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2021 Review Q&A: Cureatr Chief Clinical Officer Dr. Gregory Downing

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Gregory Downing, DO, PhD, is the Chief Clinical Officer of Cureatr, a medication management optimization, tech-enabled telepharmacy services company. In this Q&A that looks back on 2021, he reflects on a previous prediction, shares his thoughts on the current state of digital health, and highlights what he considers some of the biggest developments of the year.

greg-downingQ: In this 2021 outlook interview, Cureatr CEO, Richard Resnick predicted a massive growth of Medicare Advantage plans. Do you think this prediction has come to fruition, and what have been its implications?

Dr. Gregory Downing: This has importance to the community that Cureatr services as our telepharmacy clinic complements and contributes to the value that the Medicare Advantage program provides through commercial carriers. In 2021, statistics show that more than 4 in 10 (~42%) of Medicare beneficiaries, representing about 26.4 million Medicare beneficiaries out of 62.7 million, are enrolled in Medicare Advantage plans. As I speak, enrollment periods are ongoing for next year. Between 2020 and 2021, Medicare Advantage enrollments grew by about 10%. That was consistent with what we saw in previous years.

This continued growth validates Richard's optimistic view of Medicare Advantage and of beneficiaries finding these plans flexible and suitable to their health needs. And I expect this growth to continue. There is still a burgeoning growth in the aging population of those reaching 65 and beyond. Further, the Congressional Budget Office had a recent report suggesting that at the current rate, about 51% of all Medicare beneficiaries would be a member of a Medicare Advantage plan by 2030.

Such projections could prove wrong if there are major disruptions. For example, some politicians are favoring expanding the ages of Medicare and Medicaid. If we keep in place the current policy framework generally, Medicare Advantage plans should maintain their steady growth.

What's also worth noting is that the number of new prescriptions written appears to be growing at about 3% per year. Older populations are taking more medications and using the services availed to them. That's where we see that Cureatr, by assuring effective uses of those medications, can have a significant impact.

Q: What do you think were some of the biggest blockers of digital health transformation in 2021 and why?

GD: Let's set aside COVID-19 for a moment. Following the advent of electronic health records, we saw the first wave through the healthcare system starting in the early 2000s. We're now two decades into this movement and have a broad array of basic technologies deployed in the system. For some markets, like behavioral health or long-term care, the arrival of such technologies has taken a lot longer. That's not surprising. The deployment of digital health throughout healthcare looks like the topography of the United States, with high and low points.

On the economic side, digital health remains one of the most robust areas in the health sector for new investments and growth. There remains presumably what investors see are a lot of upsides on being able to optimize efficiencies and processes — anything from insurance registration to how you select your care to who is monitoring your health. These are becoming a great engine of innovation throughout healthcare.

From the consumer angle, this has tremendous benefits. Consumers can reach their provider and schedule on their own or obtain services in their home they previously could not.

No doubt influenced by COVID, many of the major health systems today have well over half of their patient encounters occurring virtually or in the home. That's a big shift throughout the whole healthcare economy. It means lots of changes, lots of competition, and lots of value being created.

The key to and the enablement of the shift are the advances in information and communication technologies. No doubt there are great disparities throughout our country in this regard, and we must be really cognoscente of not making those gaps wider based on who has access and who does not. If things like 5G wireless networks come along and we improve our ability to ensure we are getting the services to everyone who can benefit from them, digital health will continue to have a rampant energy behind it. This will help move information to the places it needs to go, enable people to participate in healthcare in ways they haven't been able to before, and will fuel the consumer movement around tailoring healthcare to one's personal needs and desires and do so in one's own hands literally with a phone.

Having said that, there are significant blockers that must be acknowledged. One of those is access to the technology itself in certain geographic regions. In other cases, we haven't overcome information blocking and the interoperability issues sufficiently, and there is a big, ongoing debate around this. The Cures 2.0 Act aims to address these issues further in terms of how we move information across different platforms. That will be under intense scrutiny from a policy side over the next few years, and it's likely that this will be something that will need further addressing to make sure information is able to move across health systems as well.

