HealthIMPACT Live Presents: The Future of Access and Delivery- Who is Getting Left Out of Telehealth and What Does it Take to Deliver More Accessible Virtual Care for Everyone?
Originally Published: Nov 15, 2021
YouTube Video: https://youtu.be/pw7XW5T0Mfo
Since the onset of the COVID-19 pandemic, the utilization of telehealth, remote patient monitoring, and virtual hospitals and smart home solutions has skyrocketed. While increased utilization has been rightly celebrated, many groups have fallen through the cracks. Elderly patients, rural patients, those with disabilities, language barriers, or lack of access to technology or sufficient internet connectivity have been left behind. !n this session, we will dive into where groundbreaking technologies and programs are making a demonstrable difference in outcomes and experiences for patients previously underserved by virtual health solutions and what health systems can do to better reach these sections of their patient populations,
Lee Schwamm, MD, Vice President, Virtual Care, Mass General Brigham
Josh Goode, CIO, SCAN Health Plan
Jan Smith Reed, Director, US Healthcare, T-Base Communications
Shahid Shah, Publisher and Chief Editor, Medigy.com, Moderator
Shahid N. Shah: Welcome back Health Impact audience, so we have a very popular topic that we've covered a few times this year.That is back for a redo, and that is the idea of how accessible it the virtual care that we seem to be delivering more and more of over the last couple of years, especially. It is becoming more important or less important in certain areas, so what we wanted to do was to talk, both from a healthcare delivery angle and we've got Dr. Swann to help us with that we've got Josh from Scan Health Plan to help us from the payer and the plan angle and Jan here is going to help us understand what does accessibility and access have to do with each other, and how does that work with a virtual care. So one thing I wanted to start with is the idea that, for example, we know we've got elderly patients we've got rural patients those with disabilities language barriers etc coming in, because we've done a really good job of opening access to patients, so those patients that had to drive for many, many hours can now just come on to video.
But we've made the assumption that oh once we've made video available or audio available. That means access, and of course that's not true because access is not the same as accessibility so we're going to talk a little bit about that as to say you know we're is virtual care today what's good. What's working what's not working, but really, what does access actually mean both from a provider perspective as well as a payroll perspective. And then, where does the tech fit in with respect to accessibility so with that Jan i'd love to have you introduce yourself, I will then go to Lee and then Josh and then i'll pose the first question to us.
Jan Smith Reed: Thank you i'm john Smith read i'm working for T based communications and what we do is focus clearly on making communications accessible. So my whole life and health care, whether on the operation side or sales and marketing and account management side. So you know, here we are moving to a digital world health care is certainly still in the big print business, and I think we all understand that. But i'm really excited to talk about the technology how that really impacts accessibility, but then how there's so many means of communications with Members that we still need to keep in mind and make this accessible as well.
Shahid N. Shah: yeah fantastic welcome Lee your intro.
Lee H. Schwamm, MD: Hi Dr. Lee SchwaMM i'm the Vice President for virtual care at the mass general Brigham Health System, formerly partners healthcare. I'm a practicing stroke neurologist in my spare time and i've been in the field of digital health for about 20 years and I just want to TEE off something that Jen said, which is. You know, we don't we have so many implicit assumptions and we don't recognize I love that like you know we're still in big print. So our front door is inhospitable to lots of people and our digital front door is inhospitable to a different group of people.
22
00:03:08.250 --> 00:03:17.880
Lee H. Schwamm, MD: we're never going to have a perfect front door We just have to have mitigation strategies to make sure that our doors are open, in one way or another to meet as many patients needs as possible.
23
00:03:18.270 --> 00:03:25.410
Shahid N. Shah: And it was just such great insight say josh if you could do a quick intro and then i'll jump back to ask a quick question from me about that, what do you just post.
24
00:03:25.800 --> 00:03:33.030
Josh Goode: Sure, I love those insights or white i'm josh good i'm CIO scaling group and health plan we're a medicare advantage.
25
00:03:33.600 --> 00:03:51.660
Josh Goode: plan based in southern California, we operate in three states Arizona Nevada and obviously California obviously as a medicare advantage plan serving the senior population so yeah happy to be here today and talk about the their perspective on telehealth and virtual care.
26
00:03:52.320 --> 00:04:02.070
Shahid N. Shah: awesome so the one of the reason I wanted to start with you as you guys have been doing this for decades right, not just two years postcode so, given the past couple of decades that you've seen at.
27
00:04:02.550 --> 00:04:03.900
Shahid N. Shah: Now you're bringing a brigham.
28
00:04:04.440 --> 00:04:12.630
Shahid N. Shah: So tell us a little bit about what the current landscape of virtual is mostly we see things working, but if you can home really on.
29
00:04:12.840 --> 00:04:26.010
Shahid N. Shah: Where are we not doing things, maybe, as well as we could be in terms of virtual care and what's not working, would probably a good place to start then i'll have josh and Jen jump in on what they see in their landscape as well.
30
00:04:26.550 --> 00:04:34.020
Lee H. Schwamm, MD: Great well thanks thanks so much Shahid, so a lot of our early work really focused on institutional.
31
00:04:34.680 --> 00:04:45.360
Lee H. Schwamm, MD: Consultations you know, keeping a stroke patient in an emergency room in new Hampshire local by providing expert advice initiating care, but it was always a chaperoned interaction.
32
00:04:45.960 --> 00:04:49.290
Lee H. Schwamm, MD: And then we began to experiment with virtual visits pre pandemic.
33
00:04:49.620 --> 00:04:57.450
Lee H. Schwamm, MD: It was pretty much a coalition of the willing, it was providers who are interested in piloting this it was their patients who were really eager to do it and we found.
34
00:04:57.810 --> 00:05:09.180
Lee H. Schwamm, MD: You know, it was mostly wealthier patients who live far from the hospital who preferred to come virtually as opposed to the two and a half hour, you know round trip drive and all the inconveniences.
35
00:05:09.840 --> 00:05:15.810
Lee H. Schwamm, MD: When covert hit it was no longer virtual versus in person right, it was virtual versus nothing.
36
00:05:16.380 --> 00:05:26.280
Lee H. Schwamm, MD: So the doors open pretty wide all we had massive adoption in our provider group almost 10,000 providers of all the people who ended up doing a visit that year.
37
00:05:26.880 --> 00:05:36.330
Lee H. Schwamm, MD: 90 plus percent did it in the first six weeks so right, it was just this like everyone's doing it now, and all the patients were being scheduled for virtual and a lot of them.
38
00:05:36.660 --> 00:05:41.970
Lee H. Schwamm, MD: Really struggled, and so we saw right away, like everyone else, that if you didn't speak English if you were older.
