Key Takeaways
- Healthcare leaders must treat digital health as a core strategic imperative to counter unsustainable costs and competitive encroachment from retail giants.
Digital health is no longer a side project; it’s the front line in the fight to save American healthcare from unsustainable costs, burnout, and vanishing access in rural communities. The stakes are high: U.S. healthcare spending topped $4.5 trillion in 2022 and continues to outpace inflation and GDP growth. Leaders are desperate for solutions that don’t just digitize paperwork but fundamentally change how—and where—care is delivered.
That’s why voices like David Fletcher’s, System Director for Telemedicine at Vandalia Health and veteran digital health consultant, matter more than ever. On a recent episode of The American Journal of Healthcare Strategy podcast, Fletcher unpacks two decades of telemedicine leadership—from the early days of rolling video carts in Arkansas to today’s AI-driven, consumerized platforms. His perspective is unique: he’s been inside both academic medical centers and payer-provider hybrids, has watched big tech’s march into care delivery, and now consults for organizations racing to keep up.
The central question: Can digital health and telemedicine not just improve but truly save healthcare? If so, who stands to win—or lose—in the coming transformation?
Short answer: Two decades ago, telemedicine was clunky, expensive, and a logistical nightmare—yet it was already closing gaps for patients in underserved communities. That early innovation, says Fletcher, built the foundation for today’s explosion of digital health tools.
“We were in Arkansas, kind of surprisingly an early adopter… Our Medicaid plan really invested in it, and that helped us get it off the ground before a lot of health systems really were able to.”
In the early 2000s, video visits meant rolling a bulky cart with specialized hardware into a rural clinic. Broadband was so scarce that Arkansas needed a $102 million federal grant to connect its counties. Even then, patients would travel to a local clinic just to use the video cart to consult with a specialist at a distant academic center.
Why this matters now:
The need for infrastructure investment—like broadband—remains a policy challenge in rural America.
The early days instilled a focus on value creation and equitable access:
“When I was finally implementing new programs, I had that background of thinking about value and equitable care across a lot of demographics… That’s part of what I do every day.”
Many U.S. regions still face the same digital divide, making lessons from those pioneering days relevant to today’s leaders and policymakers.
Key takeaway:
Digital health’s origins were pragmatic, focused on necessity and equity. Despite the tech revolution, some barriers haven’t changed—and those who ignore the infrastructure gap risk repeating history.
Short answer: Telemedicine has expanded from specialty consults for the few to mainstream primary and urgent care for the many. Consumer expectations, not just technology, are driving this reversal.
“It used to be that in Arkansas, our whole bread and butter was we had the only Maternal Fetal Medicine specialist in the state, located in Little Rock. That was a big point of emphasis. But now, it’s really expanded. Primary care offices are doing it, urgent care—all that.”
Why did this shift happen?
Consumerism: Patients expect healthcare to match the convenience of apps like Uber or Netflix.
“Patients have come to expect that as well… so you see Amazon, Walmart, Dollar General getting into that space.”
Wider broadband and smartphone adoption: Most Americans now have a video-enabled device in their pocket.
COVID-19 acceleration: Even small hospitals had to adopt some form of telemedicine during the pandemic.
Implications for leaders:
The competitive threat is no longer just the hospital down the road—it’s tech giants and retail chains moving into healthcare.
If your organization doesn’t offer virtual urgent or primary care, expect to lose those patients to someone who does.
Key takeaway:
Telemedicine’s scope now covers the full continuum—from chronic disease management to urgent care—changing not just who delivers care, but who owns the relationship with the patient.
Short answer: Telemedicine is a subset of digital health. Digital health is the bigger, messier universe—encompassing data analytics, connected devices, AI, and workflow automation, in addition to virtual visits.
“Telehealth is a component of digital health. I think of digital health as the harnessing of two major forces for improving patient health: data/information, and technology.”
How does this play out operationally?
Telemedicine = direct patient-provider video or phone encounters
Digital health =
Remote patient monitoring (e.g., weight tracking in CHF patients)
AI-powered triage or scheduling
Digital stethoscopes and diagnostics
Data-driven population health
Why it matters for strategy:
Digital health enables earlier intervention.
