OptimizeRx Corporation (OPRX) Earnings Call Transcript & Summary

All right. Welcome, everyone. We're going to give it a few more seconds for more people to join us, log in. We're super excited to have all of you join us for this very exciting and very timely webinar. So let me see -- you people are punctual, and we love this every webinar, the amount of people who are signing on, like, right on time. So a little run down in the meantime. I want to officially say, hello, and welcome to our series: Learning Together, Navigating COVID-19. Today's session is: The Rapid Adoption of Telehealth. Will it stick? OptimizeRx is facilitating conversations, connecting key industry stakeholders to help drive innovation, collaboration and education to help stop the spread of the coronavirus as we explore the transformational changes occurring in health care. Joining us today are Carla Smith, CEO of Carla Smith Health and Former Executive Vice President of HIMSS for 17 years. Carla recently spearheaded the American Telemedicine Association's quick start guide to telehealth, a resource where providers looking to quickly establish telehealth services during a public health crisis. Also joining us is Randy Parker, Founder and CEO of Genius Rx. Randy has 30 years of experience, starting and building successful disruptive consumer-focused companies, including MDLIVE. Our moderator today is OptimizeRx President, Miriam Paramore. Now just a few reminders before we start. You can submit your questions via the Q&A button on your screen at any point during this webinar or yes, you can also e-mail us at [email protected], and we'll be happy to direct your questions to the appropriate person. When you submit your questions, know that we will be answering them or panel will be answering them at the end of the discussion. And again, if you send them via e-mail, we could also answer them later. And now let's get started with Learning Together: The Rapid Adoption of telehealth, Will it Stick? Miriam, all yours.

Thank you so much, Myra. Hi, everybody. Thanks for joining. Hi, Randy and Carla, it's so delightful for me to talk to you guys at all. We're great friends. We're great professional collaborators. And today, this is a topic that we all hear about and are very interested in. And guys -- for you guys listening, Carla and Randy are both true experts in telehealth. So I want to kind of kick us off by asking Carla to sort of introduce yourself a little bit and frame telehealth from your perspective. And then I'll -- Randy, you introduce yourself and frame it kind of quickly from your perspective, and then we'll get into some meat. But I want people to know who you are. So Carla, do you want to self-introduce real quick?

Sure. Thanks a lot, Miriam. And I really appreciate OptimizeRx creating this webinar and the education that is going to happen today, looking forward to the conversation. So I am an executive strategist, 100% focused on the health care space. I run a strategic consulting company and have been doing so for about 1.5 years now. Prior to that, as Myra mentioned at the very beginning, I ran the North American Division of HIMSS for 17 years. And as part of those responsibilities, if it happened in North America that rolled up to me as a member of the executive management team. So while I was at HIMSS, I launched the public policy efforts, the thought leadership efforts, all of the subject matter expertise and research, et cetera. And by the way, I also was the leader of the team responsible for that little event known as the annual conference. Before I was with HIMSS, I spent 10 years running the vendor trade association in health IT. So I have been in this space for a very long time. And as we were preparing for this webinar, Randy reminded Miriam and me that MDLIVE was founded in 2005, which seems like an EON ago, but so much has happened. I can remember just before 2005, the then Chair of the HIMSS organization during an annual conference where everyone was assembled in the big meeting room, of teaching everyone how to pronounce the word interoperability. And that was only a year or 2 before MDLIVE was founded. And how much has happened in this last 1.5 decades. So one of the things that really catapulted the use of digital health in the health care market, of course, is a meaningful use program that came into play. And getting all of that infrastructure and all of those pipes in place then made it possible for us to think about the promise of new modalities of care such as a telehealth. And now, today, right now, literally, in the time of COVID-19, there is an absolute explosion in the use of telehealth which is why OptimizeRx has brought us all together so that Randy and Miriam and I can talk that through with everyone and help you engage appropriately. So thanks for the opportunity.

Thanks, Carla. I'm going to come back to you in a few minutes and talk about the American telemedicine guide and all the different kind of...

Absolutely.

How-to guides. Randy, I'd love for you say a little bit more about yourself and then tell us what, in your opinion, telehealth means. What that phrase that we're all hearing so much about means.

