Episode 21: Is the patient the quarterback or the football? Tackling care integration with Mark Clermont from Cecelia Health

Justin Steinman:
Definitively Speaking is a Definitive Healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.
Hello, and welcome to the latest episode of Definitively Speaking, the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, chief marketing officer at Definitive Healthcare, and your host for this podcast. I'm joined today by Mark Clermont, the CEO of Cecelia Health. Cecelia Health is a virtual first provider organization delivering integrated care to patients across all chronic disease risk profiles. Their virtual specialty care solution combines clinical interventions with digital touchpoints to offer a comprehensive suite of synchronous and asynchronous disease management, including capabilities like remote clinical support, device training, remote patient monitoring, and telemedicine, all delivered via a national network of specialty providers.
Now I'll grant you, that sounds like a mouthful, right? But to boil it all down, Cecelia Health essentially offers something they call virtual specialty care. And if you want to know what that is, well sit tight just one minute and Mark will be more than happy to explain it to us. Mark joined Cecelia Health in February 2021 after spending nearly 30 years in a variety of leadership roles at places like Lumeon, Provant Health, Wolters Kluwer Health, UpToDate, and Mercer, among other places. So like me, he's been around the proverbial health car back a bit and I'm sure that we'll get to all sorts of interesting angles today. So Mark, welcome to Definitively Speaking. We're happy to have you.

Mark Clermont:
Oh, thanks for having me, Justin. Fantastic time to be here. Beautiful Boston. It's fantastic.

Justin Steinman:
It is gorgeous out today. Cold, but gorgeous. So let's get started here. What is virtual specialty care?

Mark Clermont:
Well, we'll make the assumption that people know what specialty care is.

Justin Steinman:
Fair enough.

Mark Clermont:
And so let's start, we're primarily focused in endocrinology, nephrology. So let's call that diabetes and chronic kidney disease, that kind of thing. And you can go down the street and hopefully get an appointment with somebody in a brick and mortar building and see your local endocrinologist, if you're lucky enough to get an appointment. But you know what? With the advent of telemedicine, we go back to 2009, that's when the company started doing telemedicine, before that was even a word. And here we are, we provided it across all 50 states, and we provide access for patients. They're just frankly aren't enough specialists in the world.
You and I, we go see our primary care doctor, they do all sorts of great things for us and send us home with all sorts of updated labs and protocol to basically go exercise and eat and that kind of thing. But every once in a while, you need to go see a specialist. And getting in there just takes a really long time. And if we can make that more convenient and maybe a little more expedient and overall improve your healthcare experience, hey, that's a win-win-win. Let's do it.

Justin Steinman:
But people seeing specialists is not a new thing. It's an age old problem. I have some data I'll get to in a second, but what suddenly changed? Why is virtual now there, and why aren't 90,000 companies jumping into this space if it's such an opportunity?

Mark Clermont:
Well, there's a lot of answers to that question. One, the technology has finally caught up with us. You and I are talking here virtually. And so one part is that. So now you can have a much richer and robust conversation with someone, whether it's telephonic or video based, you name it. So one. Two, we have, certainly as accelerated by the pandemic, frankly, it's a lot safer and a lot easier for patients, and certainly more convenient to, and there are some patients, frankly, who just have a hard time getting out of the house. There may be other challenges there. So it's hard to get brick and mortar. So patients want this, they want the convenience of it, or the necessity of it, frankly. And if you can provide, and there are certainly a lot of contexts for which virtual medicine visit, telemedicine visit makes sense. And so this is what the public wants. And frankly, this is the way that we can scale access to these very precious commodities, which are our specialist clinicians.

Justin Steinman:
So let's talk about some of the size and scale here. So according to the CDC, there are 860.4 million physician visits in the US in 2018, or about 2.6 visits per person. Of those visits, the CD estimated that 49% of the visits were to specialists, which works out roughly 421.6 million visits. Now fast forward to last year, 2021. Actually, I guess, it would two years ago, since we're in 2023 now, but we'll go back to 2021 when they have the most recent data, according to data I pulled from the Definitive Healthcare database, the volume of outpatient specialty visits climbed to nearly 500 million in 2021. That's a jump in just those four years from 2018 to 2021 of 19%, while the US population only increased 2% in that time period. Why is the volume of specialty care growing so much?

