It's been a year of trial d struggle with health care t the forefront.

Something might never be te same.

How has our experience chad the system?

Join us now for a community conversation.

Health care after Covid-19 presented by Capital Blue Cross.

Here's your host Brittany Sweeney.

Welcome to the latest installment of our Communiy conversation series Health Care.

After Covid-19.

Tonight, we'll have a candd nversation about how the coronavirus has changed heh care over the last year and what health care will looke moving forward beyond the changed the health care industry in a multitude of ways.

In just about every way how people access their care, w people receive their care d from whom they receive ther care.

Joining us remotely, our leaders in the health care industry to share their perspective on a range of topics on our panel is D Steven Clasi, president of Philadelphia based Thomas Jefferson University and Cf Jefferson Health.

Since 2013, he has been leg one of the nation's fastest growing academic health institutions.

Under his leadership, Jeffn Health has expanded from te hospitals to 14.

Also joining us is chief physician executive of Lehh Valley Health Network, Dr Robert Murphy at Mulvaney d he is executive Vice Presi.

And among his many responsibilities are govert relations, telehelth and ug data analytic to improve hh outcomes.

Also here is Michael Spieg, president and CEO of good Shepherd Rehabilitation Network.

Mr Spiegel joined the good Shepherd last August after serving as president and CO Seo at Brooks Rehabilitionn Jacksonville, Florida.

His career in health care administration has focusedn rehabilitation.

Now let's get to our first topic.

The pandemic has disruptede in so many ways.

Big picture here.

Let's start by talking abot wh the pandemic has taughts about our health care preparedness and readinessa nation and as health care delivery systems.

Is it wrong to say we just maybe weren't prepared fors on a different level and hw come why is that?

Let's start there tonight,r Classico.

Why don't you kick things f for us?

Well, first of all, thankss great to be back.

I obviously didn't do a vey good job when we met last r talking about the future of health care because I predt this pandemic.

But look, I don't think the ndemic actually taught us anything.

We didn't know we knew thae had spent a lot of time log at how we can give folks as to this broken and fragmen, expensive and inequitable health care system.

And I think the pandemic actually just accelerated .

If you just look at what happened with hospitals log hundreds of millions of dos while insurers literally in some cases doubled and trid their revenues based on hoe get paid, when you look ate fact that we really in most places hadn't been preparer health care at home, think about banking.

Right.

We don't get up in the morg and think going to tell a .

But banking has gone from i percent in the bank to 90%t home.

So I think we've learned at of things that we already .

And I think that frankly, e pandic is now showing us tt we really have to up our g. Dr Clasico, I just want toe reference to the show thatu were referencing before wet in February of 2020 just ws later, everything shut dowe coronavirus really wasn't e yet.

So we talked about the fute of health care.

But I think so many thingse sped up in health care bece of this pandemic and we wil get to that.

I just wanted to move on me to Dr Murphy and ask you, w do you think we could have better prepared for this pandemic as a nation, as specific health carsystems?

What do you think we should have done differently?

Well, I think Brittany you know, I echo pretty much wt Dr Clasico said about we basically in health care Nw what the strengths and whas weaknesses were.

We knew the disconnect bete patients and between and between know resource availability.

We knew that we were spenda lot of money for potentialy not investing in the wellns of our communities.

And I think what happened s the pandemic.

What it did is it really brought to the forefront te fact that we were really ur invested in public health, public health infrastructu.

So whereas you've seen tooI would say, very remarkable occurrences that came out f the pandemic.

One is are our pharmaceical come Legion's beyond wherey of us I think would have expected as far as vaccine production.

So we have tremendous intet and capability in that reg.

So I think all of us on the show today would would owea debt of gratitude to to our compatriots in in that rea, but also feel the full confidence of our ability o withstand the remainder ofs pandemic because of what they've been able to suppls with.

The second thing is I thint brings it brings to the fos that actually when you look around the country, some te best vaccination rates aret the hands of our large or well-established community hospital and health netwo facilities where the ones t have the connectivity, the communities where the oneso understand where patients l go for access.

We also understand to a lae degree, you know, the factt in several communities thes a lack of trust in large hh care systems ia lack of rel ability to to touch pointsd for years have have been looking at how to mitigate this.

This limitation of health e so that we can deliver heah care to the entirety of our community, not just folks o have the ability or easy as to health care.