Great. I appreciate it. I've spent my entire career over 30 years, really focusing on trying to change and disrupt and solve big problems using technology, using automation and using an improved experience between a consumer and a big problem. The beginnings of my career was always focused on the entertainment space early on, where I started as a projectionist in my high school. And at that point, the only way to watch film was either in a movie theater. It was the only way to watch a film. And for me, I was obsessed about film and technology. And in 1975, when Sony came out with the Betamax, time-shifting recorder, I was completely excited to believe that now I would be able to see film everywhere and anywhere, not just have to go to the theater, but that was not the business model that Sony thought was possible. And from that, I was able to launch and actually run the first pilots on the original format of Betamax with theatrical movie content that was in a rental format. And over the 20-so years that I stayed in that industry, I learned all of the ways that you need to pivot and adjust to change behavior, both at an industry that has set in their ways to a consumer demand that, in many cases, are not aligned. And we learned a lot in what I would say that it taught me to look at my next disruption. And I think about it as the time I spent with Wayne Huizenga, the founder of Blockbuster, or Blockbuster to Netflix. And although at -- when I then exited the media space to solve my next problem, which was finding a better way for consumers and patients to speak to their doctors using technology, and that came from an experience of being a dad and for the first time, taking my sons to a pediatrician office, to then find out that this experience was just a horrible experience in the way I was treated as a consumer, and I thought I could apply this type of capability and technology to health care. But it came from a lens that had no health care experience at all. And as Carla and Miriam saw and experienced at that time, health care was imagining only the way that they had learned to practice for the prior 50 years. And we went on a quest to make this available along pushing the rock up the hill, fighting regulatory issues, state medical boards. It didn't make sense to me. The human body is the human body why I had to have a physician who was licensed in New York that couldn't treat a patient in New Jersey when it didn't make sense to me. So we drove that. I'm really proud over a really long period of time to get to the point where we are today, where MDLIVE has over 40 million members. And is seeing the type of transformation that is unfortunate that has been created because of COVID-19. I see that as the silver lining. The same point way past COVID-19 will get resolved. The digital health space will now be able to take advantage of the capabilities it has, not in taking away brick-and-mortar care, but in being part of it to allow the care plans to be more efficient. So happy to be here today.

Yes. Well, it's -- so you've given us a lot to chew on, both of you guys there. We've all been in technology most of our careers. And Carla and I mostly in health care, you, Randy, about half and half, half entertainment and health care, but from a consumer lens. So I wanted to chat for a second about telehealth, the biggest word that we're talking about today. The tipping point is here. Now all of these new technologies have a tipping point. And we're using the phrase so -- the term so broadly that a lot of people don't understand that this has actually been going on to some degree for 15 years, computerized in some degree. So I'd like to talk for a minute about telehealth and its uses for just to help the audience kind of have a frame. So there's what we used to call telemedicine, which used to be -- when there used to be like real phones, it used to be, the patient called the doctor and maybe they got $15, the doctor was reimbursed $15 maybe, and that was a telemedicine visit from way back in the days. And that's still part of -- that's where, I guess, telehealth came from that phrase. But there's -- now it's really in my mind, virtual care and then there's care management, which can be digital. There are telemedicine visits or e-visits. They're virtual pharmacies, which Randy, you're starting. There's remote patient monitoring. There's so much. There's the specialists that are tele-consult to that rural hospital that doesn't have that specialist on site. So I think in the current crisis, we're talking about mostly visits, a patient visiting their doctor via a virtual visit. But it's much bigger than that. So I'd kick it maybe, Randy, to you first, how do you frank -- what do you think that even means? And then what is the tipping point about? And then come back to you, Carla, with the same question.

Yes. So I think there was a big distinction between telemedicine and telehealth, certainly as it evolved. Telemedicine more in chronic-type conditions and being able to manage, whether it be tele-ICU or these type of components. Today, I don't see a difference between the 2. And I think of it not as tele anything. We think about the way we conduct all of our needs online and the tool that technology provides to the physician, which the requirements that today are available and certainly now will get accelerated in FDA approvals when we think about the use of technology here is the -- how to take the data and make it actionable about the patient, how to be able to draw images about the patient and how to be able to evaluate blood and other types of data analytics and that the way that we see now that is occurring is it's not whether you're going to do a telehealth online visit from a patient perspective or see them in person, it's when in the care plan and the care journey do they need to be seen in person and when can those cases be done using telehealth. And that broad sense opens up a component of where this was more of a convenience care, similar to the way we saw urgent care. Maybe 15 years ago, most people would say, that's a lower standard of care and I'm not going to go to urgent care. Telehealth platforms that we see today are the next urgent care capability where it's not less than by using a telehealth visit, it could be equal to, and in many cases, better than. When you think about disasters or what we're seeing now with COVID-19, most of the patients that are calling, I would call it, worry care. They're not sick. They just need to get immediate access because they're isolated about whether or not they need to go to urgent care or whether they need to go to an ER, and that's a big case of what they're happening. The next evolvement, I think, is in the physicians that I've spoken to over the last month are how they're going to be thinking about using telehealth and technologies to change the way they practice medicine, meaning that having the patients that are sick stay at home, regardless of virus and treat them using technology and/or referring them to specialty when that ultimately takes place. And that evolves a new specialty of a virtualist. Telehealth docs that are actually trained to know how to use data and information to make that type of capability and also virtual primary care because it's a whole new set of tools. It's not just a telephone or a 2-way Zoom conversation. It's having more data about the patient that you can react to, more clinical information in front of you than they ever had before. So it's very, very powerful.