Mark Clermont:
Well, you have a lot of things. Well, one, I think that's a good thing. So less and less what we're seeing is a scenario where primary care family medicine is trying to do everything all in one visit. And frankly, there's just out of necessity. If you only have 15 minutes to see a patient, you need to maximize that efficiency. And frankly, we may talk policy at some point, from a policy standpoint, we're also asking our clinicians, our primary care providers, to do more and more and more within that 15 minute window. So we're busy documenting in their electronic medical record system. We're busy trying to capture all these other required elements around social determinants of health and health equity. These are all very necessary and essential elements of ensuring equitable access to physician and patient care.
But at the same time, it's all falling on the same burden, primary care. And then you also compound that with HHS having a national aspiration to get everyone within the US to have a primary care practitioner by 2030, and you have an efficiency equation here. So you have to figure out something. Okay, so let's start teasing apart the primary care practitioners, each patient encounter, how can we make that more efficient? Okay, well there's some things that I should be doing or should I refer out? And medicine of course is getting more complex. It's accelerating and changing our understanding through research and studies, just the practice of medicine continues to get more complex. We've been seeing this as we go along, and certainly saw that back in my old UpToDate days with Wolters Kluwer, we were trying to understand the synthesis of all of this and help provide some decisioning guidelines at the point of care.
All of this points to, hey, you need to go see a specialist, let's get you referred out. So that's the good clinical intent view on this. You might look at, I've heard some other folks talk about, well, there's some maybe lesser areas of can you maximize the revenue per patient in that context? I personally don't ascribe to that. I can't imagine seeing any kind of clinical decisioning that's influenced purely by aspirations to enhance revenue. But reality is that that is also a byproduct of a referral out to specialists.
And so yeah, we see this significant increase in need. That doesn't mean by the way that patients are getting in front of those specialists in any expedient way. Frankly, there just aren't enough of them. And so if that's pushing out someone's care, I think one of the stats I recently saw was pushing out a 26% increase in average wait times to see a cardiologist. Now this was just from 2017 to 2022. So 26 days average wait time to see a cardiologist now is up from 21.1 to 26.6 days, that's a pretty significant increase just in wait times. And that's emblematic of having roughly 7,000 cardiologists in the country. And so how do you scale that? It's a tough equation.

Justin Steinman:
That's fascinating. There's a lot that you just said. So let's unpack some of that. So what I really heard you start to say, and there's a lot of logic in what you said, I like that, so I heard you say HHS is driving everybody to get a primary care physician. Got it. At the same time as we've talked with about other guests in this podcast, we have got a massive shortage of primary care physicians in this country. Something that is just unbelievable, and it's only getting worse as more and more people are leaving, primary care physicians are leaving, and pursuing other careers.
So if I've got a declining population of PCPs, so only X amount of hours in their day, and even if they're working X plus two, if they're working 10 now they're working 12, which I hope they're not, but if they are. And you've got HHS driving more people into the primary care world, you need an outlet valve, if you will. And it sounds like you're saying that outlet valve is to send these people to specialists and to drive up specialist usage, right?

Mark Clermont:
That's right. That's one of many outlets.

Justin Steinman:
Right. So couple questions to follow up from that outlet valve. The first one is, specialists tend to be more expensive than primary care physicians. So isn't HHS inadvertently driving a cost increase in the healthcare system?

Mark Clermont:
That's a very provocative question.

Justin Steinman:
We try to be provocative here on Definitively Speaking.

Mark Clermont:
Yeah. I guess the counterbalance to that is, are you creating at the end of the day, better care for a patient, better clinical outcome. And so if you're looking at this from a longitudinal perspective, you're reducing the instances of negative outcomes, maybe the recidivism, the readmission rates to ER. Maybe you're directing patients better than directing them into urgent care, and even more expensive modalities of care. So I think there's some bright folks there who are really good at analyzing data. I suspect some of those factors went into their analysis.

Justin Steinman:
I mean, I was being provocative. I was actually having a little bit of fun here, but that's what we got to do. But you could actually argue that we take the whole thing, an ounce of preventative care, treat my diabetes now, get it under control, saves me from 27 emergency visits down the line. So maybe you're adding costs upfront and taking it out down the line in ERs and other places.