Sure.

Of course, hindsight is 20.

And I want to move on to Cf good Shepherd Rehabilitati, Michael Spigel.

How do you think we could e prepared if we were looking back now, what do you thine should have done differenty wh it comes to preparing fr a pandemic like this?

You know, given that a lotf thought since the pandemic started, I always come baco the word how much do we usr imagination to think aboutt could happen?

I was living in Florida.

You always wondered what wd happen if we had the 100 yr hurricane, how prepared wod we be?

So I think a lot looking backwards and saying how cd we as a country and healthe system prepare differently?

Is the need to use the imaginion of what c happen Gamma And then you get into that challenging point of n you use your imagination of what could happen in 100 yr event.

How do you prepare for tha?

How do you afford to prepae for that?

How do you build the system Gamma So I use that word imagination.

I think it takes a lot of imagination to think of th0 year event and what would u do?

The other part of your question, I would concur wh two physicians that I thinl of us in health care, the pandemic didn't show us anything.

It greatly exposed weakness that we already knew exist.

It brought them to the forefront and part of the a of health care that I lead would say long term care ry exposed a model that requia modernization.

And then the other thing I think the pandemic did waso mentioned is its speed it .

Our thinking about things, whether it's technology or other ways we need to do ts differently and better.

I think we might have been moving along at pretty workmanlike pace, but I thk the pandemic is really goio speed things up by who knon order of five or 10 times.

So that's how I would answr your question.

And you mentioned weakness there.

I want to move on to our nt topic.

Perhaps nothing has highlid disparities in health care access more than this pand.

Reporter Megan Frank takesa look at two issues how thel out of vaccines left some seniors behind and the bars to access for people of cor when it comes to vaccine distribution efforts.

A lack of access to a compr or the internet makes signg up more complicated.

When it started rolling oue realized that it was fragmd and that wasn't conducive o the 65 plus population.

Bill Johnston Walsh heads Pennsylvania's AARP chapter when his group sent out a survey to its 1.8 million members within a 24 hour period.

The agency heard from moren 3500 people.

We basically heard that, yu know, thathis was a Wild West.

It was a crapshoot.

It was a degrading Hunger Games.

They really felt that loss getting in the queue to bee to have the vaccine.

According to Pew Research,e than 25% of people 65 andlr don't use the internet to e a real person answer phonee and help them get that appointment is key right n. Thank you for calling the Pennsylvania Department of Health at a recent briefin, the State Department of Heh invited Reverend Denise Weh invited Reverend Denise Weh in Pittsburgh to speak abot the issue.

Welch said Pennsylvania's k community has multiple bars to the vaccine, including reluctance to even sign up fighting against General suspicion against the healh care system and fighting against the history of unethical, experimental Tan directed against the Africn American population in our nation, many black citizen, including myself, decided against taking the vaccine.

Welch says her congregatios now encouraging members ton up.

Johnston Walsh says another issue is that it takes lonr for some people to fill out online sign up forms.

That appointment is gone ad they have to go through the whole process again.

Still, he remains hopeful t more people will be able to sign up as part of its cov9 outreach efforts.

The State Department of Hun Services is creang regional health councils.

These councils will work to reduce health care costs ad address disparities in the health care system.

For PBS.

39 Community Conversation n Health Care After covid-19.

I'm Megan Frank.

Now a couple of things I'de to hear your perspective o. Gentlemen, let's start wite vaccine and the state's decision to let providers t up their own portals and registries instead of a ste centralized system.

There's been a lot of frustration from patients d oviders, especially as vaccine supplies started wh just a trickle.

How could we have done this better?

Dr Murphy, let's start witu on this one.

Well, I think Brittany hadu know, fortunately in the Vy we live in an area where wd quite well and continue too quite well with vaccine anr Clasico is in an area where they you know, they are vey effective as delivering vae to the population they ser.

The proem we had in Pennsylvania was really a misunderstanding of the inventory you is the begin.

We thought a vaccine woulde plentiful and it turned out would not be.

And then a lack of a straty as far as how to really gee most shots and the most ars initially in Pennsylvania, there were about there abot 1,500 entities that were sd up to distribute vaccine.

Currently it's about it's t a quarter of that.