It's fascinating. It's a great -- that's just great. And that's a lot to chew on as well. Carla, in thinking about what he just said, what do you see that has tipped? What does the -- what it has tipped and what's not tipped and what's your view on that spectrum of all those different things under the word telehealth?

Okay. So I concur with Randy. We passed the tipping point, and we're not going back. Now that being said, post pandemic there could be a decrease in the use of telehealth, but it's not going to go back to pre-COVID levels. And I also agree with Randy in that this is -- we're in a cultural change moment where our clinicians are being -- and our patients are being empowered to embrace the art of the possible. Because to Randy's point, if you're ill, you don't want to go into the clinician's office. By the way, all of the parents out there who have had to take sick children into the pediatrician, those are awful experiences, right? They're just awful. So there are so many -- it's actually easier, Miriam, to talk about the types of health experiences that are not set up well for telehealth than it is to try to describe all of the items that telehealth is well equipped for. So for example, trauma. That's very difficult with telehealth, right? Birthing a baby, you need to have people in the room. Surgeries, right? Those are examples. However, there are ones that you might think, oh, well, that won't work with telehealth, when in fact, it might work very nicely, which is, for example, stroke. There are real opportunities and uses for telehealth in stroke care, same thing with intensive care units that there are telehealth uses for tele-ICU that make telehealth very valuable to both clinicians and the patients. And Miriam, I think that there are a couple of barriers that still need to be overcome in this. So for example, broadband. There are still several million people living in the United States who -- actually more like 30 million people living in the United States today who do not have access to high speed Internet. That's very difficult for telehealth when you don't have that. Another -- and that's also their libraries, their schools and their clinical practices. It's not just people in their home. Another example of a barrier is reimbursement of actually being able to get paid for your services. CMS in this time has provided numerous waivers, nearly every state now, also has enacted licensure waivers, but let's all remember that clinical licensure is at the state level. It is not at the federal level. So these are examples, Miriam, of barriers.

So I want to stop you right there because I want to talk about this. We all know as health care experts that if providers do not get reimbursed for something that tipping point -- that is not a tipping point. So the technology is there, the consumer demand is there and the efficacy is there. Randy, I love what you said about, it may have been viewed as a substandard form of care or something, but it absolutely is not, and it's probably superior in many cases. Many, many cases. So we just leave that alone. So let's all say we all love it, and my cat is coming in here. But are we at a point where we feel like the reimbursement has tipped as we get into this new way of practicing medicine so that we don't get a retraction by the provider because they're not getting paid enough? So let me throw it to Randy first, and then I'm going to come back to Carla. And then I want to talk about state licensure and that other stuff that is also -- will stop in its tracks. But Randy, what do you think about reimbursement? Where are we with that?

I think a lot about it. And I think that is a really good -- that becomes a big obstacle and blocker for this transformation that needs to be considered. What we found over this flu season even before COVID-19 that the demand finally of the tipping point of utilization and getting both payers and physicians wanting to do this and patients moving towards it, created a demand that where the patients that wanted to use it were not able to be serviced for those visits because there were not enough physicians who would participate and across the leading telehealth companies out there, the 4 or so that control -- that have the majority of the patient contracts with the payers as networks today, they were seeing 50% more in cases of more than 7,500 visits per day that were putting tremendous pressure that they didn't have the physicians that were willing to take it. And then in order to get the physicians to meet their SLAs and contracts, they were like Uber and Lyft, having to go to pay more, just to get to physicians to take their calls. I don't want to at all compare a physician to an Uber or a Lyft driver, but from a surge model, and then what that has created is that the reimbursement does not cover the infrastructures or the physician's ability to do that because they're saying, why should I take $30 when I'm going to get $120 in my office. And so the payer contracts have to get an alignment with the fact that the amount that they get paid should be power pursuit to a degree to what they would get in an office visit. And there's a lot of work to be making that happen. So I think that, that has to get solved. I think this will force some of that because the payers themselves or certainly, if you think about their contracts are going to have to readjust it, but that's going to be slow, and that is going to be a major continuum blocker for success.

Yes. I want to ask you on that note, Carla. What is the status of reimbursement right now based on the Medicare stuff? Is it -- has it been brought to parity with a walk-in visit? And how does that get -- I really don't know. I'm not current. So what aren't the special reimbursement things that are happening right now?

