S3E3 – Transforming Virtual Care & the Path Ahead with Chris Bevolo

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Jenn Dellwo: Welcome back for another episode of RadioRev. I’m Jenn Dellwo: Thank you for joining us for season three. This series of episodes focuses on silver linings and new innovations in healthcare. We have experienced a lot of uncertainty and change over the last 15 months, catapulting the industry into a reality where creativity and bright spots have unexpectedly emerged as a result of the pandemic. So, this season really is about focusing on the bright spots—the innovations and the positive outcomes—highlighting the member stories that don’t often get heard. Today, we’re joined by Chris Bevolo:, Chief Brand Officer at ReviveHealth and host of “The No Normal Show” podcast. Welcome to the show. Thanks so much for being here. 

Chris Bevolo: Great to be here. Thank you for having me. 

Jenn Dellwo: Why don’t we jump right in. Tell us a little bit about yourself and what inspired you to start “The No Normal Show?” 

Chris Bevolo: I have been in healthcare marketing for a long time, I guess over 20 years now. Most of that time has been spent working with hospitals and health systems in terms of branding, marketing, digital, you name it, all of it. I had my own agency for about 20 years up until 2014 here in Minneapolis where I’m based. And then we were acquired by ReviveHealth, which is where I’m at now. At Revive, I do all kinds of things. I work with our clients providing strategic counsel. I help lead the growth of the agency, and now will be helping build a new brand that we’re going to be launching pretty soon. “The No Normal Show” actually started in March of 2020. It started a week after the NBA shut down, where as you know, the world was in chaos. Our clientele, our biggest set of clients, which are hospitals and health systems, were obviously scrambling to figure out what the heck they needed to do. Our audience, our marketers and communicators, those types of leaders…and so we started a podcast called “The Daily Report.” It was a daily because at that point we needed daily updates. We started every show by reading the Johns Hopkins case count to death count. And we did that for about three months until summer, until June. And in June, things were supposed to kind of quiet down, and we weren’t sure what was coming in the fall. We knew it could be bad. We just didn’t know how bad. But, it had stopped being a crisis at a level where our audience needed updates on a daily basis. So, we pivoted, and we decided we were going to do something a little more in-depth than just reporting the daily updates—what was going on and some advice that we were giving. And at the time, there was a lot of talk about the ‘new normal.’ What’s the new normal going to be like? Our perspective was to forget about the new normal. There’s not going to be a new normal. Or if there is, it’s going to be a long time from now because we have to get through COVID. And even once we get through COVID, it’s going to take a long time for the dust to settle in terms of us understanding the actual impact of this once-in-a-century event on our society. So, we called it—it’s not the ‘new normal,’ it’s the ‘no normal.’ Never going to be normal again. And so that was the name of the show and also the focus of the show, which is really a weekly podcast that looks at how hospitals and health systems need to change in all types of ways moving forward, coming out of COVID and also, down the road a few years, because it’s a completely different world now, both in our industry and in society. So, that’s me, and that’s the show. 

Jenn Dellwo: I love the concept of the show. And you certainly have no shortage of topics that you’ll be able to cover on a weekly basis. Transitioning to today’s topic, which is virtual health, last week on our show, we talked about the overnight transformation of telehealth and some of the bright spots and challenges from the payer perspective. Could you talk a little bit more about the provider perspective and how things have shifted? 

Chris Bevolo: So, virtual health. Let’s stick with that. Telehealth been around for a long, long time. But really what exploded is what we would call ‘virtual health,’ and that is the ability for patients to interact with their caregivers directly via video or otherwise. But obviously, everybody’s focused on video. We all know what caused it, right? I mean, everybody had to shut down. From a healthcare provider perspective, the only way other than emergent situations that you could actually deliver care in the spring of 2020 was virtually. And the transformation was astounding from a provider standpoint. There are all kinds of examples of this. I’m sure you’ve heard of many, but the ones we like to cite are one system went from having zero virtual visits ever to having 75,000 in April of 2020. So, in one month it went from zero to 75,000. Another huge, prestigious academic medical center that I will not name went from an average of 25 virtual visits a week to 25,000 a week in April of last year. And I don’t know what’s more astounding, to be honest, that it was 25,000 or that it was 25 before COVID. And that kind of shows you where this was. Even though there’s obvious benefit to it, there are all kinds of reasons why this had not taken off, not the least of which were regulatory reimbursement hurdles, many of which were just completely and utterly removed, which was just a godsend. Folks, just from a CMS perspective, from a state regulatory perspective, from an insurer perspective, they just took away all the obstacles to allow this to happen. And so that opened the door. And then we’ll talk a little bit more about how health systems stepped into that opportunity and really built the capability to deliver all of that. It was a huge deal. And I think what’s more interesting, we’ll talk about this in a little bit, too, I know, is where it goes from here. But it was vital. Essential. Most health systems had a huge financial hit from shutting down. And I think the AHA said, collectively, health systems and hospitals in 2020 were set to lose like $3 billion from shutting down their services. And so the virtual visits obviously were essential to the providers, but also to the patients who were able to, in many cases, get the care they needed virtually. 