And different states wherey have very highly effective rates of delivering vaccine like West Virginia.

They basically left it in e hands of the five biggest health care system, I thinn in Pennsylvania, what we he and what we learned througe earlier state interventionh nursing homes is that we ln that the health care systes really do hold the key to e kingdom, at least in the Commonwealth, Pennsylvania, because we are well connecd to our communities, were pd in areashat are ver accessible and in many in y regards we are you know, we have proven track records,r example, what you're showig there, I believe is Dorneyk mass vaccination site thatr Spiegel and Dr Classico myf are very familiar with.

And that single site can deliver 4000 doses a day.

Similar sites exist in Poco Raceway at Hampton Communiy College sites down in Philadelphia also have high capacity.

And so, you know, just fore one health system, Lehigh Valley, we have the abilito deliver 36,000 doses a wee.

So when you take when you e an entity like being able o partner with Shepherd and s touchoints or, you know, te institution of Dr Clasico s with all its touch points w that's a tremendous abilito connect with communities a, you know, it makes it sound simple.

But we're also the folks tt understand the disease, understand what epidemioloy is, understand decontaminan is and are best probably sd both to deliver and to delr in a safe and efficient ma.

Dr Murphy, we seem to be starting to open up more vaccine sites, more drive through clinics, that kindf thing.

But I can remember I beliet was late February when youd I talked and there was a lf frustration.

There were even times whenu were getting vaccines thatu know, u weren't getting know, u weren't gettingenoe signed up, talk to me about that frustration and how tt could have been alleviated faster.

Yes, but I mean, that was a tough time and I'm sure ABo and Dr Clasico, you know, t a little sleep over that ae all did.

So that was my first point about the federal governmet not really having a good se of inventory.

So the expectation was thae states would receive vaccit a cadence and a reproducibe cadence thatust not then.

There was also the confusin about how best to deliver e vaccine to what populatione had in Pennsylvania.

We had the Janai category d initially were trying to deliver it to those that we those being the populationf 75 or older.

And at that time during the cadence of delivering those vaccines, different guidels would be issued which would inflate the queue of people waiting to get vaccines any to get appointments when vaccine was still quite ra.

So led to frustration by te community we're trying to e led to the frustration on e part of those trying to der and it's only been just ine last week or two that the Commonwealth after what thy called smoothing exercise,s been able to deliver vaccie reproducibly into the handf those that have signed on o provide vaccine.

And Philadelphia, maybe Dr Glassco being a slightly different area because Philadelphia is one for for areas in the country that a direct relationship as oppd as a little bit different experience.

We're absolutely Dr Clasics going to ask your opinion s Philadelphia does sort of e a different system going on right now.

But you do have hospils boh in the city and then in the outer parts of the city in these suburbs that are parf this state wide rollout.

Each individual, you know, health care system gives te vaccine so what's your perspective on all of this?

Well, I think that before e hit the nail on the head, u know, one of the things tht happened during the Covid surgeries and was true thae have value is that we realy had radical collaboration between the health care in Philadelphia and Temple Jefferson and the rest reay got together.

And the big mistake, I thik that was made frankly on te government side is not just looking at those we togethr handle about 5% of the pats in Philadelphia and we were just able to get those dos.

We would have been able to figure out how to get it te right folks to get to the people who need it the mos, the people that are underserved, etc.

I think we exist in 10 counties, two states and literally there are certain things that if I did what y said, I had to do in one county, it would be againse law another county.

So we basically ignored everything that the state d local governments told us o and follow the science.

We have lots and lots of freezers, so we got lots of Fizer, Moderna and the wayy chief marketing officer sad it, there are arms, we have vaccines.

We're going to we're goingo inoculate because what was happening is that literally people were telling us to t until they had the rules ad then the federal governmens saying, well, if you don'te the vaccines, we're going o send somebody else.

So we just said we're goino use all our vaccines, get .

And you know what?

You guys figure out your r, but we're not going to wair that.

And that's why you make the decisions.

That's a tough one for sur.

And I know Mr Spiegel is shaking his head as well.

What's your input on all of this?

Yeah, I think part of it gs back to one of your originl questions about how could e have prepared for the pandc perhaps differently.

So I look at the vaccinatin processes.

We went from identificatiof a disease that developmentf vaccinations in incredibly short period of time and tn the need to manufacture millions and millions of ds in a very short period of .

