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Brands that can connect with their audiences more viscerally and more authentically will always be successful. With the Insights Out podcast, you will get access to deep and detailed conversations with the heads of leading organizations to understand how they are making their customer relationships work best and how we can all become more aligned to deliver strong value exchanges and better realize the benefits. I\u2019m your host, Dr. Natanya Wachtel. Welcome.<\/p>\n
Hi. Welcome to another episode of Insights Out, where we talk about all things insights in the healthcare space. Today, I have a very special guest, Dr. Brittany Busse, and she is the co-founder of ViTel Health and has a very amazing story that I\u2019d love her to share with us and tell us a little bit about what she\u2019s working on. And we\u2019re going to focus today on some of the things in the health coaching space and how it\u2019s having an impact on deeper scoring, among other things. So welcome, Brittany.<\/p>\n
Thanks, Natanya. It\u2019s really great to be here with you today.<\/p>\n
Can you give us a little bit of background on you and how you came to build this ViTel Health empire?<\/p>\n
I guess I would start out by saying that when I started my pathway towards becoming a doctor, I initially thought I was going to practice in psychiatry. So, I got into medical school and undergraduate degrees in both physiology and psychology, and I really wanted to focus on helping people with addictions, helping people with mental health disorders. And I saw myself functioning in a way more of a therapist, probably, or a guide to these individuals. And as I transitioned throughout my clinical years, my first practice was in psychiatry, and that\u2019s not how I saw it being practiced. I saw a lot of prescribing, a lot of throwing our hands up in the air, saying, we don\u2019t know what to do with these people, and we\u2019re just going to keep adjusting their medications and putting them on more and more things until we maybe exact some kind of a balance that allows them to function in the real world with a whole bunch of side effects. And I took one look at that, and I said, I cannot do that for the rest of my life.<\/p>\n
There is no way I can barely take Tylenol, even when I have a migraine. I don\u2019t like to touch medicine. I\u2019m not going to be able to have a fulfilling life if my entire life revolves around rather than creating relationships around writing prescriptions. So I turned away from psychiatry, and I realized that most of how medicine is practiced from an MD standpoint, or even potentially a DO standpoint, I don\u2019t know, I can\u2019t speak to that experience is around writing prescriptions for things and these quick-fix solutions that people just want to walk into the doctor. And by nature of the system that we\u2019re in, you only have 10 or 15 minutes, and the simplest outcome with the least friction is just to give them another prescription and say, I\u2019ll see you again in six months, 12 months, whatever the next appointment schedule is. And I would see that in practice after practice as a medical student. And I can\u2019t abide by this. So I practiced. I decided to go into surgery because I was like, okay, save the hernia, fix the hernia, move on.<\/p>\n
And I was going to say because the other thing is the whole we are just a bunch of body parts. So the prescriptions are treating maybe a symptom that\u2019s occurring somewhere on the body that\u2019s connected potentially to something else, but that\u2019s a different doctor.<\/p>\n
Exactly, exactly. So surgery is taken apart.<\/p>\n
Organ that you\u2019re.<\/p>\n
So, your organs have been taken apart and given to different specialties. And your primary care provider and your primary care physician has an overview of all of those things.<\/p>\n
Right.<\/p>\n
But maybe not the depth that they would require, because there\u2019s so much information and there\u2019s so many prescriptions, there\u2019s so many mechanisms of action that now we\u2019re relying on more and more specialists to have that knowledge base that is narrow but deep instead of wide. So the primary care physician ends up acting as a quarterback for healthcare, even the coach on the sidelines, managing all of the different positions and physicians that the patient is going to and trying to collate that information back to the patient in these 15-minute intervals that they get with them. So it\u2019s really difficult for physicians. It went through my training process. I had health issues of my own, prevented me from continuing in my surgical training, found myself practicing in an urgent care for a period of time again. Really, at that time, before telehealth was the epitome of retail medicine. I paid $50, where\u2019s my Z-pack? There was no relationship. There was a different physician every day on staff. I happened to work four out of seven days a week, so I had some relationship with more regular patients but not like a relationship in terms of providing primary care services. It was a revolving door.<\/p>\n
Yeah, I was going to say. And the support, like the whole network, was always ever-changing, right?<\/p>\n
