 Now, Cloudwell, that's the magic word for the day. This is Sink Tech OIM J5 Delta, nine o'clock buck on a given Tuesday, and this is Vick Archaria. I get that right? Yeah. Archaria. Okay, and he's the CEO and founder of Cloudwell, and we need to know more about Cloudwell. We need to know why, what it does, how it does, what its future. I mean, I'm bristling with questions about Cloudwell. Welcome to the show, Vic. Thanks, hello, Ajay. Thanks for having me. Happy to be on. So in 2,000 words or less, what is Cloudwell? So Cloudwell Health is Hawaii-born and raised. It is the first all-digital, physician-founded, health-health organization. So through a virtual platform, a smartphone, a computer, a laptop, patients can access a Hawaii board-certified doctor from the comfort of their home during workplace break to access medical care, such as primary care, pediatrics, urgent care, or mental health services. And so the company was really founded to provide nice accessibility for medical services for all of the residents in the state of Hawaii. That was the premise. That's why the organization was designed, and that's how it was founded by Dr. Neil Chauhan and Dr. Cedric Strong, work and live in the state of Hawaii. So we wanted to provide something that was accessible, affordable, and equitable for all the residents in the state of Hawaii. And so considering the major shortages of providers in the state right now, Cloudwell is a great option because you can get care the same day in just a few clicks through the comfort of your home. Yeah. You know, as you describe that, I keep the word democratization pops up in my brain because there's a disparity in the way people can get healthcare. And this tends to flatten that, democratize it, don't you think? Significantly. So a lot of times in many other different types of telehealth platforms, it's very selective. It can be very selective in terms of the types of insurance plans and health plans that they accept. With Cloudwell Health, we accept all the major payers in the state of Hawaii, including Medicare and also Hawaii Medicaid, which is very rare, which is very unique. And so that was, again, goes back to our mission statement, providing care that's equitable for all the residents in the state of Hawaii. And even those who want to pay out of pocket or if we need to pay out of pocket, we will provide care as well. So to your point, there's significant equality in terms of how we deliver our services because we want it to give back. We want to provide a significant community benefit by accepting all the major payers in the state, including, again, those that pay out of pocket, that's our way of doing so. Yeah, that really touches me. So one question, having a discussion about this show, one of my buddies, and he said, oh, this has been around. Has it been around? I'm not sure it's been around. Can you talk about it, whether it's been around and how long it's been around and how Cloudwell difference from what's been around before? Sure. Telemedicine is not necessarily a new concept. It has been around for about 10, 10 plus years, but it really came to the forefront during the COVID onset of the COVID-19 pandemic. When many clinics started to shut down, many outpatient facilities started to shut down, Telehealth was the vehicle to reach out and provide care to patients. But with the Cloudwell difference, it's quite significant. So if you use some of the national Telehealth platforms, you could be living in Hawaii, but you could be interacting with a provider that's in Maine. And it's very difficult to establish a connection. You're in Hawaii, you're trying to relay your care and your concerns to someone in Maine. There's a lot of different cultural nuances, communication nuances that are very different. With Cloudwell Health, you know that your provider is board certified in the state of Hawaii. So it's patients from the state connecting with providers and clinical coordinators from the state. That creates a lot of patients really like that a lot. It provides them a lot of comfort, knowing that, oh, this is great. Not only can I receive care in just a few clicks, but the administrative coordinators I interact with, the clinical providers I interact with, they're also here in Hawaii. So when it comes to understanding the patient and navigating their care, we're very good at it because we live in the state. That's a significant difference. Not all telehealth platforms can do that. Yeah. Well, there's also questions of license too, right? If I wanna get medical advice from somebody in Cincinnati, I always pick on Cincinnati, by the way. There's nothing special about Cincinnati. If I wanna get medical advice from a doctor in Cincinnati, there's an issue about licensure, isn't there? Yeah, there are medical license challenges. With the public health emergency due to the COVID-19 pandemic, some of those have been waived temporarily. But before the COVID-19 pandemic, and likely after we're in a more stable situation, so to speak, those license challenges will be put back into place to a certain extent. Maybe not to the way it was before, because everybody has seen the benefits of telehealth. But regardless of those barriers, having a cultural connection to your provider is very important. Because people need to be able to understand you, they need to be able to understand where your concerns