And just like prepare thing about preparing for the pandemic, all of the preparation and thinking ws happening in real time.

How to best get the doses t to the health care provides who wou be most effective delivering the vaccination.

So I think it goes back tow much of this had to be thot about in real time and howh like your original question could have been thought abt and preparations years ago.

If you will.

So y one way I look at it, though, is being optimistis really between, what, the beginning of January say vy late December to today.

What may be about.

25% of the country has recd at least one vaccination, c You think about that way.

It's a prettymazing feat tt really hospital systems, particularly and others hae been able to pull off.

You.

The other piece that I woud point out in from the news piece that you showed is ss also a situation for older adults, for those older ads who were living in, let's , assisted living, independet living, long term care, thy had a much more organized y to get their vaccinations.

So really it was seniors lg at home became really the y difficult group of how do y acute, how do they registe, how do they sign up and ses living in some sort of facy there is much greater organization by the governt and health care systems to provide vaccinations to tht group.

Sure.

And I don't think we're thh And I don't think we're th.

I think there's a lot of seniors out there and peopn that one a group who stille having a problem getting an appointment for a vaccine.

What do we do about that, Brittany?

Let me just say I think ths one thing that maybe people one thing that maybe peoplI thought it was a great segt that your reporter showed t people that are afraid to t the vaccine.

It's not the people refusio get the vaccine.

They're hesitant.

And as was brought up, thee hasn't for the right reasof you are an African-American person, you've grown up learning about Tuskegee and some of the clinical trials that were done for the wrog reason.

So it's been very effectivr us has been we started something called hashtag rl talk and we vaccinated abo0 African-American Latino pas and reverends and they weno their congregations not juo tell them, hey, look, I go, but also to find out why pe were hesitant and we foundt things like literally there rumors that the vaccine haa GPS and that ice was goingo get you.

You know, if you got a vac, knowing that and being respectful of those thingst they heard alloweds to say, explain why that wasn't tr.

So I think what we're findg is with communication, with radical communication, radl collaboration.

You can really get to those people, but it takes real .

That leads me to my next question.

That's exactly right on par with where I wanted to go h this conversation.

Covid-19 infecting and kilg people of color at disproportionate rates.

It's opened a national conversation on racial disparities in health cared reaching communities of cor and what health organizatis are doing about it.

Dr Classico, we just heardr thoughts.

Dr Murphy, your thoughts on this?

Well, I think the basic disconnect exactly what Dr Glassco referred to about e lack of trust, also a lacka lack of mobility and a lacf access and lack of connecty anin some fashion.

So I think there's a lot tt we in Pennsylvania, particularly southeast Pennsylvania, have to thane black physician Covid vaccination program.

That's down in Philadelphi, the consortium of black physicians who went to ther communities to vaccinate themselves, vaccinated African-American nurses.

And gradually there's becoa momentum, a comfort level that's actually a ripple et through many communities.

We tryo reproduce that in e Lehigh Valley through our community health partnershs with churches, with school, with the school districts d with representative.

And we have an underserved community like the LGBTQ community.

So it's those conversations that have to happen to stao to engage the communities h that.

Then you also have to reale that we have to stop lookit our communities as pients come to a hospital.

We have to look at our communities as being the communities that we serve d oftentimes that means being able to to take the fight o the front door and so to as patients potential patientr community members in the ps where they congregate.

And if it's a senior living facility as a senior living facility, if it's a drug ad alcohol rehabilitation cen, it's a drug and alcohol rehabilitation center.

If it's a church, it's a church.

This is a barbershop in the barbershop.

So in the valley where we'e lucky enough to have partnd with Toyota and have multie mobile vaccination units tt we have in the community bringing bringing the vacce to the underserved in the places that they feel most comfortabl which often plas away from bricks and mortad white coats.

And of course, this is a tc that could be addressed inn entire show.

So our next community conversation will explore e issues.

Join us April 15th as our n Gen. Ortega hosted a community conversationn vaccines and communities of color.

We'll hear about efforts ae national, state and local levels to reach underserved communities and their plans going forward.

It's a live forum seven pm Thursday, April 15th, exclusively on PBS.

39.

Let's move on another big shift, not just who gives e care but how we are getting that care.

