but for the rest of the care team that's going to be involved in utilizing or adopting any new technology. So those four key requirements have really become foundational to our strategy and really have helped to be the springboard for any new resource or research or really program or initiative that we've kicked off. And what you were referencing is something called Telehealth Implementation Playbook, and we started this implementation playbook series, Digital Health Implementation Playbook Series in 2018, and the first one that we did was for remote patient monitoring. And this was an example of where we knew remote patient monitoring is evidence-based, and we could point to the evidence for that. We knew that through something called the AMA's Digital Medicine Payment Advisory Group and their work to help to show the evidence that was already there, that helped to make the case to the CPT editorial panel to actually get new codes created for CPT codes, for remote patient monitoring. As you think about the potential for reimbursement from that, then there was CPT codes that, again, could start getting covered and paid for remote patient monitoring. The liability piece of that, we also wanted to highlight, right, where, again, the right steps are being taken to ensure that there was a confidence index, that the liability was in a good place for any physician or health system that would be utilizing this. And then lastly, this playbook primarily focused on the change management that goes into just adopting and integrating a new technology such as remote patient monitoring or telehealth into environments. And our approach for this was we did qualitative interviews with different stakeholder groups and different practice settings, so think large health systems and then even private practices, to show where there were successful use cases and case studies of this technology getting implemented in. And this was all pre-COVID, right? So this was showcasing, here are kind of novel and put that in air quotes like steps that you can take to introduce these solutions that, again, evidence-based, that you could feel a level of confidence around. And let us show you a blueprint of sorts of how people have gone about effectively introducing these into their workflows, how they've aligned, what success looks like to them, and then how they're measuring and really quantifying the outcomes, as it relates to just introducing one net new thing. And at the end of the day, how we like to think about this, is the juice going to be worth the squeeze, right? If you introduce one more thing, and this I think speaks well to the topic of your podcast, Manny, but is the juice worth the squeeze overall in terms of, is layering in and taking the work to integrate this into my workflow going to be worth it in the end for my patients, for the care team that I'm working with and of course for myself?
Emmanuel Fombu:
Which is quite interesting and fascinating. I really love that groundwork that you put in, especially, look at the lobbying efforts, look at CPT codes they brought in. And this was in 2018, like you mentioned, right, ... in 2016 and in 2018, and then 2020 hits, right? Now, we have, right, so now we're in full COVID mode where now, our remote patient monitoring telemedicine is not longer a luxury or luxury thing to have, right? So now people are adopting it.
Meg Barron:
That's right.
Emmanuel Fombu:
So did you see any kind of like massive adoption, or hopefully, you did?
Meg Barron:
Yeah. Definitely yes, right? And this was where it was good to have some future-focused programs already that were established. So things like these playbooks that we ended up just drastically expediting the timeline to finish, as well as something called a telehealth initiative, where we actually worked with different state medical societies to identify practices that were under 50 physicians and clinicians that were in those practice settings. So they didn't necessarily have the resources of a large health system that was interested to set up telehealth. So we helped them actually get telehealth integrated into their practice environments. Again, an example of where we drastically expedited the timelines and had a lot to show for it at the end because we ended up creating something called the Telehealth Immersion Program, where we took a lot of the insights and learnings from the practices that on the ground were not only adopting telehealth. And just as, for context, 50-plus percent of physicians use telehealth for the first time during the pandemic. So if you use as an analog electronic health records and the amount of frustration that went into the adoption of just this new technology that was disrupting workflows, the fact that enthusiasm was as high and continues to be as high as what it is for telehealth, I think is a great sign that if and where a technology can really fit a need, people want to adopt it, right? But again, it has to help really meet those key requirements that we were mentioning earlier.
Emmanuel Fombu:
Now, ... I read a book several years ago by Robert Wachter, Dr. Wachter called The Digital Doctor, right? And it's a big focus on the EHR kind of component of this, or conditions being in the hospital. And then we've had the telemedicine period, the have the remote patient monitoring period, where you see the telemedicine companies or the ... companies coming together because from healthcare. So with that being said, as we look towards the future, what key technologies do you see impacting our space and actually shaping what the future healthcare looks like from the AMA perspective of your perspective?