39
00:05:42.870 --> 00:05:46.560
Lee H. Schwamm, MD: And if you had other social determinants of health, you were much more likely.
40
00:05:46.890 --> 00:05:56.370
Lee H. Schwamm, MD: To struggle and we used audio only you know good old telephone as a way to bridge care for a lot of those patients now in behavioral health that might be fine.
41
00:05:56.820 --> 00:06:04.770
Lee H. Schwamm, MD: But in other conditions, not having the videos are real limitation, so one of the risks, I would say, one of the early failures for all of us was.
42
00:06:05.280 --> 00:06:09.780
Lee H. Schwamm, MD: We were not able to address the health needs of some of our most vulnerable patients.
43
00:06:10.410 --> 00:06:15.840
Lee H. Schwamm, MD: Now those patients ironically had always been able to come to our front door, they just needed to you know get on the bus and.
44
00:06:16.260 --> 00:06:21.300
Lee H. Schwamm, MD: and be able to show a piece of paper at the front desk of where they needed to go they didn't even need to speak.
45
00:06:21.960 --> 00:06:26.940
Lee H. Schwamm, MD: English to generally to you know, make it to our office and then hopefully an interpreter was there to.
46
00:06:27.360 --> 00:06:32.700
Lee H. Schwamm, MD: Help them navigate the visit if they didn't speak English, so I think we really we struggled there.
47
00:06:33.030 --> 00:06:40.620
Lee H. Schwamm, MD: We struggled getting interpreters into our video enabled interactions initially we we didn't have a good conduit to bring our interpreter.
48
00:06:41.190 --> 00:06:47.940
Lee H. Schwamm, MD: vendors into that we struggled with children, particularly those who require a portal account.
49
00:06:48.240 --> 00:07:00.720
Lee H. Schwamm, MD: But are in that middle age group, where they're they're minors, but their parents can no longer like have you know be present if they you know it's complicated but there's this middle age group, where the you know the the regulations get really thorny.
50
00:07:01.830 --> 00:07:13.980
Lee H. Schwamm, MD: And I think that we really still don't have a great handle on our patients with visual and cognitive deficits, I think, for the hearing impaired, we do have the ability to have asl interpreters join.
51
00:07:14.790 --> 00:07:22.800
Lee H. Schwamm, MD: But for the visually impaired and for those with cognitive impairment we're really relying on a chaperone you know family member or loved one somebody who's going to.
52
00:07:23.160 --> 00:07:30.840
Lee H. Schwamm, MD: Help them navigate that visit, and you know quite frankly we've always relied on patients to bring their own helpers to these visits anyway right we.
53
00:07:31.140 --> 00:07:37.470
Lee H. Schwamm, MD: We encourage patients to bring people with them to visits, it makes them more effective as patients but we've now put another.
54
00:07:38.370 --> 00:07:47.340
Lee H. Schwamm, MD: burden on the backs of the quote unquote support system for the patient now they're not just emotional support they have to be cognitive support tech support.
55
00:07:47.790 --> 00:07:53.730
Lee H. Schwamm, MD: And that can be really challenging so I, I would say that those are our early struggles we've made a big.
56
00:07:54.150 --> 00:08:00.570
Lee H. Schwamm, MD: Big commitment to translating our portal into multiple languages we've made a big commitment to creating.
57
00:08:00.990 --> 00:08:07.890
Lee H. Schwamm, MD: sort of digital access coordinators who are stationed in some of our primary care clinics in areas where we're patients have been.
58
00:08:08.580 --> 00:08:18.270
Lee H. Schwamm, MD: suffering and struggling to get on to our digital platforms, those are helping but those are still you know small numbers, and so we just got a big grant from.
59
00:08:18.930 --> 00:08:37.980
Lee H. Schwamm, MD: One of our local foundations to study better ways to bridge the digital divide and we're hoping to do that with digital tools, because we know that from a Labor perspective we can't afford a one on one human interaction and so we learned that chat interactive texting.
60
00:08:37.980 --> 00:08:39.270
Lee H. Schwamm, MD: interactive voice.
61
00:08:39.600 --> 00:08:52.590
Lee H. Schwamm, MD: There are other vehicles, besides print or plain old telephone that even our older patients or patients who don't speak English as their primary language are much more comfortable leveraging so let me pause there and turn it back to you.
62
00:08:52.950 --> 00:08:59.670
Shahid N. Shah: Now that's a great day landscape overview and before bringing josh in on the on the payer and the plan side.
63
00:09:00.180 --> 00:09:09.060
Shahid N. Shah: What do you think Lee is the outlook let's say the short term outlook next 18 to 24 months, if you look back at the last 18 months you saw.
64
00:09:09.390 --> 00:09:24.540
Shahid N. Shah: Massive spike your reasonable drop, because every couldn't sustain that massive spike so a reasonable drop, but do you see it further leveling now, or is it now continuing to fall as far as utilization through telemedicine and.
65
00:09:24.960 --> 00:09:32.730
Lee H. Schwamm, MD: Remote patient monitoring yeah, so I think what we're seeing is differentiation our behavioral health specialists or 90% plus virtual they're never going back.
66
00:09:32.790 --> 00:09:34.380
Lee H. Schwamm, MD: To the office on a regular basis.
67
00:09:34.740 --> 00:09:43.710
Lee H. Schwamm, MD: I mean, there will still be office space providers, but the bulk of that is going, and we have payment parody for behavioral health indefinitely now so that's you know that's that's sort of mainline.
68
00:09:44.580 --> 00:09:58.200
Lee H. Schwamm, MD: I think some specialties are going back toward mostly in person, also to address a lot of pent up demand for in person, services and I think we're seeing patients are beginning to express preferences or we're beginning to target patients.
69
00:09:58.530 --> 00:10:08.460
Lee H. Schwamm, MD: To one technology versus another but i'm worried that it's not thoughtful and intentional it's just path of least resistance and I don't want us to snap back.
70
00:10:08.820 --> 00:10:19.200
Lee H. Schwamm, MD: To wow just have them come in right we don't want that we also don't want hey I don't like to work in the office on Friday so i'm all virtual on Fridays don't you dare book me and in person patient, I think we.
71
00:10:19.890 --> 00:10:30.870
Lee H. Schwamm, MD: We have to really embrace both a moral imperative, as well as a business reality if we stop offering this service our competitors who offer it as a digital first alternative.
72
00:10:31.350 --> 00:10:43.860
Lee H. Schwamm, MD: are going to attract a lot of patients away from us, so I don't think we have a choice, but we have to do is address that plus the moral imperative that Jan was alluding to at the very beginning, which is.
73
00:10:44.370 --> 00:10:57.840
Lee H. Schwamm, MD: We have to have make sure our doors are open for everybody, and it may be one door for one person, maybe a digital door for Jan and an in person door for josh, but we have a moral imperative that as a academic health system we can't sure.