Telemedicine is becoming or already has become a game changer for many providersd patients.

The pandemic really acceled it to use primary care.

Doctors and specialists are using it.

How about rehabilitation, r Spigel?

Are you seeing telemedicinn a place now that it wouldnt have been a year ago 100% a You know, like many other thin post Covid learnings s how Covid is really going o accelerate by some factor, something that might have n occurring at a very low pa.

So take something like peoe requiring rehabilitation, y the disabled population.

It's a population we serve every day is the disabled population who already have issues with isolation, acc, transportation that we bele that telemedicine TELERATE rehab is going to be for my an excellent solution.

I think it's going to be amazing to watch this, nott the let's call it the fancy FaceTime or Skype with somebody, but it's going te all the technology that's layered on top of that canp with diagnostics and help provide objective informatn back to a physician, a therapist, whoever.

So I believe it's going toy a great role, not just in b everywhere else.

And I believe what it's gog to look like in five yearse ability tella technologiess going to be something thata out of science fiction.

The other side of though is technology has, I think, gt potential to bring access o people.

But technology, if we're overreliantn overreliant on it can have the potential o maybe provide less access o certain people who don't he the right equipment, don'te the right technology, don't have access to internet ano forth and so on.

So there's kind of dual edo it.

It really has the potentiao expand access, but it alsos the potential to create otr barriers, if not carefully monitored and watched for .

It's definitely more of a force, but not going to tae away that in person.

Dr Clasico, you may not hae pricted the pandemic, but I how telemedicine and just getting your health care on your phone was going to rey take off and wow.

Did it ever take off in the past year?

Yeah, I think I remember Id you that I invested $50 min in a cell phone telehealth program called Jetconnect n 2012.

When I said that to my facy it was like I need to be te psychiatry ward.

That's proven out pretty w. But I think for us and I tk both Michael and Bob have d this, that literally it's t about the technology at Jefferson.

We health care in any addrs that we want people to view Jefferson as their partner starting at home in some respects getting to we have that network or Jefferson'a general care facility meane failed to keep you healthy.

So the key is how can the % of people that are not patients, there are peoplet want to be able to thrive way.

How can we be there partner starting at home so that wn th do get sick they're not going to go up and down the school expressway to see wo has the coolest billboard.

They're going to look us tr partner.

I think it's the same thing Michael, with rehab now isr for various people to start home, you know, and obviouy in a very severe situationu can concentrate on the high resources that a hospital.

Absolutely.

In the past year.

Do you think that the progm has just taken off?

I mean, telemedicine is thy everybody connected duringe pandemic.

They didn't want people wih Covid coming in.

But what kind of advces hae been made just in a year?

So I just to give you numb, we did 100 thousand teleheh visits between 2015 and Decembe 31st.

2019.

We did 100,000 in Februaryd March of 2020.

So, so, so obviously the numbers are there but I thk what's starting to happen I think Dr Murphy put well we actually now looking at how people can do labs at homew people can do diagnostics n our most successful intellectual property thisr was creatingearable that literally people can go to sleep at night that will measure their temperature,e respiratory rate there, the heart rate, etc.

So we'll put continuous da.

Brittany, my car right nows better care than I do.

It turns continuous data at night when I wake up in mog says, hey, Steve, my right front passenger tire is a little please fill it up.

Meanwhile, I'm going to gor a physical in two weeks and somebody is going to say, Steve, on April 10th, your blood pressure is X, your G is why this is what you dor the next 12 months.

So we're going to move to a continuous data at home mo.

I think.

I think if I can just takea second to augment and you t places like good Shepherd r Jeff or Lehigh Valley havee is we've invested to Dr Glasgow's point.

He was a pioneer this $50 million in 2012.

We invested this because is the right thing to do and e saw the need to connect oue the traditional health care unit that was done basicaly basically on the on on a commitment to do the right thing in the Commonwealth f Pennsylvania.

It was nand remains uil the emergency authorization cae through.

There was no payment mecha.

Well, so all the investment Clasico just referenced was by being Forsayth knowing t he would never recover just basic fees for this.

But he was going to invest because that was the right thing to do to keep people well.

And by doing that, there wd be some some recovery in te long term.

What we have now is kind oa tipping point.

