Expanding Access: Leveraging Health Technology in Rural Communities
Across the contrary, rural communities face long-standing barriers to care. Ranging from provider shortages and geographic isolation. To limited infrastructure and health system fragmentation. These challenges have serious consequences for prevention. Chronic disease management. And health outcomes, particularly in cardiovascular care. But with challenge comes opportunity. Today we will explore how innovative health technologies Virtual care, remote monitoring, mobile diagnostics. In data-driven solutions are transforming how care is delivered closing gaps and creating new pathways to equity in rural health. We're privileged to be joined by a distinguished panel of leaders who are driving this transformation.
Dr. Yana Goldberg, Chief Medical Officer. Of heartbeat health, a trailblazing virtual cardiology platform that brings specialized cardiovascular care to patients wherever they are. Carla Robinson, CEO of Canary Telehealth. A leader in remote patient monitoring and hybrid care delivery models that meets patients in their homes and communities. And Dr. Eduardo Sanchez, Chief Scientific Officer for Prevention at the American Heart Association. And the principal investigator of the National Hypertension Control Initiative. Which is working to eliminate disparities in blood pressure control across the nation, especially in rural and under-resourced communities. Today's conversation will focus on how we can harness technology not just to extend care.
But to reimagine it in ways that are accessible, affordable. Culturally responsible and scalable. We invite you to use the Q&A function to submit questions throughout the session We'll reserve time at the end for Q&A. So let's begin by asking each of the panelists to briefly introduce themselves And then we'll have them share their perspectives on how their work is helping to expand access in rural communities And why health technology is such a critical part of the solution.
So let's start with Dr. Goldberg. Hi, everyone. I'm Yana Goldberg. I'm a cardiologist and chief medical officer for Heartbeat Health. Great to be here. And Carla? Hi, I'm Carla Robinson, CEO and co-founder of Canary Telehealth.
And Dr. Sanchez. Hey, everybody. Eduardo Sanchez. I work for the American Heart Association Chief Medical Officer for Prevention. I'm happy to say I am the former principal investigator because we have finished that project. So I'll be talking a little bit about thoughts and insights from that. But I get to speak about it as opposed to being on the plane. I've already landed and I'm in the waiting room now. Yeah, I was thinking about whether it should be present or past tense, but even though the work is done, the learnings from that project I think are ongoing.
So Jana, could you start? Tell us a little bit more about your work and how it relates to this topic? Absolutely. Yeah, absolutely. So I'm Jan again, Chief Medical Officer for Heart B Health. So Heartbeat Health is a virtual first cardiology practice. You can think of us as a cardiology practice in the sky. We are married to a product company that has really build the infrastructure for building out virtual first workflows. But we are a clinical service company. So we're really focused on Bringing in cardiology services to areas that need them, either rural areas or areas that also have gaps, which include urban areas. From a clinical service standpoint, this spans really anything that we traditionally do in cardiology, which generally falls within two buckets. That includes cardiac diagnostics. Largest being echocardiogram and CECG monitoring. And then in the second bucket, patient care. When it comes to diagnostics, one of really our hallmarks has been bringing in and building out national population health programs around early detection of disease. So for ECHO, our largest program is really focused on bringing in echocardiogram to diagnose stage B heart failure and then manage patients accordingly. And then similarly for CECG, identifying patients who are at risk of arrhythmias, patching those patients, diagnosing them, and then managing them.
On the patient care side, it really ranges anywhere from as lightweight as a specialist providing a PCP, a care plan, and that could be in the form of something as simple as like an e-consult. All the way to what I call our kitchen sink program, which is our kind of heavy hitting longitudinal care that we provide our sickest patients. Think of your heart failure patients who may have recurrent hospitalizations. For our longitudinal care programs, this is a combination of virtual visits to both add and titrate GDMT rapidly. Remote patient monitoring if it's clinically relevant for that patient, so particularly monitoring of blood pressure, heart rates, weights. And then also the care coordination, which is the third component, ensuring that patients are filling their medications and going to their testing and then following up. And then really, I mentioned one of our hallmarks is bringing diagnostic, building out diagnostic first programs. So we've sort of created a bridge between the two programs, which is bringing in diagnostics, identifying disease.
