Telehealth: The New Normal in Primary Care

Dr. Jon Lensing co-founded OpenLoop with a mission to make healthcare more accessible for all. The current telehealth boom has connected patients to care within multiple specialties including primary care and, overwhelmingly, mental health.  

In this episode of The Connected Care Team, Dr. Lensing shares how telehealth has expanded patient care outside of the confines of geographic boundaries and how OpenLoop eases administrative burdens for clinicians.

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Transcript

Dr. O'Connor: With us today, we have Dr. Jon Lensing. Dr. Lensing received his medical degree from the University of Iowa and is the co-founder and CEO of OpenLoop. Welcome to the show, Jon.

Jon: Thank you Will, appreciate it. Excited to chat more.

Dr. O'Connor: Yeah. Tell us – I’m fascinated about your journey from, uh, rural Iowa to becoming a physician, to becoming a, a founder. Can you talk a little bit about that?

Jon: Absolutely. I'm still stuck in rural Iowa, but, uh, it's a great place to be. I grew up in a small town called Pella, about 10,000 people, a big farm town, best known for tulips, Dutch people, and windows. And then went off to a small school called Calvin College up in Grand Rapids, Michigan. Studied science as well up there, ended up starting my first company operating the drone space.

Eventually exited that to a partner when I graduated and then came back to Iowa City for medical school. Um, progressed throughout my studies, there ended up joining an ad-tech startup that was making wearable health technology for livestock, particularly pigs. Um, helped run research there for two years secure a lot of state and federal grant funding eventually left that position because it turns out medical school is a little more time-consuming than I thought. 

And ended up graduating, matched in plastic surgery for residency. Began that, but then, and also started OpenLoop as a side project to address a lot of the inefficiencies that I saw in medicine. And I was kind of planning on running that as a side project, Will, for the longest time.

But then, there came a point along that life cycle, where the company had started achieving enough growth and traction, where I thought I could have a bigger impact on healthcare by doing that full time, rather than going on any further with my clinical training. So never where I thought I'd end up, but it's been an exciting journey to say the least.

And here I am, again, still stuck in the middle of Iowa. 

Dr. O'Connor: Let me ask you this, Jon, how does a guy from Iowa get into scuba diving? It sounds like you're a big scuba diver.

Jon: Ah, that's a great question. Um, I've always had a fascination for the water. 

Dr. O'Connor: Yeah.

Jon: A lot of people that like the water, you know, they always say that they, they would rather have been born a fish. I think I probably fit into that category. Um, ah, there's something about - there's something calming about being in the water, not hearing any noise, particularly it's, it's a, it's a very peaceful experience.

Eye-opening because we really only ever get to see the top of the top of the water, you know, above the surface. And then there's an entirely new world underneath it. I, since a little, since I was a little kid, I always wanted to get to scuba diving. Then finally pulled the trigger a few years back. Got certified and have never looked back. Taken a million, million different courses on ecology, you know, stress and rescue bringing a lot of the health aspects.

And I've gone on numerous dives, but it's been, it's been incredible. 

Dr. O'Connor: Sounds like it's been, uh, an exciting journey. Tell me a little bit about OpenLoop.

Jon: Yeah. Um, we've gone through a couple iterations of OpenLoop. I think some of the inefficiencies that I saw within medicine were really around this growing disparity between an ever increasing patient demand and a very stagnant clinical workforce, unable to meet that demand. And I knew that a lot of, you know…colleagues had additional availabilities with better schedule that were going underutilized. Patient cancellations, mornings off, afternoons off, albeit sporadic.

And so it became a question for us at OpenLoop of how do you take an already preexisting workforce and now make them more efficient at delivering care with those, with those available hours? And so when we first founded OpenLoop, we had this notion where we could take clinicians from high-density, metropolitan areas.

So Des Moines, for example, or Chicago, and then plug those same clinicians in, within a one to two-hour driving radius outside of their home base to help meet rural hospitals, rural clinics. Um, a lot of their backlog of patients. We launched that in January of 2020. Um, saw some great initial traction with it, scale that very quickly during the first month of the pandemic to assist and, um, help out a lot of those hospitals that were needing additional staffing, but then very quickly, uh, moved towards the digital health space.