I think, in the health care trying to flip the health e paradigm to value and toucg people atome and that you, the government has seen fit that that health care shoud support digital health, telehealth and hospital ate type programs by reimbursig them like you would a docts visit.

So with that type of of, yu know, Ballan to the thinkif touching people in the community is worth some soe commitment on the part the insurer, instead of sending dividend checks to the owns of the insurance company, d able to b much more impactful in making sure tt our community stayed well.

And we in the hospital buss would only have to take caf those in their very two sts of the show.

And of course, during this entire pandemic, people red heily on telehealth.

Do we think it's going to continue that way?

Do you think that it has changed for the long haul?

I think when the good Shepd side and the rehabilitation side, I think it's like adoption of almost any technology, kind of an inil spike.

spike.Right.

And the spike is forced ups by closure and you know, of of facilities, lower acces.

And then, you know, there's that depression after that initial spike and then thes that steady climb as people change and the technology changes, people realize, yu know, like clinicians reale how many more people you cn touch or they realize it'sh more than just a two way conversation.

You know, Doctor, class gos about diagnostics.

I think about a disabled population.

Often the first signs that something isn't going wellh somebody living with a disability is decline in function.

And that's often the firstn of an emerging medical eve.

And so the ability to be ae to kind of monitor in reale and pick up on those decli, I think that's how technols going to evolve.

So I think on the rehab sie there was that force used t of excitement then a bit as people began to come into clinics and now it's new technologies being develop.

I've see companies show me really kind of for state ft line tell a rehab that wast even envisioned two and the years ago.

And I'm working on today.

So I think over the next fw years they'll be that steay climb, that it becomes much regular more highly utilizd modality.

Sure.

It's just incredible how ft it took off over the past .

And I want to talk about te marketing side of things.

The vaccine, of course, pee signing up with that digitl health with vaccines and ty have given providers tusans of touch points with individuals, potential pats who could come back to cone other health services.

Health systems are collectg information when someone registers in a portal or ss up for a vaccine.

So here's the question.

What are the health networs doing with all this data?

Dr Murphy, do you want to t with that one?

Well, I mean, the data that we're collecting is in lare part we have in the health systems a lot of data alrey and many of the patients ae coming back to us are our patients that we already he an interaction with the amt of data that we're taking o provide vaccine is actually quite limited.

So we have to take in enouh data to know what categoryd what stage to put them in.

What the what we can do wih data that is protected to a degree is we're able to stt to model how populations mt be expected to respond and where we can potentially se needs and communities going forward.

So for example, many of the large systems, Michael, ind Shepherd would have have da that would predict who wouo poorly going home with a certain a certain conditio.

Dr Clasico.

And I can tell you probably within you know, within a thousandth of a decimal pot what ten people in diabetic population are likely to rn to the emergcy room five times in the next year.

And by having those large a sets and those large data elements that we can really talk about population healr public health in a way that makes sense in a way that d of aligns with the paradige three of us are trying to advocate for tonight and tt is invest in wellness, touh people with a with experie.

99% of their lives and be h more proactive so that you don't have the big, big catastrophe at the far end.

So the more data, the moree are able to understand dats very helpful to us in the e care setting during the pes of Covid because we could basically model who we expd to deteriorate and become dependent on ICU admissionr ventilators, which helped o model how many physicians e needed, how many intensivee beds we needed available ad things like that.

So there's a true science n medicine now about data analytics and the more date have, the more the more capability we have to to be able to predict and do the right thing to our doctor.

Glassco, should patients be concerned at all signing ut all these different locatis just to get a vaccine appointment Gamma They're uploading their informatio.

Is there any concern there?

Should there be concern th?

I think there's huge conce, actually, Brittny.

One of my non dayjob roless in the World Economic Forud the Digital economy.

And we talk a lot about trt versus technology.

And I think it' goingo be a real decision over the nexn years.

As we get more and more daa starting from I'm going toa real life example.

We did a pilot.

We looked at people that hd congestive heart failure we hearts weren't working well when they were in the hosp.

And we want to know why pee came back and they offereds full access to their data t It turned out that like ifu ordered two pizzas the firt week you went home, you're probably going back to the hospital because we put yon a salt diet.

So the question is that's great.

Prediction.

But do you really want your hospital to know everything about you?

And when you start to get o genomic data, literally how private is that?

So we've been talking a lot about enhanced.