And then using virtual care to build out novel care pathways off of that diagnostic testing, which for some patients who have really mild abnormalities, perhaps they have stage B heart failure, they're asymptomatic. Helping their primary care teams manage those patients through an e-consult care pathway. Or for those patients who have higher risk findings, need really more comprehensive specialty care management, we'll then shuttle patients into those pathways. So that's really become I'd say our hallmark, the last thing I'll say on that is this has really grown quite organically in a number of different settings. The first and really our bread and butter has been the primary care setting. So working with large primary care groups
To build out programs and become sort of a cardiology adjunct to their care and their goals. And this has been really focused in the at-risk setting. Second to that has been the in-home setting, so bringing in virtual first pathways into the in-home setting. And then we also have other relationships. We also work directly with payers. And we also are involved with clinical trials, most recently being the TRANSFORM trial. Where we are providing, we're essentially providing the medical intervention for patients who have coronary artery disease by CT and plaque analysis through a clearly scan. So really excited to be here and looking forward to sharing and learning more from this group as well.
Yana, what has been your experience in rural areas or in areas where maybe they don't have access to specialty care? Yeah, I mean, there's a huge need. So when you look at, there was, you know, I think a lot of folks saw this data. There was a lot of press around this data. But if you look at The US counties in general, it's estimated that about half of the US counties, right? About 22 million residents have no cardiologists located in their area. So we do have an overlap with a significant amount of rural areas, although we are very anchored also in urban. I would say what has been the highest need is twofold. One, actually supporting Those patients clinical teams on the ground who are managing them. So it's very, very PCP centric in those areas. So how can we kind of help their PCPs manage those patients? But then also secondly. How can we actually impact their care for those higher risk patients? So perfect example, and I think we'll talk about this more and more, but those heart failure patients, there's you know really strong evidence out there that we need to get patients on quadruple therapy for half ref and this needs to be done quickly in order to effectuate reductions and readmission and improvements in mortality. And so that is a particular area as well where If you imagine practically speaking, to have those patients who have heart failure commuting into brick and mortar specialty, it's not going to happen. It's not feasible for those patients. And so telehealth in particular for those patients has really been impactful to getting them on appropriate guideline directed therapy and reducing hospitalization. The last thing I'll say with that, on top of sort of our broader clinical impact and outcomes, we also run a trial just to have really put some rigor behind what we're doing. And essentially what we did was randomize patients following discharge.
To either usual care versus usual care plus the heartbeat model, which was frequent visits to titrate GDMT, remote patient monitoring, care coordination. This was in a heterogeneous but high-risk cardiac population. So about 70% heart failure, followed by that coronary disease arrhythmias such as AFib. And we saw 53 and 44% reductions in cardiac and all-cause readmission among improvements in blood pressure, quality of life, health literacy. So there's just. So much we can do there. Great. Carla, we'd love to hear about Canary Telehealth and the work that you're doing. Sure. So at Canary, our anchor service is remote patient monitoring for people with chronic conditions. We operate a call center. To all sorts of outreach, primarily around coordinating preventative screenings. And then we also do, as you mentioned, the in-home screening to help close gaps in care.
But all of this is really in support of patients with chronic conditions. And then we do that care coordination to facilitate that linkage back to the primary care setting. I would say as it pertains to rural, I'll tell a bit of a very recent story just from this past week. There is an aging patient who's in southern georgia who would have sudden spikes in her blood pressure that would start the series of events. She goes to the ER, ends up in the hospital. And most recently, she needed to go to rehab following the hospital and the most appropriate care was about an hour away. Created conflicts for her family members to go visit her while she was in rehab.
But given comorbid dementia It created some cognitive issues, emotional burden on her if they didn't come visit. So the real challenge here was how do we stop this cycle where she didn't end up in the hospital corresponding rehab. The patient was put on remote monitoring and they were able to, so then you get this immediate coaching and feedback. All right, what happened? We see this spike. What happened?
And you would find out that it's seemingly mundane things, right? So went out to dinner. Had a well-balanced meal seems healthy enough had friends over. You're not going to cook as bland food as you may normally eat right when you have friends over because you want to entertain. You went to visit a friend. They don't have the same dietary restrictions as you. So all things that seem very normal and that the patient have been doing all her life. But now her body was just much more sensitive to those types of things. And so the nurse was able to see and she was able to see, it wasn't really a sudden spike in blood pressure. It was a series of events That ultimately showed itself up in a way that led her into the ER. So allow just much more coaching feedback and behavior change. And it have really, really significant impact. Implications for this patient who wants to be at home. But when she was in rehab, she ended up going to memory care because of being moved And so it has huge impacts in quality of life and cost containment for the healthcare system and the like. So that's just an example of how we're seeing
One of many examples of how we're seeing this play out, particularly in all of our locations, but particularly in rural areas has some uniqueness to it. And Carla, a lot of times we hear a concern that technology can create a digital divide. And certain people can't access and we actually may be creating even more disparities. But what has been your experience in how people are accessing digital technologies. No, I think that's a very good concern. It's something we should continue to keep before us. I think as it pertains to world, there's been a lot of work, particularly You know, 2008 and between 2008, 2012 and investment in infrastructure and broadband access in rural areas. And so a lot of that has been enabled, if you will, at the infrastructure level. Still lots more work to do. Lots of places that still don't have access, but a lot
A lot less pressing advantage than it used to be. But then there is the the last mile of that, right? The front end, the patient utilizing that technology We've also seen a lot of improvements there. I used to go to these fairs and you see all these devices and and you know I've got a, you know, a few degrees And it was still a little cumbersome to operate. But it's gotten so much better. Now we're seeing a lot more cellular Enabled devices where all the member has to do or the patient has to do is to take their reading and it transmits for them. So if they can learn how to take a proper blood pressure reading, if they can learn how to take a consistent weight reading. Which we would need them to do in any case to monitor their condition on their own.