“If you know in the patient’s home that they’ve been trending in a bad direction, you can intervene earlier… Particularly for chronic diseases, where a lot of the healthcare dollars go.”
Backend optimization: Much of the impact is invisible to patients—improving patient flow, decision support, and population health management.
Key takeaway:
Executives must see telemedicine as only the entry point. The broader digital health ecosystem will separate winners from losers—by enabling smarter, more scalable, and data-driven care.
Short answer: We’re on the cusp of a real shift—because payers, not just providers, now demand value. Digital health tools will be essential for making value-based models viable at scale.
“The payers are really pushing for that… The healthcare cost just can’t continue to grow at the rate they have been. If you’re a health system and you’re on the hook for the overall health of patients, how do you manage them if you don’t know they’re sick until they show up in the ER?”
Key drivers:
Shared risk/shared savings models are becoming more common, even if full capitation remains rare.
Digital health provides real-time, actionable data for proactive management—identifying risk and intervening before costly hospitalizations.
Payers and consumers are both demanding care “closer to home.”
Less expensive for the payer
More convenient for the patient
What about provider incentives?
In fee-for-service worlds, preventing ER visits can paradoxically hurt a hospital’s bottom line.
“You’re essentially punishing yourself for doing those things… That was a big reason I wanted to go to Geisinger—because they were both the payer and the provider, so it made sense to invest in prevention.”
Key takeaway:
As the industry transitions to value, health systems that master digital health will thrive. Those that stick with fee-for-service—and ignore the digital imperative—will see margins and relevance erode.
Short answer: Small and rural hospitals face existential threats from Amazon, Walmart, and others. If these giants withdraw, communities could be left with no care at all.
“Primary care isn’t really where most health systems make their money… it’s kind of a loss leader, but it’s how they get patients into their system. If Walmart takes those, when that woman decides to have a baby, is she going to have that hospital there to deliver?”
Potential scenarios:
Retailers win the “front door” (primary/urgent care), draining health systems of revenue and referrals.
Hospitals close:
“If Walmart leaves, you could have thousands of people in the middle of the U.S. with no healthcare access… They’ve got to drive two hours just to get basic care.”
What should small systems do?
Invest in digital tools now to keep patients in their ecosystem—even if it feels like a stretch.
Seek outside expertise to overcome organizational barriers.
“It’s difficult to know whose job it is to do telemedicine… Sometimes it’s important to have a neutral party help set it up.”
Use telemedicine to address provider shortages—by extending reach through remote staffing or partnerships.
Key takeaway:
Ignoring digital health is not an option. Small health systems must “go digital” to remain viable—or risk being replaced by retail and tech giants who may not stick around.
Short answer: Focus on two leverage points: organizational clarity and creative workforce solutions.
Clarify ownership of telemedicine and digital initiatives.
Many systems are organized by service line; telemedicine cuts across these lines.
Appoint a leader or team—or bring in outside help to launch and scale digital services.
“Just getting through those organizational barriers is huge. Sometimes an outside consultant is key.”
Use digital health to solve provider access challenges.
Virtual nursing: Experienced RNs can work from home doing admissions, discharges, and paperwork.
License portability: Partner with telehealth firms to tap providers licensed across multiple states.
Leverage labor flexibility:
“Sometimes providers are willing to take a little less pay for the convenience of working from home—especially with young kids or lifestyle needs.”
Additional ideas:
Keep digital workflows simple, especially for older patients.
Embrace digital health as a tool for both patient retention and workforce sustainability.
Key takeaway:
There’s no “one size fits all” solution—but leaders must act now to build organizational muscle around digital health, before they are forced into it by outside competition or crisis.
Short answer: The biggest misconception is that older adults won’t use or benefit from digital health. Data shows they love it—if it’s designed with them in mind.
“Older patients absolutely love it… Our surveys at Geisinger would start with ‘I actually’—because there was a little surprise at how much they liked it. If you make them go through 30 steps, yeah, they’ll be frustrated—but so will younger people.”
Why does this matter?
The U.S. population is aging. Failing to engage older adults digitally is a strategic error.
Digital health can reduce social isolation, transportation barriers, and care fragmentation for seniors.
