Telemedicine Growth in the US

Speaker 1Well, Milton, that was, uh, an introduction I've never received before. Thank you very much.

Speaker 1Um, and Thomas, I have to give you kudos. Uh, you got the crowd stirred up. That was good. Um, you always know a good talk when you see people in the crowd, sort of, you know, in, in, in a good way, just sort of being a little adversarial. So well done, OK.

Speaker 1So, uh, I wanna talk to you all today about Orthopedics, orthopedic Telemedicine, and I'm very passionate about Orthopedics. I'm an orthopedic surgeon myself. And I wanna give you some secrets, um, to success and failure in the startup world. Um, obviously, we're a very young company. Um, I'm very blessed to know Milton, um, to get to know him, uh, in August of last year. We've made a lot of progress, uh, with his team, and I'm very fortunate to be here today. So, thank you very much.

Speaker 1So here are two quotes that I want to start the, the talk off with, um.

Speaker 1Both of them inspire me, and I hope they inspire you, and this is why I do Telemedicine.

Speaker 1So the first is Tolkien. Uh, all we have to decide is what to do with the time that's given to us.

Speaker 1And then this quote is attributed to Gandhi, be the change that you wish to see in the world.

Speaker 1And from a young age, I was sort of given uh opportunities in my life by my parents to um pursue Medicine and I felt that it's, it's my responsibility to get back to the world in the way that I can. So that's why I'm here today.

Speaker 1This is a little uh video about Orthola. In a world where the best local, regional and national physicians are accessible to all patients, how about a world where patients without access to healthcare obtain the best medical expertise.

Speaker 1OrthoLive is the world's first orthopedic Telehealth provider. At OrthoLive, we have a vision for the future of healthcare which at its core is affordable, efficient, and responsive. OrthoLve essentially means that you can get any orthopedic question answered immediately in a live video feed with the provider. That's really what it's all about. We want instantaneous access and the ability to contact us at any point in time regarding any injury that somebody might have.

Speaker 1You can't beat the convenience of Orthoive. See your provider anywhere and anytime.

Speaker 1OK.

Speaker 1But I don't really wanna talk to you about Orthola today.

Speaker 1What I wanna talk to you about today is growth of Telemedicine and how it occurs, OK? And so, I wanna outline a few secrets to success and failure that I've found in a short year of being in Business.

Speaker 1So I want you to first um understand the four tenets.

Speaker 1And the 4 values of being an American physician.

Speaker 1Second, I want you to understand the 4 tenets and 4 values of the American healthcare consumer.

Speaker 1Then understand our health system and what the issues are right now in our health system.

Speaker 1And then look at two models of Telehealth growth. The first model is direct consumer, and the second model is organic growth, and I'll explain those in a little bit.

Speaker 1And then I want to think about Telemedicine in that way and solve the healthcare system problems by using one of the two models and then also give you some secrets to success for your Telehealth startup or even, you know, Business that you've been in for a long time.

Speaker 1So the first part of the talk is about developing winning strategies, understanding consumer values, physician values, and the healthcare system.

Speaker 1So Telemedicine has to serve physicians.

Speaker 1It has to serve healthcare consumers.

Speaker 1And it has to serve the healthcare system to be adopted.

Speaker 1And what are the tenets of being an American physician? And I know these pretty well because I am one and I live in the system that uh we all sort of get a little frustrated with right now, but

Speaker 1The first is that people, physicians, you know, they go into Medicine to be helpers. They're, you know, altruistic, compassionate people.

Speaker 1They're trustworthy people, and that's what, you know, is at the core of every physician.

Speaker 1But they're driven and competitive people. They have to fight through school in order to get to where they're going.

Speaker 1But right now, they are overworked, they're fatigued, they're frustrated. Um, and they're frustrated by the current model, but they're unwilling to change. And why is that?

Speaker 1Well, change decreases Efficiency for them.

Speaker 1It throws them out of their comfort zone, OK? And that is bad for practice of Medicine.

Speaker 1If you get thrown out of your comfort zone, you can't be efficient, and then you, you start to get swamped by paperwork and etc.

Speaker 1So, the hierarchy of American physician values is important for all of us in this room to understand. If you want to adopt Telehealth in a positive way in this country, you need to understand that physicians are driven by Efficiency.