Then the technology takes care of the rest for them. And that's where we really need to be. We want to see more of that. We really haven't seen the adoption of wearables as fast as we might. And I think we'll see more of that. But a lot of the patients that we see who are 80, That's still kind of a foreign concept. And I want to see more of that. I think we will see more of that. But there are a lot of people who, if they have the traditional The device that they're familiar with that now do extra things for them. I think we're seeing a lot of traction with that. Great. And Eduardo, we'd love to hear about your experiences with the NHCI and then just overall with how American Heart Association is addressing access to rural communities. Absolutely. Thank you so much for having me with these really amazing co-panelists.
I'm going to do a little bit of a use case through the lens of blood pressure, high blood pressure, sometimes referred to as hypertension. So we live in a nation where we live in a nation where using AHA's definition roughly half of the population has hypertension. But let's focus on a different subset of that, which is the part of the population that has blood pressure that probably needs to be taken care of with medications. And that is still very high at one of three adults. With what's called stage two hypertension, they probably need to be on medications. And I'll talk about the probably maybe as we go down the road. So that's one challenge is one, it's a very common problem A very common problem that exists. Everywhere in the United States. And so when you overlay that with what is the reality in rural America.
Where there's basically less stuff in more spread out space. That's one of the challenges of of rural America. And so whether we're talking about healthcare availability. Healthcare access, which constitutes insurance cost transportation. And then add to that technology availability, access, affordability, and accessibility. It is both a challenge and an opportunity to think about how maybe connecting some things using technology may make it possible to overcome the fact that there's less stuff that's way spread out.
So the elements of blood pressure control include measurement. Management, which may include medication, particularly for that one out of three with that kind of hypertension I talked about. And I'm going to talk a little bit about some of the other issues that might affect someone's ability to take care of their blood pressure, sometimes called social determinants of health. Sometimes called non-medical drivers of health. And I say that because technology can actually help with that set of factors as well.
Back in the day. Let me stop for a second. So given all of that. In 2020, late 2020, an announcement was made that the American Heart Association would be part of the National Hypertension Control Initiative. It was an initiative that was aiming to improve blood pressure control in 500 federally qualified health centers.
Which are federally designated community health centers that provide care for 32 million Americans in the United States, all 1,500. These were the 500 that were lowest performing. Those 32 million are seen in the 1,500 health centers. They are by definition, low income. High percentage uninsured. High percentage black people, Latino people, and American Indian, Alaska Native people.
And oh, by the way, this project was going to take place In the early days, in the early part of the COVID pandemic. So, A, we had to figure out how to do some things virtually, including training and technical assistance. So I would say to you, what we learned was how to best use technologies to support three really essential elements of any healthcare ecosystem. The healthcare system itself, and we learned how to do training and technical assistance to those providers. Practice site factors, and I'll come back to those. Those include some of that training and technical assistance. But electronic health records and use of self-measured blood pressure devices, home blood pressure devices for patients. That is connected between the practice side and home. And then patients are another really important factor. And before I go any further, I just want to say full disclosure.
Canary Telehealth was one of the partners that participated in some aspects of The National Hypertension Control Initiative So we came to realize a few things. One, technology can be used to do virtual care. And I was going to say that back in the day when I was coming up in an FQHC, when I thought a patient might have high blood pressure, I measured it, I measured it. That's an important point to make. I measured it, a doc measured it in the clinical care setting. We've learned now and know that docs may not be the best at doing it, and we probably ought to be using digital devices as opposed to manual devices where people are using stethoscopes to listen to sounds. And that patient would come in and I would see them and I'd say, Ms. Jones, your blood pressure is high. We're going to put you on this medication. I'll see you back in three months. Rtc in three months was like the standard, not a good standard. Because I might not have gotten Ms. Jones blood pressure under control in two to four weeks. Which is what we ought to be looking at. And three months is way too much time for Ms. Jones to be walking around with elevated BP. And then she might come back three months later and say, oh, your blood pressure is not elevated. And Bad Me would say, oh, maybe you should eat less salt. I'll see you back in three months.