Leadership takeaway:
Don’t design digital health “for millennials only.” If you simplify the experience, older adults can—and will—use it, driving outcomes and satisfaction.
Short answer: Digital health alone won’t “save” the system, but it’s a necessary foundation for everything else—value-based care, workforce flexibility, and consumer-centric service.
Fletcher’s experience across health systems, payers, and consulting gives him a unique vantage point. He’s clear-eyed about both the promise and the pitfalls.
“I’m not opposed at all to Amazon and Walmart… They’re super convenient, and I hope they push the industry to get more consumer friendly. But I also want to make sure we don’t lose those hands-on, local health systems that do the hard work when people need it most.”
Whether you lead a multi-state system or a rural hospital, the message is clear: digital health is not a distant threat or a luxury—it’s the new cost of doing business. Leaders should:
Map your digital health capabilities against patient expectations and market trends.
Invest in broadband, workflow redesign, and digital literacy for both staff and patients.
Partner—don’t compete—where you can’t build expertise internally.
Design solutions for all ages and abilities; simplicity wins.
Monitor the competitive threat from retail and tech, but use it as motivation, not paralysis.
The future won’t wait. As Fletcher reminds us, “the main thing is to keep these kinds of digital tools available, or risk losing the local access that communities depend on.” The digital health revolution isn’t about gadgets—it’s about survival.
For more insights or to connect with David Fletcher, System Director for Telemedicine at Vandalia Health, visit Fletcher Health Consulting or follow him on LinkedIn. For strategy leaders, now is the moment to take the next step—before the choice is made for you.
<p>[Music] hello everyone this is Cole from the American Journal of healthc care strategy and here with me is David Fletcher a longtime uh digital Health executive David please introduce yourself Cole thanks very much I'm as you said David Fletcher and I'm currently uh have my own Consulting uh company called Fletcher Health Consulting um where I I work absolutely in um digital health and telea health tele medicine um increasingly with AI as well and Healthcare and before that you were at uh ginger as the AVP of tele medicine and then you had been working with University of Arkansas and tele medicine for many years and then before that you in tele medicine as well so you've been in this digital Health space for a long time how many years has it been that you've been working in digital Health yeah I'd say 20 years now that I've been in uh in digital health and it's it's a new enough industry that uh I I always joke I'm kind of the grizzled old man of of tell health because we were we were in Arkansas kind somewhat surprisingly we were a pretty early adopter of it we uh we had our our Medicaid plan there really invested in it and uh that that really helped us kind of get it off the ground before a lot of Health Systems really were able to so yeah um last 20 years really been in in uh digital health and then really before that mostly was kind of a data analysis and program evaluation um which at the time you know I was like oh wow you know I'm not sure if this is where I wanted my career to go you know this is kind of drudgery and things like that but I will say uh I uh it ended up being enormously beneficial to me it was H you know the really so your early career kind of stuff has benefited you uh this this far out absolutely absolutely so it really changed the way I thought about when I was then when I was finally you know implementing and doing new uh programs it it I had kind of that background of of thinking about things in terms of what value is this creating and I actually I worked on site with the Arkansas Medicaid Program and so I got a a flavor for how policy makers think about things and and you know how important it is to kind of show Equitable care across a lot of demographics and and you know show that you're creating value and and doing things in a very efficient manner so it ended up being a uh very useful I use it you know that background is part of what I do every day for sure excellent that's always I I try to tell people too and we've heard a lot of fellows even say this that they didn't you know go into school for that reason or X Y or Z and then they're seeing it benefit them even five years out and didn't think it would so that that's incredible what did that tele medicine look like back in like 2005 I mean that's you know a couple years after I was born there um so what you know are we are we doing video is it over the phone what did that look like sure yeah so it was at that point we were mostly doing video um now we had a lot of of caveats to that compared to now so so really it was mostly like a big old cart which we still use honestly to this day but but we were beholden to it we didn't have necessarily assume that oh everybody of course has a video device in their pocket at all times like awake or asleep on them you know we really had to kind of have so really it was mostly folks coming into a clinic maybe in say a small Hometown far away from an academic Medical Center um and then we would have that cart in there and then we could if we had the Broadband we could dial up that card and and get access to a specialist that way um so and you know that was a huge challenge at that point too you know we actually in Arkansas we got a like $102 million Grant to expand Broadband all through the state specifically for that purpose to to allow us to get tella Health all uh you know to every County in Arkansas um so yeah we've come a long way there you know now it's so ubiquitous you know mo most folks have a have a smartphone have a