Jenn Dellwo: Right. And do you have any insight into how some of these legacy health systems were able to handle the overnight need? How they were able to innovate to keep up with the demand? Those are some big numbers. 

Chris Bevolo: Yeah, they are. And this is not an industry known for fast-paced innovation. It’s just not. And that’s not necessarily a slight. We’re talking about a world in which people live and die based on the care that’s delivered. So, obviously very risk averse, very conservative, always looking at best practices. It can take years for clinical advancements to really take hold in the industry. As an example, it took years and years and years for hospitals and health systems to open mini clinics. As another example, just the kiosk in the mall. It just takes them a long time. So, in this case, again, it’s kind of…necessity is the mother of invention. When the only way you can deal with your patients is virtually, you’re going to move heaven and earth to make that happen. I think an example of how they did this was—typically you’re going to see any kind of technological change or advancement in a hospital or health system—or any organization—can be driven centrally, can be driven by IT. It’s going to go through all kinds of long testing, implementation, and then a command-and-control rollout throughout the organization. There’s just no time for that. So, most hospitals and health systems just sent out a message to their providers at a clinic level, at a department level, at a doctor level, and said do whatever you need to. Regulations were lifted in terms of HIPAA requirements. So, you didn’t have to worry about whatever means you were using. People used Zoom, they used Microsoft Teams, they used Duo, they used whatever the heck they were comfortable using. And it was not consistent across the systems. Again, there was no time to really think that way. It was just, “Hey, Dr. So-and-so, whatever you need to talk to your patients and you’re comfortable using, you use it. And we’ll help you as best we can.” And that’s not something you would typically ever see in these kinds of organizations. But it’s what allowed them to move from zero to exponential growth in a month. 

Jenn Dellwo: And you mentioned the HIPAA regulations, but we also saw some loosening of CMS regulations. Can you speak to that a little bit more and how things are likely to proceed as we come out of the pandemic? 

Chris Bevolo: I’m not an expert in this, but we’ve helped a lot of our hospitals and health systems with this. And if you’ve never tried to dig into this, the regulations and some of the reimbursement restrictions, in retrospect, sound almost unbelievable. So, the best example is CMS had a rule up until COVID that you could not deliver virtual visit services to people in their homes. It was basically you have to deliver care where you deliver care. And so anything that’s outside of that is off limits, which in retrospect, sounds insane. That was not even two years ago that was the rule. And so they waived all of that stuff, which normally—it was all under review. A lot of the telehealth regulations had been under review, but it can take two to three years for that review to officially go through and for changes to take hold at a regulatory level. And they just, by emergency decree, wiped them all out. Another example of this is telehealth parity, which basically means providers get paid/reimbursed at the same level for a virtual visit as they would for an in-person visit. And a lot of that is state-by-state regulation. It’s by insurance contract. Some states, like Minnesota, mandate telehealth parity. Basically they require insurers to reimburse providers at the same level. But again, that’s not true in every state. But those kinds of things were also just taken off the books. So, all of that was cleared out of the way, which was necessary. And now basically where we’re at is, it’s still under review. There’s still a lot of discussion at the federal and state legislative levels about all these regulations about health parity. CMS is also reviewing it. The Trump Administration wanted to make those changes permanent. They announced that in December, but that didn’t take hold. So, now it’s just a question of can federal and state legislators really bake these changes in, in an expedient manner, or is this going to have to go through the traditional channels of regulatory review, which means it could take a long time. They could continue to issue emergency decrees, but those will be harder to do as COVID starts to wane. So, the hope is this can all be permanently changed this year, but that remains to be seen. 