74
00:10:58.500 --> 00:11:02.820
Shahid N. Shah: Great and josh bringing you in let's take it let's bring you in on a hard question which is.
75
00:11:03.570 --> 00:11:12.750
Shahid N. Shah: Lee mentioned payment parody can you describe what that means for the audience and then say has payment parody or payments in general.
76
00:11:13.710 --> 00:11:19.440
Shahid N. Shah: led to what you believe to be more or less use of telemedicine, during the last 18 months.
77
00:11:19.740 --> 00:11:29.340
Shahid N. Shah: And then i'd love for you to start with that answer after answering we know what is payment parody and what do you guys see about that, what do you see as the next 18 months as far as utilization is concerned.
78
00:11:29.760 --> 00:11:37.590
Josh Goode: Sure yeah and it's amazing listen to the talk there and just the experiences, I mean on the payer and the provider side very, very similar.
79
00:11:38.610 --> 00:11:50.790
Josh Goode: You know experiences across the board, or why but payment integrity, I mean looking at that, I mean the reimbursements I think you know definitely over the last 18 months, as you know, increase the access.
80
00:11:52.080 --> 00:12:03.690
Josh Goode: You know, from a you know Tele health virtual care perspective, and you know I do see that continuing I mean I don't see us, you know going back, I mean we made the statement about you know our competitors would.
81
00:12:04.800 --> 00:12:10.320
Josh Goode: You know, really move into the space, if we were to pull back and not offer you know these type of services.
82
00:12:10.680 --> 00:12:24.090
Josh Goode: yeah I don't see us going back, and you know what we've been focused on at scan is how do we enable you know our Members, our patients, how do we enable them to be able to access the services, you know we you know we.
83
00:12:24.870 --> 00:12:36.240
Josh Goode: You know, like to make sure we're offering a wide variety of services, for you know our Members, you know digital is not not for everyone there definitely is a digital divide out there.
84
00:12:36.630 --> 00:12:46.500
Josh Goode: But we want to make sure we have the the right touch the right channels, the right services, you know for our members and that's where you know we feel we really have to have a broad.
85
00:12:47.310 --> 00:13:02.010
Josh Goode: suite of offering of services that that will support all of our different Members across the board, but you know, as I look out over the next 18 months, you know, continue to see the adoption, accelerate.
86
00:13:03.030 --> 00:13:13.170
Josh Goode: You know we're working with our Members, trying to get them more comfortable trying to bring down the barriers of that digital divide, you know, one of the stories I like to talk about.
87
00:13:14.130 --> 00:13:21.780
Josh Goode: When I talk on this subject is you know when the pandemic hit one of the things we did a scan is we launched a member of technology support line.
88
00:13:22.830 --> 00:13:31.710
Josh Goode: You know we're looking to support our Members were you know what we have seen with a pandemic our Members were really thrust into this digital world.
89
00:13:32.040 --> 00:13:41.460
Josh Goode: If you wanted to maintain care, you had to be digitally savvy I mean there was not an option, you know, to go visit your clinician in person.
90
00:13:41.910 --> 00:13:57.300
Josh Goode: And it's been very successful so you know, I was a little nervous, our first call was a 92 year old Member it took 45 minutes, but he he needed an email address he had never send an email before and had to register on a patient portal to get access to.
91
00:13:58.320 --> 00:14:08.310
Josh Goode: The Tele health side and we walk them through the process of setting up an email address, and you know walk them through what that visit would be like you know the visit.
92
00:14:08.730 --> 00:14:21.030
Josh Goode: You know, is you know the experience is very different it's not the same as an in person experience but, but we, we continue to educate our members and look to see adoption continuing to increase over the next 18 months.
93
00:14:21.990 --> 00:14:32.190
Shahid N. Shah: got it so josh as you think about the struggles that you had early on more those mainly struggles on the patient side and the providers.
94
00:14:32.820 --> 00:14:47.070
Shahid N. Shah: got their education and came up pretty quickly or was the problem on both side that the providers weren't ready and the patients sometimes were sometimes a patient's weren't ready in the providers, where is that still going on, that that dichotomy.
95
00:14:47.610 --> 00:14:55.230
Josh Goode: You know what I would say it's more on the patient side, nowadays, I mean so definitely at the start of the pandemic, it was on both sides, you know we.
96
00:14:55.590 --> 00:15:03.960
Josh Goode: You know, and obviously you know each patient is different, but we saw a pretty large digital divide, I mean obviously you know we're working with the senior population.
97
00:15:04.680 --> 00:15:14.310
Josh Goode: And you know there were struggles, you know getting access to care, and you know just you know the basic things of signing up for a patient portal.
98
00:15:15.330 --> 00:15:24.150
Josh Goode: You know, things like that can be challenging I mean they seem simple and easy, but they can present challenges to those that are not as digitally savvy or.
99
00:15:24.900 --> 00:15:32.700
Josh Goode: Or, as advanced or white, and I, I think, on the provider, the health system health plan side you know we've gotten better.
100
00:15:33.630 --> 00:15:41.820
Josh Goode: You know, with our you know Tele health our virtual virtual care offerings or when you know, one of the things we saw you know at the onset of the pandemic.
101
00:15:42.570 --> 00:15:54.990
Josh Goode: You know a lot of these Tele health solutions were behind patient portals and yeah so you know, as I talked about you know you had to go register, you had to go yeah i'd have email, which you know for like the example I gave.
102
00:15:56.190 --> 00:16:04.920
Josh Goode: You know, some individuals don't have email and they're not used to using email, and I think we've gotten better as a health system where we've made access.
103
00:16:05.400 --> 00:16:15.900
Josh Goode: Much easier, you know now you get a text reminder and click the link and you're right into your you know virtual visit, or what so you know we've gotten better as a health system.
104
00:16:16.770 --> 00:16:22.890
Josh Goode: We brought down some of those barriers to the access and made it a little bit easier for those that are not as digitally savvy.
105
00:16:23.220 --> 00:16:30.000
Shahid N. Shah: If I So if you let me put some words in your mouth I think what you're saying is that you're going to have you're going to see it you're predicting at least.
106
00:16:30.300 --> 00:16:38.850
Shahid N. Shah: leveling and staying at level or going up, as far as real patient monitoring virtual care, etc, is that about right or D, so you don't.
107
00:16:38.850 --> 00:16:39.870
Shahid N. Shah: Think it's going to be coming down.
108
00:16:40.290 --> 00:16:47.340
Josh Goode: yeah I don't see it coming down I think we're going to go up I don't obviously it's not going to be like it was at the onset of the pandemic where.