Bad answer. Or I might say, let's put you on medications. I'll see you in three months. That's half the right answer. Should see you back in two to four weeks. So what we've been able to do and figure out with the National Hypertension Control Initiative and all the research that's out there, including the kinds of work that Carla's doing.
With Canary Telehealth is that one can do a few things. One, we got to confirm that someone's blood pressure is elevated. That can be done in a person's home using technology, using the right protocol to determine that blood pressure is elevated. When that person's blood pressure is elevated, Ms. Jones doesn't need to come in anymore to get a prescription because I can digitally contact the pharmacy and in fact. In a better case, the pharmacist is involved in the care and is seeing that data and can say the best medication might be X for Ms. Jones because here's the other things that she's on in her other medical conditions along with the doc. But done at the pharmacy, which is closer to that patient in rural America than maybe the clinic is, and or it obviates the need for a two-hour drive. One hour, one way, one hour sitting in the waiting room and waiting and getting seen and getting evaluated and discharged in another hour home, three hours of one's life. And if that blood pressure change is made, somebody on the health team can call Ms. Jones and say, Ms. Jones.
In two weeks, please do that protocol again. And we will try to Let's see what your blood pressure is doing. If blood pressure is controlled. Then it would be appropriate to perhaps return to clinic, see you in three months for all the other things that we need to do, cancer screening, vaccines, et cetera. Or no, we need to make another change. Here, go to the pharmacy and in two weeks, we'll do this again.
There are ways to lighten the load on the system, lighten the load on the patient. Having said all that, Carla and Yana have experienced that you have to have things right. And this is where I'm going to stop and then we'll let it go to questions. The healthcare system has to be thoughtful and keep up with and know all the capabilities of the EHR and other aspects of what it is doing, including its connection, for example, with a remote patient monitoring platform. The practice site also has to have some understanding of its own EHR as it relates to the work that's going on in that clinical care setting, but also understand the connection to those self-measured blood pressure devices, whether they're cellularly enabled, Bluetooth enabled, connected directly to the EHR, or connected through a intermediary or remote patient monitoring. Platform. And then on the patient side, it's important to know, does the patient understand how to use this machine, have the ability to purchase the machine or have it delivered to them and also do those protocols and be able to participate in his or her self-management.
So I'll stop there and just say, I think the promise of technology is very, very high. There are some details that we need to be paying attention to and learning from some of the pitfalls that are overcome that then we can apply to how we do it tomorrow as opposed to how we did it yesterday. And I'll stop there. So, Eduardo, just a brief follow-up on that. So you mentioned in rural areas there's less stuff and it's more spread out more He also mentioned in your experience, you would take the blood pressure We worked on a landscape analysis of the blood pressure devices back during The project and we we evaluated, you know, I think around 20 platforms We're in the process of like updating that and the number of devices and platforms has grown significantly. We know it's, you know, can you just comment on how important it is that the device is actually a valid device that actually produces An accurate reading.
I'm so glad you asked me that. Validated devices are vices that have been tested by a third party to assure their accuracy, reliability, reproducibility of results. And validate bp.org is a website that can provide that sort of guidance. Now, that sort of guidance not only for home blood pressure devices, and there are categories such as Bluetooth enabled, cellular enabled, EHR integrated, smartphone applications that are associated with particular validated devices. Validate bp.org gives you information about the device and other really important information because the EHR might be well matched. For the machine you have that the doctor's using, that's really important to know because that makes everything a whole lot easier. And then the other point that you were making, two points. I think both Carl and Yana mentioned doing it right, doing the blood pressure measurement right. And one of the things that the American Heart Association, along with the AMA, the American Medical Association through Target VP, and then also our materials through the National Hypertension Control Initiative.
Provide folks guidance, both visuals and then a visual as in a infographic, but also videos on how to do it right at home. So that you're not doing your blood pressure over your shirt. You're not doing your blood pressure while your bladder is full. You're not doing your blood pressure watching your favorite TV show that makes you really excited at your game show that you love to watch. The price is right. That's really, really, really important. In addition to all the others. So validate VP and then the right information for patients. And I'll just take the time to say one of the things that's really important is kind of figuring out the high touch, high tech. Because Ms. Jones may, in fact, the patient that Carla mentioned might be even a better patient who forgets How it is that she's supposed to do her machine, because I think I remember, Carla, you saying that patient has some cognitive issues.
