Creating Deeper Connections Through Telehealth | E. 91

The Healthcare Leadership Experience

Telehealth became an essential part of healthcare during the pandemic and is here to stay. Josh Klein shares his vision for its future, and the role of Emerest, with Jim Cagliostro.

Episode Introduction

Josh explains why telehealth is still stuck in 2020, how technology can strip the humanity from healthcare, and why the missing element in telehealth today is social determinants of health. He also explains how Emerest is going above and beyond virtual communities to make real patient connections, and why true leadership is always allowing others to shine.

Show Topics

• Leading by example

• Poorly applied technology can strip the humanity from healthcare

• Telehealth is stuck in 2020

• Digging into the social determinants of health

• Building virtual patient communities

• Creating an oasis of caregivers

• Leadership is letting other people shine

07:59 Leading by example

Josh explained how volunteering as a paramedic inspires his daily work.

‘’It helps me in so many different ways. As leadership in general, the role of an actual paramedic is truly when there's an emergency, there's usually a pyramid of system where if it's not such an acute emergency, an EMT can be doing this stuff. If it’s a trauma, somebody hurts themselves, they don't need help. But if it's a true emergency where the person's life's on the line, if there is no leadership, the emergency will go south. It will go sour. So in order for the call to be successful, the emergency to go well, to have the outcomes that's desired to save someone's life, if they need to get to a hospital alive. There needs to be a lot of leadership in that role and taking control of a chaotic situation more times than others. And that's taught me enormous, enormous values and learning from other paramedics. You know, what I learned in the health care space. I've been blessed to do this for a very long time, more than I'd like to admit already by now. Different people that have different backgrounds, different capabilities. You know, this, volunteer organization has, you know, a few 100 paramedics and seeing how a paramedic that is a shop worker or a baker or a Forbes list guy or a finance guy, how they lead is learning. If you're constantly learning, learning their skills how to engage. So it gives me an enormous amount of learning experience and insight and being able to carry it over to what I do in the, in my workspace.’’

10:21 Poorly applied technology can strip the humanity from healthcare

Josh said the focus has to be on the patients, not technology.

‘’Well, first and foremost, thanks for picking that card because I couldn't agree with that one more. And I think it's just a trickle, then there's just a snowball effect how this happened. You know, technology, everybody wants a piece of it in a certain way, but it's more from the business side. Lots of leaders whether it's payers, hospital systems, frankly, or people that are in the health care space. The word technology just became, you know, a thrown around sexy word to say, let's apply technology, let's apply everything. And in my mind, it's driven sometimes, not by all, by certain needs or certain desires, not really wanting outcomes for the people that are receiving care. And I think the biggest fault to that is once they convince themselves that they applied technology, they automatically take a back seat and said, let the machine do it. And that's where you fall off. If you take off the eye of the prize that you want to treat somebody well. In our in our case, it's patients at home. Yeah. We can throw certain technologies. You can throw monitors and, you know, monitor their vitals. And the company is like, oh, I saved a couple of dollars. And that is not what health care is supposed to be. That that is just gonna further break the system by perhaps maybe saving money for certain people …’’

12:48 Telehealth is stuck in 2020

Josh explained why telehealth has not progressed since the pandemic.

‘’(In 2020) … telehealth mushroomed … it was forced upon, frankly, lots of providers. And they relied on just that when COVID came. And there were millions of people that were in need of care and had no access to care simply from a logistical standpoint. You had, hundreds of thousands of patients millions of patients that needed for whether a doctor's visits how many doctor's visits were simply missed because, a, the doctor wasn't available. He was home hiding under a blanket… and the patients couldn't even access them. So there was definitely no question that the telehealth concept, of course, the reason why it mushroomed is, you know, necessity is the mother of all invention as they say. So there was a necessity to connect patients with whoever that is. So the telehealth, of course, made sense and there was a need. So, of course, today that the the simple concept where you can speak to your physician on camera, it was good in 2020 when COVID was there. It's still good today. It still needs a lot of work. It shouldn't be missing these elements, but 2020 really blew that up in a way. And lots of people stayed stuck in that 2020. They stayed stuck in, oh, I can give my patient an opportunity to speak to a doctor, I don't like to speak ill of the way it's done. But so many of these programs are just designed to follow billing codes and trying to make business out of it. I'm an entrepreneur, and I'm all for doing good business and creating companies that, create jobs. But the second you lose focus on the bigger picture, we will see trends with the telehealth with certain entities that have tried. And they might have had amazing intentions. No questions. But they're losing sight of lots of different areas.’’

20:12 Digging into the social determinants of health

Josh explained the importance of truly understanding patient needs.