Jenn Dellwo: At this point, only time will tell. So, the pandemic obviously taught us a lot of things. But one big thing that I can think of is we found out that virtual health is useful. It’s been 15 months since the start of all of this. What’s happening now? How do we move forward? 

Chris Bevolo: That’s the biggest challenge from a provider perspective, because all of this was forced upon them. One of the biggest obstacles wasn’t just regulatory or reimbursement issues. It was their own physicians and providers who resisted this. And so they, of course, were forced to change because that was the only way they were going to get paid and the only way that they could see their patients and deliver the care. But there’s a real fear that now that we’ve opened back up, that COVID is hopefully starting to wane—though, of course, with the Delta Variant, that’s a really qualified statement—that they’re going to start slipping back, that there’s going to be an assumption that, hey, as we get back to whatever normal is that people are going to want to go back to the way it was. And that’s just a fundamental misjudgment. I use myself as an example. I had never used virtual care before—maybe once with Teladoc—but not with my normal doctors. I was forced to do it. I will never go back. In fact, I push my providers constantly when they say, “OK, well, we’ll have you come into this office.” And I say, “Why? Why do I need to come in? Can I do this virtually? You don’t need to take my pulse even. This is just a checkup.” I have type 2 diabetes. He can see the lab test. There’s nothing I’m doing there for which I need to be in person. And so in some cases, I’ve pushed them, and they say, “Oh, yeah, OK. We can do it that way.” So, it’s the fear that folks will relax, they’ll revert, and they will not read the tea leaves of how consumers have changed. 

Jenn Dellwo: Right. And if you as the consumer are the one who is pushing the provider to make the virtual care visit happen…I can’t see a lot of individual people doing that. 

Chris Bevolo: Well, I don’t know, you’d be surprised. I think it’s always a dangerous thing to talk in terms of broad, sweeping generations. But, millennials, and certainly Gen Z, were already pushing in this direction. I remember an article that we would share with our clients a couple of years ago, and it talked about older Gen Z/younger millennials saying, “I don’t even understand why I need to go into the doctor. Why do I need to go wait somewhere?” Because it’s so foreign to the rest of their experience in life. And that was before COVID. So, while consumers may not do what I did and push back, I think a lot will. What they may do, though, is say, “Well, jeez, this sucks. Now I’ve got to drive again. It takes me 20 minutes. I’m going to have to find parking, maybe pay for parking, wait in a doctor’s office, read “Golf Digest” from 2015. I don’t want to ever do that again. If you’re going to force me to do that, maybe I’ll find somebody else.” And so even if they’re not hearing that feedback directly, they should be worried about that kind of response. 

Jenn Dellwo: That’s definitely a good point. So, thinking about the last 15 months, with virtual care as an overarching theme, what do you see as the biggest silver lining? 

Chris Bevolo: Well, I think that the way health systems had to innovate probably is not the right way to innovate. It’s not just turning all of your employees loose to do whatever they want to do. That’s one end of the spectrum. But they were on the other end of the spectrum, right? They were on the super slow, we’ll do it when we can, we’re going to take our time, we have 25 virtual visits a week, and that’s OK kind of thing. This forced hospitals and health systems to really think about innovating at a much faster pace. And there were a lot of stories in the trade publications about the adoption of digital technologies beyond just virtual care, where IT folks, CIOs would say, “Normally this would have taken us two years, and we got this done in six weeks.” Because they had to. And in most other industries that speed of innovation is required to survive. But these are big, slow organizations that have never really been forced to act that way. So, I hope the biggest silver lining is an acceleration of how these organizations move, how they innovate. We see it at the marketing department level. We see it at the planning level. Annual plans in 2020 were just a joke. What’s the point of an annual plan? Organizations would go through planning on a monthly basis. And that’s the kind of thing you need to adopt long-term if you want to innovate and thrive and really move forward in a successful way. I think that’s the biggest silver lining for these organizations. 

Jenn Dellwo: What do you think the biggest hurdle is still and is there anyone that you’re seeing emerging as a leader that seems willing to tackle those barriers head-on and come out as the leader and saying, “This is the way it should go moving forward?” 