And all that patient may need is a call from somebody from Canary Telehealth. Same as Jones, remember, let's walk you through the steps. And may not need to talk to Ms. Jones for another few weeks. But that kind of ability to engage somebody with some high touch. Culturally, linguistically appropriate customer service also helps particularly on the patient side. But I would say to you that what we learned through NHCI is that kind of Tailored. Customer service and technical assistance is very, very helpful at the practice side as well. Those practice sites are different than others. They don't have… IT officers like maybe a health system has, and they might need, I don't want to use this term pejoratively, but they may need some hand holding. I hold my mom's hand. I hold my mother-in-law's hand. I'm holding it out of love, not out of anything pejorative. They may need a little handholding to get from where they are to where they need to be. But you got to start with a validated device.
And then some of the wraparound that might help a person make best use of that device the clinical site make best use of that device. And the health system, which is trying to track what's going on with our patients with hypertension, get a better handle on what percentage of folks are at the blood pressure level that they're trying to achieve. Thank you. You've all really set the stage. I want to encourage the audience, if you do have questions. To use the Q&A function, we'll try to get to as many of those questions. While those questions are getting teed up, you set the stage for what to be excited about and what's out there. Yana, let's start with you. What are some of the challenges or barriers? What is in your way for really achieving this potential and what are some of the strategies you're using to mitigate some of those challenges?
Yeah, you know, I think that one of the One of the things I think we've already touched on, which is access and not ensuring that technology is not amplifying where there are disparities. And I think both Eduardo and Carla commented on kind of what they're Their teams have been doing. I think very similarly We, you know, years ago when we had started out had started out with an app and realized very quickly that that would not work. We moved away from requiring Wi-Fi connection or Bluetooth to To provide services. When it comes to visits, we've really leveraged just use of smartphones. So just clicking a text message link. When it comes to devices, we actually really much lean into simple blood pressure cuffs and scales. It's worked for our group. So I think one key for us in terms of mitigating the remaining disparities out there i think um Those have been good workarounds. I think a lot of focus is also on the reimbursement landscape for telehealth. I think we could probably have an entire Discussion in itself. I think a lot of questions coming our way just with the Right now, policies kind of going through September 2025 on expanded access.
Eligibility, the impact to audio only services, difference between behavioral health coverage and other specialties, I think is certainly top of mind for folks. I think for us, we have, because we've provided kind of a broad range of services and the way they've been built out and the partners we're working with. We do think that will have a minimal impact with that, but I think largely the telehealth landscape as a whole, folks are nervous about. I think for us, we've been able to support the infrastructure to kind of support that. But I know that is I think that's often top of mind for folks and will continue to be top of mind.
I think until folks feel a little bit more stability in that landscape. Carla, how about you? What are some of the challenges and barriers and what are you doing to mitigate those? Yeah, I think one of the ones that we've discussed earlier was the social determinants of health. And we certainly see that. And so that it was coming up kind of in an ad hoc fashion, I would say. And now we've implemented screening for that in a structured fashion because we know those things exist and how do we get ahead of that?
And to help people to help people in an instructor fashion, connecting people with the social services that they need to participate in the program. So we provide and more broadly to participate effectively in the management of their care So I think in many times if we're not being deliberate about addressing those. Then they're going to create barriers and impediments to the programs that we're rolling out. I think there are some particular reimbursement issues that are particularly acute in rural communities just because of the way Medicare does the payments and the geographical payment index, the reimbursement is actually lower in rural communities for RPM than in other areas. So there was some legislation that was introduced just last week seeking to kind of close that gap.
And then the last piece I would say is there are a lot of people who don't necessarily qualify for nurse monitoring, right? Like clinical nurse monitoring it may not be warranted or don't have a reimbursement path to that. So Medicare reimburses for it, but some commercial plans still don't. Medicaid in many states often does not. And so what we found is we're able to serve a population of people who can work through a self-management program through a digital health app. So I think about it as kind of a portfolio, right? You've got people who need the attention of a nurse, you have people who who have that reimbursement option. Then there's a whole host of people and I just think about The folks that Eduardo mentioned. You know, one out of three is a lot of people, right? Half is a lot of people and we're not going to get to all of them through traditional channels. And so some of the community-based organizations that we work with, they're out there in faith-based organizations. They're out there and it would be a barrier for them to for their constituents, so to speak, to participate through traditional monitoring.