Sure. So from a CMS perspective, Miriam, CMS has increased reimbursements and put into place waivers so that Medicare beneficiaries who are seen by clinicians, those clinicians are better able now to bill CMS or services rendered. And also, on a state-by-state basis, Miriam, because the states are responsible for Medicaid so the states are making big changes around reimbursement for Medicaid beneficiaries. And Miriam, you mentioned early in this conversation about the American Telemedicine Association and a guide that I was honored to be able to give to the ATA. It's now available online, and it's free, doesn't cost anybody any money. It's called a quick start guide. And in that, Miriam, there is a whole page on financial considerations, where we've offered up the URLs that people can go to, to get the absolute current information of what's happening right now with various reimbursement and financial consideration issues. This is literally changing in real time.

Yes. So what is the URL for that guide, Carla? And what are the other -- you don't have to do it right now -- or you tell us right now if you want to -- okay.

Yes. Yes, it's the ATA quick start guide to telehealth. If you just Google that, it's going to come right up.

Let's give the group a couple more resources and Myra, who has helped us put all this together, will send out an e-mail after this and we're going to tell everybody, but the AMA has a guide, right?

They've got a great guide. They've got a great guide as well.

The American Telemedicine Association, which is the one that you did. Is there anything else either of you know that's a great resource from a provider's perspective, I guess?

Well, actually, there's another one that just came out, Miriam and Randy, from -- it was a partnership between CTA. CTA is the association that -- oh, for heaven's sake, I've suddenly blanked on the name -- the consumer technology show that happens every year in January.

Oh, CES. Okay. Yes.

Consumer electronics...

CES, right? Right. CTA is the association behind that. And they just partnered with the ATA, and there is a resource, the free online resource and it's called healthtechdirectory.com (sic) [ TechHealthDirectory.com ]. And it lists about 200 companies that offer telehealth services. Some of those services, Miriam, are consumer-facing. So for example, wellness apps, relaxation apps those kinds of things that are very accessible to consumers and also provider-focused apps -- or excuse me, vendors. And so that resource is another one I wanted to mention.

I muted myself. I muted myself, sorry, because my cat was in here running around. So I wanted to talk about the industry and vendors who are servicing and filling this gap. So HIMSS is a group, the biggest health care tech conference in the world, thousands of folks on the floor, MDLIVE, a great leader that you started and built, Randy, in this particular space. But I found a couple of days ago, Becker's Hospital Review had published a list of here are 275 telehealth companies that you should be thinking about if you're a hospital. So here we go again into, either everybody is -- yes, either everybody -- it's like population health and then patient engagement, now it's telehealth. Everybody throw themselves in there. How do we sort through what's going to happen in the marketplace in terms of telehealth, and I'll make that a little more narrow. So I think the ride-hailing example is good, Randy. I know we don't mean to be insulting, but the ones that I'm familiar with, if you think Teladoc, which you mentioned earlier, and MDLIVE or American Well, those are the 3 leaders. Those, to me, I would call them consumer-driven, meaning I want a doctor to help me because I have a sore throat. So I'm going to try to make that happen. It's probably on the back of my insurance card, those 3 labels or logos. To me, that's consumer-driven, consumer-initiated. I want a doctor -- I want to FaceTime a doctor, but I don't care who the doctor is. Is that a good way to think of that? And can you comment on that model? That reimbursement is a little different. But just -- can you just comment on kind of that consumer model, that section of telehealth? Is that what's tipping? Let's talk about that.

Yes. So the first thing, when I first thought about entering the space of the telehealth space at that point, the one thing that I really wrote on my whiteboard is what would the value I would bring to stakeholders when all doctors connected with their patients using technology and mobile, and that was kind of the first thing I put on the board. And so the thinking around how we connect and the leading companies out there that are -- have the scale that have contracted as networks with providers to be able to drive that immediate access have a very important component as a quarter back to navigate appropriately, but in no means to take patients out of the physician that is caring for me on a regular basis that I evaluate. It is a care team, and it is the interoperability concept that we were talking about here that this can solve if it's collaborated. And I want to make sure also that we don't exclude, which happens constantly, the behavioral health, the therapy and psychiatry and counseling component that needs to be engaged here as well. And so the movement towards who is my primary care physician versus who is caring for me as a team, I think we'll have all of those components and need to have all of those components as we move forward. The fear that the providers have that they're going to lose that patient responsibility has to be embraced in a different way. And I think reimbursement can change that. I think switching more as we see. We've been talking about value-based care forever, and there are successes of that, but very few. And as we move to some form of Medicare for all platform, not -- I don't have a crystal ball moving away a private pay option. This type of capability has to be put into a place, and you can't do without technology, you can't do without scale. It's more than the convenience of just connecting and saying, hi, having what I call desktop manner with the patient. It's can and how do we kind of move -- if I think about my next kind of futurist perspective and we think about the way that doctors and patients will connect, it is more like the try quarter, right? That we've seen in the future. That still has to be brought back to the care team. And it has one meaning for continuous well care, and it has another for the chronic patient population. We see people that are wearing Fitbits and Garmin watches are also doing the 10-Ks. Sorry, that would be you. But the people that really we need the data around, not to stereotype that, are more than likely not the same people that we see on the Apple commercials. Very sensitive about how we drive this and how we make it available, lots of insurance companies now, my United Healthcare plan, is -- provided me with an Apple Watch. And so we're finally making that component. What their -- how they manage that data and who that goes to will be the difference about how they can have a popular -- a more healthy population.