Speaker 1That is an equation that is Productivity divided by time.

Speaker 1They want to get home earlier. They want to improve their workflow and their processes, and they want to avoid duplicating efforts.

Speaker 1They want stability. They don't want to change.

Speaker 1And they also want to improve the lives of their patients, but at the top of the list is really.

Speaker 1Potentially getting home earlier, being more productive.

Speaker 1They also like to enjoy competitive advantage versus their peers.

Speaker 1What about the healthcare consumer? What do we need to know about the healthcare consumer in order to gain Telehealth adoption across the United States?

Speaker 1Well, the first thing that people want is they want a compassionate physician. That's the biggest, most important thing for everyone to remember. When you have someone that's starting out as a physician on Telehealth, they have to be able to be compassionate, they have to be able to show that.

Speaker 1I'm gonna go back one, they want quality. They desire equality that's important.

Speaker 1They would like Efficiency, but it's not critical to them, OK?

Speaker 1And they can't explain value.

Speaker 1The American consumer does not understand value, um, unless they're an insurer or an employer or a third-party administrator.

Speaker 1So value is best understood by those people, but patients aren't really involved in that type of decision making.

Speaker 1So when you look at the values of the American consumer, trust is paramount. This happens via word of mouth, mostly in the United States today. Quality matters, but it's perceived. You see a lot of healthcare systems sort of building the Taj Mahal, uh, where I'm from in Cincinnati, we have a hospital system that's built this giant orthopedic institution and people flock to it, you know, they come to it because it's just, it looks the best.

Speaker 1You know, there's team physicians out there that, um, you know, I feel like sometimes they are really about Marketing uh in the orthopedic space and maybe don't have the ability to produce the same way that Other physicians do.

Speaker 1And value is the least important for the average healthcare consumer unless of course you're an employer or an insurer.

Speaker 1So tell us Medicine must satisfy physician and patient values to be broadly accepted.

Speaker 1From a physician's standpoint, we don't understand if Telehealth will provide Efficiency.

Speaker 1They certainly don't want the change of Telemedicine right now.

Speaker 1But they accept that Telemedicine can definitely help patients.

Speaker 1And it provides a superior service. It gives them a Telemedicine, you know, sort of a, a competitive advantage, if you will.

Speaker 1What about on the patient value end? Is there trust? Well, certainly, Telemedicine opens up sort of a gap, and so there's a question of trust and whether trust um can be achieved with Telemedicine.

Speaker 1Quality is also for concern for, for patients.

Speaker 1But certainly they accept that it's efficient and it's wonderful for them to be, be able to see a provider very quickly, and there's value.

Speaker 1So, what that means is that we have to prove Efficiency to physicians and they will change. And you need to prove trust and quality to patients, and they'll flock to your doors, OK?

Speaker 1What about our healthcare system? Let's look at this. So the tenets of the US healthcare system are that it's fee for service right now. It rewards high Productivity. Who's responsible for that? I am, OK.

Speaker 1I do a lot of Surgery, and I'm driving up healthcare costs right now.

Speaker 1There's a high administrative burden out there that.

Speaker 1Goes to coding, claim submission, high overhead costs, and insurance companies and the government are sort of responsible here. Chronic disease is rising in the United States and patients really, you know, bear the responsibility there.

Speaker 1And then businesses increase the economic burden.

Speaker 1So can Telehealth help the system?

Speaker 1Fee for service. Yeah, we can help the system for sure. We can offer Telemedicine at a low, low cost because the overhead is, is lower.

Speaker 1How about the administrative burden? Absolutely, we can help. We can help the system from an administrative standpoint, especially if we are using sort of a a direct cost model.

Speaker 1What about chronic disease? I think Fruit Streets here, they would beg to, uh, to argue that chronic disease can definitely be affected by Telemedicine, but I think it's up for question right now, right?

Speaker 1Um, and how about big Business? Can Telehealth help to unify the marketplace? Well, right now I don't see it. Someone that may be a little smarter than me certainly can enlighten me on this, but I don't see Telehealth sort of unifying the healthcare marketplace, at least yet. Hopefully that will be to come, uh, with potential insurance contracts and things of that nature.

Speaker 1Let's talk about direct to consumer versus organic growth. These are two models of Telehealth, OK? And I think it's important to look at Telehealth from a model standpoint. This is direct to consumer, OK?