are. Especially if you need specialty care or some second or third steps in your care management, it's great to have somebody that actually knows the terrain of the state. And that can help a lot, especially. Yeah, recommendations, yeah. Yeah. So, can I pick my doctor? For example, I mean, this is a real live world problem. I'm Japanese, let's make me Japanese for a minute. And I'm going to be more comfortable with a Japanese doctor, or at least a doctor who has a Japanese name. That's no guarantee these days the doctor will be Japanese, but at least the doctor has a Japanese name. Can I pick a doctor? You can pick a doctor. We'll try our best to accommodate when, we have to make sure that the doctor is available during that particular timeframe that you want or need the care. But our team will do our best to try and accommodate you as much as possible, yeah. Okay, I do want to get into the technical and the production issues about this. But first, it strikes me from what you said so far is that you've worked it out, so this is appealing to the community, to individuals who need access to medical care. That seems clear. But how about the doctors? In earlier efforts, the doctors were reluctant. I'm not even sure why. Maybe it was professional issues, liability issues, compensation issues, scheduling issues. How have you gotten by all of that in order to make the doctors make themselves available? So we're fortunate enough to have a medical team that really enjoys providing telemedicine services. So part of the vetting process when we look at candidates to serve on our platform is do they really have a passion for not only taking care of patients, but also telemedicine and how the process works. And the more we get into the detailed discussions with the providers during the interview process, they were very selective and we want to make sure that those that are on the platform are comfortable with it and can provide care at a very high level of excellence. And so a lot of that goes through during the vetting process of people who want to be on the platform. But what we're finding is that once they're on the platform and taking care of patients, they absolutely love it. They love interacting with the patients. They're very comfortable with the telehealth platform and it's very easy for them from the comfort of their home to provide great medical care. So we're very selective, but then the right people come forward and we're very fortunate to have them. Well, they have to be somewhat altruistic to do this, but a query, whether they make the same money as they would practicing clinically in their offices and whether that's an incentive or not, if they don't make the same money, that's a barrier. If they make exactly the same money, no barrier there because it's easier for them, just like it is for you and me to sit on Zoom here. It's easier. I don't have to get dressed up, right? In fact, a doctor can practice from home as a matter of fact. So query, do they make the same compensation? And what about all those decoding issues, right? For doctors and the filing the forms and doing all the, let me call it the paperwork. It's electronic paperwork, but doing all the paperwork that you have to do to practice medicine these days, is it easier, harder or the same? So our physicians, to your point, they can practice from the comfort of their home. And so to have that type of flexibility when seeing patients, especially some who have young children, they really enjoy it. It's a great addition to a lot of the day-to-day clinical care that they provide in a hospital or in a clinic. So we have an electronic medical record. And so through that electronic medical record, it makes it easier to code and bill for services appropriately and accurately. And so we have ways to help our providers make sure that they're documenting appropriately. And then depending on the acuity of the patient, we set a certain code, billing code, and then that can go automatically from our billing company to the insurance company. And so what has helped a lot for us is installing an electronic medical record. It's called elation. So elation is used at a significant level in the state of Hawaii. It helps a lot with the billing and coding and ultimately sending these to insurance companies. And so that has been a great addition because without an electronic medical record to assist with the billing and coding, a lot of that has to be done manually. And that takes a lot of time. Our administrative coordinators have to spend a lot of time doing reconciliation. That still needs to be done with an electronic format, but not to the extent of if you're doing it on paper. So we went- Are you billing for the doctor? In other words, the huge, I mean, is it no fuss, no must? The whole thing is automated as far as the doctor is concerned, where the code is established. I mean, I guess he has to answer some questions, but the code is established. The bill is sent to the insurer. The copay bill is sent to the client or he pays the patient. He pays with a credit card, what have you. And the doctor never really has to hire staff in order to practice. He never has to do all those aggravating, human resource and paperwork issues that doctors have to do in their offices, which turns a lot of them out of the practice, frankly. So query, is that all automated on the system? So at the present time, we have