Mark Clermont:
Yeah, I mean, that's right. And by the way, we see that in our own data. From our perspective, if we can reduce ER utilization and patient hospitalization by 12% in our diabetes management protocol, that's fantastic. If we can improve somebody's adherence to therapy for congestive heart failure, let's say, and so therefore again, they don't represent in ER, and at the end of the day, they're living a healthier and happier life with reduced instances of expenditure, that's a win.
Well-published data out there for patients with, even just look at hypertension, we work with within our patient panel, call it about 110,000 patients that initially present to us with hypertension. They may have other, in fact often do, have other comorbidities. But if you think about someone who's without cardiovascular disease, let's say, and again, I'm specifically talking about hypertension in this case, there's a two and a half X inpatient cost, a 2X outpatient cost, and a 3X prescription spend. All of that's an increase if you have hypertension that you need to treat and maintain.
So if you are doing a better job of maintaining that, or maybe even someone who's on that cusp of moving into a hypertensive state, you can help extend a healthy lifestyle that defers and delays that onset of hypertension that needs treatment, that's a big win, and that's a big cost reduction to the system as well as a reduction in the amount of time that someone needs to come and present.
I'll add one other piece of data here. So from our data, and I hope this isn't unique to Cecelia Health, but for us, our pieces of data that we look, if we work with a patient with hypertension for six months, and we follow that patient in data for the ensuing 12 months, if you set the right kind of behaviors, and it takes six months to get there, let's say, you set the right behaviors for that patient, 12 months later they're still adherent to their therapy, and they're still, because they're adherent to therapy, they're also living a better and healthier lifestyle and not needing to, let's say, escalate their medications or present back into emergency room, et cetera, that's a huge win. And that's a burden lift from all of this other volume that we're talking about for patient access.

Justin Steinman:
Yeah, it's the old saying, an ounce of prevention is worth a pound of cure.

Mark Clermont:
Absolutely.

Justin Steinman:
So I want to go back to something else that you said a few minutes ago, which is that there is a shortage of specialists in this country. I think, again, shortage of primary care, shortage of specialists. If we're increasing the volume, and you're offering virtual specialty care, you're siphoning, I guess, in-person specialists away to do telemedicine specialists. How are you solving that supply problem of specialists?

Mark Clermont:
You could call it working smarter. So let's use our example. So we started as an endocrinology practice. This company was founded by a gentleman who was in his mid 30s diagnosed with type one diabetes, and he was very appreciative of the support that he got from his diabetes educator, whose name happened to be Cecelia. And so that's the founding principles of the company. Where did the name come from? The incredible thing that she did for him. And so he wanted to bring this to the masses. This long predates actually setting up a specialty clinic itself. This was mainly focused around the coaching and more of the lifestyle management elements of learning to live with diabetes and get up and running. We've since pushed ourselves into the core of medicine itself. And so now we are not only working within the core of medicine, but all the way out through to the lifestyle and coaching realms. And you can bridge across those things.
But if you look at access to endocrinologists, you start to realize pretty quickly there's only about 7,500 endocrinologists in the United States. And if you were to look at those, map those out across the US, you'd see a very challenging bit of access for anybody who's in a rural setting. But I'll say even here in Boston and our home base in New York City, there are quite a few endocrinologists, but still insufficient numbers of endos for the patients who need them.
And so what do you do about that, to your very important question? And I said work smarter. And so one of the ways that you can work smarter is by leveraging a very precious resource. So take a registered nurse, registered dietician, get advanced certification, become a CDCES, and now you have the appropriate credential working with an endocrinologist's supervision, you can now scale up endocrine services.
And so we've been studying this for years, but we've been doing it and studying it for years. There'll be some data published at some point early next year as part of a three year study that we participated in with the Jaeb Center for Health that demonstrates specifically this very thing. That if you can use your frontline triage, leverage your precious resource CDCES as your frontline triage, combine that with the oversight of an endocrinologist, and escalate to endocrinologist as appropriate, and do a excellent job of understanding when and where to do that, that's how you can achieve scale just specifically in that specialty.

Justin Steinman:
Got it. So it's almost like the old saying, helping people practice at the very top of their license, if you will.

Mark Clermont:
100%. 100%. And frankly I guess some people would say, is that hard to do? It is made easier to do today more than ever because of the access to data and because the technology can be driven in a way that can allow for near real time or at least expedient oversight, and have the right kind of feedback mechanism to course correct where you need to. And then personalize that at a patient level so that you can do this and do this successfully and produce the kind of outcomes that we're having.

Justin Steinman:
How much of what you're doing is really specialty care versus chronic care or chronic care management?