We're very concerned about things.

Eye contact tracing, Googl, the former CEO Geissinger s the head of Google Health.

Now, they had amazing contt tracing tool, but frankly, people didn't want Google o know everything they were g in this country.

There's a lot of concern at how much people not now, of course, they put everythinn Facebook or Twitter so peoe know more than they should.

But when it comes to their health data and their genoc data, the only people they trust are their doctor and their hospital.

They don't necessarily trut the big tech pieces.

That's going to be a challe for us as we move forward.

Absolutely.

And Mr Speaker, thoughts on that Gamma Yeah, I would ae with what Dr Classico said.

There's tremendous potentil and opportunity in using da to improve care.

Examples of how we use datr one example, may be to reay understand somebody who's y disabled.

What's their likely path.

But it has to do there's sl adjust to or to adjust to e data.

Right.

There's a privacy, the trut factor, but then there's a tremendous potential for improving care, just like a is used to the example of constantly diagnosing your diagnosis in your car or my other things.

So there's two sides to it.

But the more altruistic appropriate side is how doe improve care Gamma How do e better predict what might happen to somebody and howo we prevent to the degree wn maybe bad things that would have otherwise happened?

Sure.

Let's move on.

Even before the pandemic, y practices were relying mord more on physician assistans strain on our hospitals and strain on our hospitals an.

Dr Clasico, do you think wl see more of this decentralization away frome doctor, the centers of the health care universe and me even a way from the doctors office or ERs as places the go to?

I hope so.

I mean, I've a really big .

Even when I was in Lehigh Valley around getting peope practice to the height of t they can do is we you know, when I was the chair will e WEHI, we started one of the first nurse midwife progras there, you know, for for te ght folks.

I think a lot of what happs is literally that different states have different ruled a lot of them are based on what's necessarily best for everybody.

It's what the government ad state medical society has .

So even as we talked about telehealth, I can practicef I'm standing there in 40 different states, but I can only do telehealth at abou8 states because a lot of the states have cut barriers.

So think back to back if wn ATMs start, if you need a different ATM card for evey state with a different code wouldn't have the kind of g that we have.

So I think we have to get a federal model that basicaly makes telehealth uniform cs and allows people federally whether the doctor of nursg practice or an advanced nue practitioner or a PA to practice to the level thaty are that they are capable f practicing.

I want to move on from that question just the interestf time.

Let's move on to how it all gets paid for.

Millions of people in the t year became newly unemployd and may have lost that connection to traditional employer based health insurance.

Are we moving away from tht and from the consumer's perspective, what are the s and cons Dr Birx if you cod take that one?

Well, I think you're dealig with on this call today,oue dealing with people who lot at the population at its mt vulnerable.

So we may have a slightly different perspective.

And I don't mean to speak r the other two, but I thinke we as a nation do not snd r health care dollar effectiy or efficiently and I think there's a lot of research t has shown that and there'sa lot of a lot of movement tw can we do things different.

And there's no question ths a move towards having a lar government paid or supportd system.

The question is, is how fat and how quickly we move the and what will be the commel market's response to it.

Right now, the commercial market helps underwrite sof the some of the offerings n the exchange, for example.

But there's an evolution in place.

What has to come of this, though, is and I think what we're starting to see the pressures for is we're an g society where a society in which the payers into our health care system, traditl health care stem, Social Security that supports and Medicare, Medicaid, the pas are not keeping up with the demands on that.

We're stressing the we're stressing the 18% GDP thate already invest in health c. So there's going to have te a way that we shift away fm volume to value.

And this is something thatu know, Spiegel's Línea good Shepherd.

I know Dr goes along the national leaders of Jeffern in this regard of the shift from volume to value a vale based care And I think those of us who look at a fixed dollar or decreasing dollar as far as national spend can only sen see only to the benefit of having a shift from certain service provided at a at an episodic basis to one that provides care for someone through the continuity of r journey in life.

Because if you invest earln and you spend the dollar wisely, people would be healthier.

People won't require those diabetic five visits to anR every year because we'll understand who they are wil intervene better or spend l be less.

And ultimately, the more we connected to a person, the better the outcome will be.

So I think it's as much ast the traditional mechanismsf payment are.

But how those mechanisms manifest, the policies that they write in shifting the philosophy to value Dr Gla.