It is.<\/p>\n
Like vibration of you have someone who you can triage with or work with that you.<\/p>\n
We had a binder full of local specialists, and we could call the specialist and see if they were accepting new patients, but the relationships weren\u2019t there, didn\u2019t have relationships with those people. And when patients had a new diagnosis, for instance, we had. A young man come in. All he wanted was a commercial driver\u2019s license so that he could be a truck driver and he could make money. And he could also get health insurance. When he gave his urine sample for his commercial driver\u2019s license, it was full of sugar. And we said we can\u2019t pass you because you have diabetes. And he, I don\u2019t know about that, but think maybe he did know about that, but there was nothing I could do. Like I wasn\u2019t a primary care doctor. I wasn\u2019t a diabetes educator. I couldn\u2019t put him on a prescription. All I could do was say, you need to get in with a primary care doctor, and here\u2019s the SAC County clinic, and hopefully they can help you, but until you get your diabetes under control, I can\u2019t provide you with the CDL license. And it was just like crushing for him because he needed health insurance in order to get care. And the only way he could see to get that health insurance was to get a better-paying job. And we just had no resources for people with these types of chronic conditions. Nor did I have the time to sit him down and find out what are his lifestyle factors. I was congratulated if I saw 100 patients in 12 hours like that\u2019s a lot. It\u2019s a lot of people in one day. And so I really just wanted to.<\/p>\n
Can\u2019t even imagine a cocktail party like that. So.<\/p>\n
I know it\u2019s like in and out all day out of the rooms. And I just needed something else for me, for my life. Like, I was so burned out, for lack of a better term, burning the candle on both ends. There\u2019s no satisfaction because there\u2019s no relationship. I never got to see outcomes because I usually never saw anyone again unless they happened to be like a worker\u2019s comp patient who was seeing me on a more regular basis.<\/p>\n
Yeah.<\/p>\n
And it was just a lot of me feeling ineffective in what I wanted to do for people and change their lives. At that point, I turned to telehealth, mainly because it was a nascent specialty where I thought I could make an impact and, in fact, was able to make an impact as a medical director working for a company that was trying to actually improve the workers\u2019 comp process, create relationships with patients, make it so that they could have the same physician every single time they needed an appointment, and really focus on continuity of care and better use of health resources. But again, that just didn\u2019t. It didn\u2019t sit well with me in the long run because the physicians themselves, I felt, were always being taken advantage of, and the physicians weren\u2019t happy.<\/p>\n
And when they\u2019re not happy, the patients aren\u2019t happy, and the whole system starts to fall apart.<\/p>\n
Yeah.<\/p>\n
We started. Yeah, we started ViTel Health. We came together with that idea of the mission of happy physicians, healthy patients, and that in order to create this, we needed to surround both the physicians and the patients with everything that they needed for this sort of thriving practice from a digital health standpoint, because we weren\u2019t doing anything as far as in-person clinics, although some of our physicians do own and operate in-person locations, but just surrounding people from that digital health standpoint with all the tools and resources that they need, not having a business background, most physicians are hesitant to go into practice. They want they need a lot of legal resources. They require malpractice insurance, they require finances, and they require patients to treat and also to pay their bills, and keep their doors open. And there\u2019s a lot of administrative work that comes with that. So we take.<\/p>\n
The whole industries, right? Medical billing. You can\u2019t open a back of a magazine without an advertisement for that.<\/p>\n
Yeah. So we wanted to put all of that in one place so that they could have a seamless experience from idea of having a clinic all the way through, opening the doors, and providing care to patients. We also found that physicians needed additional revenue streams and also additional ways to impact patients, which is where the remote patient monitoring chronic care management side of the business comes into things. So, where it is used traditionally, remote patient monitoring involves digital health equipment. So Bluetooth-connected devices that monitor patient\u2019s weight, blood pressure, pulse oximetry, glucose, so you can have connected glucometers. There are some doing respiratory so for like, peak flow or other kinds of spirometry measurements. So, all of these different measurements that you can be taking on your chronically ill patients. And again, it\u2019s looking at how do we surround the patients with this health experience. Because we know that health is a lived experience. It\u2019s not something that happens once a year in the doctor\u2019s office. Right? So I go to my doctor once a year, and then health ceases to exist until the next time I see my doctor, and they take my blood pressure again. Your blood pressure didn\u2019t cease to exist in that time period. It\u2019s happening continuously, and it\u2019s great if we can have a measurement of that blood pressure and what it looks like on a day-to-day basis, and how it\u2019s impacted by lifestyle factors like your diet, how much you exercise, how much stress you have in any given point in your life, your social network, your social connections, and all of those things are actually having a day to day impact on these numbers that you were only seeing once a day in the doctor\u2019s office.<\/p>\n