Mark Clermont:
I like the framework. I didn't come up with this framework. It's a loose visual for thinking of the core of medicine as kind of the sun, and having these outer rings that eventually are filled by, let's say, lifestyle and coaching and maybe even consumer level outer ring. So maybe it's like Saturn, I don't know. But if you think about most population, if you think of what a health plan does, historically, they would hire a digital health point player, let's say, to address diabetes, sticking to our knitting here, and they're kind of working in that outer ring. And it's important work. There's no doubt about it. It's effective work, it makes a difference for people.
But historically that's not connected into the core. And the only connective tissue historically would be the patient, him or herself. And patients aren't that good at being the connective tissue across a fragmented system. And so these single point players are really challenged with having longitudinal success, not just with patients but longitudinal success with their buying population, the population health teams. Because how can you demonstrate an ROI over a long period of time, or even in the immediate period of time, without having some connective tissue into the core of medicine?
So I think that's one of the unique things that Cecelia Health has realized over these past two years. As we set up and took this endocrine practice, nephrology practice, pulmonary practice into this virtual realm, licensed in all 50 states, but also ensured that we had the connective tissue with the lifestyle and the coaching, now you've got something that's much more powerful. And frankly, this is how patients like to work.
I'll add a third piece. There is another ring to this that is influenced by or operated by pharma. And oftentimes we talk about healthcare as being just sort of that intense vertical pillar of healthcare system funded by health plans and government, and it has all its own machinations, and et cetera. And we think of pharma as mainly clinical trials, research and development. Not really paying attention that there are some fantastic patient support programs that are funded by pharma with blockbuster drugs. And patients are in those programs getting better, receiving care that kind of falls in that lifestyle coaching realm, and having a lot of clinical success. I think what we would all say is clinical success. And we see that.
Actually, I talk about a tale of two patients. Both of whom, let's say, are discharged with congestive heart failure. One goes and has a tremendously positive experience with her primary care practitioner, and maybe even her cardiologist. Becomes adherent to therapy. Because of that, let's say 12 months later, fast forward, maintaining well and so never had to go back into ER, et cetera. And so there's a nice blue check mark next to this patient success story. And pop health teams are great, happy, everybody's high fiving each other.
Over here, you also have a patient, let's say she called into one of the blockbuster drug pharma programs that is a nurse-led program that pharma pays for. And that patient also becomes very educated on congestive heart failure, becomes adherent to therapy. And frankly, doesn't present back to ER, et cetera, is successfully living with that. So here she is in this context, there's no data over in an electronic medical record system. There's really limited claims information. And yet this patient got better and is successfully managing her congestive heart failure. That's a gap in this, I think, as we think about these outer rings and we work across this. And these are the things that we're exposed to with Cecelia Health. We happen to also support these patient support programs. So we have this unique purview into the core of medicine as well as outside. And this other tier, this other ring of pharma led patient support programs. Pretty interesting stuff.

Justin Steinman:
Yeah. I was taking some notes as you were talking, it feels to me like you're bringing together pharmacy or drug companies, coaching, clinicians, payers, nurses, all in kind of orbit around the patient as the sun, if you will. Let's just keep going solar system analogy here. But that's a lot of people you're trying to coordinate. Who's the quarterback? Let's just mix metaphors even more. Who's the quarterback here?

Mark Clermont:
Yes. Well, we could go into particle theory perhaps to try to bring it back to the solar system. So it is use case specific. So that use case one that I described, is the quarterback the primary care provider? Is the quarterback for this patient's improvement due to a cardiologist involvement? Is it the supporting personnel, the nurses who are doing the education and doing the check-in appointments? I'd say the quarterback of this, at the end of the day, everyone's going to put the blue check mark next to the primary care practitioner. And that's fine. So I guess let's call the PCP the quarterback in this case. But I would argue that it was actually the system that was the quarterback. And the patient herself in many ways had to be the thing that glued all that together. And that's not necessarily a positive statement by the way.