Yes. And I think that all of that data interoperability is so fascinating -- and it's a whole different conversation. But Carla, in response to that, I was talking about, I just want -- I want any doctor, I have a sore throat. I just want to hail a doctor. That's really different than a doctor selecting a telehealth tool to use and running their own practice, to manage their own patients, right? So talk a little bit about what you see as having tipped, who are those vendors? Is it in the EHR? Is it sidecar? Who's making those decisions about designing the new normal practice, which includes both on-site and how does that work?

Sure. So there's the B2B model, there's a B2C model as well and then there are hybrid models. So within an independent stand-alone clinical practice, you can do something incredibly simple to get started. You can do Zoom for crying out loud and offer telehealth. Now I would recommend that, that not be your long-term solution because there are security issues, there are HIPAA considerations, the whole interoperability and being able to document your encounter. There are telehealth solutions that are going to work much better for you long term, right? Then there are telehealth vendors that will white label their product for you entirely. So you could be -- the Smith and Paramore practice, and nobody has any idea that it's actually [ acne ] vendor back there who's providing that telehealth platform, it is invisible to our patients. Then you get into the larger enterprise considerations. And there are -- to your point, Miriam, there are EHR vendors that have got telehealth modules that can be added so that there is the interoperability and the integration. And there are also telehealth vendors that can -- and I love your sidecar analogy, that can be bolted on to existing enterprise initiatives. One thing that's very common in enterprises is the multiple use of EMRs. You have lots of providers out there that are using 2 or 3 EMRs.

A lot of them.

So trying to figure -- yes, there's a lot of them out there. So trying to figure out how to help the clinician be able to make telehealth part of his or her new normal. I got 2 pieces of advice. One is the policy piece of advice and the other one is an integration. The policy piece is, we got to make reimbursement stick, right? No going back on reimbursement. And the second thing, which is more of an internal thing that needs to happen is single sign-on. We have got to make it easy for our clinicians to utilize the technology that is available so that they can take best care of their patients. So do not make them use 2 or 3 different sign-ons and passwords. That's just the kiss of death for long-term use.

Yes. Convenience. So we talked about

Convenience

In prepping for this, and I like the concept of if I'm a provider designing the way I run my practice, which is, is it about 40% that's still are not owned by IDNs? Is that about the right statistic? Or is it more like 50%? Like half the practicing physicians are still independent office-based physicians that are not owned by IDNs. Is that about right, guys? Is it about half and half? Okay. So those guys are going to -- are running small businesses, guys and gals. They're running small businesses. Are we going to see a couple of things? So this is what I'm hearing, so I want your thoughts. We always want MDs to practice at the top of their license, nurses to practice at their top of their license. Pharmacist, we've got this whole pharmacist is a health care provider or not and all this stuff, and that's changing. We just talked about testing as to whether or not tests have to be done by certain people. So here's what I'm hearing being predicted that in terms of using telehealth in a practice, we might see the carving up of either slices of time a day or a couple of days a week that are the telehealth visits for the practice and they're staffed by a nurse practitioner. That's a concept. And then the other concept is testing and how much testing is a pharmacist allowed to do as a health care provider. So making testing more democratizing testing and letting some of that, not just COVID testing, but just basic testing. So it's kind of a 2-prong. It's that top of license thing. Is this telehealth movement pushing us to segment or think about care delivery visits and testing in different ways and who is the health care professional that does it? So what are you seeing there, Randy? I know you're big in the virtual pharmacy right now. We haven't even talked about script writing and 90 days versus all that stuff. But talk to me about delivery of care, modality and the professional that does it. What has telehealth changed in that?