Meg Barron:
Yeah, great question. I think we still, there's always work to do, just in terms of the, really, optimization of technologies such as telehealth, and now, how do we help to best blend in-person and virtual care? So we've termed this, or we speak to this largely as digitally enabled care, right? So this is in-person and virtual being as well integrated and coordinated as possible. So I think there's a lot of work to still be done to make that as efficient as possible, especially based on use case. I think the areas and from the baseline digital health research that I was mentioning that, again, we started in 2016, we repeated and launched actually a month before COVID hit in 2020 is when we released that. And then we did a latest iteration of that just this past year, and the key requirements have remained the same, I will say. But we did ask in this last iteration about emerging technologies, so think digital therapeutics, think AI, think virtual reality, and what physicians, again, were utilizing today versus what they were excited about utilizing. And I'll say that current utilization of things like AI or at least the acknowledgment or understanding if they are using AI in practice, and this is again in 2022, was 1 in 10 physicians, right? Same for digital therapeutics. But the anticipation to use, and this is even pre-ChatGPT being every headline that you can possibly imagine, the anticipation to use is quite high, right? And the receptivity to use technologies such as AI and digital therapeutics, quite, it is there, but it all gets back to those key requirements around, show me the evidence, show me the outcomes, right? Show me that the liability and kind of reassurance that if I use this, it's going to be there. And then last but not least, that workflow integration piece and workflow adoption piece just has to be as streamlined as possible.
Emmanuel Fombu:
That is quite fascinating, and I agree. I know we're running out of time, but I'll ask you one last question. If you have time for one more minute. One more minute?
Meg Barron:
Yes.
Emmanuel Fombu:
Right? One minute, and I'll let you go. So with that being said, so do you intend to build some of these playbooks out for beyond just telemedicine? And do you see like maybe playbooks in AR or VR? Is that something that you should be going?
Meg Barron:
Yeah, yeah. Great, great question. So two things. One, yes, very, very soon we will have our latest playbook out, which will actually be on health-at-home. And that is a new model of care, right? Health-at-home, or to some degree, everything old is new again, right? Of how do you make it as efficient as possible to have a health-at-home model of care? The other that we're working on is actually on AI and showing the varying use cases in both device-based AI as well as non-device-based AI, things like ChatGPT. What use cases are being utilized in practice today? And then to some extent the risk stratification of that of if you're using AI for administrative purposes versus for clinical decision support, vastly different, right? And then in things like our future of health immersion programs. So we actually pivoted the name from Telehealth Immersion Program to Future of Health Immersion Program to be more overarching of a lot of these different tools, technologies, that are getting utilized today. We have an upcoming session in collaboration with the Digital Therapeutics Alliance, where we'll be talking through both what our digital therapeutics as well as existing case studies and kind of the evidence to back that up, and one coming up around virtual reality and augmented reality and how that's getting utilized in practice today and again where outcomes can get pointed to. So please check those out. Those are all freely available on our AMA website.
Emmanuel Fombu:
Thanks a lot, Meg. This has been quite a fantastic conversation. I'm sure the audience has been listening will have linked the contact information below the show notes. And Meg, I would love to have you again on the show. I'm sure there are multiple things to talk about, and in different verticals, so I'd love to invite you again.
Meg Barron:
This is great. Yeah, really looking forward to it.
Emmanuel Fombu:
Thank you, and thanks for your time today and hope to see you again soon.
Meg Barron:
Of course. Yeah, you too. Thanks, Manny.
Emmanuel Fombu:
Thank you for listening to Bite the Orange. If you want to change healthcare with us, please contact us at info@EmmanuelFombu.com, or you can visit us at EmmanuelFombu.com or BiteTheOrange.com. If you liked this episode and want more information about us, you can also visit us at EmmanuelFombu.com.
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