Chris Bevolo: Some of the barriers are outside the realm of control of hospitals and health systems. We talked earlier about the regulations. If those were to slip back—if in some ridiculous world the CMS goes back to ‘you can’t deliver virtual visits to people who are in their homes.’ I’d like to think there’d be a riot if that happened. But that, along with reimbursement, will be a big challenge from their own perspective, though, again, it’s not being complacent, not relaxing, not thinking, “OK, we’re through the crisis so we can relax on adopting and advancing virtual care.” What we tell our clients is, “If you’re building a health system today from scratch, virtual care would be the default everywhere. In-person care would be an option.” And obviously, you’re going to always deliver in-person care. You guys do surgery and all of that. But wherever you could do virtual care, you would do virtual care. And that should be kind of the vision moving forward, which is a huge shift mentally for them. And they have to see the need for that. So, that’s the biggest hurdle. You asked about who’s doing this well. There are a couple of organizations that come to mind. Cleveland Clinic, which’s often out in front of these kinds of things, in 2019 actually launched what they call The Clinic, which is an online virtual care environment that was through their partnership with Amwell, which is a large telehealth provider. And then recently they, as part of that, created this sweeping second opinion offering through that venue. So, they’re really trying to leverage virtual care in new and bolder ways to go beyond even the realm of their geographic footprint, as they always have, and reach out across the country or the world to deliver value virtually. Another one is Intermountain Healthcare out of Utah. They were the first, I think, two or three years ago, to launch what they called a ‘virtual hospital.’ Others have followed in their footsteps. And so while that goes a little beyond just virtual visits—that includes telehealth and all kinds of other things—just the idea of a virtual hospital is where this whole industry needs to go. Those are two examples of organizations that really are out there. And there are others, too. But those are the best two I can think of. 

Jenn Dellwo: After all the change and uncertainty of the last year, what’s something that makes you feel optimistic about the future? 

Chris Bevolo: That’s a tough question. We got through it. Well, I hate to say we got through it because I don’t want those words to come back and bite me with Delta hanging around out there. But we’re getting through it. We got through it and not in the best way. Let’s be honest. We could have done far better as a country in moving through COVID. But I think we’ve learned a lot of lessons. And I think some of the changes that were forced upon us during COVID that will likely have a longer-term holding are really great changes. One of the best examples is work from home. And it makes me feel optimistic that organizations, most of them, not all of them, but most of them are recognizing, hey, the 9 to 5 butt-in-the-seat model, which really is just a vestige of the industrial age from a hundred years ago, is not required for us to be successful. And we saw that in the pandemic as workers of all stripes, of all organizations, all industries kept their organizations alive, most of them in working from home. And so the relaxation of the need to have people commute, which is such a colossal waste of time and energy and resources—it doesn’t mean we shouldn’t be in person. It doesn’t mean there isn’t value to being in person. I don’t mean it that way, but just having flexibility. I’m really optimistic about those kinds of changes in society. 

Jenn Dellwo: I definitely agree with you. So, my final question: What’s something positive that’s come out of COVID-19 for you personally or for the healthcare industry that never should go back to the way that it was before? 

Chris Bevolo: I would say virtual visits, for one. We talked about that. I never want to do a six-month checkup for my diabetes in person again, ever. There’s no reason for it. I never want to do a consult with the surgeon in person if it’s not required. Even some things like now when I have an appointment for a doctor, I can check in online ahead of time. Super convenient, right? Instead of having to do all that right there in the office, no more clipboards, no more repeating all the things. They know all of that. That kind of stuff should just never go back. And there’s so much more opportunity to move it forward. That to me is—it’s the topic of this podcast—but it’s the most obvious thing to me. It just should never go back to where it was. 

Jenn Dellwo: Absolutely. Well, Chris, thank you so much. If people would like to connect with you, what’s the best way for them to get in touch? 

Chris Bevolo: The best way is probably via email: CAB@thinkrevivehealth.com. I’m on Twitter, but I haven’t been on Twitter in like three years. I’m one of those anti-social media people. I dropped off Facebook three years ago because I don’t want my data abused, and I dropped out of Twitter because I thought, “Why am I volunteering myself for all this vitriol? I think I’m not going to do that anymore.” So, if you find me on Twitter, you’re not going to see me active there. The best way is probably email. 

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