#CareTalk Podcast – Game of Drones

#CareTalk Podcast – Game of Drones


– Hey, David, is that Amazon
drone delivering your book? – Hey, John, actually I ordered
a new kidney for my brother. (energetic music) Welcome to CareTalk, your monthly home for incisive
debate about healthcare, business and policy. I’m David Williams, President
of Health Business Group. – And I’m John Driscoll,
the CEO of CareCentrix. – John, I saw a wild article the other day and it was about a drone. – How wild was it? – It was this wild John, it was
a drone delivering a kidney, for transplant in a patient in Maryland. – David – Pretty crazy. – David, David. – Is it like a publicity
stunt or the real thing? – Drones are the future, dude. I mean, you are missing a lot. There’s a tremendous
movement to use drones as delivery for critical
medicines around the world. I don’t know whether you’ve
seen this company, Zipline, but in Rwanda, they can guarantee delivery within 30 minutes, of bloods and drugs that are absolutely critical, life saving, when the trip used to take,
you know, 3 to 5 hours, if it happened at all. There’s 3 billion people around the world, who don’t have access to
critical medicine or blood, on a realtime basis. And if you’re a mom
bleeding out postpartum, and you need blood, this
kind of service is critical, and it’s already established,
and it already works. I think you’re gonna see the
adoption of drone technology, which is rapidly getting
cheaper and more effective, to deliver critical medicines, even in difficult parts of the US. And it’s gonna be a
game changer for access to critical medicines, I
think, around the world. That kidney example is not unique, and I think that drones
would make a lot of sense, what’s wrong with drones? – I didn’t say anything’s wrong with it, but I think you’re pointing out that, it’s gonna have like, an edge case, a very elite thing. – No, no. – You’re not gonna
deliver that many kidneys, but there’s always the need
for blood in remote areas. You know, in China, they’ve
got a company called EHang, as long as we’re moving around the world, and this company can
actually carry a person, and they’re talking about
using it for lung transplants. I’m a little worried,
John, it might come out, grab you, and harvest you. (laughs) – You’re… (laughs) I don’t wanna talk– – Enough about that. – I don’t wanna talk about China, but drones are the future–
– Fine. Fine. – of transport– – Fine. – Think of it as a future
of transportation vehicle. – I’ll think about it that way, John, but, let’s talk about disparities, since you sort of bring it
up with my Maryland example, your Rwanda– – No, the Africa– – Example– – Disparities don’t just happen in terms of access to care in Africa. There’s huge disparities, there’s more and more
statistical evidence, that the disparities in the US, are getting worse not better,
and are not being addressed. If you just look at the wealth disparity, one statistic, the Brookings
a few years figured out, or tested, what’s the
difference between the lifespan of a wealthy person and a poor person? One cohort born in
1920, the other in 1940, if you were born in 1920, and
you were wealthy versus poor, you lived five years longer. If you were born in 1940, again, with more access to
more modern technology, the actual disparity between
wealth and poor lifespans, was up to 12 years. What you’re seeing is,
disparities are growing, as opposed to declining
in the modern world, and that’s crazy. You see it across race,
gender, as well as poverty, and if we’re going to fix
the US healthcare system, we need to invest more resources, not just studying it, but
addressing these issues. – Well, John, I think you
pointed out with the drones, how that can actually reduce disparities, with your example of Rwanda; and I think technology has the possibility to reduce disparities,
but also to increase them, and I wouldn’t be surprised if you see– – How do you get there? – I’ll tell you why, I wouldn’t be surprised
to see if your 5 years, to 12 years actually goes
to 20 years or 50 years, in the future because as
people can actually invest in being able to get artificial organs, there’s gonna be kind of cyborgs, I know you don’t like the term, and people that–
– Can I replace you? – Part of me. What’s really gonna happen is, there’s gonna be a huge
disparity between people that can afford to
replace their own organs, and those that can’t. But John, I know you don’t like that idea, but what’s happening right now is, if you think about how
you measure disparities, one way that I read that
was very disturbing was, looking at outcomes of
people with diabetes. An African American is
up to 10 times as likely, as a white person, to lose their leg to
amputation from diabetes, and that is a very sad
state of affairs, John. – Well, you’re way too
afraid of technology, and I think actually technology can also help us leverage more
of the increasingly shrinking physician and clinical workforce