Digital health had just boomed and were experiencing a lot of the same issues, but through a few different iterations within that space, we finally stumbled upon, uh, our model of what we are now and the easiest way to describe that, Will, is we are like a Telehealth company that helps power other telehealth companies.

And we do this by providing what we call full-stack clinical operations. So I know it's a mouthful, but… 

Dr. O'Connor: Yeah, what's a full-stack clinical operation? 

Jon: Yeah, in summary it's, it's our clinicians utilize our technology and our legal infrastructure to see our telehealth partner’s patients for them underneath our partner's brand names. It's a lot, lot going into there.

We have this network that we've curated ourselves, about 6,500 clinicians across the country, across a variety of domains of specialties. We have all the tech infrastructure necessary to see these patients virtually across state lines, as well as the, uh, medical operations and legal operations that house all of our compliance and regulatory components. 

Dr. O'Connor: What types of technology are you using to enable these providers to see patients all over the country?

Jon: So very much like a traditional health system or clinic would use, um, we have all of the EHR functionality to order labs, to write prescriptions, to record and document clinical notes, patient intake forms. But if you look at the actual market of telehealth, it's really broken down into two distinct categories.

The first being synchronous, such as video chats, like you would do on FaceTime, Zoom, or Skype, and asynchronous work, which is where a patient fills out a form, giving all their information then, and then a clinician on the

back end reviews that, and then has some sort of action to perform. And so we power both of those types of encounters through our system.

But then some of the other tech components in this revolve around scheduling, so matching the correct clinician to the correct patient within the correct specialty within the correct state and time zone, et cetera. So a lot of different integrations just to make sure that the patient gets booked with the correct person on our end. 

Dr. O'Connor: Got it. And what's the breakdown and services you're providing? How much primary care versus specialty care are you delivering?

Jon: Yeah. So our network is comprised of primarily physicians and it's, that's about a 60, 40 split between primary care and specialty care. Um, about a third of our network are EPPs, and that is about a 90 10 split between nurse practitioners and physician's assistants. And then about 20% of our overall workforce is reserved for, uh, mental health.

And this includes psychologists, licensed clinical social workers, licensed independent social workers, licensed marriage and family therapists. And a few other different types of providers. That doesn't quite match up though, Will, a hundred percent to what we see on the demand side. I'd say about 75% of our overall, uh, patient visits just require a PCP. Less so on the specialty care. We're seeing a growing and growing trend even on a weekly or daily basis within the mental health space and then demand for services there. 

Dr. O'Connor: I was going to ask you about mental health services. And if, if you've seen a, a spike in that, um, you know, from the time we've been in, uh, COVID.

Jon: Yeah. It's actually incredible. I think telehealth is aptly suited to deliver mental health services at scale, in a very de-stigmatized fashion. When you think about it – somebody from a rural community, town of five, 10,000 people. You know, people within that town and there used to be a stigma surrounding mental health, where, you know, if you had to drive to your therapist, office, your car was in that parking lot, and you don't know how many people are driving past you, they're seeing your car. And they're like, oh Yeah, you know, Susan or, or John Doe is at therapy, they must have something going on with their life. 

And now being able to take that service and get it delivered from the comfort of your own home, where you feel more at ease and able to divulge more information to get the help and therapy that you need. It's seen a tremendous increase, um, and it's reflected across all areas of that sector. One, the amount of mental health telehealth companies that are out there. Close to 700, approaching a thousand within the near future, many taking different approaches on how to address these different mental health issues.

And then even from a clinician standpoint, the salaries and the pay rates for clinicians that are practicing within this sphere have just increased dramatically. And as some of these, some of these therapists were making $45,000 a year before all of this. And they're now bringing in 150 to 160,000 a year just because they're in such high demand. 