a $0 copay. And so we've waived copays because of the onset of the COVID-19 pandemic and the public health emergency. Oh, that's very nice. Yeah, it's a great service to our patients. They really like that. We have a team of administrative coordinators that are part of Cloudwell Health. And a significant part of what they do is do a lot of the billing reconciliation after the visit has been done to make sure that we've captured all the appropriate information that everything's been documented appropriately. If they have any questions, they'll go back to the provider, but they're really the conduit. They're the conduit between the actual visit from the provider to the bill being dropped and going to the insurance to the billing company. So that administrative coordinator group provides a lot of the support for providers to do their job. So it's fairly simple. Because we have a robust and high performing group of clinical coordinators, they can handle a lot of that. So it takes away, so the providers do not have to get involved in too much of the billing and coding, et cetera, which can be to your point, very burdensome. Yeah, well, does that mean this is kind of a new way to practice medicine? I can practice, let's just assume I don't wanna have a clinic. I don't wanna have the traditional classical medical office. I just wanna do it from home. I'm licensed. I went to school. I know what I'm doing. So I do it at home like this, like you and me today. I have resources. I have the web to look things up. I have my books and so forth. And of course I have my Rolodex for referrals. But do I have to have a staff? Can I get along on Cloudwell Health without a staff? So if you're a provider and you wanna join Cloudwell Health, we would have to go through appropriate vetting process, but you can because we have a team that manages the infrastructure and the operations. So provided you're board certified in the state of Hawaii, provided that you have a passion for not only taking care of patients, but you want to provide telemedicine-based services. We have an entire team that can support you in taking care of patients. And so we have providers that live across the islands, different parts of the state that wanna get involved. And once they join us, they really like it because we have an operating model that's very user-friendly and provider-centric. And so to answer your question, yeah, I provided you check off some critical boxes. We can try and find a way to get you onto the platform, yes. It almost makes you wanna go to medical school. Yeah, yeah, our providers love it. There's times when some of our providers are very young children, some of the children are in the background and they're taking care of patients because it supports just the busy lives and especially with the COVID pandemic and the stay at home orders. It's very supportive and empathetic towards that. And patients like it. Yeah, and truth is that everybody says, well, virtual meetings are not as flesh and blood. But I'll tell you, I do a lot of virtual meetings and I get to know people better in a virtual meeting. It's sort of an intense connection. And so I don't see any downside in a doctor. We'll talk about the physical aspect. That may be a downside. But I guess what I wanna ask you next is about the scheduling. You referred to that a minute ago. You gotta find somebody who's available at the right time. You gotta find a patient who can connect on a common ground schedule with the doctor that he would like to have or she would like to have. So how do you handle that? This is a technical question. How do you handle the scheduling issues? Because we're talking about iterations visits of about half an hour. I don't know what the common interval is but how do you handle the amount of time and when and who is buying into what part of that schedule? So our schedules are mapped out weeks in advance. And we always make sure that we know that certain providers take shifts just historically during certain days, certain time blocks during the day or night. And so we design it based off of historical patterns. And then obviously we speak to the providers way in advance if to make sure that these schedules work for them. Now if there's an emergency or somebody's not able to be on the platform then we have a bench. We have a bench of providers that can come in last minute if needed to provide care. And so there's various tracks. So you have the urgent care slash primary care track that's one block you have and pediatrics can be in that block or sometimes pediatrics will be separate. Then you have a mental health block. So that's our block with a team of therapists. That's a separate block. And so there is a lot of coordination and communication that has to take place. So again, we plan this out way in advance to really make sure that we provide care because we're open at all hours of the day and night. And so we're open at the present time from six a.m. to one a.m. the next day. So that's a big chunk of time. And so we have to be very diligent and very conscientious to make sure that all those shifts are staffed with the right number of providers. What's nice with what I call the cloud wall difference is that our clinical coordinators who are from the state they all live in the state of Hawaii, they call patients before the appointment. And if you're a new patient to make sure that