How Virtual Healthcare is Transforming Patient Care: Michael Dalton, Ovatient CEO

Today we're exploring creativity and the human spirit with an individual that I've come to really enjoy working with. And some people who are watching Radio Maine might be wondering what is the relevance to actual Maine? Well, I'm going to kind of turn the camera a little bit back to myself. And in doing so, bring it back to Michael Dalton, who is the CEO of Ovatient, because for those of you who watch Radio Maine, you know that I spend a lot of time working with artists of the Portland Art Gallery as a means of supporting our family business. But in my real job, my day job, it is actually working as the medical director and a family physician with Ovatient. And this has enabled me to continue to live in the wonderful state of Maine because I am offering virtual first care with a company that is creating access to health by doing things virtually. So welcome Michael Dalton, CEO of Ovatient. Thanks for coming on today. Thank you, Michael, I'm interested to know a little bit about your background, just how did you get to be to a place where you said, I believe that virtual first care is going to be important to the future of healthcare, and I want to work with systems like Metro Health, which is in Cleveland and MUSC in South Carolina so that I can make this type of virtual care more integrated with the systems that currently exist. When we were looking to be able to create Ovatient as a company, it really started first as a concept, a belief that what we were providing to our patients at that time. And I did come from working at Metro Health in Cleveland, and previous to that it was Summa Health in the Akron area. And what we had seen is oftentimes working with vendors who they weren't necessarily connected to a patient, it was oftentimes could be really something that was more transactional in nature. Yes, we were prioritizing convenience. You may be able to be able to see a provider, but did that provider really know you? Did they know your medical history? Were they going to be able to connect with you over a continuous journey within your life? And that's not what everybody needs. Sometimes they just may need an episodic visit to be able to make that connection. But oftentimes, especially as telehealth and virtual care, as it becomes more ubiquitous, there's higher expectations that are expected as well from a patient as well as from a care team. This is really part now of your care that you're getting on a daily basis. And I think one thing too that really stood out for us when I was at Metro was that oftentimes patients were being faced with their own barriers to care, and that could be their work schedules and maybe childcare. Transportation was a huge issue. It still is a huge issue. And so I think what we wanted to do is really find a model of care and create a service that could really meet patients where they're at. And that could be in their work, it could be at their home, and everybody has a different definition of that. And I think that was something that was really important for me. I also know growing up, one of the things that I remember vividly was just hearing about my grandparents and the trips that they always had to make from rural Wisconsin to Madison or to Milwaukee to be able to see a specialist. And so really where I am excited and where I think the potential for virtual first care is going, and I know we might have an opportunity to talk about it later, but is that really bringing that high quality specialty care to a patient's home so that they're not having to travel 3, 5, 10 hours to be able to be seen by a specialist. That will be the, maybe the not the rule, it's the exception. That's what you would need maybe once a year or once every couple of years to be able to see that specialist. I know you've previously talked about the erosion of trust between health care and patients. How do you feel like Ovatient is able to contribute to positively rebuilding that trust in the virtual first care model? I think trust is an incredibly important component. I've said before that we are not the United States Treasury. We cannot print more trust. It is really a finite resource, and it's something that we take incredibly seriously and in our care model and how we care for our patients, but also how we work with the care teams at our customers because they may already have a well-established relationship with their patients, and we take that seriously. And so if we have the ability to take care of one of their patients, we want to take the best care of 'em and then hand them back for that care continuity. I think for virtual first care for a patient and how we are rebuilding trust for them in the healthcare system is that we are truly meeting them where they're at. There is not an instance where that patient feels that they may have white coat syndrome, they're having to travel to a health system or to be into a clinic, and that can be anxiety inducing. And so really in the comfort of their own home, maybe with the support of a loved one, that they can feel that really the only thing that's in between them and that visit is this same video camera that you and I have today. And they're really then on equal footing with their provider, with their care team, and it really makes for more of a conversation. It allows them to more easily establish that relationship with their provider, and it really almost provides that true house call that we're able to make for them. And it's on their terms that they're able to seek care to receive care. And that's what I'm really excited about. And that's what I think a lot of our patients and why we've had so much adoption of the care model that we're providing today is because of really removing that barrier to care and creating that opportunity to listen for our patients. One of the things that you've emphasized is the ability of Ovatient to increase access to care. And of course there is the access to care for specialty services, for example, which I know that a patient is moving toward. But then there are also other access issues that our current patients with Ovatient are dealing with on a regular basis. And I'd like to hear you talk more about that because