The air you breathe it\u2019s looking at a whole person in their whole life, which is the insights part of Insights Out here. Why I was so excited to talk to you about some of this is that you come from a unique perspective, shifting towards this complementary approach to wellness, right, that has the hard clinical parts that are needed, whether there\u2019s a surgical intervention that\u2019s needed or a pharmacological intervention that\u2019s needed, but not in lieu of or without considering potentially all these other layers that you spoke about. And so there seems to be a readiness in the marketplace. And I say marketplace meaning of providers and the funders of the infrastructure to shift towards this more collaborative approach to care, and not necessarily seven specialists, but collaborative across different kinds of disciplines in treating chronic disease. And I think that\u2019s an exciting thing we were talking about before. But why do you think this is gaining the traction that it is and where are some of the areas that you see the most impact that either surprised you or is just remarkable?<\/p>\n
I think the traction initially was coming from the fact that during COVID, there were a lot of new billing codes that came to be birthed around remote patient monitoring and chronic care management, and there were a bunch of people who stepped into that space, and said, this seems relatively straightforward. We just give the devices to the people, and we take their readings every day, and then we send that off to CMS, and they give us a check, and we get part of that check to ourselves and part of the check back to the doctor\u2019s offices. And everyone makes money,, and we\u2019re all happy. There was a lot of that happening, and a lot of that was not impactful. Right. It didn\u2019t provide any benefit to the patients. The patients weren\u2019t incentivized to use it on a regular basis, which they need to do. They need to use it at least 16 times a month in order for it to remain billable. And people aren\u2019t going to do something just because their doctor told them to do it. We know that and or benefit them.<\/p>\n
Pejorative. There\u2019s a lot of head in the sand, and it was during the pandemic as well.<\/p>\n
Yeah. So we realized that if we were going to offer this service that it needed an arm of impact, it needed the personalization, it needed that the touch part. Right. So we looked at it, and it can be high-tech and also high-touch. And the high-touch portion involved a team of healthcare coaches. What I love about healthcare coaches is there\u2019s several hundred thousand of them in the United States. In fact, I believe there\u2019s more healthcare coaches than primary care physicians currently who have certain certifications across the board. We can talk about different certifications, but they\u2019re there, and they\u2019re ready, willing, and able to be able to guide patients on making different choices when it comes to seeing the numbers that are reflected to them back, rather than the patients just taking the numbers for the sake of taking them. The healthcare coaches are able to guide them on making better choices for food making better lifestyle choices. And then also, from our perspective, it was really important that the healthcare coaches live in the same area as the patient, right? Because a healthcare coach in Ojai, California, telling someone in Detroit, Michigan, that they need to meditate more isn\u2019t going to really have the same impact on that person as somebody who has the same lived experience as them, who understands the community, the layout of the community, access issues as far as fresh produce and grocery stores access, as far as safety conditions for getting outdoors for exercising. All of those things sound really simple to those of us who have the privilege of walking outside safely. But that\u2019s not the case for a lot of individuals. And so we need somebody who understands the barriers to health before that person can give that the patient actionable insights on how to make their health better.<\/p>\n