109
00:16:48.150 --> 00:16:58.110
Josh Goode: You know Steve client, but I think we're going to see a steady climb, as we get better and we make it easier in the technology gets better and it makes it easier to.
110
00:16:59.250 --> 00:17:01.710
Josh Goode: be able to service our patients, you know robot with.
111
00:17:02.040 --> 00:17:07.110
Shahid N. Shah: guided and so again when you look at the technology getting better as josh just put it.
112
00:17:08.100 --> 00:17:14.400
Shahid N. Shah: there's a lot of problems and you heard Lee and josh to talk about just data like getting an email account was a problem.
113
00:17:14.790 --> 00:17:22.050
Shahid N. Shah: doing all of the other support around it, etc had been a challenge, so when you start to then think about this idea that.
114
00:17:22.350 --> 00:17:32.550
Shahid N. Shah: you're going to need to try to improve accessibility for hearing impaired learning impaired cognitively impaired as as we mentioned you're talking about visually impaired.
115
00:17:33.510 --> 00:17:44.640
Shahid N. Shah: Are those numbers high enough to to merit and enormous amount of priority to be spent on it so i'd love for you to start there again is to say, what is the an obvious part of this, that you know.
116
00:17:44.970 --> 00:17:54.480
Shahid N. Shah: Are we talking about 2% of the patient population that needs to worry about accessibility, or is it 90% of the population that we need to about worry about accessibility and then talk about.
117
00:17:55.050 --> 00:18:03.630
Shahid N. Shah: Of those where we do need to worry about accessibility and improving access, how do you actually go do it when you have 900 other things to work on.
118
00:18:04.770 --> 00:18:14.940
Jan Smith Reed: You know we all have the priority issue, and I think that the important thing to remember is that when you make things accessible it's better for everyone.
119
00:18:15.360 --> 00:18:28.650
Jan Smith Reed: So if you are going to make a documents available in a portal, the way that they read and flow for everyone is better, so I think of it that way, but I really back up a little bit to think.
120
00:18:29.490 --> 00:18:43.590
Jan Smith Reed: we're we are going in medicine to both the provider and the payer side is more outside of the hospital more outside of the doctor's office more in home so i've spoken recently to.
121
00:18:43.950 --> 00:18:53.100
Jan Smith Reed: organizations that are getting ready to ship equipment to someone's home to do physical therapy in their home and be monitored over a TV and that's what they're building toward.
122
00:18:53.520 --> 00:19:00.630
Jan Smith Reed: So if we're going to go there and I think that's where we're going, not in the next 12 months, maybe, but that's where we're going.
123
00:19:00.930 --> 00:19:12.780
Jan Smith Reed: Then, while we build all of that capability, we have to be thinking about how do we engage everyone, and I think cms has been extremely.
124
00:19:13.590 --> 00:19:23.550
Jan Smith Reed: vocal verbal about this, that they are looking for outcomes to be better, regardless of what environment, you are putting the person in so.
125
00:19:23.970 --> 00:19:36.150
Jan Smith Reed: I think that eventually we won't be measuring some engagement things that we're measuring now will be measuring things like how well did your remote monitoring work how well did your remote equipment work.
126
00:19:36.480 --> 00:19:41.730
Jan Smith Reed: You know, those are going to be the different kinds of clinical outcomes that we're going to be reporting on.
127
00:19:42.060 --> 00:19:54.630
Jan Smith Reed: For now, the new caps measure says Member satisfaction engagement is equal to that clinical outcome, which means you can't worry about how many people are.
128
00:19:54.900 --> 00:20:10.020
Jan Smith Reed: blind or disabled or the things that you want to categorize them as being disabled are we disabling anyone, because there is no room for that if you all have worked and i'm sure you have everybody.
129
00:20:10.380 --> 00:20:22.470
Jan Smith Reed: You know, on the whole measure of outcomes sometimes it's down to I can remember my days ago we kind of get three people in here, we got to get those results up and we just need three people.
130
00:20:22.770 --> 00:20:34.200
Jan Smith Reed: So it comes down to every person matters, and I think, as we move to consumerism more and more, we have got to make sure that there is information available to everyone.
131
00:20:34.440 --> 00:20:42.330
Jan Smith Reed: they're going to have to make decisions they're going to have to have access to information and just because a person is buying doesn't make them.
132
00:20:43.380 --> 00:20:54.330
Jan Smith Reed: i'm able to understand or incapable of managing on their own, many of you may know, I work a lot a lot with lex gillette who's a paralympian.
133
00:20:54.600 --> 00:21:05.790
Jan Smith Reed: done a number of interviews with him on health care he's an extremely successful person he doesn't expect to bring a third party, along with him to a doctor's office visit.
134
00:21:06.060 --> 00:21:16.710
Jan Smith Reed: You know if he will talk about needing to stand 60 back and yellow social security number or a credit card number, you know out to the person who's sitting there to.
135
00:21:17.040 --> 00:21:21.870
Jan Smith Reed: You know, like this, you are disabling me and i'm, not to say phone you know.
136
00:21:22.230 --> 00:21:30.540
Jan Smith Reed: So we've got to think like that we've got to think not only from the clinical side are the on off buttons on capable of being read.
137
00:21:30.810 --> 00:21:45.960
Jan Smith Reed: By a person who has low vision and when we think of the numbers to your point let's think about elderly adults, they have vision impairments, so in this world of print, they would like the option to get those things in large.
138
00:21:45.960 --> 00:21:46.380
Josh Goode: print.
139
00:21:46.710 --> 00:21:56.340
Jan Smith Reed: don't force me down a digital road just asked me if I could get that in a large print and I will love you as a health plan so there's a lot of ways to go here.
140
00:21:57.240 --> 00:22:02.310
Shahid N. Shah: got it no that's that's a really, really good insight is that if you're looking at prioritization so i'm an engineer.
141
00:22:02.520 --> 00:22:11.400
Shahid N. Shah: And as we make things we always have to prioritize them and say okay we're going to go after this user group first or that audience second but I love the way that you stage this.
142
00:22:11.730 --> 00:22:18.510
Shahid N. Shah: Jan and i'll have the comment on the following statement, and that is if you took any one sliver.
143
00:22:19.200 --> 00:22:28.320
Shahid N. Shah: of accessibility issues, whether it's age or visual or audio etc, it might be 2% 5% some single digit percentage one sliver of them.
144
00:22:28.620 --> 00:22:36.600
Shahid N. Shah: But then when you start to accumulate these they hit 20 3040 50% of your entire population, and I think I love the way that Jan put it, which is.
145
00:22:36.990 --> 00:22:46.830
Shahid N. Shah: Go ahead and target the least common denominator and then you get the most of the benefit and the bang for the buck for almost everybody else so.