social determinants of health, it's become kind of a buzz phrase, but you are actively doing something with Ovatient to change that particular social determinant of health access to care. I've oftentimes thought about access to care about the capacity that seeing or having more providers or more ability for scheduling on a template. I don't think access really comes down to just a slot in a schedule. It really comes down to the time of the day that a patient is able to be seen. It's removing those barriers for transportation that they can be where they're most comfortable, where they have the resources to be able to be seen. That really means access. I think access too is around the ability to pay oftentimes in virtual care models and with telehealth patients, they've had to either pay cash, use a credit card, they might have to be part of a subscription model to participate and receive high quality virtual care. And that's something that we've used as a means to distinguish our care model is that if you have insurance or maybe you're uninsured, we can provide you with cash options to be able to receive care. But the vast majority of our patients, they're able to utilize the insurance that they have today. I've been heartened by this, is that the highest number of patients that are using our services today, they are on Medicaid. And then the next number is actually the employees of our customers, which are health systems. So I think it really is a testament to be able to say, we're creating access for patients who may be on Medicaid and have a number of other social determinants that they're trying to address. But at the same time, our employees, at our customers, they have access issues themselves thinking about being able to get away from the bedside or from the office to be able to see a care team that really is concerned about them. And so I think that that's something I've really fully now appreciate. Even what we've been able to do through our care model. One of the things that comes up often with standalone virtual care organizations and companies is the lack of integration with things like the electronic health record or communication platforms for patients. Talk to me about the decision to work with Metro Health, MUSC, other places that have Epic and have MyChart and the importance of integration generally, as far as making sure that virtual first care is a seamless experience, We really were conscientious and intentional about building a care model and a company on top of Epic and to be integrated there because that's oftentimes in my previous roles where I saw the disconnection and also the adoption that would come from a provider or care team, the first thing that they would ask is, does it integrate with Epic? They really feel comfortable, they want it to be in one place, they don't want to work within two different screens, models, multiple applications. And that's really what we started to see is you started to grow out this huge ecosystem of singular applications. And the more that we can do within the EMR, the better that our patients and our providers can be able to connect through that interface that Epic has provided through MyChart and that patient portal. And I think one thing that we've seen too over years is that patients are comfortable with They understand its capabilities, some of its limitations as well, but it's a tremendous means by which to communicate with a care team as well as to be informed about your own medical record and have that information at the ready. So I do think that as we contemplated this, we didn't want patients and we didn't want our providers have to go to a different ecosystem. It really was important for us to maintain and build our care model. And I said in our company, really on top of Epic. And so what we've seen today is really a seamless ability to provide referrals, to manage prescriptions, to better just coordinate care across care teams within our customers. And so I think it has not been easy. I will tell you that it has not been easy to build on Epic. It's not a drawback or anything to do with Epic. It's just that this is that as you think about all the complexity, especially in primary care and as you know well and really being the quarterback of the team, you need to have all the plays for them and their playbook and at their disposal to be able to provide the best care. And so that, that's how we designed really our model of care is making sure that primary care team could be truly that quarterback and at the center of care for our patients. Michael, talk to me about how Ovatient is leveraging data and digital systems to improve care of patients by their local healthcare systems. We're leveraging data from our patient records as well as from the patients and their electronic health records within their own customers to really provide one continuous care journey for our patients. So I think we're able to bring in years of that historical medical record and be able to then incorporate that into our care planning as well as our best practices for the care that we're providing. And I think that's what I'm excited about in this space is that we over the next, I'd say 3, 5, 10 years, are going to be able to really share with our customers and their patients how this virtual first care delivery model is going to improve overall health outcomes. And we're still in the early days, I like to call it that we're kind of like in maybe the second or third inning of virtual care and telehealth and understanding how that really becomes just standard of care. And I know there's many health systems who've utilized telehealth, especially in areas where there's high rural populations. But I think really from a virtual first approach and being able to do that from a comprehensive way, I think we want to be able to use the data that we're generating to then share that with our customers, with their care teams and their patients to be able to build a better care model for their own health systems and for the patients that they're treating and so that they understand how virtual care can improve those health outcomes for their patients. Michael, I know that transparency in healthcare is important to you. How do you feel that the work that Ovatient