Speaker 1The definition of direct consumer is Telemedicine that's offered through an app or web portal for patients at large. There's no brick and mortar, OK?

Speaker 1Does everybody understand direct consumer pretty well? OK. Most people are using that right now. Now, let's see how it fits the value equation.

Speaker 1Well, physicians have already bought in. They've decided that they're going to participate in this model, so they've already accepted it. It's efficient for them.

Speaker 1They don't need to worry about change in this model because they've already, you know, signed up. They're a part of MD Live, for instance, and they're good with that. They know it helps patients and it gives them sort of that competitive advantage that they're looking for.

Speaker 1But on the patient end, there may be sort of a gap here. There may be still a lack of trust that's occurring.

Speaker 1There's still a question of quality because they don't know that physician. That physician hasn't touched them yet, um, and that's really important as we're in medical school, we learn that, you know, the physician touch is so important and Telemedicine is suffering from that in terms of broad scale adoption right now. We're suffering because we don't have the ability to touch the patient. Therefore, trust is lost in some way.

Speaker 1But patients agree that it's efficient and it adds value.

Speaker 1Providers have already bought in, but how do we prove trust in an online environment?

Speaker 1And how do we prove quality if there is no trust? These are the two questions I've been wrestling with with my startup as we try to answer this in order to gain a better understanding of the market.

Speaker 1So consumer trust is an issue for direct to consumer. All Technology takes time to gain momentum and trust, but healthcare is personal.

Speaker 1OK, it's personal and it's not a taxi service. All right, so you can't run it like a taxi service and expect good things to happen. So the most important barrier, if there's one thing I want you to remember, the most important barrier for Telemedicine to overcome in the United States is trust.

Speaker 1Until it's perceived as mainstream and at that point in time we're going to be OK, but we have to be able to develop and establish trust here in the United States.

Speaker 1If your direct consumer company fails to deliver on trust, then it will fail.

Speaker 1What are the secrets to demonstrating trust? You need to hire compassionate people. It's #1. #2, you have to have a strong value proposition.

Speaker 13, deliver on quality every time.

Speaker 1You need a strong QA program. You can't have providers that are struggling and not have a good QA program. So that's something we're working on very hard at our startup.

Speaker 1And your Technology has to work 99.99% of the time. If it doesn't work, you're gonna struggle, OK?

Speaker 1How does the US, uh, sorry, how does direct and consumer model fit the US healthcare system? So it can help from a direct, uh, fee for service, uh, process.

Speaker 1It can improve the administrative burden.

Speaker 1As we know, it may help in chronic disease.

Speaker 1Still hasn't unified the healthcare system for me yet, so I'm waiting on that one, but I think in 5 to 10 years, we can have this happen.

Speaker 1So it can be a revolution in our healthcare system, but we have to deliver on trust, as I mentioned.

Speaker 1And it can really end up changing the way that Medicine is delivered across the United States.

Speaker 1So what's the biggest hurdle to direct to consumer Telemedicine?

Speaker 1We've said it, trust, OK? So that's big.

Speaker 1What is organic growth?

Speaker 1Organic growth is the growth of Telemedicine in a community-led effort beginning in small clinics and private Practices.

Speaker 1That's where we have brick and mortar established already, and then we're adding Telemedicine.

Speaker 1So, let's look at this value equation.

Speaker 1What about the physician values here? Efficiency.

Speaker 1Well, physicians are still questioning the Efficiency of using Telemedicine right now.

Speaker 1They don't really wanna change. There's question marks in their minds about using this. They agree it's gonna help patients. It provides them a competitive advantage. They like that.

Speaker 1But patients, if you look at this, patients already trust that physician. They know they're gonna get great care, so they trust.

Speaker 1They know they're gonna get great quality, so they trust.

Speaker 1They know it provides Efficiency and it provides value for them.

Speaker 1And there were talks earlier today about putting the patient first.

Speaker 1This is where Telemedicine, I think, is going to be adopted most quickly.

Speaker 1It's in the organic growth area, but providers have not bought in yet, OK? So how do we prove Efficiency in the office environment? We have to do that with Telemedicine to make it adopted.

Speaker 1And how do we help physicians that are, you know, really resistant to change? It's important.

Speaker 1So the physician buy-in is critical.

