The Viability of Telehealth, Improving Chronic Condition Management and Responding to the Speed of Technology in Healthcare: Belle’s Q&A with Dr. Christian Wilson

Dr. Christian Wilson serves as Medical Director for Belle, overseeing the company’s delivery of virtual clinical support for medically complex individuals.  Dr. Wilson has served as a resident physician with New York-Presbyterian Hospital, a management consultant with Boston Consulting Group and as an assistant professor of medicine with Columbia University’s Irving Medical Center. He has also spent time as a traveling hospitalist. We recently sat down with Dr. Wilson to explore a range of healthcare topics.

Despite significant investment in the development of chronic care management solutions throughout the years, the healthcare system doesn’t seem to be effectively addressing this area. What’s the disconnect?

People don’t fully understand chronic illness as a general rule. They don’t understand the gravity of not doing the small things that actually become big things down the line. We must create more touchpoints for patient education and support in order to boost adherence. We have to bring solutions to their front door and create an easy path to engagement. There are a lot of programs out there that attempt to help patients with chronic illness. They offer incentives for tracking steps, going to the gym, using a remote monitoring device etc. Or they call and check in on patients. There are not a lot of active, hands-on programs where people are being supported consistently.

The other side of the coin is that most chronic care management solutions in the market today are disconnected from practicing clinicians. I don’t think I’ve ever met a primary care physician who refers patients to a specific chronic care management program or resource. These solutions are largely operating in a vacuum and not integrated with an individual’s care plan and care team.

You believe a short-term mindset in healthcare is preventing us from making things better in the long term. Can you explain?

Yes, this is absolutely an issue. It makes sense that keeping people out of the hospital saves money. And yet, we don’t want to spend money on prevention and efforts to keep people out of the hospital.  When you look at how we are operating as a healthcare system, too often we are short sighted and lose view of the long term. In some cases, we might actually spend more money in the short term in order to drive significant reductions in cost, and gains in quality in the future. I think we need to find a way out of this short sighted mindset in favor of longer term strategy.

Can virtual care delivery serve as an effective substitute for supporting individuals with chronic conditions?

There will always be a need for in-person care. That being said, there are absolutely scenarios where virtual care is highly effective in engaging with people to support chronic condition management. One of the things to keep in mind is that with virtual care, you lose some of the information you gain during an in-person visit. Being in the same space as the patient, in close contact with them and taking in their surroundings. That’s not possible to accomplish in a telehealth visit. I am a big believer in having someone in person with the patient to fill in those blanks and create a more holistic and human experience. A community health worker for instance to assist in the telehealth call and gather the important information a clinician isn’t privy to through a digital connection. This combination of tech and touch is very powerful.

Is value-based care part of the equation for improving chronic care management?

It’s been well documented that the incentives we are using are misaligned with our goals. We pay frontline clinicians based on volume. We don’t reward them for keeping patients healthy and out of the hospital, or for meeting standards for chronic disease management. There’s been movement toward value-based care, but it needs to be more widespread. When possible, providers should take the lead in advancing the adoption of value-based solutions. This means being proactive with health insurance plans by proving they can operate in a different way and deliver better patient outcomes, and then negotiate how they share in the value created.

There has been an explosion of technology in the healthcare space, fueling a host of AI-based solutions and exponential sources of data. Is technology moving too fast?

Yes, I believe it is. We are generating all this data via apps, devices, platforms and other methods, but providers have to be able to access this data, interpret it and use it to improve patient care. Most practices don’t have the infrastructure for this. So, we’re just producing a mountain of data for them to sift through, and that really isn’t very helpful.

There’s a similar phenomenon happening with AI. We have a worsening shortage of clinicians, and technology will be needed in some regards to help address this shortage. The problem is that AI is moving so quickly, and we haven’t trained doctors on how to use it appropriately and effectively.  Also, a large portion of clinicians are older, closer to retirement and less inclined to adopt new technology. Given the rate of innovation involving AI, healthcare has to be at the forefront. If we don’t get more clinicians using AI now, learning its proper applications and limitations, it will be impossible to integrate it effectively later. We’ll miss the boat.

You mentioned the worsening shortage of clinicians. What can we do collectively to address this?

It’s not a problem you can solve quickly, unfortunately. We have to get out ahead of it and get more young people interested in things like healthcare, chemistry and biology.  We need to do a better job of financially supporting teachers so we get the very best from that profession as well. We need them to inspire the next generation of doctors, nurses and other healthcare professionals. We are not currently filling the funnel for the future workforce. That has to be a focus.

And then it comes back to aligning incentives in healthcare. We don’t currently incent generalists well, for the amount and complexity of the work they are doing. Certainly, when compared to their specialist colleagues. It’s no wonder we are struggling to keep enough primary care physicians in full-time practice.

Stay tuned for additional Q&A articles featuring industry experts. Want to hear more from Dr. Wilson? Have an expert you’d like to recommend we interview? Contact us here to continue the dialogue.