So I think that it's forced the -- as you said, to allowing the physician to work at the top of their license. Some of the challenges that now can be worked out either by leveraging additional care teams like nurse practitioners for the right use cases as well as pharmacists, will help that. The other part around this is that what telehealth has done is made it more convenient for doctors to connect with their patients, maybe -- but what it's not done has made the physicians more efficient using telehealth services. So the doctor doesn't have to necessarily go into the office or the patient doesn't have to drive to the office. The amount of patients that a physician can see who is an MD or a specialist will be almost the same amount if they're spending 10 to 15 minutes with a patient within an hour doing that intake. And so we have to improve the automation of, a, leveraging when a nurse practitioner or pharmacist can be used and when it needs to be sent with inside a virtual setting or we have really just shifted the modality to doing it the way the world is operating now on home, doing it virtual versus powering the physician. And I think the key components around that is how do you segment that automation and efficiency. And 2, which the EMR vendors have struggled in creating a consumer or an optimized experience. I have lots of doctors who say, they can still write a script quicker on their pad than they can entering it into their e-prescribe platform. There has to be the use of robotic processing, AI and Big Data. There has to be more information than a chart that is showing what I filled out manually, but to be reactive and intelligent about where I've sat in my journey and what medications I've been on. Are there adverse effects to a medication I had, asking my mom what she's allergic to when she's 88 years old is just not efficient. And if we can start to present that and let them react appropriately, I think we'll be able to be much more efficient and much more scalable, but allow for a much healthier population, leveraging the care that we have.

Yes. And those comments -- jump in, Carla, go ahead.

Yes. Thanks, Miriam, because I did -- I wanted to jump on some of the things that Randy was talking about. I want us to be very careful and not fall into a false narrative that somehow there is a magic bullet here or a holy grail, right? So Randy pointed out some of the challenges around using technology that docs and PAs can still write a script faster than entering it into the system, that is true. Another one that's important to think through, and Miriam, you brought it up, is workflow. Does the clinician who's going to be interacting with patients via telehealth have a support system who's going to get the encounter set up, make sure all of the paperwork has been filled out, understand what the patient's insurance is, make sure that the patient is centered in the screen and not like me coming off right now and the doc can't even see the patient? Or does the clinician have to do all that because that is not going to save them any time.

Yes because that won't work. It won't work. No, you're exact -- I'm so glad that you jumped in because all of that stuff was what I was thinking when Randy said efficiency. So what I don't want to happen as a tech-forward, consumer-forward health care person is I don't want to see us into this false tipping point or everybody goes, well, yes, it's just easy and you save time and you Zoom them and it's -- when we all know that, again, unless the provider is reimbursed at a level that they find adequate to offset their otherwise $120 volume thing that they're used to doing, hamster wheel, and it's not a pain in the butt to them to do it because then they'll view the bad thing. Then, they won't be -- well, maybe I get $100 instead of $120, but I still -- I either don't like it or I think it's not -- it just doesn't work for me. And so that breaks down for me into things like how do the appointments get scheduled? Is there -- are all the scripts written in the EHR? How do you document the encounter because it's not in the EHR? Or do you schedule it in the EHR and then you just in write the physician notes, oh, I saw her on Zoom. Some of these best practices may be in the guides, they're probably evolving...

Yes, they are.

That is technology. That's workflow. And so I don't want to untip on the workflow. So Randy, you've got an idea on that, I can see.

Well, I do have an idea. And some of this is -- there's nothing -- there's no technology limitation to allow this to be integrated and cohesive. The problem is the business rules or the entities and the creation of silos of not wanting to connect every other industry, whether it's fintech or e-commerce has solved this problem. We go to Amazon today, and we buy an item on Amazon, which goes to tens of thousands of retailers and the box just shows up. We don't have to do that. So e-commerce has solved it. Finance has solved it. I can do that with my banking all day long. I could pay on my app and send you money. But -- so the tech is there. It's one, the -- of course, the HIPAA compliance and the privacy, which I think in some ways, it -- not that it's not important, health care has used this as a way to stop innovation in that case. And the other part is the evolution of how this could go from each and every person, whether it's how my physician is going to speak to another physician and a specialist and why a referral when my -- I know clearly that -- or my physician knows clearly that I need to go to a orthopedics -- orthopedist and -- but because of the system, it's forcing him to make -- or her to make me go into their office first to get a referral when it's really clear I just sprained my leg. These are problems that -- they're not -- none of the problems we're talking about here are limited by technology anymore. Maybe they were, but that's resolved. Now they're business decisions, reimbursement decisions that are governing all of that.

Licensure -- so licensure, privacy and security relaxation. So I've got 3 questions that have come in. We're coming into 15 minutes. I'm excited. So I'm going to read the questions. Okay. First question, what are the nurses' roles in telehealth? What are the benefits and challenges for nurses? I'll just open that up. What do you think, Carla?