But with the app and combined with a health coach, there's some tracking that's able to take place or some education that's able to take place. We educate them on life's essential aid. That's able to take place. And now they are, and we've got really, really great results with that and seeing double digit the clients in systolic and really impressive improvements in diastolic VPs as well. And people are having more educated conversations with their doctor And so it's appointing them back to their provider is where I think the real magic in this happens. Instead of living with side effects and therefore parking the medication, right? They're understanding that there are options and alternatives and being encouraged to seek out their provider. So I think the barriers really is the more we can foster that communication with the patient You know, as mentioned earlier, three months is a long time, right? And so the more that we can be that touch point in between to foster the communication with the patient. The better results I think we'll see.
Eduardo, Carlo mentioned social determinants of health. She also mentioned life's essential aid. Could you talk a little bit about social determinants and also non-medical drivers of health? Absolutely. And Carla, thank you. All that you said is a great setup. And one of the reasons why it's important is that among that one third. That have blood pressure that probably needs to be taken care of medications. And I'm going to stop there for a second because I've said it like three times now. In the ideal world and in the world that we operate in, it is possible in some patients to get them off of medications. And sometimes I am, put the challenges put in front of me. Well, why don't you start with lifestyle? And what I say is, and I hope you all agree, is that the medication will bring someone's blood pressure down to a level that their risk of having a heart attack, a stroke, exacerbated heart failure, and doing damage to their bodies is almost immediately brought down. Whereas lifestyle change, which can be quite effective, can take a while to get there. You don't go from And I'm not suggesting that everyone's a couch potato, but let's just start in worst case scenario. You don't start with couch potato.
To a world-class athlete. That doesn't happen overnight. That doesn't happen in two weeks. So I found when I was in clinical care that doing both with the hope and even the aim down the road of maybe reducing medications or taking people off was very realistic. But let me go back to the social determinants of health because that's really important because there's great national data that says when you look at things like education level, folks who have not graduated from high school, for example, have lower blood pressure control than people who've graduated from high school. It's not a question of being smarter. It's probably a question of the resources that one has when one is at one level or another, because when one looks at income, there is absolutely a relationship, again, a lower household income
Translates to lower levels of blood pressure control than higher levels of income. And lastly, what kind of insurance you have also makes a difference. In general, not having any insurance at all. Way lower than people who have insurance. Now, those can be mitigated by understanding what might be the challenges associated with those things. And so out there, there are social navigation, social needs platforms in addition to some of the things that exist, such as Canary Telehealth, where an individual can go on a website, kind of do a little bit of, or someone on their behalf can go and look at what might be a social determinants of health issue. And then connect people to resources. In urban areas. Where there is more stuff that's less spread out. And notice I keep using those technical terms.
It is possible to say to somebody, we'll go to that place that's a mile away and go and get some services. That may not be as easy to do in a rural community. We did some work in NHCI looking at what are the things that when people use social navigation platforms, they are seeking to get some help with. And the top 10 include, I'm not going to read all of them, food related Demands. Housing related demands, help paying for rent or to pay their bills. A dental care came up in the top 10. And transportation came up in the top 10. Transportation for healthcare came up in the top 10. So think about it. If you're challenged with purchasing food and or paying the rent. Medications may fall to number three or number four or number five on the list of things I got to pay for today in order to be able to feed myself and or have a roof over my head.
It also allows the healthcare provider and or the social service agency to begin to try to mitigate those things because when those things are addressed. We also find people's blood pressure increases. I will say that as it relates to opportunities to support use of health IT. I think it fits in the way I've thought about and we tried to deliver the National Hypertension Control Initiative systematization and leveraging systemness when that's possible. So if a provider is part of a large health system. How do you leverage that large health system to support the primary care doc? Oh, and oh, by the way, I do want to mention 80% of hypertension care is provided by primary care docs. So all our solutions need to think about primary care sites.
All our solutions need to think about how to support primary care in order to get this work done because, Jana, in those same counties. That don't have cardiologists. They generally don't have even a primary care provider available. I know because I read the article. I reviewed the article. And help provide some feedback in that vein that there's a paucity of a lot of stuff when there's not a cardiologist and it's important to know all of those. But systematization and protocolization. So rather than ad hoc ways of doing the work.
How does one maybe create the tool that helps a practice All practices use generally the same approach to procuring validated devices And then distributing those validated devices to their patients, whether that's who should get them and how to do it. So more HIT training is probably important. And more training may sound awful, but you can't use a thing that you don't know anything about. So the right amount of training. Consistent communication regarding HIT, whether that's the EHR is going to undergo an upgrade or we're adding something that's going to allow us to do social determinants of health Or not take in the data from home blood pressure devices and calculate A equivalent blood pressure control level for that patient. Consistent support for patients regarding their use of technology. I talked about that earlier.