you know a smart device and and Broadband can still be a challenge in certain rural areas areas but you know pretty pretty broadly uh adopted at this point do you think there's like a shift now where instead of using tele medicine to see a specialist it seems like people are going to see the specialist in person but they're doing tele medicine for Primary Care it almost seems like it's kind of been reversed well I'd say it's it's definitely expanded to that it's you're right it's it it used to be almost like in Arkansas that that was our whole bread and butter was we had a a the only Maternal Fetal Medicine specialist you know they they deal with high-risk pregnancies the only ones that we had in the state at the time were located in Little Rock which is basically Smackdown in the middle of the state so that was a big point of empasis at the time but you're right we weren't really doing Primary Care Urgent Care all that kind of thing now um that's really expanded so that Primary Care officers are doing it and I think you know as consumerism has really picked up and you know Netflix and uh you know Uber and these kinds of things like we don't hoof it around and look for cab and wave them down anymore we hit a button on our phone you know and uh so patients have come to expect that as well and uh and so yeah there's all kinds of virtual Urgent Care um now and and I think that's something that we're going to see a lot of you know as we go go forward is that folks are going to expect that and that's why I think you see like Amazon and Walmart and Dollar General and people like that are getting into that space um because it's you know consumers really are demanding it yeah Amazon's I I think it's uh one I think are they the one medical I think that's what they're called and they're $10 a month right and you can uh you know have like unlimited access to some things I guess so when you you decided to leave Arkansas and can go to Danville Pennsylvania for what was the reason for that change what what made you move over there yeah so the biggest reason was that Ginger is um a fully Integrated Health System meaning they both a insurance plan and a and a hospital system and that's very helpful in the tah Health World um particularly because there are a lot of things that we can do using digital tools that will prevent an issue um which makes all kinds of sense in a value-based world or where you are the payer if you're both the payer and the provider um so I I don't want that patient to get sick because then I've got to pay for it whereas if you're just a straight provider in a feif for service World which is what Arkansas was just didn't have that much very much value based care in a way you're hurting yourself it's like oh that's great that you prevented somebody from having to come in uh with their you know their diabetes you know spiking um but now I can't build anything you know and you know of course providers want to do the right thing I don't mean to make it mellan but they're you're essentially punishing yourself for doing those things so so that that was a big reason I wanted to to come to Geisinger and and it really helped us we were able to really grow that the tele health program you know I don't know 200 times previous volume because you know we we had that both sides of the of the operation there right that and I I did read about that and it does seem like you had incredible success there and then with that success you decided to kind of go into the Consulting but the Consulting wasn't specifically tele medicine it was kind of like a bit more broad right digital health absolutely can you help us understand what is the difference between tele medicine and digital health and like what does digital Health mean from your perspective yeah so that's a great question I would I would say toal health is a component of digital Health I'd say digital health is a broader umbrella for it and then the way I think of digital health and and I this is my personal opinion like you you could ask a hundred people experts in the field and you get at least 95 different answers if not a 100 um so the way I think of it though is really kind of the harnessing of of kind of two major forces for for improving patient health and so one of those is you know kind of data information you know kind of this data Revolution that we've had and harness you know marrying that with technology so like uh digital tools such as smart devices and and carts and digital stethoscopes things like like that so being able to kind of get all that data and honestly you know Healthcare kind of lagged in that and electronic data for a long time because you know we had paper records and you know and there were a lot of reasons for that it was it was very hard to kind of get everybody to coess around a couple basic you know uh standards for an electronic medical record uh but once we did now we have all this mountains of data and then that allows us that data can drive what's happening with all these tools and you know smart devices and things like that and and remot patient monitoring things like that so it's kind of the miring of those two technologies and using it for the purposes of health so you know like the data I think of you know I'm a football fan and uh you know it's metrics have just taken over the sport you know and and so there's all these talk this talk about you know like this is when you should go for it on fourth down and and they can now track like if you fumble in the third quarter you're odds of winning went down by X percent I mean it's it's amazing almost to a ridiculous extreme at this point and and so it's that that same kind of level of information now kind of getting into Healthcare where you know hopefully we'll we'll do even more good than uh helping Andy Reid know when to go for it on fourth down in in