Ben Rooks is a healthcare information technology (IT) expert recently named to Cureatr's Strategic Advisory Board, which is providing expertise, insight, and guidance to the company's management. Rooks is the founder of ST Advisors, a strategic and financial advisory firm focusing on healthcare IT, IT-enabled services, and pure healthcare services firms as well as their financial sponsors. Prior to founding ST Advisors in 2009, he spent six years as a senior investment banker where he advised healthcare and medical technology companies on transactions ranging from $40 million to $365 million. Prior to moving to investment banking, he spent 10 years as an equity research analyst, where he was one of the first to focus on health IT as a discrete investment sector.
Q: What impact do you think the pandemic will have on healthcare information technology?
Ben Rooks: I believe the biggest, long-term impact that the pandemic will have on healthcare information, and in many ways the entire healthcare industry and other industries, is the realization that you don't need to be in the same room as someone to get things accomplished. I was recently on a 90-minute video call with an investment banker and a client doing a diligence session that would have normally required hours of traveling and coordinating to conduct the same meeting in-person. The pandemic has demonstrated that this is a trip I didn't need to make.
Just like the pandemic is changing the investing world, it's changing the healthcare world and showing just how much we can get done virtually. People are realizing that they don't need to go into the physician's office or meet face-to-face with a pharmacist as often to get some of the care they need.
Q: The pandemic has seemingly pushed telehealth into the mainstream overnight. How do you think this development will affect our healthcare delivery system?
BR: Building on my previous response, I think it will have positive and negative implications for various participants. On the one hand, telehealth can make physicians more effective because they can practice anywhere, which can permit them to streamline their practices in any number of ways.
On the other hand, I’m concerned it's going to be especially rough for primary care physicians (PCP) at a time when they already have plenty of challenges. If I can do a telemedicine visit for a minor acute illness, which is covered in full by a lot of health plans, rather than go see my PCP, that is lost revenue for the physician. I think this dynamic will become a challenge.
I also wonder if the reimbursement for such a virtual service will come under pressure over time. Right now, there are a lot of policies calling for parity between virtual and in-person care.
However, as a consumer, I would argue there are often benefits to being face to face with a physician, such as when you need to have a physical examination of your throat or ear. Since a virtual appointment can't deliver that same level of benefit, should it really cost the same amount?
If I'm a payer, I'm wondering if I need to pay the same reimbursement to a physician to provide virtual services since doing so is probably cheaper for the physician as there is less need for office space and staff costs. That may put further pressure on reimbursement.
Systemically and similarly, if I'm a managed care plan and one telehealth company charges X and another company charges 0.95X, do I want to use the latter? Then, after some time passes, there's a third company that charges 0.85X. Do I use this company? Such a scenario would likely lead to even more downward pricing pressure on the sector.
There will be upward pressure because volume will increase, but I wonder if pricing will come down.
Then there's the matter of who is providing telehealth services. As telemedicine becomes more ubiquitous and accepted and my physician starts offering telemedicine, maybe I don't need the services of a dedicated telehealth company? I think such a scenario, where speaking with a physician remotely becomes less of a differentiator and that further leads to pricing pressures, is motivating some telehealth companies to make investments so they can offer customers a broader solution, with Teledoc’s purchases of InTouch Medical and, more recently, Livongo, being topical examples.
Q: How can IT help further strengthen access to care and services?
BR: One of the things that's exciting about health IT is that it can make care and services more available to people who might otherwise have challenges receiving them. During the pre-COVID days, if someone wasn't feeling well, they may need to take time off — possibly unpaid — and travel across town to wait in an office — that might be full of sick people — to see a physician. Now technology is showing that this scenario may not require the individual to travel at all or take time off if they are diagnosed as being well enough to work.
In addition to IT making care and services more convenient and accessible for people who do not have the luxury to take time off to see a physician, it will hopefully help make care and services cheaper. I think scenarios such as the one I just described could help with addressing some of the social determinants of health that we're seeing in people who are otherwise medically underserved.