is doing is increasing that transparency between and among patients and their care team? I think transparency and being able to share information and have access the same access to the medical record or information about your care plan is incredibly important. It goes back to the original question around how do we rebuild that trust? And it really provides that equal footing. It lends to shared decision making, and I think that really is easy. Sometimes I think easier to be able to do. When we do have that equal footing, it's not somebody sitting across a desk and behind a monitor or feeling that they have, maybe it's awkwardly placed that they're to the side or there's an angle as they're being able to connect with that patient. And just as we're doing here and we're looking at each other and connecting across the camera in a video, I do think it allows for that an easier conversation, a place that maybe that anxiety is reduced and then you're able to just share what your concerns are as a patient equally for the provider to be able to talk about what is the path that we're going to take, the decisions that we're going to make together. I think that's one of the values and benefits that we can provide through this care model. One of the things that I know is very important to you is attention to the health of your actual virtual care team and attention to the wellbeing and the building of relationships. How do you approach this in a space that is almost a hundred percent digital? So this might sound ironic, but I think we've had to be in a digital, fully remote environment in which we're working, we have to be even more intentional about being personal and making sure that we have the times for conversation, really making sure that we're approachable, we're available, we're taking inputs from the team because oftentimes when you're trying to pack everything into a 15 minute huddle or a five minute conversation, we don't have the proverbial water cooler. We have to make that time in order to be able to have those conversations and make sure that, as I mentioned, just that voices from our team members are being heard, that they're being respected, that they're being valued, because otherwise it could feel in this remote environment that something could be lost. So making sure that we're picking up the phone. I have a general rule that if you can't say it within two emails or a couple back and forths in a chat, conduct a video call, pick up the phone, just make sure that there's that connection. I think too, just being cognizant of and making sure that we have a place for when there are concerns from our care team that we're there to be able to hear them. If there are talking about I'm feeling some of that isolation working through, then how do we provide a more connected care team and environment knowing that that's somebody could say that's created greater inefficiency because we have these additional times for conversation. I actually think it leads to a more effective team, a more effective care model that then will create greater efficiencies. But we really have to make sure that we're, I don't just say patient-centered care. I want to say that we are providing person-centered care, and that is both for our patients and our care team members. Because if our care team is not in a place, if they're feeling isolated or they're feeling not supported, we don't see that as readily or easily, especially being in that remote work environment. So I think also too, Lisa, just making sure that we've all taken kind of an open door approach to our leadership styles and making sure that we're accessible. That's some of the feedback that I have heard from the team, which has been reassuring is that they have felt supported, they've felt cared for, just that they are supporting and carrying our patients. We need to do that the same for each other. Michael, I know that you and I have a shared interest around leadership and theories of leadership and that we both have academic backgrounds that include degrees in leadership and organizational development. One of the areas that I think you feel strongly is the importance of servant leadership. How does that manifest for you as a leader and as the CEO of Ovatient? I do feel very passionately about servant leadership. Former CEO that I worked for really crystallized it for me when he said, if you're not serving a patient, you're serving someone who is. And for me at that time, I was, look, I'm never going to be a clinician. I'm not going back to medical school. I'm not going to become a nurse. I'm not going to go to become a pharmacist. I grew up in a family though. My mom worked for a health system. My dad was the CEO for a mental health clinic, treating patients with their clients with severe and persistent mental illness. And he was a psychologist in his career. And so for me, I had this really desire to care for people to serve and to take care of others, but I have to do that in a different way. And so for me as a leader, it's making sure that there is no task that's too small, really being able to roll up my sleeves. If that means that we need to be able to block a template, if that means that I can make phone calls to patients, I'm happy to. I actually love being able to do that. It gives me the ability to connect with our patients and to do that on behalf of our care teams. And I think too, just from that service is just understanding our team members, how do they want to be supported? How can we best support them? And that's really important to me, especially not having that physical proximity, not being able to be in the same office with a team member is again, being very intentional and asking those questions about how can we support you knowing that can't be there physically, and it's just showing some small acts of appreciation or kindness or just having the ability to make that conversation to pick up the phone. Those are the things that I think are really important for me. You've also made a priority of in-person time together, whether it's in-person training amongst the clinician team and the administrative team, or whether it's leadership in-person time, or whether it's you going to MUSC, Metro Health, spending time in-person with people. How