146
00:22:47.220 --> 00:22:53.370
Shahid N. Shah: lead, do you agree with that statement and what would use to tell innovators that are out in the audience.
147
00:22:53.820 --> 00:23:04.140
Shahid N. Shah: Looking to build the next thing from your perspective to say guys Please concentrate on this improvement that improvement Where would you tell them to focus their attention, based on what you've seen.
148
00:23:07.740 --> 00:23:08.400
Shahid N. Shah: So you're on mute.
149
00:23:09.630 --> 00:23:17.940
Lee H. Schwamm, MD: Sorry, I was with you right up until the least common denominator statement, and let me say why, which is, I think what we really want to do is hyper personalization.
150
00:23:18.210 --> 00:23:29.040
Lee H. Schwamm, MD: um what we want to do is plan for all eventualities, if possible, by creating extensive ability and allowing for local customization.
151
00:23:29.520 --> 00:23:39.450
Lee H. Schwamm, MD: On top of a standard, you know platform software platform and so two things one is you know, there are standards for accessibility on the web.
152
00:23:39.990 --> 00:23:46.500
Lee H. Schwamm, MD: That most developers just don't adhere to and hospitals really need to pay attention to that so that.
153
00:23:46.980 --> 00:23:56.220
Lee H. Schwamm, MD: The print can get larger the picture can be read out loud as text the user doesn't have to rely on a graphical interface, in order to interact, they have.
154
00:23:56.580 --> 00:24:02.100
Lee H. Schwamm, MD: Other ways that they can make progress, you know the graphical user interface that that apple really.
155
00:24:02.670 --> 00:24:11.640
Lee H. Schwamm, MD: You know capitalized others may be invented it arguably but apple really brought it to life was a boon for many people to become intuitively comfort with computers.
156
00:24:12.030 --> 00:24:22.350
Lee H. Schwamm, MD: But it took a big segment of the population and set them back those who were not capable of interacting visually so so I like the idea also around.
157
00:24:23.040 --> 00:24:34.050
Lee H. Schwamm, MD: You know, thinking about equity and inclusion, it makes us serve everyone better because what it says is, let me just question all of my core assumptions about how you're going to consume my product.
158
00:24:34.530 --> 00:24:43.050
Lee H. Schwamm, MD: and try to make it as easy as joyful as seamless for you as possible, so I guess, I would say, if I had to you know say one thing.
159
00:24:43.470 --> 00:24:50.820
Lee H. Schwamm, MD: To two designers and developers and innovators, it would be there's no free lunch right everything's a trade off that's that's you know given.
160
00:24:51.420 --> 00:25:00.750
Lee H. Schwamm, MD: But focus on an exquisite user experience, if you really focus on that and design your core principles around that you will make a lot of progress.
161
00:25:01.200 --> 00:25:06.150
Lee H. Schwamm, MD: And I said what I said at the very beginning, I think it's it is ultimately those still a moral imperative.
162
00:25:06.660 --> 00:25:11.700
Lee H. Schwamm, MD: it's not a business imperative for many businesses, they can get by just fine with the 85%.
163
00:25:12.360 --> 00:25:17.010
Lee H. Schwamm, MD: For healthcare, it should be a moral imperative if you have any question about it from a business lens it shouldn't matter.
164
00:25:17.430 --> 00:25:24.660
Lee H. Schwamm, MD: You should be compelled to get there, morally, no matter what so let's figure out how to do it in the most efficient the most effective the most successful way possible.
165
00:25:24.960 --> 00:25:32.220
Lee H. Schwamm, MD: And who knows, we may gain increased engagement and loyalty from other segments that we didn't anticipate reaching by this new strategy.
166
00:25:32.550 --> 00:25:36.420
Lee H. Schwamm, MD: That, I just want to share one anecdote with you that really exemplified this for me.
167
00:25:36.840 --> 00:25:43.950
Lee H. Schwamm, MD: Years ago I went to the va hospital in our in our area where I live in Boston as a couple, but I went to meet with a friend who worked there.
168
00:25:44.490 --> 00:25:50.520
Lee H. Schwamm, MD: And I got in the elevator and I was so I had this like Epiphany when I looked at to push the floor.
169
00:25:51.030 --> 00:25:58.710
Lee H. Schwamm, MD: and realize that the buttons are laid out in a horizontal row along the side wall of the elevator not vertically like we're used to.
170
00:25:59.190 --> 00:26:06.090
Lee H. Schwamm, MD: And that's because many of these buildings were built after the Vietnam War many veterans were in wheelchairs, they couldn't reach above you know for.
171
00:26:06.450 --> 00:26:15.030
Lee H. Schwamm, MD: On the keypad and so when they're all laid out horizontally and that's one of those moments I was like, of course, but it never occurred to me ever.
172
00:26:15.480 --> 00:26:24.360
Lee H. Schwamm, MD: That the layout of the keypad was a physical limitation for some and so that's where this focus on equity inclusion makes you realize.
173
00:26:25.080 --> 00:26:31.740
Lee H. Schwamm, MD: barriers that are affecting the majority, not just a small portion of the of your patient population.
174
00:26:32.340 --> 00:26:43.410
Lee H. Schwamm, MD: That you can do some amazing things for and then everybody benefits, so I I want a second what Jen said when you think that way you do a better job of focusing on the user experience everybody benefits.
175
00:26:43.470 --> 00:26:49.440
Shahid N. Shah: So, could we expand then your idea of you know, Section 508, which is the.
176
00:26:49.890 --> 00:26:53.070
Shahid N. Shah: General REG REG I think it's an OSHA REG if i'm not mistaken.
177
00:26:53.280 --> 00:27:01.410
Shahid N. Shah: But the section 508 regulations indicate what you should be doing to make things more accessible, is that something leave that you guys and then i'll ask josh to answer the same is.
178
00:27:01.650 --> 00:27:12.930
Shahid N. Shah: Is that something that you require in your rfp to meet, just like, for example, somebody bought something at the va they would have to meet section 508 compliance, for it to work at the va do you require that at your institution.
179
00:27:13.260 --> 00:27:21.810
Lee H. Schwamm, MD: You know I suspect we do as a healthcare, you know, a public building facility, I suspect we do I don't know the answer to that specific question.
180
00:27:22.110 --> 00:27:33.060
Lee H. Schwamm, MD: But we have a very focused effort on, as I said, you know diversity equity and inclusion and I think what we what we really need to be doing is extending that.
181
00:27:33.450 --> 00:27:45.060
Lee H. Schwamm, MD: Beyond that concept beyond its physical boundaries of you know, making sure you have a ramp at every entrance to a more of a metaphorical approach, which is that accessibility is always.
182
00:27:46.170 --> 00:27:49.830
Lee H. Schwamm, MD: One of the core design principles as you sit down to build anything.