that we need to augment. So, augmented healthcare is
gonna be your friend, David, and if we were ever able to actually successfully
manage the pricing of drugs and heart technology, you shouldn’t be afraid of a
cheaper heart that works well, that would be accessible,
– I’ll take one of those, one and a half or 2 valve hearts, – But I think the challenge on
race is actually even deeper, – Yeah if you actually, statistically look and you normalize for, access to care and income. What you find is, for
African American men, you still have worse disparities, which is worse outcomes, even across wealth and access to care. Which is just crazy, we
have to invest in it, but technology’s your pal– – John, you could look up– – Don’t fight it. – If you look up disparities,
if you look up David Williams, you’ll find a David Williams, believe it or not, there’s more than one, who’s actually at the Harvard
School of Public Health. He’s written a lot about
implicit biases that are there, even when you have a
well defined protocol, somebody from a disadvantaged group, like African American, are gonna be less likely to
have that protocol applied. – But why wouldn’t technology help there? – It might. – Cause technology is race blind. – It could– – We need to be more blind
to race, gender and income. – All right. – We’ll move on, but I think some of the
artificial intelligence databases, have been shown that they can actually– – The bias. – Reinforce the bias, so lets talk about some more technology, since you want to talk about that, and you say I’m afraid of it. I’m not afraid John, I’m not afraid of technology, but one of the things that happens is, you’ve got insurance
companies like Humana; that are experimenting
with companies like, Doctors on Demand and Teladoc, to offer a virtual, first approach. So, instead of seeing an actual doctor, you’re gonna see, I guess,
your phone, is that the idea? – Well, don’t be afraid,
again, fear not your phone. – Okay, I’ll just be dismissive of it. – I think– – Where’d my phone go anyway? – We need to leverage
all the tools we have, to get people access to
care, the right care, when it’s convenient,
and access to resources. I think it’s been shown over time, that if we can get people
access to convenient care, and cheaper, which all of
this telemedicine provides, you actually have better
use and more thoughtful use. You avoid the unnecessary
script, the unnecessary test, and you’re meeting people where they are. I don’t know whether it’s
gonna be virtual first, or virtual and, but I think virtual
visits are being embraced. You’re seeing it, not just with start ups, but you’re seeing people,
my 85 year old mother, is very comfortable with technology, as long as it gets her the
access to the information she needs. It’s not gonna replace docs, we actually need more
heart-centered humane care, but it gives us the ability
to augment and grow access to care when people need it. A lot of what goes wrong in healthcare, happens on nights and weekends. I know at CareCentrix, we
focus a lot on being accessible to our patients in need 7/24, 365, because that’s the only way you can truly, get people, you solve for some of those access to care, things that happened just
based on the work week. – That’s fine John, I think the tech works, it’s okay, but, I would be concerned about
getting virtual care, when I actually need real care. – Don’t be a fraidy cat. – All right. – What do you think about this CBO report about Medicare4all? It’s getting a lot of attention. What say you? – So, John, everybody’s
been talking about how expensive Medicare4all will be and I’m sure will be expensive. So, they asked the CBO to issue a report, as they often do. They didn’t come up with any numbers. Even though, on things like – Is this the Congressional Budget Office? – Yes. So, like, they should talk about, it should be more quantitative, but you’ll look through the report, there’s not much in there. I think it’s ’cause it’s hard to define what Medicare4all actually is. – That makes a lot of sense. – And, you know, certainly
it’s gonna be expensive but they point out some interesting things which is that, you know, not everybody has, even if they have employer based health insurance, it’s not as though they keep it for that long and so you’re comparing Medicare4all versus talking about being scared with, okay, something boo, that someone’s gonna take away my health insurance. Well, people get their health insurance taken away, all the
time by their employer. – I don’t think that’s fair. I think that they
clearly dodged the bullet but this year, Medicare4all is really a shroud around the fact that we’re losing access to care. Care is still expensive,
drugs are still expensive and people are angry about it. I think it’s a cluster
term and it’s pulling together all of the
things that people don’t like about healthcare and they want, the public’s
demanding some sort of action. When you take Medicare4all
