Speaker 1: COVID-19 has been pretty much like an atomic bomb. In the five years or six years since we founded, there were big changes. We had to serve 10 times as many patients, and we had to do that at warp speed.

Speaker 2: There is a real value in making change slowly, and maybe in particular in healthcare. And when we make changes slowly, we can slowly iterate until we get to that best solution. Sometimes when we make changes very rapidly, we sometimes will go to solutions that may not be ideal.

Speaker 3: When COVID-19 struck our country, we had to shut a lot of things down, and it was dangerous and difficult for people to get to doctor's visits in person. So we had to have access to healthcare, and one way that we knew was available was through telehealth.

Speaker 4: What is telehealth? In short, it's healthcare over the internet. Healthcare providers realized that the majority of doctor's visits consists of a doctor and a patient, well, talking. So more and more providers realized that they can do these consultations online. But a lot of our laws kept them from doing that. In light of the pandemic, though, regulations were adjusted to let people have continued access to healthcare from the safety of their homes. One company that was affected by the shift to telehealth is a company called Emoka Mobile Health.

Speaker 1: Emoka uses video and human engagement to help patients take every dose of their medication. So patients video record themselves at every dose, taking their medication, and we receive that video, assess it, and then engage back with them and support them to take their next dose of medication. Now, this is actually a practice called directly observed therapy, and it's been the standard of care for some diseases since the 80s. Even in situations where, for medication adherence monitoring, we had to monitor thousands of people, the pressure to do so was nothing compared to what we experience now during the pandemic. So we had to roll out within days to thousands of people at a time, and that forced our business to adjust and to adjust on the fly. We had to enhance the technology to handle scale.

Speaker 3: Doctors and hospitals and health systems didn't necessarily have the equipment in place, and their staff was not trained in how to deliver telehealth services. This seems crazy, right? Because telehealth has been around forever. But it is the reality that we were really caught flat-footed at the beginning of COVID, and that was because of the barriers to adoption from the regulatory and legislative infrastructure. We have to be prepared to deal with crises like COVID-19, and the technology is there. The apps are there. But sometimes we can't get them out to the market and into use by patients because of the regulatory constraints that are still in place.

Speaker 1: The way that the regulatory bodies viewed technology started to change. Between February and June, we saw about 5 to 10 years of regulatory progression.

Speaker 2: Something that we couldn't have done 10 years ago or 20 years ago now suddenly was available. Medicare said everyone in the United States could have a telemedicine visit within their home. Previously, they had limited telemedicine to some select populations. If I, as a physician, want to take care of a patient in another state, I have to be licensed in the state in which the patient is located. In the context of the pandemic, a bunch of states said, you know what? If you're licensed anywhere in the United States, you can take care of patients. That changed things. As well as a lot of nitty-gritty details of codes and what you could prescribe, etc. Those all have changed things. And I think I go back to that same idea that we need to be very careful in healthcare and move in a slower way than it might happen if you're in the gaming world or the search engine world or whatever other application that you have. It makes a ton of sense that you need to move a little bit more slowly and more carefully when it comes to healthcare and emphasize that you need to have the evidence that this works.

Speaker 4: In light of the rapid evolution of remote monitoring, people started asking more questions about telehealth. Of course, some people have been skeptical of it all along. But the pandemic brought these concerns to the forefront and fueled disagreements about the role regulation should play.

Speaker 3: So every year CMS goes through a process where they decide what types of services are going to be reimbursed for physicians and what types of services are not going to be reimbursed and under what conditions. What CMS has proposed in July of 2021 are some different interpretations of remote patient monitoring and some of the constraints that had been opened up during COVID may not be made permanent and that's going to be a problem for the industry.

Speaker 1: The challenge for us is that regulation could pick new winners and while we have an excellent product that can help a ton of people get better faster, we may be excluded from being one of those winners by regulation alone. While regulation is opening up in a lot of ways, the challenge for EMOCA is that it's obvious that technology is needed to improve patient care right now, especially in the middle of a pandemic.

Speaker 2: When we've done some evaluations of some direct-to-consumer, these apps that you can get to do a video visit, we find the vast majority of the visits that happen do not replace an office visit or an ED visit, but the vast majority are new utilization and in net, it increases healthcare spending. And we all know in the U.S. healthcare system that healthcare spending is a huge problem and I think from my perspective, in many cases, a drain on our society and really holding us back and not improving health the way we want. And, you know, a lot of people, again, looking to telehealth as a way to improve it. I think we need to be quite skeptical of that claim, unfortunately.

Speaker 3: If you look at the overall trajectory of telehealth and the long view, providing access to telehealth services actually reduces the overall cost of care in a longitudinal sort of way over time.

Speaker 2: The other fundamental issue is if we introduce a telehealth application and only those who are wealthy and therefore have the smartphone, know how to use Zoom, etc., they can access it, that might be helpful for them. It may improve their health, but it actually could widen those disparities because those disadvantaged populations don't have access to the technology.

Speaker 3: The FCC is doing a lot to support better connectivity in rural areas. They recently designated $200 million to institutions who serve rural patients to help them provide better connectivity to their patients. All of that $200 million was grabbed up as soon as it was put out there.

Speaker 4: With so much uncertainty to date, regulators, business owners, and legal experts alike agree that more regulatory clarity is needed.

Speaker 1: Being a health care entrepreneur is very satisfying because you can be involved in helping a patient. But the challenging part is that providing a quality outcome or improving the quality of care is not necessarily recognized by our antiquated regulatory schemes. So just because you improve care does not mean that the provider is going to take it up unless they're compensated for it.

Speaker 3: To have the ability to sort of pivot in a situation where it calls for a little bit of a change and to be able to do that in a creative way is really something that we should be fostering in the health care system as a whole. We don't want to overly constrain these companies to the point where there's something really interesting and great that they could do, but they just can't because of the regulatory infrastructure.

Speaker 2: When we talk to a lot of doctors, they'll tell us these are the great things. I'm so glad that telehealth was available during the pandemic. Then we ask them, are you going to continue using telehealth afterwards? They're like, no, probably I'll go back to in-person care. I feel it's better health care. Telehealth is kind of like a drug, and it has its benefits and it has its side effects. That's just the nature of health care. I think instead of criticizing doctors for being skeptical, I think we should applaud doctors for being skeptical. It's a good way to practice medicine is to be skeptical and cautious with new things that are coming out. Microsoft Mechanics www.microsoft.com