I know we've talked about , but do you have anything ee todd to that?

It seems like that ties rit into your investment, into telehealth.

Yeah, well, I'll get back o the a perfect example.

As Dr Birx said, when we ft started doing health, we cd move 50% of our patients ay from our expensive, ineffit medicine department and we would going bankrupt in a traditional insuran model because people were willino pay insurers and willing ty 1,500 dollars.

Somebody showed up at my dy and maybe $49 for teleheal.

We went to our 32,000 employees.

Where were the payer?

The provider and the emplor and we had a differential copay.

If you came to our emergeny room through Jetconnect its zero Covid you just showedp in our emergency room.

It was a 500 or we were abo give much better care patit satisfaction through the rf and save $10 million a firt quarter that we did that by getting people closer to h. So I think it's the reason places like Kaiser, UPMC ad Intermountain that are payr providers have really beene to provide better care at a lower cost.

I don't think every health system needs to own a prov, but we're going to need different kinds of strategc alignment between largeealh systems like Lehigh Valleyd Jefferson with payers in or for us to not have that fragmentation.

I talked about at the begig of the show.

Mr Spiegel, do you have anything to add Gamma Yeahe have a bit of a different e and what we do shepherd maf the patients we see are eir newly disabled or living wa disability where they happo be frail and elderly.

So a very disproportionate percentage of our patientse already covered by a govert payer Medicare or Medicaid medical assistance and almt by design, those systems ry chop up and fragment care r an individual who has very complicated lifelong needs being disabled, living wita disability, aging with a disability, being very fral and elderly.

So the evolution in payment systems really for these populations was kind of aly mentioned about giving the providers more opportunityo wrap care around the persod wrap that care over a longr period time, particularly e individuals who are disablr already frail and elderly d or living with a disabiity.

So that would be, I think,e recommendation from our si.

Sure.

And this next questionies right into that.

And I'd like to start with.

There's a class of Covid patients we call long halls those with lingering long m symptoms and wondering frou specifically, Mr Spiegel, f there are rehabilitation services now tailored specifically for them.

Right.

That's a great question.

It's interesting.

It's say Covid didn't exis.

There's a large there's a population go through a hospital.

They may have a long ICU sy maybe on mechanical ventiln and they have very similarg term needs as, say, a long Paula Faris Covid.

But really that kind need t as recognized as we would e it to be, whether it's a Cd patient or whether it's somebody who has cardiac ad pulmonary disease.

And so there historically hasn't been the recognitiof the role that rehab can pln helping somebody restore te function or capacity there independence.

And I can't say or experiee host Covid has kind of awan that recognition because is always been there, whethert was somebody who had Covidr somebody who had some other cardiac pulmonary disease.

So there is a definitely ad for individuals that have d this kind of care and longU stays, etc, just hasn't ben one that has been really historically picked up.

Sure.

And in the interest of tim, we're going to move on from that topic one year ago ons show, we discussed what a pivotal time it was for heh care providers with many oe networks canceled, dating r expanding the range of services.

What do those plans look le now?

Dr Classico, if you could n Gamma Well, we've gone froo hospitals to 18 hospitals r five years, so I'm not sure where the normal normal en.

It's interesting because se we last talked, we were ine middle of a Federal Trade Commission fight in mergerh Einstein Health Network ann insurer called Health Part.

So I think that I think a t of people believe that if anything, consolidation wil accelerate after this becae Pthey saw how vulnerable hospitals were.

I mean, I think we all losI mean, we literally had thaa 500 million dollar differee doing everything right.

Right.

Because, you know, the perl protective equipment addedo our supply costs.

Well, active cases went do.

So I think literally in orr to mitigate some of those things, I think you're goio see some creative partners, creative partnerships betwn rehab centers and, you kno, acute care facilities, skid nursing facilities and oth, assisted living facilitiest also larger systems.

So the question becomes dos es health care go the way f telecommunications?

Do we end up with three orr major systems in Pennsylvaa and you could argue that wd in essence make health care more efficint.

You could also argue that d be anti-competitive.

And I think that's the kinf discussion that's happening now.

Sure, sure.

And Dr Murphy, how about te real estate boom for medicl facilities, especially hern the Lehigh Valley?

It seems there was a new specialty office or surgicl center popping up on every corner for a time that with