you're comfortable to make sure walk you through what to expect to the appointment to walk you through, you know, this is your provider this is how it's gonna work. They'll answer your questions and they'll communicate with you even before the appointment. And that's very nice what I call high touch feature where it's like we're really connecting with you and making sure you're comfortable before the appointment even starts. And then after the appointment is done with the provider, we'll also check in with you to make sure that you have everything that you need especially for new patients and make sure you have all the right resources to answer any questions. A lot of telehealth platforms do not do that. And that's the what I call the high touch patient focused way we deliver care. And so I give a lot of credit to our clinical coordinators because they handle a lot of this that we're talking about right now. And again, what's nice that they all work and live in the state. So if you need labs done or radiology services, they know, they know. We're gonna talk about that. But you know, that kind of engagement is really good. And if you go to a classical clinical visit, it's rare that you get a call from the doctor before or after, the common approach is neither. Although, I have to say that Straub is pretty good about online information. And you can see the result. You can see the result of the tests and so forth. Now in your system, in a cloud well health system, I can look up the doctor, right? I'm gonna see the doctor's bio. I'm gonna see where he went to school, how long he's been practicing or she and in what areas he's trained in and so forth, right? I can see that, right? You can see that. You can see that. If you have any questions about the provider or any questions about how the care process works, our coordinators can help answer those questions. And so, yeah, all of that is very transparent for the patient if they have any questions. And if you need to see a specialist after the appointment is over, our team can help you with that. And we can help you navigate the specialist network that we have. Well, that's true. I wanna make a case study with you, actually. Case study. Okay, I wake up at three o'clock in the morning and I have a sharp pain in my zorch, which is an organ between the liver and the kidney. It's in Cincinnati, by the way. Cincinnati, okay. Did you wake up in Cincinnati? Let's say that. Let's add that to my background. Okay, now, okay, it's three o'clock in the morning. You don't have a minute of schedule at that point in time. How can Cloudwell Health help me when I'm in Cincinnati with a pain in my zorch and I have come to rely on Cloudwell Health? I like what you do, so I wanna use Cloudwell Health. What do I do in the system that you have? Okay, so we'll have some fun with this. Let's say you're from Cincinnati, but you're visiting Hawaii. All right, okay, fine. So if you run a Google search, you can find us. There's certain type of keywords where we'll come up. You go to Cloudwell Health, book your appointment. In just a couple steps, we're gonna ask you what's going on and everything. I ask you for some general information, which is all encrypted. And then we open right at six a.m. And so we will reach out to you. We're gonna introduce ourselves to you. We're gonna get a sense of how you're doing. At six a.m. your appointment starts. And so depending on what you need and what the provider thinks needs to be the next steps to assess your situation, that's your appointment. And if you need to get labs done or you need to go to radiology or you need to go to an emergency room, our coordinators will help you with that. We'll assist you to try and find the next step if necessary. I'd be concerned about a pain in my zorch, especially if it's an acute pain. And it would be an easy conclusion that I need lab tests. I need to do some kind of differential on this. So does Cloudwell Health help me affirmatively schedule the lab test, tell me where to go, what to do, what kind of tests would be appropriate and expedite my effort at getting a test? Yes, we can help you with all of that. We also have lab facilities in Hawaii that interface with Cloudwell Health. So because of our electronic medical record elation, those results can interface. And so if you go to the lab and we would tell you what's the best lab to go to depending on where you are. And once those labs are drawn, those results can interface. And so it's a great service because it all flows right back into your chart. So we can track you and make sure that you're getting the appropriate level of care, but also when you come back or if there's any secondary steps, we know what those lab results are. So it's all electronic. It's just always still going to the primary. And the primary, he decides, and we all agree that my Zorch is in trouble. And I have to see a specialist. I have to see a Zorch specialist as soon as possible. Okay, now is my primary on Cloudwell Health gonna put me together with a Zorch specialist? And how does that work? So we have a specialist network. And so depending on, we'll assume that this may need GI, some GI work to address your Zorch situation. And so we would contact the appropriate specialist in our network that we have contractual relationships with to help expedite your care. And so we would get you to that next step. We would