183
00:27:50.190 --> 00:28:02.460
Shahid N. Shah: got it and so josh are you if you're familiar with section 508 compliant it that's something that that you know whether you, including your rfp etc, and would you recommend that to our audience members to add that, to their rfp.
184
00:28:03.510 --> 00:28:10.800
Josh Goode: I would we do included in our fee, we included in our overall design process across the board, and you know.
185
00:28:11.340 --> 00:28:19.170
Josh Goode: To the point that Jan and we are making you know accessibility are really key here, you know as I look at how we're going to continue to.
186
00:28:19.770 --> 00:28:36.600
Josh Goode: You know, transform in this space, you know, making it where a user you know can personalize you know the experience you know we've taken a one size fits all approach to this and you know everyone is different, everyone has a different experience and having the ability.
187
00:28:37.830 --> 00:28:45.510
Josh Goode: To be able to tailor and craft that I mean yeah one of the things we do is scan we do a lot of research work with our Members, our population and.
188
00:28:45.960 --> 00:28:50.190
Josh Goode: You know, looking at some of our survey results ever coming back one of the.
189
00:28:50.550 --> 00:28:59.940
Josh Goode: One of the challenges our Members were having I want to say it was around 14 or 15% or less just with the communication, you know there's a communication barrier as.
190
00:29:00.480 --> 00:29:11.610
Josh Goode: You know you're communicating over you know video call versus being in person, and you know there's little things like you know, do you know, having a teleprompter that is enabled you know.
191
00:29:12.480 --> 00:29:18.720
Josh Goode: there's a video call where you know I can personalize that if i'm having a challenge communicating with my clinician.
192
00:29:19.230 --> 00:29:35.250
Josh Goode: I can enable a teleprompter but things like that you know I would encourage us to continue to look at how do we personalize, how do we give those options to our Members, our patients to be able to personalize and really develop the best experience for them.
193
00:29:35.940 --> 00:29:44.520
Shahid N. Shah: yeah and so joshua what i'll do here is editorialize a little bit as an engineer, we have when we do prioritization it's really, really hard.
194
00:29:45.060 --> 00:29:55.350
Shahid N. Shah: So one of the things that you, we do have that we did not have 10 years ago or or even five years ago, was the availability of design systems.
195
00:29:56.100 --> 00:30:03.480
Shahid N. Shah: With already accessibility built directly into them so as an example microsoft's fluency design system.
196
00:30:04.170 --> 00:30:14.370
Shahid N. Shah: salesforce is lightning design system or adobe's spectrum design system most major corporations now have built their design systems.
197
00:30:14.580 --> 00:30:21.690
Shahid N. Shah: So you can actually go if you're a small startup if you're innovator and you're saying like look I don't have the personnel I can't build all this on my own.
198
00:30:22.680 --> 00:30:30.300
Shahid N. Shah: Great user and they're all Open Source so it's not like they're asking you to pay for these use the Open Source ones, and I think I would recommend you know both the.
199
00:30:31.260 --> 00:30:38.220
Shahid N. Shah: Lee and josh to look at those and say even for startups even for the early ones, if they use a proper design system.
200
00:30:38.520 --> 00:30:50.760
Shahid N. Shah: accessibility is not always built in because it's non trivial to add accessibility right so it's not built in, but you can build on top of it, without having to go from scratch any other things like that jam that you would suggest that.
201
00:30:51.240 --> 00:31:02.490
Shahid N. Shah: You know it's low lift that either the leaves and the joshua's of the world can do when they're buying something or the engineers are the words like me can do and we're building it what kind of advice would you give us.
202
00:31:03.060 --> 00:31:14.550
Jan Smith Reed: yeah so a lot of that can be done from scratch at the beginning, so if you're starting a website and you're starting to portal, if we are engaged with you, we can build it from the scratch up.
203
00:31:14.880 --> 00:31:21.720
Jan Smith Reed: A lot of engineers or programmers are not trained and accessibility, that is not touched in their training.
204
00:31:21.960 --> 00:31:28.290
Jan Smith Reed: So when they're coming out they don't not know they're going to go in and program for you, but they don't know how to make it accessible.
205
00:31:28.620 --> 00:31:39.480
Jan Smith Reed: So we do audits on websites and portals to help and will give you the exact instructions on what to do to bring those up and will continue to audit, so that you are meeting all the requirements of what.
206
00:31:40.890 --> 00:31:55.080
Jan Smith Reed: I would also encourage you, and we're seeing more and more health plans and providers now proactively saying hey we're offering accessibility again right out of the gate you get a lot of really positive.
207
00:31:55.530 --> 00:32:02.580
Jan Smith Reed: impression of that so we're offering this here formats, you can get items printed if you're receiving print.
208
00:32:02.880 --> 00:32:10.920
Jan Smith Reed: Or, if you want to have this accessible PDF for your hobbies and things like that those can come to you in this format as well.
209
00:32:11.190 --> 00:32:20.640
Jan Smith Reed: So we're seeing a lot more health plans and provider saying yep we want to do that proactively we're going to let the patient or we're going to have them Member tell us.
210
00:32:20.910 --> 00:32:27.810
Jan Smith Reed: And then we're going to flag their file and every communication that goes to them is going to be in that alternate format.
211
00:32:28.050 --> 00:32:37.200
Jan Smith Reed: So that might be Braille it might be a large print and might be an accessible PDF, but we will make sure that they get it in the format that they want.
212
00:32:37.650 --> 00:32:53.970
Jan Smith Reed: So we're certainly you know very focused in the banking industry, education and banking have been light years ahead of health care in this, we are all just getting up to speed on that, but we know the security requirements all of that around healthcare and I just remind everyone that.
213
00:32:55.050 --> 00:33:11.430
Jan Smith Reed: Of the obamacare affordable care act brought 508 right front and Center to say healthcare This applies to you, you cannot just sort of do it the way you were so that's why I think we're seeing a lot more focus and a lot more movement and saying.
214
00:33:12.030 --> 00:33:25.740
Jan Smith Reed: Inclusion means something more than we initially thought about when we said oh we're leaving people behind were much better now, as he says it thinking about who all are we, leaving behind.
215
00:33:26.160 --> 00:33:30.540
Shahid N. Shah: Now that's great Dan and in the last few minutes that we have left that talk to me a little bit about.
216
00:33:31.200 --> 00:33:33.570
Shahid N. Shah: What are some of the excuses that you here.
217
00:33:33.870 --> 00:33:45.270
Shahid N. Shah: And I know you're going to talk about this, because you probably hear them all the time is I can't do this accessibility, because of money, I can't do this accessibility, because of time because of prioritization tell us what are some of your most popular.