‘’Are they really alone? How long have they been alone? Loneliness is such a broad word as well. Loneliness doesn't necessarily mean that they live alone. Some people are lonely when people are right there in their home. They just might be there. They're just people that are just you know, they like there's some people like to be alone, but it it's truly understanding really what are their needs. A lot of people, especially the elderly, they tend if they don't feel well automatically, besides their mood changes, they truly have whether it's anxiety, depression, and mental health problems. And if the assessment that we do is really get as much information as possible on that individual and put in things in place to address them. So, when we make that assessment, the same way we have a risk assessment on the clinical side of, you know, whether they need a lot of nursing. How much social interventions do they need? Do they need a social worker every day? If somebody has, true, for example, mental health problems, and lots of them sadly do, whether they've had it for all their life, or if it developed over time, or frankly, COVID did them in, so to speak. So is addressing them and helping with that and giving them really tools to have somebody to speak to. Besides that, we have a large social group program. We have social workers that speak to them. We have psychiatry and that truly understands their medications, understanding, managing their medications properly. Well, how many times we've had patients that when we took them on the clinical side, no. There's no mental health problems. Magically when we did the assessment, somehow, we found out, you know what? They can use something to help them.’’

25:23 Building virtual patient communities

Josh explained how he used technology to build connections for vulnerable patients

‘’…. You know, people just like company. And, you know, the 1 on 1 concept is very, very good. But, if we're talking about home care patients that don't get the opportunity at the snap of a finger and just go out. …an elderly person (will) tell you they don't see many people 8 o'clock at night, a group of 75 year olds getting together for dinner. It just doesn't happen that often. You might see it here and there, you know, where they have a, a $30 free buffet once a month. But you're not gonna see it in a systemic way, and it's not that popular, frankly. So what we really believe was how can we take somebody that's ordinarily home alone, or even if they do have, make them belong to a group. …. and we made groups. …we derived it from artificial intelligence and machine learning, but not before we really did lots of research. Everybody had input. So what we call it a grouping model where the groups are up to between 6 to 10 elderly in a group. And we wanted to give that group legs and have, you know, the best potential for success. And so the nursing department had input as to how that group was created. The social workers had input, you know, where that specific individual can in which group they would fit. And then we use technology to mush it all and to gel it all together. And we still reviewed it as humans to see. So we have now dozens of groups where we have elderly people on our platform. They play games. They talk politics, news, current events, and we're seeing so much success on our platforms where these groups are, and it’s lots of times in the day. Some of them are up 5 o'clock in the morning already kibbutzing and schmoozing as a group at 5 AM.’’

38:53 Creating an oasis of caregivers

Josh explained how Emerest encourages physical interaction and activity for its patients.

‘’It's very unhealthy to have people just constantly staring at their screen. So besides programs that we do, that we engage with them with exercises, get your you know what out of your bed a little bit or out of your recliner there. You know, we do a lot of yoga exercises with our elderly through our platforms. But one of the things back to the grouping model, and that's the one thing that I promised myself and to the people that that helped me build this, is I don't want that to become that. That's not something that we wanted them to become telehealth potatoes. …. You know, I'm blessed to be the CEO of thousands of caregivers. So in every state and borough that we operate, we built an oasis for caregivers where they can go. And it's like a 5 star spa where they have manicures and pedicures and hair services for free for our home for our home health aids. So the thousands of home health aids that we have, they have access to that. …. So that's primarily on the weekends because caregivers work during the week. So what we're doing is taking these groups of elderly now that have been created, and we're having them come out and have lunch together.’’

41:36 Leadership is letting other people shine

Josh emphasized the importance of learning from others and leading by example.

‘’I learn every day from the people around me. And, leadership is letting other people shine. And, you know, to me, the word CEO, the e, has a lot of different meanings. It's emotional. It’s so many chief entertaining officers sometimes. And, yes, the number 1 is you have to lead by example. And a different CEO position in the finance world might be different meaning of leadership. In health care, you don't sell a commodity, but you sell care. If you genuinely do not show the people that are helping you build these companies, you do not really have that same vision, ….. You first and foremost have to care for the people, for the people that are working with you, whether it's the CEO COOs, nurses, home health aids, you have to let them shine. There’s no such a thing as a bad idea. I've never ever dismissed an idea. I might have inside thought, yeah, I don't know. But not to let them feel that their voices are not heard, that's the worst thing. Everybody wants to feel that they add value in a certain way.’’

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You’ll also hear:

Growing up in a healthcare community: Josh’s early life and career history: ‘’Mom started when I was very young, a nursing agency. And she staffed nursing homes and hospitals…. I grew up where nurses used to come and have dinner.’’

What’s really missing from telehealth: ‘’But the real thing that's missing in my mind, and that's where we really shine, is the social determinants of health (SDOH) and mental health. And that's where I really believe we're going to be an outlier because for some reason, people are just letting that fall by the wayside.’’

Building out support for SDOH: Managing the social and clinical needs of patients. ‘’The nursing team picks up certain things that they will call social work department. You know, the patient just mentioned something to me. I think you should have a conversation with that patient about it and vice versa.. ….my pride and joy is the social and mental health that we're building out. And we're doing lots of different very cool ideas and constantly advancing it.’’

How Emerest created a television studio to support the lonely and vulnerable: ‘’What would you want if you're elderly, home, bored, alone, not feeling so well? ….This is just, as they say, studio 1, we’re mid construction for other studios.’’

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