play a role, direct role in helping you get to that next step. Now there are situations where it's so serious that you have to go to the emergency room. And so we're very clear about that. You know, based off our assessment, this cannot wait. You have to go to the ER. But if it's something that needs a more specialist focus and you have, and there can be some time, we'll help you with that. We'll get you to the next step. Yeah, well, it sounds like what would happen if I was visiting a doctor in person, actually. But it sounds like maybe the Cloudwell Health Doctor would follow up and he would check back with the Zorch specialist or the emergency room or whatever and check in with me later, am I right? Yes, yes, we do that. If you have a primary care physician that needs to be briefed on what transpired when you were in Hawaii with your consent, we can do that. And so just so your primary feels involved, knows what's going on with you and is briefed on your most recent situation, yes. So, you know, let's assume my Zorch is very exotic, whatever it is. And it's not the first time, not the only time it happens and that I have an ongoing problem with my Zorch. And I want to get back to the same doctor who helped me steer a course through that channel in the first place. How much trouble is it for me to, I guess it's a scheduling issue, but I want to go back to the same doctor as if I was on the outside in a clinical setting and I want to always have him or her because I like him. I like the way he operates. That's the wrong term to use. I don't want to use that term. I like the way he moves. So can I stick with him? You can. We'll try and accommodate you as much as possible. Now, based off when that doctor is on shift, based off what time they're available, we have to link that up with when you are available and when you need to be seen. So I don't want to promise anything, but we'll try and accommodate you as much as possible. All the doctors do a great job. All of them are first class boards certified in the state of Hawaii. So there's a lot of nice interchangeability. So if for whatever reason, we're not able to accommodate you, we'll be very open and honest about it, but you'll be rest assured, seeing somebody just as good. And of course, every doctor has access to my medical record. If I give them permission, I suppose they can get my medical record from my previous doctors, my regular clinical doctors as well. Correct. With your consent, with your signed consent, we can obtain those medical records from your previous physician. Yes. Oh, that raises a whole bunch of questions about the technology. You say signed consent and take electronic signatures, Vic. I give a lot of electronic signatures in my life. Do you take them? We're not at signed yet electronically, but we also work a lot with other practices who once you sign it, will fax that consent to their office and then they will fax, will receive through fax a lot of your historical medical records and then those get indexed and filed into our electronic medical record as reference documents when you're receiving care. Yeah. So I mean, I thought it would be helpful if I had a scanner attached to my computer. Yeah, I wish I had one too sometimes. It would make it a lot easier, but we'll receive, we'll be very diligent about getting all your records, we'll receive everything and yeah, we'll file it in the chart so that depending on the physician that sees you, all the reference documents are there. Let's talk about the technology now. I assume you have a virtual program sort of like Zoom or Skype or WebEx and it's built into a website. Can you talk about the technology that you developed and that you're using now? All the patient interactions are done on Zoom and so our electronic medical record is encrypted and that's elation, but the way we're interacting right now, we use Zoom and that's a good feature because a lot of people, especially due to COVID are familiar with Zoom and if there's any questions, then again, our coordinators are there to help you out. Yeah, and there are certain things, for example, that you don't have to go to a laboratory to learn if you're a doctor. I mean, for example, you can say, oh, your hand hurts. You have something going on in your hand. Why don't you show me your hand? You know what I mean? I mean, am I right? There are things like that that are visible and if you have decent reception, the doctor can see over the Zoom. Am I right? Yeah, yeah, so there are many situations, not all, but many where the visit can be conducted on Zoom and so visually the doctor can assess how you're doing. Now, if there's additional blood work or imaging that needs to be done because of those interfaces with other facilities, that information can flow back into the chart so I can have an even more nuanced discussion with you because I'm looking at your labs. I'm looking at your scans and so that helps a lot. It's just like a regular visit to the doctor. And there are some situations to your point where in areas like dermatology, for example, that they can assess visually if you raise your hand or you need to show them certain, your neck, you know. I don't mind showing them in my pushy either. Yeah, yeah, it's, you know, during COVID, a lot of these services went to telehealth and what we're finding is that a lot of people, a lot of the providers, like this is