Dr. O'Connor: Yeah, I would imagine they would be able to handle additional volume and have a, a full schedule, you know, working with someone like OpenLoop, because you're able to schedule patients from, you know, from, from all over.

Jon: Absolutely. We're no longer confined to geographic boundaries. So, you know, more rural areas that had very limited access to services like these are now getting plugged in across the country with therapists that can meet their demand. And then they think there's been a big paradigm shift in how employers view mental health, particularly during the pandemic when people were more isolated that employee wellness and, and, um, health is becoming an evermore prominent discussion within a lot of these large employers. And now they're starting to add additional employee benefits, particularly around the mental health space. 

Dr. O'Connor: Hmm. You know what you said about this helping to de-stigmatize mental health I think is, is really important. You know, in my experience many patients chose not to seek out services that needed them because of that stigma and this, you know, it sounds like you're really providing a way for those patients to, uh, to, to get care in a way that they couldn't previously.

Jon: Yeah, I, I don't, I don't think we could take that credit. I mean, a lot of our talented partners are out there bringing people in doing the hard work of de-stigmatizing this, this entire narrative. And then we're just there assisting on the back end of getting the correct people there to, to meet their patient demand.

But absolutely it's, I mean, think back 20 years ago, nobody was willing to disclose if they had a therapist, but now it's, it's pretty common talk amongst people. 

Dr. O'Connor: Yeah. Talk to me a little bit about what it's, what kind of payer relationships do you have? What are, what are payers thinking of, of these types of, of offerings, and how are they reacting to it.

Jon: That is a phenomenal question. And it's, it's a very difficult one to answer. Some payers are very archaic in their lines of thinking. Telehealth to them doesn't represent a um, a new way of addressing chronic conditions or, or chronic problems within the overall delivery of healthcare. And so they're a little bit slower to innovate. 

Then on the opposite end of it, you have players like United healthcare. Who are bringing in a lot of their own specific verticals within telehealth. They have their own primary care. They're starting to develop mental health. They're bringing in GI, psychiatry services, um, dermatology type care. And so it's players like United that I think are really going to change the overall landscape.

They're providing a lot of their patient base, this ability to get care and access care wherever they are, which ultimately drives better outcomes for the patient themselves, because they're getting access to that care much quicker. They're getting to see the specialist that they need quicker. And then, you know, everything in the spaces is driven economically.

And so even for United, they're decreasing the amount of patients that have to go to the ER or urgent care. To get this care that they can get virtually right now. 

Dr. O'Connor: Got it. Tell me a little bit about what your thoughts are around on, are, are you seeing more primary care being offloaded to telemedicine? We're starting to see that anecdotally in some of our clients where they're looking to, since it is a loss leader, for many places, they're starting to push that to telemedicine. Are you seeing some of that?

Jon: You are a hundred percent correct. And, you know, getting back to that payer discussion, we just came from a lot of these health systems categorize primary care as their loss leader, because they've been in network with these insurance companies so long that they can negotiate higher rates and take losses on other avenues of revenue.

So a lot of these hospitals make money off of ancillary services like imaging, prescription fulfillment, inpatient stays, nursing fees. And then the actual primary care portion, um, they'll take a hit on because they know that they serve those patients and they'll come back to them for the ER visits for any of the inpatient care for their surgeries, etcetera.

And so for a lot of these hospitals, there is value to set up partnerships with people who have very financially stable telehealth models for primary care, because they can service these patients at a lower cost. They can still give them quality access to care that they desire. They're driving better patient outcomes.

Um, while the hospital then is able to provide the services that are core to them. And so you're exactly right. Primary care within telehealth is booming, dramatically. And it's interesting. We're starting to see a lot of these telehealth players that are offering primary care begin to even innovate within that space.

So one of the biggest difficulties with primary care virtually, um, has been the physical exam component. You know, for, for older patients who need an annual physical. If you're looking at, uh, women who need breast exams, or you have somebody who comes in with a dermatologic skin rash. Um, all of these different components are vital to an actual primary care exam.