218
00:33:45.810 --> 00:33:56.550
Shahid N. Shah: Either humorous or sad excuses that you hear and how do you get away and then, how do you explain that to the senior leadership etc that says look guys yeah that might be an excuse, but it's not a valid one.
219
00:33:56.880 --> 00:34:09.330
Shahid N. Shah: And then, when Lisa and josh jump in I just love for them to comment on how would what what do they hear when people say no, we can't get to personalization etc so Jen tell it tell us your favorite excuses and why they shouldn't be.
220
00:34:09.750 --> 00:34:13.860
Jan Smith Reed: The excuse I really think is that we just started to winter.
221
00:34:14.100 --> 00:34:28.770
Jan Smith Reed: We don't think about them, and when we are brought to light that G, we ought to be thinking about this and, in fact, the population is much greater when to your point you think about who it really is or 2.0 it's all the people in wheelchairs, maybe.
222
00:34:29.100 --> 00:34:33.540
Jan Smith Reed: You know these are much greater amount so it's important to think about.
223
00:34:34.110 --> 00:34:42.030
Jan Smith Reed: I think the other thing is people I hear what I hear from leaders is, we have no idea where to start that seems very complicated.
224
00:34:42.360 --> 00:34:50.370
Jan Smith Reed: This is the other thing it's very complicated well it's not really all that complicated, you know we can do an audit of a website, we can make things accessible.
225
00:34:50.550 --> 00:34:56.460
Jan Smith Reed: We can meet the same timelines that you do for everything else that you have to meet and health care so that's kind of.
226
00:34:57.030 --> 00:35:09.930
Jan Smith Reed: One the other that i've heard that I find the most ridiculous is you know we sort of have a kitty set aside, so if we get you know sued for that or you know there's some risk there will have the money to take care of that it's like oh my God.
227
00:35:10.260 --> 00:35:19.170
Jan Smith Reed: What do you just spend the money fix it now and don't risk the PR nightmare, you know so that's kind of the most ridiculous one i've ever heard.
228
00:35:19.530 --> 00:35:28.950
Jan Smith Reed: But otherwise I think people you know, in general, the industry is starting to go yeah there's a moral obligation here.
229
00:35:29.310 --> 00:35:40.830
Jan Smith Reed: And this is important and it is kind of important on the bottom line now because of those CAP scores so and, as we move to consumerism.
230
00:35:41.250 --> 00:35:49.350
Jan Smith Reed: All of the sharing of information are we going to make sure that everybody gets it, are we going to be ready to take all those phone calls going gee.
231
00:35:49.590 --> 00:35:59.550
Jan Smith Reed: I don't know how to read what you gave me I can't see what you gave me I can't understand what you sent me, you know we've got to be thinking about everybody, so that they can make good decisions.
232
00:35:59.850 --> 00:36:05.070
Shahid N. Shah: yeah that makes sense, and I think you know from the moral imperative think you're going to have almost nobody disagree.
233
00:36:05.310 --> 00:36:14.100
Shahid N. Shah: There is also the imperative on the business side because you get better reimbursements with butter H caps scores, you can stay in business, if you have reasonable quality scores So those are all good.
234
00:36:14.670 --> 00:36:19.320
Shahid N. Shah: Lisa and josh in the last few minutes that we have left if you can just talk a little bit about.
235
00:36:20.250 --> 00:36:27.540
Shahid N. Shah: What, how do you actually prioritize the idea of personalization both of you are behind that concept so.
236
00:36:28.380 --> 00:36:34.020
Shahid N. Shah: How do you fund it, how do you prioritize it personalization requires an enormous amount of.
237
00:36:34.380 --> 00:36:47.610
Shahid N. Shah: Real world data so is that something that you're in a disciplined way capturing and then you can feed to the innovators or to the systems designers or how do you get to personalization Italy in your in your business.
238
00:36:48.360 --> 00:36:55.680
Lee H. Schwamm, MD: yeah, so this is what we're about to embark on an enormous way and I think it is the it is CRM 3.0.
239
00:36:55.710 --> 00:37:05.040
Lee H. Schwamm, MD: Right, so we we've we've understood and plumbed the depths of personalized advertising behavioral nudging to buy toothpaste, or you know.
240
00:37:05.730 --> 00:37:10.590
Lee H. Schwamm, MD: handguns or alarm systems right, you name it we figured out how to motivate people to spend their money.
241
00:37:11.370 --> 00:37:21.210
Lee H. Schwamm, MD: Now we want to take that information, and you know use it for good, we want to figure out how to get Jan to take her blood pressure pill morning, noon and night, we want to make sure that josh gets his.
242
00:37:21.660 --> 00:37:26.790
Lee H. Schwamm, MD: routine screenings is colonoscopy you know, make sure he takes his inhaler whatever the.
243
00:37:27.570 --> 00:37:35.370
Lee H. Schwamm, MD: Whatever, that is, as we move to more value based care again the incentives aligned beautifully in fee for service it's a little more complex but.
244
00:37:35.850 --> 00:37:43.350
Lee H. Schwamm, MD: there's so much competition and the fact that we have virtual care now has also created this open vista where.
245
00:37:43.860 --> 00:37:51.270
Lee H. Schwamm, MD: Anyone can compete with us now in our local market for patients right so it's good it's driving us to be better, so we are really.
246
00:37:51.690 --> 00:38:01.800
Lee H. Schwamm, MD: reimagining what the digital patient experience is going to be and that's going to require partnering with vendors and platforms that can allow us to collect that information.
247
00:38:02.250 --> 00:38:12.600
Lee H. Schwamm, MD: marry that data to what we know about them from their electronic health records, maybe to claims, maybe to genetics or remote monitoring, you know and kind of personalized.
248
00:38:13.020 --> 00:38:20.910
Lee H. Schwamm, MD: device information, so we can build really like your digital twin we want to build a digital version of you, that we can then.
249
00:38:21.360 --> 00:38:29.520
Lee H. Schwamm, MD: persuade to make healthy choices and get the right side of care at the lowest cost, you know all this stuff that we want to do, I think.
250
00:38:30.210 --> 00:38:33.150
Lee H. Schwamm, MD: it's becoming clear that to do that we've got to catch up.
251
00:38:33.750 --> 00:38:44.160
Lee H. Schwamm, MD: To the rest of the industries that have really moved into hyper personalization because that's what our patients are expecting now, and if they can get a trusted brand and that.
252
00:38:44.940 --> 00:38:58.440
Lee H. Schwamm, MD: You know you're done if it's trusted brand versus that my fear is that's going to get good enough, over time, that if we don't figure it out we'll be working for you know the consumer engagement platform, not the other way around.