overtime what's interesting about that too is that it it hasn't necessarily impacted the like patients don't always notice that that these changes have occurred I mean some of the you know I was in the ER 20 years ago and the ER to me seems fairly similar a lot of this is behind the scenes right where the decision- making is so much better and the the patient flow is so much better but where is it going in the next five years do you think patients are going to have this like transformed experience like what are we really looking at over the next five years yeah so you know I think again there there's two major forces that are that are pushing in what I think is going to be a pretty big substantial change in how Healthcare is delivered over the next five years um on one side You' got kind of the payers and um you know I there's this big movement toward value based care now I can imagine most of the listeners already like rolling their eyes as I say this because as we talked about I've been in healthcare for you know 25 years and um I I'm pretty sure like the day I started I was told fee for service is dead it's value based care going forward we can't afford anymore and here we are and still it's still very common to have fee for service um but I will say those folks weren't wrong they were just maybe a little optimistic about how fast it was going to happen so even now there are a lot of value based kind of programs out there so like maybe shared savings or shared risk or something like that not necessarily just a per member per month but and I think that's absolutely we're getting very close to a Tipping Point and so it's it's growing the payers are really pushing for that because it it you know the healthcare cost just can't continue to grow at the rate they have been and so how do you how do you manage if you're a health system and you're on the hook for the overall health of patients how do you manage them because I mean if I don't know that they're sick until they show up in my ER what am I supposed to do so I think the answer to that is a lot of these digital Health tools so if you know kind of even in the patient's home that they've been trending in a bad Direction you can you can intervene earlier particularly for a lot of the kind of chronic diseases where just where a lot of the healthcare dollars go to um so you can track someone's weight if they're they've got congestive heart failure and see that boy you're you're you're getting you know a lot of fluid we need to you know you take up your medication something like that rather than oh my gosh they showed up in the ER they're a train wreck we're going to have to admit them it's a mess you know and so you know I think that's going to drive a lot of that kind of digital health and drive that PA that care closer to the home where it's less expensive and so the payers are going to be pushing that and then of course on the con the patient side exact same thing so like you know like we said you know Uber and all that you know patients have gotten used to the fact that you know rather than just being stuck driving to wherever I can find an an open urgent care I should just be able to do this now or like when it's convenient for me from my living room room um and so like particularly like say a a urinary tract infection as an example you know a patient might know I've had three of these in my life and I know exactly what this is but I I need a doctor to confirm it but you know I'm pretty sure I know and it's not a big deal I don't necessarily want to like have to drive out to an urgent care and figure out what to do with my kids and so they can just press a button and yeah doctor shows up and you know and I think that's that the consumers are going to be pushing for this as well and and so and it's you know a lot of the the industry is is making it easier so like V1 is a company I you know consult with right now they can stand up a an urgent care for a health system in like in as little as two weeks so I mean I think it's going to become much more ubiquitous as as we go forward and I think health systems are really like little local health systems are going to have to really start to think in this these terms too I think that's that's been a big you know the places you mentioned I've worked they were big academic medical centers so they had a medical college and you know Etc and a lot of Specialties and and I think during covid you know even just say a single 100 bed hospital in a you know smallish Community had to step up and come up with some tele medicine because you know things were closed and and and I think that's the question is like what's going to happen for those systems now that you know okay we're back to seeing patients in person do we bother to keep up with this and I think that that kind of consumer mindset is going to really force that otherwise you know I worry that some of the smaller Hospital Systems might start to lose out to things like Amazon and Walmart and things like that not that there's anything wrong with those organizations it's just that you also want to have the ability if you do need surgery Amazon's not going to do it you need you need a health system nearby to be able do it so we we don't want to have all of those go out of business because they can't meet the demands of the consumer for the Urgent Care and the primary care things like that so so that's part and that's part of the reason I wanted to get into Consulting as well is because I I really hope that I can I can help some of those health systems that maybe they don't have the volume to have a whole team of tele medicine experts employed um but they need some ability to provide these this kind of tele medicine Solutions so that their patients don't they don't lose all their patients definitely yeah cuz but so like what happened when uh Walmart