and you pull for it, it’s like 80% approval. When you point out the fact
that 140 people are going to lose their private healthcare which actually covers
more, provides dental and whole series of things, you get about 60/40, 70/30 against. But we need to pay attention to the fact that we are having
issues with access care. I think that, you know,
we’ve talked about this, that a solution would be more managed Medicare or Medicaid-like products for people who can’t afford it. That’s probably where we land and I think CBO dodged
the bullet on pricing it because, to your point,
they don’t know what it is. – You know, it’s a simple slogan and probably shouldn’t make
policy completely on that. I think one thing to point out is that in the insurance system that we have now, the insurer can’t invest that much because for the long term, they may only have you for a year or two, and the idea is well, with Medicare4all, if you’re always on that then there could be
longer term investments. The reality of the annual budget cycle means that’s not automatic. – But, well, I think you’re seeing for Medicare and Medicaid, those insurance companies are investing. I mean, they’re investing
in new models like CareCentrix, who, with care to the home and you’re seeing more and more of that. I actually think that
insurers get a bad rap there. There is a fair amount
of turn-over with private insurers but for most of the cohorts of people who are covered
on private insurance, they’re aren’t chronic. Where there’s chronics,
where there’s a need to take care of chronical ill people, I think insurers are increasingly being more innovated and investing
in more models to address it. – Fine, John. Well, the drone has gone
but the storm clouds are gathering and it looks like thunder and – Lightening David, are you still
taking your sleeping pills, either by day or at night? – So, John, there’s a
new black box warning on these sleeping pills for things like driving while taking sleeping pills, actually going wandering around, cooking and eating. – How about podcasts? – Well, John, what I
was think was actually, I’m gonna go
– for you. When I pick my Parkinson’s pills that cause compulsive gambling
with the ones that cause me to go and drive
while I’m sleeping, I’ll go to the casino, sleeping, put it all on red
– Don’t! – And win big. – You shouldn’t make fun of these. These are real risks, people
use these pills everyday. The black box warning
is a really good thing. I’m glad it’s out there. Don’t necessarily stop taking your pills but you should be paying
attention to these warnings. It’s a big change and it matters. – John, is weed killer causing cancer? – Weed? Oh, killer. I think that there’s a
lot of noise, right now, and it’s quite serious about the fact that this Glycophosate is in
almost everybody’s bloodstream. I think we’ve been a little
too loosey-goosey about all of the chemicals that could hurt you. The statistic that
worries me is that you’re cancer incident rates for kids have gone, pretty dramatically up, from 12.5 per 100,000 18.5 per 100,000, the last time I checked
over a 10 year period. And that’s an indicator, I think, that we may be poisoning out society. So, I don’t think we really know. It’s a complicated thing, but I think we ought
to be paying attention. – I saw an FAQ from an expert
and said how much is too much? And they said it’s not known. – (laughing) Well. – John, you’re pretty arbitrary. Do you believe in
arbitration for drug pricing? – I think anything that
makes the conversation with drug companies more transparent about how much we’re over-charging, is a good thing. I’d be willing to try it, to force the drug companies to come to the table with fairer prices. What about you? – I think when President Trump retires, he may become the drugs lord. He can set all the prices, I’m for that. – (sighs) – Can technology make
healthcare more human? – I think it could. But I think what’s more likely is that you’re gonna go from a Doc in a Box to a Doc in Bot and I worry
what’s gonna happen is you’re going to
actually have, you know, artificial technology,
artificial intelligence instead of people. – You’ve artificial fears to match your artificial intelligence. I think that technology is our friend and it won’t make us, technology doesn’t make
anything more human but it could create more
room for more clinicians and frankly, patients and families to inject more humanity in healthcare. – Paging Dr Aspartame. – (laughing) – Well we’ve reached the
bitter end of another addition of CareTalk. I’m David Williams, President
of Health Business Group. – And I’m John Driscoll,
the CEO of CareCentrix. Thanks for watching. – (robotic) Take me to your leader. – Hey there listeners! Want more CareTalk? There’s more to be had
in our other episodes, so be sure to look for those and subscribe to CareTalk on your favorite service.

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