And defined roles in a practice setting about who does what when a technology issue arises. If it's related to the patient, it may be one set of people with one set of skills. And when it's related to the hardware or software. Obviously is going to be, or no it probably is a different person and a different set of skills. So I hope that was helpful. And I think one last thing is that The social determinants of health platforms and even Canary Telehealth, I don't say even to make it less than.
Canary Telehealth probably has the capability of populating and bi-directionally populating data that would be important not only for patient care, but for the patient. Patient care for the care site, but also some system insight that might say, as an example, in this particular facility, there's more people who have social determinants of health issues that look like this Versus this practice, it doesn't have any versus this practice that is a different set. And you might organize the way you do things at a system level based on those kind of insights. So the technology provides all kinds of Data that maybe is less use. That's a great question, Pamela Frank. Great. So we have a couple of questions. One is, given the barriers to PAD diagnosis in rural areas. What Evan then supports expanding early detection, especially within primary care And have any models shown to measurable improvements in outcomes? Anybody want to take that? So I'll give it a first shot. And would say the evidence base still is We'd like to see more evidence. What I would say to you is that as it relates to PAD, where there's still opportunity to do better without necessarily Looking at a brachial ankle index.
Is around blood pressure control, cholesterol management, glucose management. There's so much room to do that better. And once you get started with that, doing the things that you as a as a clinician feel like ought to get done to provide you with additional information. The other is while you're doing that to understand a risk profile and then do that which The risk profile suggests you should be doing. But blood pressure control, room for improvement. Statin management, there's less room for improvement, but there's still room for improvement. And I would say to you that understanding that someone has prediabetes and or diabetes and doing what needs to be done another place. For improvement. And once you've done that, you've got a good risk profile of that particular patient and you take the next step on PAD. Yana, is that anywhere close to being right? Yeah, I think so. I think the key that you hit on is for those higher risk patients, identifying what those risk factors are. These are particularly patients who are above the age of 65, 70, smokers, diabetes.
Have an abnormal exam and maximizing medical therapy for those key categories, including blood pressure, lipids. I think everything you hit on, Eduardo, and we'll continue to see, I think, the evidence evolve as it comes to screening. But when it comes down to these patients It is an indicator of broader cardiovascular risk, and so we have to be super aggressive with the medical management of these patients. We also had a question. Yep. I think it's worth saying, Patrick, one more thing. I think it's worth saying that. The American Heart Association had released, published. A new risk estimator that is an estimator for cardiovascular disease. Coronary artery disease and heart failure itself. Not yet PAD, but I would say to you that We're moving in the direction of being able to provide that kind of risk estimation for clinicians and for patients. It's coming. It's not here yet.
We had a question also. We're talking about things like, you know, blood pressure cuffs but I wonder if anybody has any ideas on access to cath lab deserts or other forms of lack of access. I think that we'll just… I was just reading an article in Forbes last month just talking about the, you know, essentially a crisis in terms of this lack of access and you can't really have you know specialty center that's doing you know one procedure every few months for a whole host of reasons. Mm-hmm. But, um. I had the opportunity to tour University of Chicago Medical Center a few months ago During the Go Red for Women month here in Chicago.
And to see the robotics. In action. It was just really, really amazing and phenomenal. And it is um purported to be a, you know, a potential part of the solution for these rural areas. Where open heart surgery being done, I mean. I'll put it in my terms, it looks like being done by joystick. It's really phenomenal. So I think there's a lot of technology solutions that are I would say here in various stages of being implemented and rolled out. But I found that to be very encouraging. Great. Well, I'd like to start the backside of this webinar by Having everybody talk about, you know, what are you most excited about? And in that context, you know, what does the future look like in this topic?
So again, we'll start with Yana. Sure. I think more so to answer the second, what is the future going to look like? Not that I'm most excited about it, but I mean, I think we all have to kind of pause and recognize the supply demand mismatch that exists now and that is going to Continue to grow. From a supply side.