moved into a lot of these rural rural areas I understand is a lot of the um small businesses that were selling similar Goods closed down that's right and so we're seeing a similar risk as what you're saying is now Walmart's moving into this health care so some of these smaller Health Care Systems are going to shut down what does happen when Walmart leaves we know that Walmart as a store has left some of these towns and now these towns they're 40 minutes without groceries right is the same thing going to happen when they leave without healthare are there just going to be thousands of people in you know the middle us that don't have access to health care that's absolutely my worry that's absolutely my worry especially because Primary Care isn't isn't really where most health systems make their money it's kind in a way often a loss leader but it's it's how they get those patients into their system and so when that say a healthy 20 year old woman you know gets uh you know basic visits a UTI say and if Walmart is taking those then when that that woman decides to have a baby you know is she gonna still have that hospital there to deliver that baby because Walmart is not going to do that piece you know and or is that hospital like they've lost all these visits all this Revenue they shut down and then yeah exactly exactly like you said that's my worries and then they got to drive two hours just to do a pretty basic you know a healthc care procedure so uh I think it's important that really even the smaller systems they can't just think like oh that's for the big systems to worry about like I I do think you know it's it's important for them to kind of keep these kinds of digital tools available definitely I'll ask for some pre- Consulting advice from you uh what What's one thing that you can tell some of these smaller systems you know we have some directors and VPS that watch this um what can they maybe do to to help stem the tide or you know what can they do in this situation yeah well you know I think you know one of the big challenges honestly for a lot of Health Systems and this is this is true for large Health Systems as well it's it's the organization uh and and it it's difficult in a way to know whose job is it to do tele medicine so in some cases you know we have a separate team like a geinger we had a tele health Team but traditionally a lot of Health System are kind of set up around either Specialties or service lines you know and it's and tella Health touches all of them really I mean maybe not Radiology or something but by and large women's health surgery all these different service lines um need telea help so then whose job is it to do it and and it it's it's something as simple as that can often be a big barrier and so I think sometimes it it is important to have just an outside person kind of a neutral Switzerland to come in and help set it up for them you know and I I don't mean to just plug myself there are other folks out there who can do that but I I think that is that is part of it is you know kind of uh just getting through through you know kind of some of those barriers the other big issue for a lot of rural Health Systems and this is definitely true guing or even as big as it is is access and and recruiting providers so you know as we you know all the providers that got burned out during Co and they've got so many administrative things on them right now we're losing them and a lot of them are retiring and so how do we how do and particularly it's particularly acute in rural areas so how do they even have a provider at the other end of the video call and and I think there's a couple digital Health Solutions can help with with that in a couple ways one is you can kind of extend your existing providers so so nursing is a great example my mother was a nurse and it's it's a very grueling job in many ways you know physically taxing and um and so there are a lot of you know nurses who get to the point where it's like they just physically can't walk the floor anymore they still got all the knowledge but they you know can't really work in the hospital but you can do virtual nursing where the nurse is remote and they can beam in they can do you know not every single thing there are certainly things you have to have Hands-On but like Admissions and discharges and you know things that are mostly paperwork they don't NE it needs to be done by a nurse but it doesn't have to be done by a nurse sitting in the room with you um right so so that helps and then the other big piece is a lot of what we call our provider shortage it's really more of a a you know a distribution problem so you might have like a ton of dermatologists in California but a handful in central Pennsylvania you know and and so that's the great thing with tella health is that it can kind of balance some of this out so like B1 as an example they have providers LIC Ed in multiple States and so you can work with a company like that and and get whatever specialist you need you know behavior is a huge behavioral behavioral health shortage so if you can work with a company that has Behavioral Health Providers they can be in any state as long as they're licensed in in whatever state you're in and so I think you know things like that are are going to be key for for some of these smaller uh Health Systems to continue to thrive I'll ask a quick question about that too my concern is if I was to hire like because I'm in Philadelphia um if I were to hire someone in New York City I would have to pay them like a lot more than I would pay someone from Philadelphia like my salary would be like two times what it is so how does that work with the tella Health like if I were to like recruit a doctor in California to do tella health for my company for example wouldn't I have to pay them like a California rate like how does that work yeah so it