do you make the most of in-person connections as to create benefit for your virtual first environment? I think in this day and age, we have grown more accustomed to being able to connect through a virtual or a virtual session, a video meeting. For me, I have tried to make the most of being able to travel to see some of my own team members or when we get together as a team to make sure that we balance both fun with work and making sure that we have that time, that we are intentional about creating that connection because we're getting ready to be able to do a new onboarding and orientation and of new employees. So we have another wave of employees that are coming in and we had contemplated that we could do a virtual orientation, we could bring another group of team members on. And as I looked at it, I said, this is the one time really that this team and members of the team, these new clinicians that are going to be coming on are going to have the ability to see one another, to work with one another in the same physical space. And I thought that was incredibly important as well, especially because we'll have behavioral health team members, our primary care team members all coming together and they're working within one care model. And to have that time to get to know each other, to break bread with one another, to establish that relationship is critical, we're kind of adding and making an investment really into that relational capital that they're going to need over time. And to be able to really break down maybe some of those barriers if they were only working or only knew each other in that virtual setting. So I think too, as when we do come together, there is some structure. I will say there's some irony too is that we've talked about having structured unstructured time is just making sure that then we've at least been intentional. We've blocked off that time together and let it go where it may go, and let's talk about what we want to be able to talk to make those personal and human connections. And I would be remiss if I didn't say, I mean that's one of the taglines or the areas that we're focusing on is we're saying that we're providing virtual care that's entirely human. And that is a really important component for us is that we, especially when we do have that personal time together, or if it's a time where we're in a teams meeting, it's just making sure that we can keep things professional but lighthearted. And I would just say, Lisa, you do a really nice job of being able to make that personal connection as well. And that's one thing I really appreciate about you. Thank you, Michael. I appreciate your saying that. As I'm thinking about the future of Ovatient and of virtual care, I know that the landscape is a little bit uncertain, but there are a lot of opportunities for us over the next five to 10 years. What are some of the opportunities that you are most, let's say excited by, maybe they're not opportunities that are easily worked through, but what interests you, what intrigues you on the virtual care landscape? I am really intrigued, and this is our overall vision for Virtual First Care is truly being able to build out a comprehensive virtual first multi-specialty practice. I know that's a lot of words, but really what we want is for a patient, I think that will be really an achievement once we do this, but for the super majority of their care, they're going to be able to receive that care virtually. So if it's a specialty, it's a behavioral health, primary care, whatever it might be, we're able to take care of that patient and provide them with high quality care in their home. And I think in addition, and there's a number of good companies in this space and potential partners for Ovatient that are bringing care and care teams into the home as well. And so that's where I really am excited over the next five to 10 years is really creating the virtual patient, patient-centered medical home that is in a patient's home, that it's where they're at. And I think that when we go back to that question around access, that is the access nirvana for a patient is that they won't be restricted because of their transportation, their own maybe mobility issues, the ability to be able to age in place, to be able to bring a family member from across the country into that care setting. That's I think almost imperative that we have, especially as we have this growing baby boomer population and generation that we need to care for in the home. And as we increasingly grow from into Medicare, I think that's one thing that we're seeing so many patients who are growing into Medicare that we're able to care for them than at home. And I think they'll be more comfortable with virtual care. I think they'll feel very natural. And that's where we see this great opportunity is to do that now. And by that time, 10 years from now, it's just natural. I think also I'm excited about the potential for what Epic and other digital health vendors, but really what Epic is going to be able to continue to do to support virtual first care integrations with other health systems. As we look at interoperability and sharing information both with patients and across care teams and across vendors, I do think that that's, it's going to look markedly different but in a really improved way as we're continuing to provide more information both to a patient. I think also what I'm excited about and in the next five to 10 years, I am very curious about where artificial intelligence is going to be incorporated, not just for a care team, but also for a patient. I think they're going to be much more informed. I think they're going to be able to take information that maybe sometimes came off as jargon and they're going to be able to have a much more intelligent, informed conversation with their own care teams. And I'm really excited to see how that continues to evolve and how that's going to be incorporated into medical schools and residency programs. And these are going to be things that are not kind of off to the side or an extra appendage. This is just going to be standard of care, the model of care, and we need to prepare our next generation of medical students and interns, residents to be prepared for, prepared for this. Michael, Ovatient