Finally, it's important to note that the issues concerning privacy and security remain at the forefront of our minds as we're designing new systems and approaches. We're dealing with trust in all dimensions here. Our investments in technology and innovation around these privacy and security issues is paramount right now. We plead with healthcare workers and others who are using these technologies to perform healthcare services to take privacy and security seriously and that all the precautions needed for protecting PHI (protected health information) are abided to.

Q: Closing in on two years into the pandemic, how do you feel COVID has affected digital health?

GD: It's certainly accountable for rapid adoption and deployment of digital health methods. We went from a minimal amount of use by most providers to essentially transforming overnight how they are connecting with their patients. There were policy implications about how people could get paid for this delivery of services. There were also some set asides on privacy and security rules that made the adoption feasible in the short period of time. Now things have begun settling back into a bit more of typical framework for service delivery.

What should come next for digital health? First and foremost, we must take an intensive look at what we've learned thus far so we can better understand where digital health provides the same or better value than it did in an encounter in an office or a hospital.

Second, we probably need to be a bit more strategic about how we make decisions concerning when patients really need in-person care versus remote care. I see this in my own practice, and it's hard sometimes to decide what approach to use. I've found myself wondering on several occasions, "Did I really connect with what Mrs. Jones came to see me about today or did I miss something obvious?" We must ensure we maintain a human touch in our care system.

With some of the providers I speak with, what's still in the back of their minds is how to apply technologies in a way that are complementing the best of our skills and capabilities. The world of Zoom, Teams, and other such platforms support the need for instantaneous information in ways we've never been able to achieve before. This is great, but on the other hand, there may be more intense conversations that don't have the same look and feel through technology. Some pieces of provider-patient interactions are lost in translation when meeting over video. After all, it's hard to put your hand on the back of someone when you're coming to them over a video.

As we learn more about how digital health has and has not worked effectively over the past two years, I think there will be more comprehensive ways in which digital health is adopted into practices, particularly in primary care. This will likely open the doors for things like simultaneous consultations and team-based decision-making.

I think that's another advantage of digital health. Digital technology enables care collaboration in ways that were never possible in traditional care settings. You can have a cardiologist, pathologist, and primary care doctor considering a surgical intervention on a particularly complicated patient. Being able to pull all those perspectives together is happening in some places today — even within hospitals.

Finally, I spend a lot of time in rural communities. If we can get 5G and broadband to work more effectively, digital health can really transform some of the major challenges we have in public health and primary care for people in these parts of the country where there is less-than-optimal access to the types of medical specialties and the care that's needed for them.

COVID didn't just open the door to digital health. It knocked the door down and took down half the house. Now we're fine-tuning our methods and continuing to innovate.

Q: What are some of your key takeaways from 2021?

GD: The impact on healthcare of the social change being ignited to better address equity, health, and beyond, largely framed around how we engage with one another. A lot of introspection has gone on and we've seen some action, but we're going to need a lot more action to address these challenges. Whether that's through the mix of people within healthcare and/or how we deliver healthcare and engage populations who have been disenfranchised for literally hundreds of years, we must create long-term paths for equity. We're seeing some promising changes, but these must be built upon and sustained. For companies like Cureatr and others on the forefront of speaking with patients every day on behalf of providers and engaging with the parts of the health system that are touching these areas, I think there's opportunity to extend the services and capabilities that afford better outcomes.

We've known how staggering the differences are in outcomes and access to new medications and the right treatment approaches for as long as I've been a physician. This has justifiably led to a lot of distrust in the healthcare system. We must not just bring these areas to equity but also build confidence and trust in patients, so they know they are being treated in their own best interests. That's the number one issue I see coming out of 2021.

There are other key issues to watch. We're probably about to make some major changes to Medicaid programs and extending support services for those who are still on the fringes of having healthcare coverage and plans. That social construct for making sure people have access to care — and the right kind of care — is still prominent.

There is also an incredible amount of innovation going on, whether it's in new medications or disease areas. We're seeing medications being directed to what were previously considered "untouchable" diseases. They're now getting new therapies. For complicated chronic diseases for which we've never had innovations, there is a lot of promising new opportunities there. That's all upside.

For the broader public, despite all the disruption COVID has represented, progress remains unrestrained in terms of innovation and bringing new technologies to them. The bigger question for large parts of our country is whether we do that in equitable ways that makes those benefits achievable for everyone.

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