So, having a representative set of different socioeconomic cultural backgrounds, ethnicities, proclivities and that so that people see themselves in the person that they\u2019re looking to have an instant connection about their most primal, awkward things, right? What areas where they\u2019re struggling. And you have to have a lot of trust there. And so that\u2019s another big area. That trust has been quite eroded with this lack of relationships. So I think that\u2019s really profound. And hopefully, more organizations take a page from your book in this way because these are small details, and they might not be in the business plan specifications, and they might not be in the deck, but they truly make a difference in the ability to connect and affect positive change in people\u2019s lives. And you guys have the receipts, for lack of a better way of saying it, to show that you are seeing changes in these early stages of these programs.<\/p>\n
Yeah. And there are receipts on both sides. Right? So people are getting better. They\u2019re feeling better. We have patients in their 70s and 80s telling us they feel better than they have in their 50s. But there\u2019s also the receipts on the financial side. So whether you\u2019re a physician trying to maintain a private practice with all of the overhead associated with that, worrying about being bought out by a large health system, or maybe thinking that might be a good idea right now because you\u2019re struggling, we can provide that financial cushion as well. Or if you\u2019re an insurance company looking at these types of solutions, the bottom line for that is that it saves money because you can actually reverse chronic disease. You can prevent people from getting worse. You can help them get better. The relationship that they have with their primary care doctor and with their healthcare coach keeps them out of the emergency department. There are lots of studies showing that people who have relationships with primary care doctors have better health. And they. Have lower utilization of these costly services, the procedural, the emergency, etcetera, that costs insurance companies and individuals money. So we can look at how much money this is saving overall. Yeah, on a business standpoint as well.<\/p>\n
Yeah. The pharmacoeconomic models that are emerging are some of the new things that, and it\u2019s almost embarrassing to say radical concept in the states that if you because there outcomes and then if you actually focus on wellness first and the patient motivation and the patient determination to take a role and be collaborative in that together that ultimately longitudinally it\u2019s huge cost savings from the test from the ER visits, as you said, from disease progression and other Co-morbids that often come with as the disease progresses happen, it\u2019s exponential savings as well as less of a burden on the whole system. And yet, this is not the gold standard right now. So, it\u2019s still incredible to me that you guys are part of the pioneer set. But I\u2019m really excited to help spread the word and have hopefully those folks listening and others that we engage with to understand that as a physician, you\u2019re not talking about Disintermediating the doctor, and I think that sometimes can be something that is there and or as an organization or health system might be like, we this is avoiding these other necessary pieces of care. And that\u2019s not at all what we\u2019re saying here. And that\u2019s an easy way to just push it to the side. But I think community as the foundation of health is something that you had said when we were talking earlier.<\/p>\n
We can\u2019t say that enough. And I think breaking it down into these parts, like you said, helps people understand the power of that statement and how everybody wins. Like you said, the receipts are on both sides. So it\u2019s even if you\u2019re, I hate to say this, not one of the people who is focused on the feelings side of how a patient feels and treatments, and you\u2019re focused on the cost per patient per year, you still win with this model. If you\u2019re focused on the relationship you have with a patient and how they feel about taking a leadership role in their own care, you get the receipts on that side. So it\u2019s a win. And the fact that the financial models aren\u2019t so difficult, I think there\u2019s a lot of other areas where we look in integrative, where it\u2019s difficult to get reimbursement because of what\u2019s going on there for either for testing or for treatments. That\u2019s a different road here because of our PMCM. The model is made here for everyone to win. So what I\u2019m hoping is that we inspire other groups, telehealth companies, health systems to think of this as an integrated rather than a bolt-on. And that\u2019s the other thing that I think is really great about the way you\u2019re looking at it isn\u2019t just, oh, and if we have this thing over here for coaching.<\/p>\n