Speaker 1And they have to see the value in Telemedicine. Well, what is value? Well, is Productivity over cost, OK? So you can either decrease their overhead with Telemedicine.

Speaker 1You can either drive, uh, new patients with Telemedicine, or you can improve their office flow, they get to go home earlier.

Speaker 1That's how you're going to win in this environment, OK? So you have to understand this if you wanna grow Telemedicine inside your own communities.

Speaker 1So what are the secrets to demonstrating value? OK, we talked about the secrets earlier for direct consumer, for trust. Let's talk about value.

Speaker 1If you want a physician to enjoy Telemedicine, you're gonna need to create new patients for them.

Speaker 1You're gonna have to improve their overhead.

Speaker 1You have to decrease physicians' time spent doing duplicative work. That's a problem. That's a Pain point for us.

Speaker 1And you need to decrease time spent with rechecks, recheck patients, OK? All of those can be accomplished with Telemedicine.

Speaker 1It can happen, OK?

Speaker 1So, does organic growth help to solve the system issues?

Speaker 1OK, this is the next part.

Speaker 1Fee for service? Nope, not gonna change that.

Speaker 1There's all the Telemedicine laws right now which allow for sort of equality amongst Telemedicine visits, so we're not helping that.

Speaker 1Are we helping the administrative burden? No, not really. Still using insurance. We're still coding, we're still doing all the things that we normally do. Still backed up.

Speaker 1How about chronic disease? Are we helping there? Yeah, I think we are. You know, I think we have the ability to have multiple more touch points with patients inside the office, and I think that matters.

Speaker 1What about big Business? Still not helping, OK. Um, so why suggest the use of something that doesn't solve the system?

Speaker 1Why would we do that? Because it doesn't change anything.

Speaker 1It's the status quo, OK? So, in healthcare, people want to sort of adopt change. They don't wanna change and overhaul everything, OK? So, it's important.

Speaker 1To sort of be less disruptive. What are these fish doing? They're schooling, OK. These fish are following in the same direction as all the Other fish.

Speaker 1When some fish turns around and goes the opposite direction, you know, the, the fish go, what, what, what's going on? We're supposed to be, you know, together, schooled up. Organic growth Telemedicine allows providers to maintain their Practices.

Speaker 1And it allows for easier incorporation of Telemedicine. It doesn't require a revolution, and it gives Technology a value add.

Speaker 1Why is organic growth sort of a successful early Business model?

Speaker 1Success is not built on trust.

Speaker 1You already have that.

Speaker 1OK. It's not an unknown provider, and it's built on the physician desire for Technology and Efficiency.

Speaker 1It drives phys, you know, competition amongst physicians. That's important, that competition piece.

Speaker 1And trust is already there with sort of a known provider, so that's, that's great.

Speaker 1Now, let's talk about timeline for Telemedicine adoption.

Speaker 1Direct consumer Telemedicine has a long tail region.

Speaker 1OK. It takes a long time to really get to that ramp up phase where you're really seeing a lot of growth. It's important.

Speaker 1How about organic growth? It has a short tail adoption region, OK? If you go directly to offices and you're able to sell your Telemedicine product,

Speaker 1That is a short tail adoption. You're gonna be able to get a lot of patients signed up very, very quickly in that model, but direct consumer is hard. I've done it. It's difficult. It takes a while to get people on board. You have to really take a look in the mirror, as Milton said, and make yourself better. You have to do multiple iterations to improve what's going on inside your company so that people actually will become a patient of yours because trust is such a big deal.

Speaker 1So what's the biggest hurdle to organic growth Telemedicine?

Speaker 1You have to demonstrate value to physicians, OK?

Speaker 1So Telemedicine, as I mentioned at the very beginning, is an instrument of change.

Speaker 1Here's what we're doing at Ortholab to improve that. We're making Orthopedics accessible to everyone, responsive, value-based, affordable. We're trying to lower overhead and administrative burden, and then we're looking at quality, we're studying it, we're making it, um, algorithmic, OK?

Speaker 1So, getting to sort of my recommendations, some keys to success, um, finding the direction for your Telehealth company, organic growth starts with private Practices. It starts with a stronger desire to compete in one area than hospital-based systems.