And now we have partners in the space who are building robots that can, that can, um, analyze and do physical exams remotely with a clinician who's controlling them virtually across the country. We have, um, clients who are, who are utilizing different imaging systems to look at skin rashes. Um, which is essentially a placing of dermatoscope to do dermatology exams.

It's incredible, the type of work that's coming out of the space right now.

Dr. O'Connor: Yeah, you talked a little bit about access and how this is providing patients additional access that may not have otherwise had it. What is the other feedback been from patients?

Jon: The majority of it is roped around access. And I think if we dig a couple layers, deep one is just the, the, the overall timing of everything. Everybody knows that they have the ability to go see a PCP. Um, but when they actually call in nowadays to schedule a visit with their primary care person, they may be booked six months out.

And with all of these telehealth companies out there, you're now able to book appointments sometimes within 24 hours, oftentimes within the span of a week. Um, on a time that meets your schedule. You're no longer being confined to just normal business hours where you have to take off time out of your workweek.

There's a lot of off-hours covered. There's weekend coverage now in telehealth. And so it's improved the time of the time from requested appointment to actual visit conducted, but even more so we're seeing a lot of patients who are very happy and pleasantly surprised with how quickly they can get to a definitive diagnosis. 

And what I mean by this is if you have somebody who's suffering from inflammatory bowel disease, like Crohn's or ulcerative colitis, these patients normally had to go through a PCP who would order labs or tests. Referred to a specialist who then might give a diagnosis and they might get another referral.

And so eight months later down the road, you actually have a definitive diagnosis. Now, if you already know that you're suffering from some sort of GI and intestinal condition, there are telehealth companies who address that specific area. You can log in, you can get an appointment within a week. You can get your labs done on your own time at a lab that's close to you.

Those labs are then reviewed by, by s clinician and you're given a diagnosis in a 10th of the timeframe it would normally take. And so in tying that into the third piece that we hear from patients is that while a lot of telehealth is cash pay, private pay out a patient's pockets, their overall health spend has decreased because they're able to get access to the point of care that they need on a much quicker timeframe.

So they're not having to pay multiple co-pays for each and every subsequent visit they're getting. And then a lot of prescriptions, telehealth companies are great at utilizing resources out there like GoodRX, or even just issuing their own generic prescriptions to meet these, uh, these conditions that these patients are facing. 

Dr. O'Connor: Yeah. You know, and I imagine too, it's, uh, um, for the patients too financially, even though it's out of pocket. Many of them won't have to take the day off work. I remember the last telehealth appointment I had. I was able to squeeze it in during my meetings during the middle of the day. And I didn't have to take even five minutes away from, uh, you know, my job where I would have had to normally, you know, take half a day off to, to go and, uh, and get seen for something that was, you know, very simple and could be easily handled with a telehealth visit.

Jon: That is a great point. And I mean, if, if we even look at another, um, and another iteration, it allows people who normally prolonged appointments because they would have to take off those times, get access to care now when they need it. And so, we're starting to enter a more preventative style of care that's often been put to the wayside, cause it was just, it's much more higher demand. It's not high on people's radars. But now with the ease of getting this care, it's ushered in a new era of preventative medicine. 

Dr. O'Connor: Yeah. Yeah. On, on your clinical staff, which you, you spoke about earlier, I know, you know, physician in particular recruiting right now can be very difficult. How did he go about, you know, curating and organizing your, and recruiting your staff?

Jon: It's a great question. I think, I think the, the big component here, Will, is that many of our team members are former clinicians themselves. We have former nurses, we have former respiratory therapists, technicians, CNAs, uh, quite a few former physicians on the team. And many of us understand the pain points that clinicians experience on a day-to-day basis.

So even from a physician perspective, the administrative burden that's placed on them in an office setting, the amount of charting that goes into this. The credentialing that they have to constantly be aware about privileging. We've always kept our clinicians top of mind in, in our culture here, they represent our first client to us.