Yeah. So, for us, it\u2019s really it has to be the whole solution. I think the digital health devices show people in real-time how their body is operating. So, I think it\u2019s both sides of the coin. Some people might say, oh, I only want the healthcare coaching, and I don\u2019t want to monitor the devices. Okay. You\u2019re not going to get more fit or lose weight if you\u2019re not keeping track of your weight. It\u2019s just that\u2019s just the nature of it. Like you could, you have to keep track of something, whether you\u2019re keeping track of calories or you\u2019re keeping track of the weight. Like you have to see that reflected. That\u2019s just the way our brains work as humans. We need biofeedback, and we need to see the results of the efforts that we\u2019re making on behalf of our own selves, on behalf of our bodies. Right. So, as a mind-body integration, like you have to see those results in real-time. So if you are taking your blood pressure regularly or your blood sugar regularly, and you\u2019re seeing the results in real-time of, oh, when I ate this food, this happened. And then when I ate this on this day, along with exercising, then this happened.<\/p>\n
And then, over time, we can track those trends. So it\u2019s really important to note that we need to have that feedback. And then the coaches can actually interpret that feedback for you and then help you make more impactful decisions. Right. So we talk a lot about these changes. And people think, oh, I\u2019m going to have to make some kind of huge change in order to get healthier. And overcoming the barrier to health looks insurmountable for most people. And I think we get this idea because if you look at like social media, Instagram, or whatever, and I\u2019m going to go follow a health influencer or a wellness influencer, and now they\u2019re telling me that I need five hours in the morning to go for a run and to meditate and to journal, and then I\u2019m going to make my juice from scratch with all organic produce and then got to clean the juicer. They don\u2019t want mentions of that part that takes forever. And then you have to wait a few hours. Oh, I forgot, I needed my lemon water before my juice, and then I needed my juice. And then. And by the time you\u2019ve done all of these things like you\u2019re three hours late for work.<\/p>\n
Yeah, yeah.<\/p>\n
Then you work for two hours. Maybe because you got to get home and you got to start doing your evening ritual so that you can be ready to go to bed by the time the sun goes down.<\/p>\n
And also, it\u2019s very much focused on what you can\u2019t do, what you can\u2019t do. And one of the things that\u2019s really great about a lot of the behavioral side of the coaching is all about finding those micro changes that motivate you to celebrate wins, and it\u2019s basic, but it\u2019s so it\u2019s the different flip of the switch. And so with that, you\u2019ve been able to see people reduce their medications because of these small changes that they\u2019ve made over time. In a few months, you\u2019ve said, right. So, can you talk a little bit about some of the changes in terms of like how their chronic condition is changing? And obviously, you mentioned, which is great. They\u2019re feeling better is number one.<\/p>\n
What we know about medications is that all the medications you have side effects; for instance, if you\u2019re taking metoprolol or another beta blocker usually ends in L for your blood pressure. The side effect of that is that your heart can\u2019t beat as fast. And so if you take it, a lot of people complain of fatigue when they take blood pressure medications. So, by lowering the blood pressure, we block the heart from beating faster when you try to exercise. And that, in turn, makes you tire out more quickly or feel like you\u2019re in unable to exercise. So by helping people reduce their blood pressure using a nutraceutical or a food component food as medicine, we could actually reduce the medications and get rid of the medication side effects. So now, like you said, it\u2019s a stepwise progression. Now exercise becomes more, oh, I have more energy suddenly because I either reduce the amount of beta blocker that I was taking or I\u2019m not taking it at all. So now I have more energy. Okay, what could I do with that energy?<\/p>\n
A positive reinforcement loop builds.<\/p>\n
And even something as simple as drinking more water will make.<\/p>\n
Yeah, I was going to say.<\/p>\n
And have more energy these little things. I heard another researcher talking about food swaps, and that\u2019s something we use a lot in health coaching. It\u2019s not about restricting what you eat; it\u2019s about swapping the things out on your plate. Right. So, I\u2019d say a normal US plate. You have a big 16-ounce steak and a little vegetable, and a giant baked potato, right? So you go to the restaurant, and that\u2019s what they give you. And in the case of wanting to live healthier, you don\u2019t have to completely change your plate and say, okay, now I have to take off the steak. There\u2019s no steak, and there\u2019s no baked potato. Like, I have to take those away and just fill my plate up with vegetables. Okay, ideally, like maybe we could move towards that, but what if we just reduced it to a six-ounce portion of meat, half of a baked potato. You can still have your potato if you want. And we just filled up the rest of the plate with a variety of different vegetables that are seasoned well and taste amazing. You\u2019re still getting the things you want. You\u2019re not depriving yourself, but you\u2019ve added in more vegetables, more things that taste amazing, more things that you haven\u2019t tried before. And by virtue of adding in rather than taking away, you\u2019re going to get healthier.<\/p>\n