Justin Steinman:
Yeah. So before joining Definitive a couple years ago, I spent a little over four years working at Aetna. And as part of that, from an employer perspective, I was designing insurance plans for commercial employers. And we spent a lot of time looking at care management programs, and how to try to figure that out. And at Aetna, we came to the conclusion, they may have changed, I've been gone for 36 months or so, but still back then it was the patient should not be the quarterback. The patient doesn't know enough, the patient doesn't have an MD, they shouldn't be doing it. What was interesting about Aetna was that they wanted their care manager to be the quarterback. And the doctor had too much going on. The nurse is seeing too many different patients. Aetna would quarterback it.
Now what's interesting about this, and you know could say the skeptic in this would be, of course Aetna's happy to be the quarterback, right? Because they can control the costs and they can control the utilization of everything. And so I think this idea, and it's something that we've explored on a lot of different podcasts these days, or I guess over the past year, is with all these different people jumping into the healthcare ecosystem, it gets really confusing to coordinate all of that care. And I don't have an answer in how to do all that. Do you have anything thoughts on that one?

Mark Clermont:
Well, I'd say we're getting better every day. There are some really momentous and foundational elements that are shifting how care is delivered. So you could point to the Cures Act, for example, and specifically the trusted exchange framework. People may not necessarily know those acronyms, or even what the Cures Act means. But if you think about it as from a practitioner to a practitioner, if I have access to a patient's history, clinical history, easy access to it, and let's assume in the best case that it's patient driven, I'm much more informed about that patient's history. It's not just the five things that a patient felt like I needed to know on my patient intake. Now I can have some real data.
So all of a sudden, I might be able to be a little more situationally aware about this patient who's presenting to me today, a little more situationally aware about their clinical history, the reasons why they're here in front of me. And my belief is that makes you a much more informed clinician. It happens to also be a really improved patient experience as well. Because who likes being asked? I'm an old guy. Having 50 plus years of medical history, and I'm being asked a very simple question of tell me about your medical history. What am I going to say? I'm going to give maybe the highlights or the lowlights and that's it.

Justin Steinman:
I agree. I had to be honest, I remember, I'll date myself. I'm an old guy like you, 20 years ago I broke my leg. And I remember getting a CD of my X-ray images for me to take from the x-ray to the orthopedist looking at me. And I'm going, why am I ferrying my records around like this? I don't know how to interpret this. And the guy's like, "What resolution?" I don't know what resolution the x-ray was. What am I? I mean, it's kind crazy.

Mark Clermont:
Well, it sucks. Look, we've come a little ways. You talk about imaging. And yes, I remember carrying a DVD right from the Brattleboro Hospital up in Vermont after I had a cycling accident, broke a bunch of stuff, and got back to UMass Medical Center in Worcester. I handed them the CD so they could ingest those records. And I later asked for it back. "Can I have this back? It's my data. Those are my bones that you're seeing that are shattered pieces." And they lost it. This is many years ago. I hope they've improved their process.
And so we've come quite a ways. The really cool thing, that accident, that particular one, this happened in 2017, so it actually wasn't that long ago. Because of our data access, I did a patient poll for myself leveraging TEFCA, and I said, well, what clinical data's out there? Sure enough. And with a Fire API, in near realtime, I saw my clinical history, which included this particular accident. And I could see Brattleboro Hospital, I could see UMass Medical Center, and where I went to get surgically repaired. And it was fantastic.
As a patient experience, where was this all my life? Why has it taken 50 plus years to get here? And I wouldn't say that we're here yet. It's getting better every day. But when I talk about the foundation is shifting, this access to data, it's really unparalleled with anything we've seen before. Yes, it's been decades in the making. And that's a podcast in and of itself talking about the history of HIPAA to fast forward to the NHINs to HITECH Act, and meaningful use iterations one, two, and three, and eventually get to Cures Act and this TEFCA framework. And it's all exciting stuff. But knock on wood, I hope we don't do something to look at that as a Christmas tree piece of legislation, as Washington's prone to do, and start to hang off changes that end up complicating the very important intent of that data stream.

Justin Steinman:
So let's just stop for a minute and define for all of our listeners out there, what TEFCA is and the Cures and all that type of stuff. I expected you were going to go here, so I did a little research in advance. And so I went to the good old hhs.gov and got some information. So TEFCA, T-E-F-C-A, that stands for the Trusted Exchange Framework and Common Agreement. And that's part of the 21st Century Cures Act, which was actually passed in 2016. And the Cures Act called for a development of a trusted exchange framework and a common agreement, which is basically a non-binding but foundational principle for health information exchange. And the common agreement is a contract that advances those principles.
So basically, at the end of the day, take all that government gobbledygook out, it's exactly what you're saying, right? It's creating a framework to share information, trusted handshake, securely, confidentially, so people can share clinical information with their doctors in order to get better, more coordinated care. And so I guess I come back to you and say, how are you leveraging that at Cecelia Health today? How's that been instrumental in your business?