Speaker 1It allows private Practices to expand their reach, provide better care, and obtain new patients, improving their overhead and their office Efficiency.

Speaker 1Direct consumer does have a long tail.

Speaker 1You must deliver on trust if you have a direct consumer Telemedicine program.

Speaker 1And you deliver on value with consumers that get that value equation. So if you're going to go to the root of employers, they get that. That's a perfect area for you to expand your direct to consumer Telehealth, uh, model because they understand the value and value ratchets up on that hierarchy of values that we talked about.

Speaker 1So, winning strategy number one, you need to acclimatize people. People need to have sort of a gentle administration of Telehealth, and that helps to grow the direct consumer side. So what I would suggest is try an organic growth product, help it to pave the way. You start there, and then it's easier for patients to accept this.

Speaker 1And it's especially beneficial for slow adoption areas. You'll notice across the United States, very different areas. The Midwest is sort of a slower adoption area. New York and California, are gonna be better.

Speaker 1Strategy to, create local and regional Telehealth patient trust, um, areas. Organic growth will certainly give you a way to do that, but you have to be able to prove Efficiency to physicians, OK?

Speaker 1Number 30, we went a little faster. Let's go back.

Speaker 1I think we're about 3 slides, 4 slides from the end there.

Speaker 1The bottom line is that we can change, uh, the problems that exist in American healthcare today right now with Telemedicine. Um, and one of the slides that you're gonna see in just a little bit is a map of the United States of underserved areas, and that's really what we wanna be able to do is provide excellent rural care. We wanna be able to reach populations that don't currently have the ability to, um, you know, take care of themselves, uh, from an orthopedic standpoint. That's what we're doing.

Speaker 1I keep going for a while there.

Speaker 1Um, and there's also the time factor. I mean, in multiple cities in the United States, uh, time is a huge problem. It might take someone 3 to 4 weeks to get to see an orthopedic surgeon in Boston. That's crazy, OK? We need to improve that. We gotta be able to deliver better care, improve, you know, what's happening to make sure that people can get in to see us sooner. And there's a study out of Harvard that looks at sort of the average time that's wasted on a visit.

Speaker 1And uh you'll see that in another slide. Here it is right here. Go back one.

Speaker 1So, if you look at total visit time, it's 121 minutes out of a person's day that's gone. So, we wanna improve that with Telemedicine and we can, and we are, uh, we're proving that right now in our company.

Speaker 1Here's, uh, the Boston slide. New York, it's 17 days, 26 to see a specialist. Boston, can you believe 66 days to see a specialist? I can't believe that. That's, that's crazy.

Speaker 1Um, here's our access slide.

Speaker 1Doctors waste over 2/3 of their time doing paperwork. Let's make sure we improve that, OK? So I think that's very, very important as we, as we look at um how you're going to make things better inside your Telemedicine company. How do you improve Efficiency physicians, and that's gonna help uh with organic growth.

Speaker 1So, in a summary, we're all here to encourage the growth of Telemedicine, and I think it's really important and every one of you out there, um, is doing that and I applaud you for doing it.

Speaker 1We wanna encourage local and regional growth at the office level. We wanna solve value and Efficiency issues for physicians.

Speaker 1And we wanna offer quality and compassion for patients. That's very important. Remember, be the change that you wish to see in the world. Thank you.

Speaker 2So you got some time for something,

Speaker 2um.

Speaker 2Like thank you so much for that. That was actually really, I feel like the blueprint that every company should just follow that. It was really good. Thanks for that. Thank you. I guess we have some time, um.

Speaker 3Thank you very much. Uh, that was very insightful. I'm just curious, a, a few slides from the end, you showed, uh, the, the time that, uh, a patient will spend on an average visit, it's about 2 hours, and I saw a big chunk was 60 minutes, I think was clinic time. Can you elaborate a little bit on, on what that means exactly?

Speaker 1Yes, so clinic time is just sort of waiting in the clinic. It's actually only 20 minutes spent with a provider, Ian. So, um, the, the maximum, and I was surprised at 20 minutes. I mean, I give people probably 10 minutes in my office.

Speaker 1But, uh, the average is 20 minutes seeing a provider, 60 minutes of actual just clinic wait times. They're just hanging out for an hour. Yeah.