is a very values driven organization and it's foundational to the work that we are doing with one another and with our patients. Can you give suggestions for other organizations that you think could potentially help them become more refocused on values versus where I think we've necessarily gone recently, which is more finances and other operational considerations. How can you take what you've learned as a values driven leader and make suggestions for other leaders who similarly want to reacquaint themselves with this? So we spent a lot of time looking at our mission vision values and making sure that they really encapsulated and incorporated what were the values of the team, the behaviors that we wanted to be able to exhibit. But it's been iterative. It's been generative. We started with a foundation for who was on the team at that time as kind of the core founding team. And then we shared this with our first wave of new hires, our clinicians, and really wanted them to get them to understand and incorporate this into how they would work. We wanted feedback. What we gave them was, I would say a strong straw man, but we needed them to be able to fully incorporate that into their practice and their ways of working. And so that was something that we then put together a social contract. And so that was as we sat down with the team and we looked at how do we want to work together, how are we going to hold each other accountable? What were those behaviors? What would be a violation of that behavior? And then what would we do to be able to maybe ameliorate that or address that and provide for that healing? If there was something where we saw in our behaviors that there was a violation of that and we already planned on that, we worked through that. We also then talked through and tied values to what would this look like as we make a transition from many of our team members had come from working in a health system environment and now they were coming to a startup. And we were intentional then to think about what are the values that we need to be able to draw on and incorporate for being able to as part of that startup culture, kind of that double helix of our DNA of startup and health system culture. And I think that was, they then were owners in the organization. I don't mean monetarily, it was more of they are the ambassadors, they're the leaders, they're carrying that out, they understand what some of the motivations are, what is our business model, what are we trying to be able to deliver? And we've had some great conversations with them as well as just their focus should be just on providing excellent patient care, high quality patient care, tying those metrics then to meaningful outcomes for their patients. And with that, there will be meaningful outcomes, Ovatient and for our customers as health systems. But I really do think that we started with that very core around our values and having that strong foundation if we don't have that really don't have much on which to build from. And I think that's something that's really drawn our team members to Ovatient and kept them here and something I'm really proud of. Michael, what leadership qualities do you believe that an individual who is leading in the digital health space and specifically virtual care, virtual first care, what leadership qualities do you think that a leader would best be served by having? I do think they need to be patient. I think that they need to have really great listening skills. I think they need to have, even having taken feedback, being able to hear what the team says, it still means that it's within them to, as a leader, to make the decision to have that courage and to stand behind it as well though if they have made a mistake to own it, to be accountable and to share that. And I've had to do that. I've made mistakes. Hard to believe, Lisa, I know, but I've made mistakes. And when I do though I share with the team, I'm transparent and I own it and I tell them, here's the mistake that I've made. Here's what we're going to do to move forward. And I think that's really been appreciated by the team. And I think also there's been times where I've taken feedback from them and even in receiving that feedback, I maybe disagreed and I shared with them and I was transparent, I was open. I gave them more insight into the decision making and about so they could understand the why. And I think that's really, really important, especially in this setting for team members, for employees, for patients to understand the why. And I just think sometimes as leaders, we tell them the what and the how. And I think that is not enough. And that's where it really has kind of come through in my servant leadership is making sure that I do understand how can I help you and then coming alongside them to be able to do that. And so I think that's my advice that I would provide. In finishing up our conversation knowing that this truly is your, is your baby, this is your company. You care for it like a very proud parent. And also you're up with it in the middle of the night. It never goes to sleep. It's always demanding food. It gives you some joy but also can cause some heartburn as with all babies and all parents. But this baby is growing and this baby is going to, we are with one health system, we're evolving into another health system and we're going to evolve into multi-specialty care. So as this baby becomes a toddler and then a teenager and then fully grown adult, how is that going to change your approach as a parent? I have wondered that because I know that maybe my leadership style is going to need to change, but maybe it's my approach that's going to need to change, but not my leadership style. And that's because you hear sometimes about how companies grow and then they change. And that goes back to the focus around our values. I don't think our values should change. I think we spent so much time and I really believe in the values that we have, and I want those to be just foundational to who we are. And I think as time goes along, and that's where you've seen me be more intentional about how we start meetings and making sure that we're talking about where have we seen our values in action and how are we recognizing that in some of our team memb