Mark Clermont:
And I will say a lot of people will still put this whole framework in the early innings stages.

Justin Steinman:
I'm one of those people.

Mark Clermont:
To use a Red Sox analogy. My beloved Red Sox.

Justin Steinman:
So that's a whole other podcast, one where I'll bring my box of tissues, my beloved Red Sox too. But we'll put that off to the side. I agree it is the early innings, but keep going.

Mark Clermont:
So a lot of us, a lot of the players, a lot of great companies are out there are moving the needle forward. And so whether that's companies like Particle Health, Zus Health, you see Pluto doing something interesting, and you could go through the roster of QHINs, et cetera. These players are all starting to get the plumbing right. And at the end of the day, it's one thing to get the plumbing right and to get that data, not only get the data flowing, but actually get the right amount of the right data flowing, under the right context with the right security protocols and the right permissions around it, consents, et cetera. All of those wrappers. So people are working on that stuff.
At the end of the day, what do I care about? I care about I need to be as efficient as possible with my patient and I want them to have the most elegant experience that they can possibly have. And what I don't want to see happen is a continuation of, I don't know if you yourself, Justin, use some of the newer primary care providers. I won't name names here, but I happen to use one that's well known. And my primary care experience is phenomenal. Phenomenal. Both in app, virtually, in person, it's fantastic. Omnipresent, everything. I can see my care plans, I can see my labs, et cetera.
When I got the referral to an orthopedic surgeon, I might as well have been sent into the dark ages. It was such a stark contrast. And this isn't years ago. This is just within the last six months. Such a stark contrast. There's no need for that. And so if we can leverage this framework, the data accessibility, as well as think of ourselves as in one of those, going back to one of the early phrases when we started talking here, virtual integrated specialty care, integrated with primary care. So now maybe my experience with my primary care application could have been much more seamless things. Rather than sending me into the dark ages, get my scheduling done, maybe have some bidirectionality with my care plan. So maybe my orthopedic care plan now becomes visible and exposed to my primary care practitioner. Maybe that notation gets back there, and I don't have to actually personally be the manual glue that ties those things together. And if TEFCA and leveraging the framework can help automate some of that stuff, that's a big win.
I will say this, the one thing that we're using it, our first use case for this, is no more complex than automate as much of patient intake as we can. So I gave the use case earlier, I sit down with you, you're my patient for the first time, and I start asking you to tell me the five things that are most relevant within your patient history. How about instead, you've already given me permission to draw those records in, and now I'm just having a validation exercise. A conversation that is, Justin, I happen to see back in 2010, you had this particular accident incident. Have you had anything since? How have you done? You're 12 years removed from that. Sometimes people start feeling particularly pains or aches or whatever. Much more expedient conversation, and frankly, it's so much more personalized. So that's our first use case.
And I could talk about the financial implications of that and the impacts of that. But at the end of the day, from a healthcare user experience, it's fantastic and a much more enjoyable, enriching, and by the way, that will also in our data shows this, we'll encourage you to come back and meet appropriately next time.

Justin Steinman:
Well, yeah, I mean obviously if you have a good experience, you're going to continue to come back. I often joke though, healthcare is the only place where if you have a bad user experience, you're also going back, right? Doctor leaves a scalpel in you after surgery, you're going back for more surgery to get that scalpel out.
So you asked them about my experience. So I go to the Mass Gen system here in Boston, and all of my providers are affiliated with that. And I use their patient navigator, and I have actually a really good experience. I can see all my records, I read all the after follow up visits. I play amateur doctor and second guess all the test results. But I often wonder what would happen if I went outside that network. I mean, I'm lucky, Mass Gen has a pretty big network, particularly in the greater Boston area. But if I had to go out that, I worry about that coordination of care. You mentioned something interesting, and I want to come back to it. We've alluded to just something we will both call the healthcare UX, the healthcare user experience. What's your assessment of healthcare user experience today?

Mark Clermont:
Well, I'll take the optimist view. It's remarkably better than it's ever been, but it still stinks.

Justin Steinman:
That's not very optimistic.