Speaker 2Is that waiting for the labs to come back

Speaker 1or just sitting in the office, uh, many times. So I mean you can imagine in an ER setting you're waiting for labs and that makes sense, but, uh, unfortunately in physician offices, you're just waiting for the physician to get to you and that's the frustration. Paperwork, exactly. I mean, doing insurance paperwork and, and all the things, but even filling out paperwork, they're still done with that and, and waiting for another 30 to 45 minutes. So it's a, it's a huge frustration point for patients.

Speaker 4Back here. Hi.

Speaker 4Hey, that was great. Thanks so much, um.

Speaker 4You talked a lot about trust and mentioned the physical touch component of it. And so I'm curious, specific to Orthopedics, you know, obviously, in things like telepsych, it's, it's not as, not as important, but in Orthopedics, both on the, on the patient side of things as well as

Speaker 4The orthopedists themselves, what kind of feedback or even your own experiences have you had with overcoming the fact that you can't touch them to do special tests when necessary, things like that? You might tell them what special

Speaker 4tests mean.

Speaker 1That's a phenomenal question. It's probably the, the question I receive the most, uh, orthopedic Telemedicine right now, Jared. So, uh, for me, um, 90% of all diagnoses are made via history alone. I think that applies for every area of Medicine.

Speaker 1Um, you know, I could take a poll of everyone's orthopedic injuries. I bet I could probably answer nearly all of them. Um, but it is a problem and so the physical touch is important, and that's why I really have pushed the organic growth side of my Business because what is advantageous in Orthopedics is that we get a lot of imaging and so imaging feedback, especially with the VC platform, which, which, you know, I'm using, you can share the MRI, you can share the X-ray very easily back with the patient.

Speaker 1And so that is so easy to implement in an office environment, um, but I am doing direct consumer as well and so the direct consumer side, we actually are working with employer groups, um, that have nurse case managers, people that can start to touch the patient for us. And so there are, you know, certain exams like a Lackman's, that's an ACL test for most, you know, non, uh, medical people here, but.

Speaker 1Allotment's can't really be done all that easily. But, uh, when you have sort of a nurse that can help you through the exam a little bit, that can be helpful. And then we also, um, I, I tell people, you know, tenderness palpation is very critical in Orthopedics. And so we use tenderness palpation and Other tests like I'm a Shoulder specialist, so I use an empty can or Jo's to figure out a Rotator Cuff Tear. It's very easy to, for me to do that over Telemedicine.

Speaker 1And so I tell people, you know, I don't necessarily have to put my hands on you to find the diagnosis. Let me hear your story and understand a little bit more about what you're doing, and then I can arrive at the diagnosis very easily. So, good question,

Speaker 5um.

Speaker 5Yeah, so basically you had mentioned, um, sort of this challenge of having to solve some of the Other problems that physicians face in terms of issues of Efficiency, um, paperwork and things like that in your clinics. Um, a lot of physicians in the United States, um, are already married to one EHR or another, uh, that does not necessarily have a, um, Telemedicine component.

Speaker 5Um, and even when you build, you bring in a Telemedicine component from outside doesn't necessarily fit well with the workflow per se. So is the solution for Telemedicine companies then to build out an EMR system in addition to that, or how do you get around this issue of solving the Efficiency and workflow problem that you see all the time?

Speaker 1That's a great question, and it's, um, actually what I've been working on, um, over the last like 3 to 4 months very hard is, um, creating API, um, hooks to be able to work with any, you know, any uh electronic health record system.

Speaker 1Now, cer certain, you know, uh, health records systems are a little more exclusionary than others. Um, we particularly are working with one that has an open API integration source and so that helps us on the direct consumer side, but on the platform side that we're offering to businesses, we have sort of an open API so that we can work within their own system. And another thing is that I've been working with electronic health record companies myself to provide their.

Speaker 1Platform. So we have two companies that have about 20,000 providers each. They're interested in using our platform to provide Telemedicine and so we're doing three different things to try to help with that system orientation and integration. I think it's very important.

Speaker 5Super.

Speaker 5have

Speaker 5The system doesn't always solve that issue.

Speaker 5more Efficiency.

Speaker 5Position we know that, uh, and can still lead to frustration maybe hamper the growth of the.

Speaker 5Such things, but the question is, do we need.

Speaker 5To say well either um the existing systems decide to build out your own Telemedicine platforms or the Telemedicine.