They are our high-priority clients. So we've taken cue to make sure that we offload all those burdens that normally weighed them down in a traditional setting. All of that stuff, their credentialing paperwork, their licensing paperwork, even just curating their schedule for them on a day-to-day basis. Um, charting we've made much simpler.

We decreased the amount of clicks and, and touchpoints they need to do to get to what they want to do. Write a clinical note, or even just issue the prescription or order a lab. Um, and so we keep our clinicians top of mind. I think that's first and foremost, how we are, are good at retaining and recruiting.

And the second component of it revolves around this shift that we've seen from, from in-person care to telehealth virtual care, and in a traditional health setting, a lot of these clinicians are used to seeing a variety of different patient complaints. You know, primary care providers they go through everything from obstetrics to geriatrics, to pediatrics, mental health components within there.

But telehealth itself is a very verticalized industry. You have companies that are focusing on a single specialty, in a sub-segmented problem within that specialty. We have partners that are focusing on just IBS alone. And so when clinicians first start to enter the telehealth space, they get, if they, if they're looking for jobs, they get plugged into a single telehealth partner, and then they're siloed into delivering that specific type of care.

When in reality, they went into medicine to see a full scope of problems. And so OpenLoop will fractionalize their time and democratize it across multiple partners to give them this variety that they love within medicine. But now the flexibility of virtual care. 

Dr. O'Connor: That's um, that's really interesting. You know both, particularly on the technology side, you know we have overburdened physicians and APPs in many cases with, you know, EMR technology that requires, you know, two hours for every hour, they spend with a patient. Right. And it's, it's really nice to hear you've been offloading some of that burden from them.

Jon: Yeah. I mean, it's, it's been great. We, we stress test. We user test. All of our EHR builds that we work in all of these feature sets to make sure that they align with physicians and other types of clinicians that will be working within them. And the response from that has been overwhelming so far.

Dr. O'Connor: Yeah. So Jon, tell me what is, what's next for OpenLoop?

Jon: I think we're fortunate, you know, healthcare is a great industry to be in, but specifically the spot that we're in one of our biggest KPIs, one of our biggest metrics that we track on a month by month basis is the amount of patients that we help serve. Um, And so that's been our mission, our vision since day one, you know, we were founded on this vision of delivering healing anywhere, but the overall mission of improving community health outcomes through the accelerated delivery of medical services.

And so watching that number steadily rise month over month has been, um, incredibly impactful to the team in terms of morale and, um, just inwardly looking, it's, it's been impactful to know that we've serviced that, that amount of patients. What's next for OpenLoop? There's still a lot on our product roadmap to be able to service these patients at scale and in a much more efficient manner, thereby better-utilizing clinician time.

There's additional service lines within telehealth that have yet to be tapped into wholeheartedly. A lot of new things coming out regarding remote patient monitoring. So, you know, hearkening kind of back to that preventative medicine, things, weight tracking with wifi enabled scales. Remote therapeutic monitoring. So tracking medication adherence with patients, um, and a lot of wearable technology, Will. You know, there's companies coming out with, um, EKGs that are on patients' wrists. You know, Pulse Sox that are, that are in their heart rate monitors. All of that data can be transcribed into actual drivable, um, uh, um, medical advice.

And so taking this data, accumulating it, and then providing advice back to patients and how they can better their health, the, the options are endless. Um, so I think for OpenLoop in the, in the near course, are to open up more of these verticals, continue building the product to meet our client demand and serve as these patients all while keeping clinician, patient, and client experience top of mind. 

Dr. O'Connor: Well, um, congratulations on all your success with OpenLoop. I know you're, you and your team have been providing, you know, incredible service for, you know, for your patients and for clinicians as well to allow them to practice medicine or a little bit of a different way and, and bring that to patients.

So congratulations on all your success and thank you so much for joining us on the show today. It was a pleasure talking with you. 

Jon: No, the pleasure was all mine. And thank you for the kind words. I can't take any credit for them. The team that's behind me are, they’re the faces that are changing healthcare every day. So incredibly proud to work next to them. Um, but I'll pass along the kind words. So thank you again.