How Government Can Promote Health Technology Infrastructure

Dr. David Shulkin: Government's role in health technology and infrastructure

Government’s role in health technology and infrastructure with Dr. David Shulkin

In a new episode of Cadence Conversations, Founder and CEO of Cadence Chris Altchek sat down with Dr. David Shulkin, 9th Secretary, U.S. Department of Veteran Affairs to discuss the future of remote patient monitoring (RPM) and what it will take for new technologies like RPM to take hold and get adopted across the U.S. healthcare system.

The wide-ranging conversation centered around the opportunities and challenges in reforming health systems, as well as the role that technology can play in addressing rural health disparities. It was recorded as a part of Cadence's new podcast Cadence Conversations, featuring healthcare and technology leaders discussing how new technology is transforming healthcare.

Shulkin, who has served in both the private sector as well as in government over the course of his career, began by sharing some of his many lessons learned from public service. Having previously held leadership roles at the Department of Veterans Affairs during the Obama and Trump administrations, Shulkin discussed how and when change actually happens in the U.S. healthcare system.

"When things happen in healthcare, it's because of the fact that it's both clinically the right thing to do, but also financially the right thing to do, for either a payer or for a provider, or for the patient themselves, for a company that's providing the payment services. That's when you really see the changes happen in healthcare, when that alignment works the best."

COVID-19 has ushered in a rise in new technologies in healthcare, including the transition of care from traditional hospital settings in the home using technologies like RPM. Shulkin shared some of his lessons learned from the COVID-19 pandemic, and what types of innovations we are likely to see in the future.

"We've learned there are better ways now of delivering, or at least alternative ways that are successful, in delivering care, whether it's virtual care, whether it's the use of data collection out in the field, delivering more care where people reside, either at work or at home."

For new technologies to take hold in the healthcare system, according to Shulkin, they cannot just be a new gadget or new workflow. Instead, he believes that companies must demonstrate real value for patients and ultimately enable better, more immediate, and more timely access to care.

"I do think that we're going to see technology that allows improved access, improved information sharing among the various stakeholders in the healthcare system, and improved data flow. These are the things that I think are most likely to make the difference, and not all technology's going to achieve those objectives," Shulkin said.

Shulkin concluded by sharing his views on the future of remote patient monitoring and why he is bullish that companies like Cadence can help play a role in reducing rural health disparities across the country.

"We still have a system that every year is more expensive, we still have a system where there are huge disparities in care. The biggest predictor of outcome turns out to be the zip code that you live in," said Shulkin. "And so we do need to be thinking about new ways of adopting changes in our practice, and technology needs to play an important part of that."

Table of Contents:

A Career in Management of Healthcare

Chris Altchek (CA): We're excited to speak with you today, Dr. Shulkin, and welcome to the podcast. Take us back. Can you give our listeners brief background on your work as a physician, and how that led to your serving in senior positions in government during the past two administrations?

Dr. David Shulkin (DS): Sure, Chris. It's a pleasure to be with you. I am an internist, I've always maintained an active practice, but I've spent most of my career focused on the management of healthcare. I trained specifically in both health services research, but also in the science of how to change physician and organizational behavior to move towards better quality, better safety, better value in healthcare. And that's been a really incredible journey where I've got to have the chance to lead many organizations, work with many different physician groups throughout the whole ecosystem of healthcare, and then ultimately, back in 2014, during a time of crisis for the Department of Veteran Affairs, that was known as the wait time crisis, where veterans were returning from Iraq and Afghanistan with great needs, but not able to get appointments to get the help that they needed, that resulted in the White House reaching out to me and asking whether I'd be willing to come to try to help that situation.

And of course, that wasn't necessarily a plan of mine, but I didn't feel like I could say no, that if I felt like I had the ability to help, I wanted to help. And so I left my job running hospitals and health systems to go to Washington to help fix the VA system, first for President Obama, and then later on for President Trump.

Transitioning into a Healthcare Leadership Role

CA: And I'm sure you've mentored many physician leaders over the years. What advice do you have for physicians who want to transition into administrative and leadership roles?

DS: So what I tell people is, first of all, you have to pursue what you really enjoy doing. So many people come to me and say, "Well, should I go get an MBA or should I go back to school?" And I say, "Only if you enjoy going back to school," that ultimately the experience that you get in those types of academic environments once you're a physician can be valuable.

Clinical and Financial Alignment in Health Systems

CA: And that's a great transition. As a leader in the private sector and in government, you've seen both the opportunities and the major challenges in reforming how health systems operate in the United States. What have you seen as some of the biggest opportunities and challenges, repeatedly across your career?

DS: Well, I think that whenever I look for change, you always need to look for two things. You need to make sure that what you're working on is the right thing, clinically. And that's what differentiates physician leaders.

The Future of Healthcare Technology Infrastructure

CA: Let's talk about the future of technology in healthcare. What are the biggest gaps you see around healthcare infrastructure today? And where do you think technology companies like Cadence can play a role in addressing these gaps?

DS: Technology is not going to advance in healthcare just because it's a new way of doing something, or it's a new gadget. It's got to address a real problem in healthcare.

How Skeptical Physicians Can Move Toward Embracing Change

CA: As a physician, you're well aware of the skepticism that many physicians have around new technologies. How did you personally come to embrace the constant pace of change in technology in healthcare, and what have you coached the physicians you've worked with along the way, to figure out how to adopt technology most effectively for them and their patients?

DS: I think that understanding when technology's going to be valuable and when it really is in advance over the current practice is one thing. Understanding the timing of when those changes are really going to be accepted and adopted is something else.

Government’s Role in Telehealth Adoption

CA: And the government played a huge role in the growth of telehealth and virtual care during COVID, making it possible. What would you like to see from policymakers in this post-COVID world going forward, to enable continued transformation, continued innovation, but in a responsible way?

DS: Well, I think the first thing is, having gone through what all of us have gone through these past couple of years with COVID, we have to resist the temptation to say, "Well, the pandemic is easing. It may be ending...but we can't go backwards."

The Case for Public-Private Partnerships in Healthcare Governance

CA: Is there a regulatory body that you think should be taking a leadership role here, in figuring out these self-reported standards?

DS: I think that it's not clear that we have this figured out. Right now, the FDA takes the lead on this. And look, the FDA is the natural existing body that would be taking a look at a device and ensuring the safety for patients.

Driving Health Equity in Rural Communities through Remote Care

CA: The Biden administration recently announced new initiatives to drive health equity in rural communities. What would you like to see from the government, and what would you like to see from technology companies, to ensure equitable outcomes and help address the massive gaps in care and health delivery today?

DS: Well, I think the administration has highlighted...disparities. So I think it's a very laudable goal. It is important to remember...so that this does not become one of those inequities.