pretty good. You know, this is better than expected. Yeah, make some medical determinations. So are you recording? Are you recording the visits? Are you recording, you know, when I show you something? We don't record the actual video visit but everything is documented in the medical record. And so if you want a copy of your medical record, you can receive it, but we don't record the actual video session but everything is in the notes. You can take a snapshot though. Yeah. Yeah. Well, you know, we're almost out of time and I would be remiss if I didn't ask you about the future. You know, in Think Tech, we are always looking at new software, new ways to make things work better every single day, if you will, every minute. And I would imagine, Vic, that you do the same thing. Can you talk about your examination of the future? Your, the frontier things that you plan, that you want to accomplish. So telemedicine is definitely the wave of the future. It really was brought forth into the spotlight during COVID but it's something that's here to stay. And especially now, you know, for example, there's like primary care. You know, we just started offering virtual primary care in December of last year and that's a big component because if you think about it, you know, it can take months to see a primary care physician whereas with telemedicine, you're challenging the status quo. You can see get primary care services the same day. You know, so definitely clinical programs, new clinical programs are the wave of future, also wearables. So there's a lot of talk about, you know, your results about blood pressure, your blood sugars transmitting from your watch automatically into the electronic medical record. So patients can be managed virtually, their devices. And so that's really great because not only can things be managed virtually, but you don't have to be in front of a provider to receive care. We can track how you're doing without having to have a session like what we're having right now. And so that just really improves the quality of care efficiency cost because if things can be managed virtually, it's a much more cost effective way to do it. So in addition to the access, you're also lowering the bar, you're lowering the cost levels when it comes to having wearables as two. So definitely telehealth and AI around wearables to manage health. It's interesting how COVID sort of made this clear. COVID gave us the opportunity, COVID made us look at the opportunity and now we find that through the internet, through technology, we can have medical engagements that are way more efficient. That's got to save money, but the point is that if you're sick or if you're practicing medicine, you don't want to waste time. And to have a primary the same day, it's like a miracle. And you said that this is available with local doctors, it seems to me to be a tremendous way to deflect the effect, the first while effect of the doctor shortage in Hawaii. Because just looking at it numerically, it takes fewer doctors to practice and patients can reach them more easily. It's like this has got to be the way of the future for a good percentage of medical practice right now. And I'm sure that's central in Cloudwell. I want to ask one more question. I know we're a little bit over, but when you and I talked earlier, you mentioned that Cloudwell also did mental health. And at the time of COVID, mental health is obviously every day it's more clear that it's more important than it was in terms of the demographic, in terms of the community, in terms of community mental health, we really have to address that. So tell me what you do with mental health. So we offer virtual mental health services. And so we have a team of therapists, licensed therapists, that through virtual sessions provide emotional support for those in need. And so to your point, this has been a critical area worldwide. Just due to the, especially due to the COVID-19 pandemic, there's such a significant demand for timely and high quality mental health services. And so I'm very proud to be part of an organization that offers such great mental health services. It's hard to find. Again, just through a couple of clicks, you know that you're receiving mental health care through Cloudwell, but through somebody that actually works and lives in the state of Hawaii. So this is not a therapist that might live in Florida or North Carolina. Cincinnati. Cincinnati, it's somebody from your state. And that just helps develop a connection because with these challenges, you wanna confide in somebody that you feel comfortable with. So in just a few clicks on demand when you want it, when you feel like you need it, a therapist is there for you. Oh, that is remarkable. Yeah, they're just a wonderful team. We're very grateful to have them. They provide wonderful care, wonderful comfort, and especially during this very difficult time or the past couple of years, they're there. They're there to help the community. And so it's, yes, it is an available service through Cloudwell Health. Well, Vic, I suggest that you're doing what you were born to do and you have an enormous amount of psychic benefit out of it and you're providing great value to the community. I wish you well. I wish Cloudwell Health well. And I hope we can circle back and talk about it some more. Thank you. Vic Acharya, Cloudwell Health, thank you so much. Thank you, Jay.