depends on what model so if you if you decide yes I'm just going to hire you you're an employee of my health system and but you just happen to work remotely uh that does happen we we did that at Geisinger actually that that could be an issue you know I think I will say in in healthcare it's not as pronounced as I think it is in other uh Fields like ours basically like management type things there it makes a big difference in like Physicians we tend to use things like AM AMC guidelines and things like that and every everybody kind of uses the same thing so there might be some variation uh based on cost of living but it's not huge um but the other piece is you know sometimes providers are are willing to you know take a little less pay for the convenience of working from home you know particularly if they've got young kids or you know whatever else it just it makes their lifestyle a lot better um so it it's it's a carrot kind of in of in and of itself but then the other model is you know okay what if I don't actually physically hire the provider I go with a company who's got a ton of providers just standing by and then I can pull in whoever is ready same thing like those providers they can kind of live anywhere and um they're kind of happy you know that that's their whole life they're just working remotely so they can live in a a much lower cost location that makes a lot of sense uh so swinging back around to before we close to some personal questions for our early careerists and myself you moved from working with Health Systems kind of your whole life to now Consulting what was the decision that made you want to go into Consulting yeah so part of it is you I kind of touched on is I I really do again I I'm not opposed at all to Amazon and Walmart and I I use them all the time and they're super convenient and I and honestly I hope they'll continue to push the industry to get more consumer friendly I think a lot of our digital tools in the past have been they they've been good they've done everything they need to do but you can tell they're not designed by a e-commerce consumer Focus company you know it's like sure just sign into this portal and go through these 20 steps and you know right so you know it's a little bit of a captive audience that Health Systems kind of are used to having because it's like hey you're in my catchman area where else are you gonna go so so in a way it's good I think that you know Amazon and things like that are coming up with better ways of engaging with patients um but but I I the issue we talked about kind of that moral hazard of okay what happens if they take all the primary care away and then we start to lose these Health Systems who's going to take care of the folks who need Hands-On work who who maybe need uh you know Indigent care things like that um so so that's part of it is I really want to you know the hard one experience I've picked up over these 20 years uh share as much of that as I can and kind of prevent some of that from happening and then another thing I'm very passionate about is elder care so the one of the big misconceptions that I I do my best to Stamp Out is folks uh they just assume that yeah digital health is great for people your age frankly uh that you know it's like sure they you you've had an iPhone probably what basically your whole life you know and uh and and so and it's true is great for you but there's assumption that yeah the older folks they're going to want to go into the office and do what they and and I not found that to be true I've actually found older patients absolutely love it actually I work with the West Health it's a nonprofit great organization they they advocate for for older adults and it's you know all kinds of survey data about how much they love it I always laugh like our surveys a geinger they would start with the word I actually almost every time because there was like a little bit of surprise how much they like and I think the different the main thing was we designed it because our our population Central penssylvania skews older and so we designed it so it' be easy for older patients to use and it wasn't hard for them I mean I think that's that's the the misconception is that oh old people older people are going to get frustrated and just throw their phone or not know what to do like really if if you make them go through 30 steps then yeah but I would argue younger people like you and me well you really I'm I'm older don't don't particularly like those Steps either you know we may be more Adept at getting through them but it it makes for a better design anyway if we keep it simple um and so so that's that's another thing is I I really want to try to you know it's one of those things like the old saying it's not the things you don't know that get you in trouble it's the things you know for certain that just ain't so and and I swear that is one of them everybody just it's like intuitively they think well older folks aren't going to like like no they really do I've got data that shows they love it and they benefit from it enormously because a lot of times they do have transportation challenges and uh so so it just it's a nice platform to be able to kind of help uh help health health health systems with things like that as well definitely I I think that is really beneficial and just being in your regular surroundings you know and if you need if you need a family member and you want them you can pull them in yeah yeah that's excellent well thank you so much for coming on I really appreciate your advice I think everybody all across the career Spectrum will be able to appreciate it um of course we're going to link your LinkedIn and your uh Fletcher Healthcare consult in here so the systems can go and check you out and get your Consulting Services fantastic</p>
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