I think that nurses have the same opportunities in telehealth that they do in face-to-face care. Nurses are a critical, must-have member of a transdisciplinary clinical team. And for nurses to be able to engage through telehealth, it is doing the same work just in a new modality.

And if they're nurse practitioners, they're probably going to hopefully be freed from that physician oversight thing in a telehealth environment. And we used -- they used to not be able to prescribe. And I mean, a lot of that stuff has -- those are regulations and business restrictions, too, Randy, to you?

Yes.

Yes.

That's what they are. So that's great. So I've got several more. So here's the next question. Next question. Currently, payers have lifted certain restrictions, for example, you can use FaceTime, which prior to COVID wasn't compliant. How do you see these restrictions changing in the new normal? And what will be the impact for all the players in the care continuum? So I'm going to split that into 2 parts. The lifting of restrictions that they're referring to here with FaceTime is -- that is a -- that and Google Hangouts and Zoom are noncompliant from a privacy and security and we -- let's just take a breath and treat people that are sick because we're in a pandemic. Randy, are we going to go backwards and say, PS, you can't use FaceTime and Zoom anymore. Who decides that? When does that start? What do you guys think about that, both of you?

So first, I think doctors and therapists have been using Zoom and Skype for a very long time. Whether or not it was or is HIPAA compliant and providing the security rules. I know in the behavioral health world, they're doing that continually. They're putting codes in and continuing to run their practice. I think when it comes to health care reimbursement and when it comes to this conversation, most of this relaxation that is allowing for noncompliant technology will not continue if -- because the reimbursement, I would imagine strongly will tie into having the ability to have the privacy and capability that the open systems don't have. And the majority of these visits that have been created regardless are worry care. These are not -- this is how to keep people from potentially having to rush into the emergency departments that could be resolved that has taken place. The one that I'm really going to be challenged about is the whole state licensure perspective of now they said with these compact, both for nurse practitioners and physicians that during this time, we're now going to -- give you a permission to see patients across state lines. And then coming back in 6 months and say oops, it's going to force regulation change around this topic because it was a topic that was being pushed and at the street level anyway. I mean -- and certainly, Carla can speak more about it, but -- than I can.

Well, let me flip it, Carla, real quick because I've got 2 more questions. So what do you think about the original question, payers and restrictions, roll back, yes/no?

We, as health care professionals, should be absolutely focused on no going back, no going back. This is goodness, these developments. We are creating goodness out of a horrible situation. Now in order to do that, policies have got to be turned into permanent policies rather than temporary and that's where organizations, associations like the American Telemedicine Association, the American Medical Association, for example, American Hospital Association, they are absolutely going to be taking these kinds of things on to help make sure that these policies become permanent.

Yes. I agree. So it's -- if -- for it to stay tipped, we've got to go from this temporary into some permanent...

Into permanent.

Next question. I think we've kind of addressed this, but just to maybe be a little more precise. Do you see telehealth only as asynchronous communication or telecommunication? Or do you see the need for a wider platform involving personalized videos, online communication, et cetera? How do you -- what do you see, Carla?

Absolutely. I agree, it's synchronous and asynchronous. I'll just give you 1 example that I love this story. The Department of Veterans Affairs is piloting. It's a very small pilot right now, but I just love the pilot. And that is there are close to 3 million veterans in the United States that live in rural communities. So they don't have access to specialists. And many of them don't even have access to primary care. But what a lot of small communities have is a VFW Hall.

Nice.

So what the VA -- isn't that? You're right. So what the VA is piloting is training volunteers in the community who are members of the VFW and train them in telehealth. And then there are stated times when the veterans in those areas can drive to the VFW Hall in their community, and they have a virtual appointment with a VA clinician. And they've got the support that they need in order to make that telehealth encounter happen. That's fantastic. So all of these fantastic opportunities that are synchronous and asynchronous that is all part of telehealth and where we need to go.

I love that. I wanted to say that...

I love that story.

I did too. VFW Halls, I -- listen, I grew up in rural South. I hear you, sister. So I -- we have a little press release out this morning. I got 2 out more, but for just a minute. We have 2 clients that 1 was mental health and the other is cardiac rehab, both had on-site clinics. And in mental health, this is where you came to meet with your counselor. And both of them were using our RMDY platform, which is a digital care management platform. And so now they're completely virtual. And so to me, the platform -- the larger platform is virtual care. And so Randy, I wanted to kind of get your view of, is it -- what is virtual care versus telemedicine or telehealth? It's a landscape that I'm hearing you describe, both of you guys.