Mark Clermont:
Well look, compared to where it was even three or four years ago, it's light years ahead. And I use the example of my direct primary care provider as that example. It's a fantastic experience. I hope that Mass Gen and others sure are investing in similar technologies. Perhaps they're leveraging their own EMR provider-

Justin Steinman:
They are, I think.

Mark Clermont:
... to pull that off. Now whether they can pull that off with their own EMR provider is an interesting conversation that somebody in Wisconsin may get upset about. So we'll leave that one to the side. Reality is you can advance that ball much faster. I will say this, in your experience with Mass Gen, let's say you did have the skiing accident up in Vermont, or the cycling accident like I did, how do your records get there?

Justin Steinman:
Yeah, I don't know.

Mark Clermont:
Yeah. Well, I will tell you, if they plugged into the trusted exchange framework, they stand a chance of getting there. This used to be called the information blocking rules. This is what's so funny about it. Hey you, hospital A, you cannot prevent your data from going outside your moat. You have to. And here's this trusted highway to enable that to happen. And here's the format for that to happen. They call it the information blocking rules, but it's kind of a silly name. It's kind of backwards pointing, rather than saying, this is a trusted, safe way for you to exchange records. And by the way, you need to exchange records. You can't just hold them to yourself because you're only contributing to the fragmentation in the healthcare universe.

Justin Steinman:
But you know the reason they're doing that, right? Because they're worried about leakage. And yeah, I let Justin's information walk with Justin, Justin's going to leave my network and go to a competing healthcare network.

Mark Clermont:
Fine. I'll ante in with my experience with my direct primary care provider is so outstanding, I can't imagine wanting to go anywhere else. So how about we focus on the user experience, make that great so that you don't want to go somewhere else. So you eliminate leakage in the good old fashioned way of earning it.

Justin Steinman:
And now you're getting into consumerism in healthcare.

Mark Clermont:
Well, I mean I guess it's consumerism.

Justin Steinman:
It is.

Mark Clermont:
I mean the bar is so low. What's that thing when you go underneath the pole here and-

Justin Steinman:
The limbo?

Mark Clermont:
Yeah, the limbo. I mean, there's not a limbo artist in the universe that can get low enough to get under how low this healthcare user experience bar is right now. And as I said, I'm taking the optimist view, it is much better than it was.

Justin Steinman:
Yeah. So Mark, this has just been great. I think I could talk to you for hours here, but we're over 40 minutes, and I think we try to keep our podcast in that timeframe here. So I got one last big question for you before I go. We've talked a lot today about emerging care models, changing care models, where things are going. So let's step into my portable time machine here and fast forward to five years from now. How is patient care in the United States different than it is today?

Mark Clermont:
Well imagine, so you could just carry forward the use case of data availability. And let's assume that you as a patient also now have control over where your patient data goes. So how cool would it be and will it be, because the wheels are already set in motion from the regulatory standpoint, we just need to continue moving down this path unimpeded, let's continue to make this great regulation come to life. Just like if you use one of those aggregators for your financial world and TurboTax asks you permission to log in to download your W-2 from ADP, why can't I do the same thing? Have a patient directed mechanism for moving data from one place to another for useful purposes, for good purposes. If we just tackle that one thing and do that well, five years from now, how care is delivered is just manifestly more efficient and better.

Justin Steinman:
That's awesome. Mark, this is great. I really appreciate you coming to the show today. Thanks for your time.

Mark Clermont:
Yeah, thanks for having me, Justin.

Justin Steinman:
And for all our listeners out there, thank you for listening to Definitively Speaking, a Definitive Healthcare podcast. Please join me next time for a conversation with Kelly Starman, the chief marketing Officer at PartsSource. PartsSource is the world's leading healthcare services online marketplace and the largest provider of medical replacement parts. So as you might expect, Kelly has a great deal of insight into what's going on with the healthcare supply chain, and I'm very much looking forward to hearing her thoughts on what's working and what can be improved across this mission critical supply chain where people's lives can be significantly impacted by the availability or unavailability of medical supplies and equipment.
If you like what we've heard today, please remember to rate, review, and subscribe to the show on Apple Podcasts, Google Podcasts, Spotify, or wherever you get your podcasts. To learn more about how healthcare commercial intelligence can support your business, please follow us on Twitter at DefinitiveHC or visit us at definitivehc.com. Until next time, take care, please stay healthy. And remember when you see how low you can go, make sure you're doing it in a limbo, not in healthcare.