EP320: Is Telehealth vs In-Person Care Like Some Kind of Winner-Takes-All Cage Fight? With Christian Milaster From Ingenium

If you want to hear what my mom and dad, both Medicare Advantage patients in their late 70s, have to say about telehealth (or teleconferencing, as my dad puts it), you’ll have to listen to the episode. They are not and have never been health care professionals, but they fully get that the question “What’s better—telehealth or in-person care?” asked like it’s some kind of winner-takes-all cage fight doesn’t serve anybody’s needs. And by anybody, I mean clinicians or the patient. And by patient, I mean even Medicare Advantage patients in their late 70s.

In this health care podcast, I’m speaking with Christian Milaster from Ingenium. Christian worked at Mayo for 12 years before starting his consulting firm specializing in many aspects of telehealth. He has a great newsletter, by the way. I’ve appreciated subscribing to it. It’s called Telehealth Tuesday. I would recommend it.  

Christian says telehealth is a clinical tool. That’s why there’s no answer to the question of whether in-person is better than virtual. It’s like asking, “What’s better—an x-ray, a CT scan, or an MRI?” Or like, “What’s better—a daily blood pressure test at home or one super fancy EKG a year?” I guess telehealth could also be considered maybe a setting of care. Christian probably wouldn’t agree with me. Either way, few people sit around pitting Exam Room 6 against the one on the fourth floor with the extra-wide doorway. So, let’s not even talk about this. We’re over it.

The relevant question to be asking about telehealth would be “What’s the best clinical workflow, patient journey, clinical pathway for X kind of patient or for this patient?” The tools that we choose to use or the care setting we choose should be a function of the best care plan for the patient. You figure out the care plan first. It’s just like you figure out what surgery someone needs, and then you stock the OR. It would be super weird to do it the other way around. You know, neurosurgeon walks into OR. “Hey, what’s this knee replacement doing here?” You get my drift.

What’s the why, you might be asking, if I’m a provider and I’m kinda like the urologist that my father fired the other day? And I’m thinking I’m just going to require all of my patients to come into my office all the time because that’s the way I’ve always done it and I kinda like it.

Well, let me refer you to the article written by Jane Sarasohn-Kahn the other day entitled “Virtual Health Tech Enables the Continuum of Health From Hospital to Home.” This article is great and talks about a bunch of things, but here’s a quote I particularly liked: “[The demand for telehealth] will impact every segment of care delivery and sponsor, including small to mid-sized physician practices, employers, behavioral/mental health, public/government-sponsored health [plans], and the pharma and life science industry.” She is talking about demand post-pandemic, by the way.  

Let me put a finer point on this. You know who is most likely, besides my father, to fire a doctor who doesn’t know how to incorporate telehealth into his or her treatment pathway? Yes, exactly—educated working-aged people. People with commercial insurance. The people that health systems and doctors are always trying to attract because … favorable payer mix. So, there’s that.

One more thing before I turn the floor over to the interview with Christian Milaster: I just wanted to call out something that matters, especially right now. I recently saw a post by Joe Kvedar on LinkedIn about how digital inclusion is actually a social determinant of health. The post referenced an .css-j9qmi7{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:row;-ms-flex-direction:row;flex-direction:row;font-weight:700;margin-bottom:1rem;margin-top:2.8rem;width:100%;-webkit-box-pack:start;-ms-flex-pack:start;-webkit-justify-content:start;justify-content:start;padding-left:5rem;}@media only screen and (max-width: 599px){.css-j9qmi7{padding-left:0;-webkit-box-pack:center;-ms-flex-pack:center;-webkit-justify-content:center;justify-content:center;}}.css-j9qmi7 svg{fill:#27292D;}.css-j9qmi7 .eagfbvw0{-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;color:#27292D;}