IT will also help improve quality. I've been saying for decades during my career that one of the benefits of using more IT in healthcare is that it improves care quality. High-quality care is typically more cost-effective because you have fewer errors. Looking at the marketplace, you are seeing solutions that can allow physicians and other caregivers to provide higher quality care and deliver more evidence-based care because more data are being analyzed that will help show what does and doesn't work.
Q: The pace of healthcare IT innovation is coming at us faster than we've ever seen before. What advice would you give to provider organizations looking to make smart decisions on investments in innovation?
BR: Innovation, virtually by definition, is exciting, but that's not something hospitals and certainly not physician offices have the luxury to do right now with procedure volumes down and margins under pressure.
I read a great article last year saying that healthcare doesn't need more innovation, it just needs better practices. For health systems with chief innovation officers, my advice to them is instead of focusing on innovation for its own sake, look for proven, cost-effective solutions that allow you to deliver better and more cost-effective care. Consider that there is not broad and widespread adoption of using a checklist to insert a central line, which is proven to reduce staff infections and deliver other benefits and is a really basic solution. Instead, health systems are trying to play venture capitalist and are deploying tens of millions of dollars towards some new technology that they think is exciting and hope will do some good.
I'm not dismissing innovation. It can be incredibly powerful. Think about what we can now do with a tablet. When tablets began making their way into health systems, no one could have envisioned how significant of a role that technology would play in data capturing, reducing costs, and enhancing how we deliver care today. That said, there is a lot of good we can do very cost-effectively simply by implementing practical solutions that we already know will work.
Q: Why did you join the Cureatr's Strategic Advisory board? How do you view the role that Cureatr's technologies and services are playing in helping to improve healthcare delivery?
BR: I joined the advisory board because I think technology and telepharmacy can do a lot to improve medication management and hence drive better patient outcomes. One of the things that always impresses me about physicians is how much stuff they need in your head to practice medicine. Computers are really good at keeping track of the small details that are essential to the safe delivery of care. Human beings are not as good.
When people age, they take more and more drugs, which makes keeping track of medications exponentially more difficult. You would like to think that if a person only goes to one pharmacy, that pharmacy will be tracking their medications. But the pharmacy might not be doing so, and many patients receive their medications from multiple pharmacies.
I did work years ago with a company that provided medication therapy management (MTM) solutions. I was slightly shocked and horrified to learn that people were taking 15 or more drugs without proper clinician oversight. If you're lucky, there's a source of truth that tells you all of the medications a patient is taking, but a lot of times they show up in their physician's office with a bag full of medications and little understanding of what they are taking and why. There needs to be someone who can access the information that permits them to determine where changes should be made to a regimen to help reduce harmful side effects, avoid drug interactions, and eliminate redundant medications.
Cureatr's technology helps the user do just that, which further goes to show how IT improves quality of care. Combining computer technology, medication management, and telepharmacy can help prevent what could be a tragedy or, at a minimum, something unfortunate that unnecessarily harms the patient and leads to substantial, avoidable costs.
What's frustrating about the healthcare system is that we spend significantly more than any other industrialized nation for worse outcomes. You look at the healthcare system and the ground is carpeted with wasted 20, if not 100, dollar bills that could easily picked up and not spent on healthcare. By reducing unnecessary costs, not only would healthcare costs go down, but quality of life would go up.
I think medication management and pharmacy solutions are a fabulous example of how we can accomplish these goals. And that ties back to my advice for providers: look for solutions that generate a return on investment.
A lot of things in healthcare can be a zero-sum game. We're going to send more patients to ambulatory surgery centers and that's going to hurt hospital revenue. We're going to do primary care telemedicine and that's going to hurt PCP revenue.
But suppose that by doing better MTM, we'll keep people healthier and reduce their need for healthcare services. Yes, that will hurt some providers' revenues, but I'm okay with this. In such a situation, no ox is gored. Regardless of the payer system, MTM is good for everyone.