Speaker 5And to build more efficient and

Speaker 1ultimately, ultimately what we would like to do is to build a system with everyone out here that works for Telemedicine. I think that's really would be ideal, OK.

Speaker 1Um, but again, it's sort of baby steps. It's the same thing as organic growth versus direct to consumer. We have to take the baby steps of working with all the partners until we get big enough so that we can say, you know what, I think we need an electronic health record system that works better and, and do that and work off a blockchain. And so this is all in my mind that, you know, we'll talk about this tomorrow with the blockchain discussion, but.

Speaker 1This is where we need to be thinking, guys. We need to be thinking about creating a system that works together for everyone that works off a blockchain, so we're not dealing with the same issues over and over of, I can't get data from here. Where's this data coming from? How do I do Research because I can't get data from, you know, the 10 things, the circle we saw earlier today, so that's a great question and yeah.

Speaker 6So, um, first of all, excellent talk and, uh, very logical, well thought out, um, talked about the, the trust and the, and, and the value systems that come in, but I think in every specialty, um, I'm a cardiologist, every specialty there is an arena to use Telemedicine may not be super acute care, may be chronic conditions, maybe, but I can't emphasize more the.

Speaker 6Uh, thought, uh, the ideas of, uh, education and awareness because many times it is simply, um, providing information to the consumer and having them kind of digested rather than them going out to Doctor Google and trying to figure it out themselves, which is always, um, a challenge when people come in with self diagnosis. So how, how are you kind of, um, providing that education awareness in, in, in Orthopedics and, and what, what you do.

Speaker 6And um and that that

Speaker 1process. So we are using a lot of video um education uh off of our website that's really our Primary mode right now, um, you know, I think blogs and vlogs are really important. VC has been a masterful, you know, example of using blogs and blogs to sort of educate on Telemedicine.

Speaker 1And I think everyone, every company here needs to do that because as you mentioned, as if, it's, it's critical for us to be able to.

Speaker 1Educate the populace so that adoption happens without fear, and fear is driving a lot of people away from Telemedicine right now, um, just regular average Joe's, you know, but, but we need to educate and continue that education process, and it's all part of the, the growth of Telemedicine. It will happen, but we need, you know, the faster we educate, the better we're gonna do.

Speaker 2one last question.

Speaker 7Is it me?

Speaker 7So, you know, you, you mentioned that we gotta keep it rooted in the fee for service world because providers and a lot of Other players.

Speaker 7They're, they're just not ready to change the entire health system.

Speaker 7And you wanna focus them on the incremental move to Telehealth.

Speaker 7In one of your last slides though, you said that it was like a, like at least in the case of Ortho, that it was like a value rather than a fee for Reimbursement.

Speaker 7Proposition, so it seemed like there was a little bit of a contradiction and, and I thought you probably had a good answer.

Speaker 7Uh, as to why you're not taking a fee for service Approach since you think that's key to success.

Speaker 1Yeah, so it, it all goes on, uh, two different models, right? So the, the first model, as I explained, was sort of organic growth that needs to work inside the fee for service model. It's sort of like baby steps before we start running and revolutionizing, you know, healthcare, which is going to happen, but we need sort of the baby steps.

Speaker 1The Other side is all these wonderful people out here who are doing direct consumer. You are literally trying to revolutionize the system, OK? You can do that through your cost, your value equation. If you go at it from a low cost and you come to a, you know, for instance, an employer, and you say, listen,

Speaker 1I'm gonna work with you and I'm gonna, I'm gonna basically cut your costs by, you know, 9/10.

Speaker 1That's a big deal, you know, people are gonna listen to you and so if you want to really revolutionize, you need to go to the value source. You need to understand where the value in medicines being created. And so I'm telling you, work in both, both systems, but eventually the avalanche is going to come and everybody's gonna be on sort of the direct consumer and it's gonna be fine. But if you want to sort of get there, you've got to go organically and grow it.

Speaker 1You know, at the local level and the regional level and still maintain our current system, but we're all here to revolutionize Medicine, right? And that's why everybody's here. In order to do that, you have to be able to work organic first and then you can switch to direct to consumer once, you know, everybody's on board. So that's kind of what my thoughts were.

Speaker 2Thank you so much, Mike for that. You're really good. That was awesome.