Yeah, I did that myself and I. My only regret is that I didn\u2019t have my pinnacle shift sooner because I also struggled with the idea that you can\u2019t have this, and you can\u2019t have that, and that\u2019s bad for you. That was ingrained, right? And then you rail against it every once in a while, whether you\u2019re whatever your triggers are, if that\u2019s a thing, I think this approach is something that everyone can get on board with. They\u2019re not necessarily, like you said, restrictive, that you need a juicer and all organic foods all the time. It\u2019s really just about that intersection of the human connection. And it\u2019s almost like a medical sage guide, right? Like someone that\u2019s on that journey with you who has clinical knowledge and psychological support and psychosocial support and validation, and then layering in all the other measures that you need to make sure things are going well, like you said, through the Spirometer or the blood pressure medication cuff, or checking the vitals, if you will, along the way. So it\u2019s not just subjective, but like you said, by recording it, I remember working in some pharmaceutical CNS products where people really forget, like a week ago, how they felt, or a few days. Once you have your new normal, it\u2019s your new set point. And so there\u2019s another beautiful thing I think here is that you can see longitudinally the change. And that in and of itself is motivating to keep going and keep trying. And I just think it\u2019s incredible. And I\u2019m so glad that you were able to share some of this with us today. We\u2019re coming to the end of time, unfortunately. So, I was wondering if there\u2019s anything you\u2019d love to end with in terms of either your hope for the vertical if you will, and or within ViTel Health.<\/p>\n
I\u2019d say that our goal right now is really just to help empower as many patients as physicians as possible. So we can do that either by going directly to where the patients are and then trying to reach their physicians or by having the physicians come to us. And as you mentioned earlier, this isn\u2019t about disenfranchising physicians or dislocating them from their position with patients like the physicians that we work with. Some of them were initially afraid of that. They were like, but if they see the healthcare coach as helping them with their stuff, what they\u2019re going to be like, what do I need you for? And now he\u2019s come to realize that the healthcare coach feels like his right-hand person. He can tell a patient all day in the 15 or 20 minutes that he spends with them. Here\u2019s what you need to do to help your diabetes, or here\u2019s what you do to help your blood pressure. And then they go home, and they forget, or life gets in the way, or whatever happens. And then the healthcare coach can say, remember what your doctor told you. This doctor and myself, we both care about you and your health. And that\u2019s why we told you those things. Not because we just want to take away your fried chicken or your delicious food that you were eating. We actually want you to live healthier, longer. We want you to have more health span and not just more lifespan. And by caring about the patient, by showing them that people care about them, that helps them care about themselves as well and not really helps take those first steps. Right? I think what you talked about before and the culture that we\u2019re used to around health, diet, exercise, whatever it is, it\u2019s shame-based, and shame doesn\u2019t motivate anyone.<\/p>\n
No, and it\u2019s not sustainable. So the fear of shame when you have maybe a health event like a cardiac event, sometimes people adopt a new radical diet because they basically thought they were going to die. And then, like I didn\u2019t. So let\u2019s do that. And that\u2019s took me a couple of times to get to that line as well. I\u2019m not proud of that. But rather than wait, I don\u2019t have to literally wait till something\u2019s falling off to maybe effect positive change and go towards it. And I think that\u2019s an incredible message, and I thank you for bringing together all of these worlds and help make it accessible for more people, all kinds of people. And just thank you for what you\u2019re doing. And full disclosure, I\u2019m spending some time with Brittany and ViTel Health, and I\u2019m really excited about the future here. And I hope to see more conversations and more interdisciplinary approaches to whole-person health. So, thank you so much for coming today and speaking with me.<\/p>\n
My pleasure, Natanya, and hopefully, we can have more conversations in the future as it grows.<\/p>\n
Absolutely.<\/p>\n
Thank you for listening to Insights Out. We hope you enjoyed today\u2019s episode. If you have a specific topic in mind and you want us to discuss, please reach out to us by visiting NewSolutionsNetwork.com. See you next time!<\/p>\nSonix <\/a>is the world\u2019s most advanced automated transcription, <\/a>translation, and <\/a>subtitling platform. <\/a>Fast, <\/a>accurate, <\/a>and affordable. <\/a><\/h3>\n
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