It is. But to me, it's just health care. It isn't virtual, it isn't tele anything. It is just being -- I mean, I think that that's taking us backwards. It is better health care. It's empowering and moving the policy forward so that these technologies that can be making a big difference when it comes to driving better patient outcomes, whether it's remote monitoring capability, whether it's data that's driving decisions so that we have truly access to our patient record in a way that empowers us as citizens in way to making sure that our physicians are connecting with our pharmacists in a more meaningful way about what they're prescribing. It's about personalized medicine. It isn't about tele anything. And as soon as we can apply and give physicians and other medical professionals, the power that they have and now the way that the consumer because of COVID-19 is going to demand with the right support with the things that Carla is working on, there's no turning back. The politicians lived it. So now they're seeing how their families, their parents and so when it starts to hit in Washington, D.C., where I spend a lot of time, I work as a -- on the GW as an adviser to their School of Public Health. And they're writing public policy in real time, but they're also seeing people that they know that can't get out of their houses or can't get to their pharmacies. And so this is the positiveness of what has occurred that is not going to go back, even the physicians and health plans and Medicare that we're pushing back on it, it's never going back. It's in the way it is. And that is a powerful thing. What we also saw, we don't have enough resources. We don't have enough bandwidth. We don't have 5G that we need to put in our underserved areas, but there's nothing stopping us from doing that. And if we align ourselves to do it, then the world will be a healthier place.

Well, I love that, and I love what Carla, you said, this is goodness, and I love what we're saying as a team here. This is health care. This is just health care in a digital world. And I get so tired of people talking about journeys and silos and topics, all this stuff. And I'm like, listen, these are just humans. They're just people, and they're -- they may be sick, they may not be well, they may be worried. I love that. I have one more thing. We've got 4 minutes, but this was so good. This is going to set us up for a whole other call. So Randy, I got to give you a shout out with Genius Rx, and you're 100% digital pharmacy out of the gate because this is what I want to happen. Why can't I virtually see my doctor, and they electronically prescribe, and it's at the pharmacy, and then it just comes to my house? I don't have to go somewhere, right?

That's happening this year. Yes, look for that fourth quarter. You're going to see that in a lot of cities in America. But exactly, what I saw is we were treating millions of patients more conveniently that were sick at home, and then we were forcing them to get into their Ubers or drive to a local pharmacy, not knowing what the medication was costing, whether it was covered or whether the pharmacy had it in stock. And then for the seniors, they had no way to get transportation. So we want and need to get our medications delivered to our home, the same way that we do everything else, and that's forcing us the same way, an inefficient 100-year-old legacy industry that has been able to make a lot of money on inefficiency. And again, that is no longer going to continue. We see every retailer and every component saying we'll deliver this to your home. Well, guess what? Get used to it because patients are not going to accept it anymore going forward.

Yes. And Carla, I'll give you the last word on this, but I want to talk -- I want to have another talk about digital pharmacy, but also this last question we only have -- give me a quick one. How does telehealth moving forward allow providers to handle things like home testing? How does this apply to COVID? So here in -- Carla, what I'd like to see on the testing side is I'd like for it to do a virtual visit with my doctor. And then they say, "Hey, I want you to take this test," and then it shows up in my house the next day in an Amazon box or whatever kind of box because it's something that I -- pee in a cup or whatever I'm doing. But how -- that's another avenue of convenience or virtual care. How do you see us getting to the testing side with consumers? And then we have to stop.

Oh, I could -- yes, I completely agree. And this, unfortunately, is the -- a very good reason to do home-based testing is we are all wanting to know what's going on with us and our families when it comes to COVID, and we want to be safe. So we will be open to doing home testing.

Yes. I agree. So guys, I love you, both. Thank you so much. This has been a great pleasure. Really appreciate your time. Thanks to all you guys who listened in. I hope some of this has been helpful. These guys are the experts. Follow them on LinkedIn, follow them on all their social. And thank you, guys. Thank you, Randy, so much. Thank you, Carla. Take care. Bye. Be safe.

Thank you, Miriam, Carla, Randy...

Oh, Myra, I'm sorry. I was supposed to turn it to you. Go ahead.

Listen, it's completely okay. What an amazing conversation. And clearly, we could go on and on. Very timely. Thank you, again, Carla, Randy, Miriam, and all of you for joining us today. And just as a reminder, you'll receive a link to access this webinar on demand at any time. There's so much for us to like think about and even talk further that you will want to watch this again. And also in a couple of days, we will make the podcast link available. So you can reach us via email at [email protected] with your questions, comments, ideas, happy grams or anything. And if you know someone who should be part of this series, please send us a line. We want to hear from you. Thanks again for joining us and until next time, bye.

Thanks, everybody. Bye. Be safe.