253
00:38:58.890 --> 00:39:13.590
Shahid N. Shah: Right josh in the last few seconds that we have left out what could you guys do at scan to help the innovators and those that are trying to build these hyper personalization systems do you share data, are you willing to share data how How would you work with them.
254
00:39:14.430 --> 00:39:18.540
Josh Goode: yeah we are willing to share data obviously needs to be.
255
00:39:19.170 --> 00:39:28.860
Josh Goode: desensitized or what but you know, the one thing I would really encourage the innovators to do is reach out and talk to your users are what is something that we've done while where.
256
00:39:29.310 --> 00:39:36.990
Josh Goode: You know persons that are designed, we really you know, like to get involved and get you know our ideas get our prototypes in front of our Members in.
257
00:39:37.410 --> 00:39:53.370
Josh Goode: You know, get their feedback, you know, let them be involved in that design process or white, so you know don't try to you know build or design something in a vacuum, you know engage your end user or white it's been very invaluable for us.
258
00:39:54.000 --> 00:40:02.940
Shahid N. Shah: awesome well this was fantastic as usual idea Thank you so much lead josh for catching us up on where we are with respect to telemedicine.
259
00:40:03.330 --> 00:40:13.350
Shahid N. Shah: But really talking about the important parts of of why access is not equal, accessibility and vice versa, so this was fantastic, I want to thank all of you, and hopefully you'll join us at a future event as well.
260
00:40:13.830 --> 00:40:14.910
Jan Smith Reed: Thank you.
261
00:40:15.000 --> 00:40:15.780
Lee H. Schwamm, MD: Thanks so much.
262
00:40:21.300 --> 00:40:26.460
Shahid N. Shah: Oh so Emily mentioned that that we had do you want to you want to cover another I thought we were out of time that's why.
263
00:40:27.000 --> 00:40:29.310
Emily Raisch: We were previously had about three more minutes left.
264
00:40:29.310 --> 00:40:32.880
Emily Raisch: So it's fine if we wrap up a few minutes early that's not.
265
00:40:33.240 --> 00:40:39.000
Emily Raisch: The girls and you guys and no one's ever said about that behind.
266
00:40:40.080 --> 00:40:40.260
Shahid N. Shah: But.
267
00:40:40.440 --> 00:40:43.470
Shahid N. Shah: Anything that just have a quick note that lead gen or josh.
268
00:40:43.530 --> 00:40:47.760
Shahid N. Shah: Anything you wanted to cover that I didn't we if we've got those two minutes, we can do another quick edit.
269
00:40:48.420 --> 00:41:00.270
Lee H. Schwamm, MD: I mean, the only thing I would say is that I think there is a design, there is a trade off around design and with sort of agile design and the sprint that there is a tension between.
270
00:41:00.600 --> 00:41:08.910
Lee H. Schwamm, MD: Let me start rolling it out, let me, you know, let me start mainstreaming in the literate the digitally literate you know health literacy group.
271
00:41:09.270 --> 00:41:18.780
Lee H. Schwamm, MD: While I start to do some additional design development and and and you know innovative product development in some of those other patient groups who need more accessibility.
272
00:41:19.200 --> 00:41:26.310
Lee H. Schwamm, MD: that's probably a good approach from a design perspective, but from an equity perspective that is sometimes looked at as not.
273
00:41:26.730 --> 00:41:38.670
Lee H. Schwamm, MD: Being equitable and the fear is always i'll never get to those subsequent agile scrums i'll just stop with my 85% of my of my patient group, and it was a sort of distraction or excuse.
274
00:41:39.270 --> 00:41:48.930
Lee H. Schwamm, MD: So I think there is a little bit of tension there and that's something that we think about a lot is how do we work with our equity focused colleagues to reassure them.
275
00:41:49.350 --> 00:42:04.530
Lee H. Schwamm, MD: That we are intending to cover this but, at the same time, the learning that we get from other patients may also help inform us about how to make a more accessible product so that That to me is a that's that's always a question that we struggle with.
276
00:42:04.830 --> 00:42:18.180
Shahid N. Shah: Right and that goes back to prioritization is if we and having done this so many times in my own career we almost always do exactly what you just said Lee we prioritize the easiest to do, which is the non.
277
00:42:18.840 --> 00:42:27.510
Shahid N. Shah: Accessible part and then we never get to the other park we just hope that we're going to do, but we never get to it so that's a great point is that if we don't start prioritizing it first.
278
00:42:28.200 --> 00:42:34.410
Shahid N. Shah: And I think, unfortunately, and this mostly on the government side has been not quote solved, but at least.
279
00:42:34.800 --> 00:42:48.990
Shahid N. Shah: When I know when I designed for government 508 is not an option if you're not doing it you're not going to get the deal and so guess what work gets done but that may be an area where again josh and the, we can see if people start to add requirements on the.
280
00:42:49.170 --> 00:43:00.390
Lee H. Schwamm, MD: yeah I mean what what I would say there is there, so spirit of the law and there's the letter of the law, and you can meet the spirit, without really innovating or driving value, you can hit the checkbox yeah.
281
00:43:00.510 --> 00:43:05.460
Lee H. Schwamm, MD: But I think what we're talking about here is going way beyond the checkbox to explicit user experience.
282
00:43:05.820 --> 00:43:11.280
Lee H. Schwamm, MD: For people meeting them closer to where they are, as opposed to kind of meeting in the middle.
283
00:43:11.370 --> 00:43:11.610
Jan Smith Reed: yeah.
284
00:43:11.940 --> 00:43:14.670
Jan Smith Reed: I love that it really isn't about checking the box because.
285
00:43:14.940 --> 00:43:20.430
Jan Smith Reed: You know forever at the end of your adobe it says Oh, if you need to some alternate format call this number.
286
00:43:20.610 --> 00:43:29.970
Jan Smith Reed: I don't know if you've ever called that number i've called that number you're on hold for an hour I actually got a person, finally, and she said, oh you actually need to talk to a certain person.
Jan Smith Reed: I was like wow imagine if I was blind right now, after an hour wait to then be told I would be so frustrated I wouldn't want you, as my health plan.
Jan Smith Reed: You know, so I think we are trying to not check the box, but to the point of iterations I do see most organizations taking a first step in, which is a will offer this proactively if we can get you in USB with.
Jan Smith Reed: A you know, an e PDF it's not going to be on the website and the portal yet will work to get there in it, because we might have to spend $200,000 to really make the website what we needed to be so it is iterative I do think that's where we are right now.
Shahid N. Shah: Fantastic well this was great thanks we'll wrap up now and we'll see you at a future health impact event, thank you so much.
Jan Smith Reed: Thank you.
Josh Goode: Thank you.
Shahid N. Shah: awesome you guys bye.
Jan Smith Reed: bye guys.
bye.