The sheer burden of cardiac disease will continue to go up in terms of cardiac burden. It's estimated about 45 million plus will have cardiovascular disease by 2050. Stroke prevalence is going to double over the coming decades. Heart failure will continue to grow. And particularly the areas of the country. Here we're focused on rural. Right now, at least it's projected that the disparities are only rising, right? So if you look at particular rural areas. Patients are living shorter lives. So that gap has been widening. Patients are getting sicker and our cardiology workforce is also vulnerable, right? About 23% of cardiologists plan to exit the workforce or change professions in the coming years. And so on the demand side, we have a growing burden on the supply side we are um We are not projected to keep up with that burden. And I think that it's not really a lofty concept that we have to use technology and innovation to really deal with these problems. I mean, it's reality. I think in order to accommodate The growing needs of the population. We have to get more organized on a population level. We have to diagnose those at risk early. It has to be focused on preventative therapy. And we have to have to leverage more innovative pathways in order to manage disease earlier.
And in order to do that, we cannot rely on sending all of these patients to brick and mortar care. We don't have capacity. Patients won't make it there. It's not going to be effective. And so to really look ahead in the coming decades. We're going to have to get more organized. And I think leveraging these virtual first pathways is going to be a really strong option for us to keep up with the pace of disease and focus more on preventative therapy. Carla, what does the future look like for you? I think I'd have a similar story that um just more decentralization of the care. So there is you know, in some of these rural areas, the independent pharmacy is the last man standing, right? That we don't see, obviously, especially centers of primary care providers, as we talked about. And then there's rapid acceleration of closure of the big chain pharmacies. And so I think we already see that pharmacists are doing works like flu shots, blood pressure checks, some chronic disease counseling and the like. And so I think more technology enabled empowerment of pharmacists, I think is going to be a key P. Key piece of this ecosystem that's really important. And then even beyond that, just pushing more of the care into the home, both for the purposes of prevention As well as for the purposes of chronic disease management and monitoring.
Great. We're going to have Eduardo close us out, but before we throw it to him, I do have a couple of things I do want to mention. So, Eduardo, you mentioned training. And our sister center, the Center for Telehealth. Has developed a certified professional of the American Heart Association for Telehealth, telestroke and an area where our center, the Center for Health, Tech, and Innovation, has been very involved. It's digital health and cardiac care. And we're going to be coming out. Stay tuned because there's actually going to be a certification. You'll be able to sit for and become a certified digital health professional from the American Heart Association. So that's very exciting.
We are also, our next webinar for the CHTI is going to be on the future of brain health. Where technology meets neuroscience. And that webinar is on June 11th, 2025, so a little bit over a month from now. Stay tuned on our social channels for more details. But Eduardo, close us out. Tell us what the future looks like from your perspective. Something I didn't share with you and the audience that I think is worth sharing is that In those, it was 350 of the 500 community health centers where the American Heart Association did training and technical assistance and partnered with Organizations like Canary Telehealth. In those facilities, there was almost a 20% improvement in blood pressure control. So I'm enthusiastic, not so much that I was involved with that. It's that improvement can happen. And I would also say to you that there might have been opportunity to do more had we had a little bit of more time And been able to overcome some of the friction that is just the reality of doing a project like this.
With the scope that it had. So I think that the future is about leveraging what we have Now, what we know now to do some things fairly immediately I am somebody who has an engineering background, and I like to say we didn't get to the moon. We got to the moon with systems engineering along with rocket scientists because it took a lot of people on the ground in the rocket, out there. It took a lot to get it done. And I think that systems engineering approaches today That are human design informed and AI influenced can get us a whole lot further. And we might be able to get figured out things like virtual training and technical assistance. Virtual patient care in a hybrid form. Decentralization that is connected to a system. That enables tech to support not only the work that's done by those pharmacists that are out in those places. But also the community health workers that might be able to overcome that last mile and be a part of the eyes and ears of a team. I don't know about y'all, but I had the opportunity to do home visits Back when I was in training, this is nothing like doing a home visit to understand non-medical drivers of health.
It's hard to do things when seven people live in a house that only has one bathroom and two bedrooms. And that's the reality for lots of folk out there. And we should be mindful of that. Community health workers can be that extension. And I'm going to leave you with what I think is a very apt quote. It's Hans Rosling who said, I'm not an optimist. I'm a very serious possibleist, and I believe that it's all there. It's a matter of connecting things the right way. I do think we need to figure out how to pay for it. But I would argue that if we did some of this through the lens of blood pressure control, what we could achieve by lowering the burden of disease downstream could help us figure out the ways to pay for the things that happen downstream that we couldn't Have known we're coming or have prevented. So, Patrick, thank you for inviting me.
Thank you. Thank you to Yana and Carla as well. Great conversation. This session is recorded and it'll be up on our YouTube channel in a couple of days. We'll send out an announcement on that. With that, thank you all for a great conversation.
Thanks.Pleasure
2025-05-12 12:10
