 My name is Vikramacharya. Welcome to this latest episode of Telehealth in Hawaii. I'm the co-founder of Cloudwell Health, Hawaii's first and only all virtual physician-founded telehealth organization. We've got a great show for you today. We have two physicians, local physicians on the show, Dr. Cedric Strong and Dr. Yusuf Arahim. Two esteemed colleagues, glad to get the conversation started. Dr. Strong, we'll start with you. You have a superb background. You're a physician, you're an entrepreneur, you've given a lot to the community, a lot to the residents of Hawaii. Talk to me about your background, your expertise in medicine, and what brought you to Hawaii. Yeah, so I was born and raised in Tennessee and I've always been quite adventurous. So I went off to residency up in New England and I studied there and trained at Tufts. I was in New England for almost 10 years and got quite restless there with all the northeasters and the blizzards that they get and I came to Hawaii on vacation. I loved it and I want to move into Hilo. So I moved from a small town in New England called Portsmouth, New Hampshire, if anyone knows what that is, that's on the seacoast and I moved to Hilo and worked at Hilo Medical Center and I really got to understand people of Hawaii and a lot of tradition and culture there. Then from there I kind of migrated and I moved around a little bit and I worked in different hospitals. So I worked at Kona Community Hospital, even Maui Memorial, and then I started working on Oahu at Polyomomi Medical Center and I've since worked at St. Francis, East and West, and the Castle Medical Center. So I've been all around the state. So I've seen a lot of how healthcare is run here with different facilities. I worked at eight hospitals in Hawaii, more than that on the mainland. So pretty, pretty experienced in hospital medicine. So that's my field. And so I learned that I could travel back and forth between the islands and I kept going back to Kona and I worked in the ICUs over there and Maui. And I really wanted to help as many people as I could. And now that technology is available and this platform has developed, we can help people in multiple places. So I don't have to fly around. I can be in one place and I can help a lot of people just through the virtual healthcare now. So Cliala Health is a great solution to that, was created for that purpose, and I'm able to give back to the community and continually develop the platform and software and trying to connect with communities with primary care positions, which is the latest thing that's happening now. So you can actually have a relationship with a doctor and be a primary care for multiple people in the communities and connect them with specialists, which is another shortage in Hawaii. So primary care is a shortage, but also specialty care, as far as seeing specialists for various conditions, even eye exams, cardiology, people that have heart disease, diabetes, even behavioral health. So all these sort of things we've tried to put together and they're at your fingertips and you can tap into Cliala Health and get connected to all these various fields now that we are able to connect people and looking forward to developing things even more bringing more things to Hawaii. So Hawaii tends to get things late, but once it's here, it's established people really understand what it's about. So if you've never done a telehealth visit, it's hard to explain, but it's similar to this conversation we're having on our FaceTime, and it puts you in touch with a physician and you can be on there in as little as 15 minutes. Definitely you can see someone the same day, and so there's no need to wait anymore. That's excellent. That's excellent. I mean to be able to create this type of service, but to also do it for the residents of Hawaii, all the rest, that's really impressive. Dr. Arahim, you have a pretty extensive background as well. You're a gastroenterologist, but you're also a chief medical officer of a large company. Talk me a little bit about your background and what brought you to Hawaii. Your role as a chief medical officer and we'll go from there. Yeah, so very similar to Dr. Strong. I trained in New England. I did all my training here and went into a gastroenterology fellowship followed by interventional fellowship and moved to Hawaii around 2003 or so, and I was actually living in Hawaii continuously for over 12 years, and then my life kind of changed a bit, so moved back now to New England, but I'm still in Hawaii. I'm mostly in New England, but I'm in Hawaii all the time. While in Hawaii, I had the opportunity to develop a private practice and then parlayed that into Honolulu's first outpatient, freestanding ambulatory surgical center. It was one facility called Pacific Endoscopy Center in Broad City. Now we have merged with three other facilities, so there are three facilities in Oahu and one in Hilo. We have, you know, humility aside, we have probably the most brilliant gastroenterology specialists on the island. We have about 70 percent of the total volume of procedures that are being done in Hawaii, and that would not have happened without the affiliation with Covenant Physician Partners, so Covenant Physician Partners is a mainland company actually in healthcare, was actually the first healthcare successful healthcare venture in Hawaii, so they partnered with us, and through the partnership we were able to kind of spread our wings and expand and create, you know, the model of mergers and acquisitions, which basically, you know, you get bigger, you get stronger, you negotiate better with insurance, but you also have better, you allow patients to have better access to you, and more convenience and of course it saves people a ton of money, because when you do a procedure at a freestanding facility, your co-pay is much less. So actually, basically it's fee-for-service still, but really the cost savings are really tremendous, especially with co-pays to patients. So as of 2014, I was invited by Covenant Physician Partners to become their Chief Medical Officer, started kind of as a part-time commitment, and then it basically evolved. So Covenant Physician Partners is now in gastroenterology, we're in ophthalmology, pretty soon going into orthopedics and cardiovascular, we're in anatomic pathology, we're in anesthesia, and we're in about, you know, 20 different states, over 45 facilities, and growing really very aggressively, our private equity partner who facilitates and makes all of this possible is, you know, KKR. So I am now basically mostly in Hawaii now than on the mainland, you know, just trying to kind of pick up my practice again, but GI is looking great, GI care is more promising than ever, and since we've had the pandemic, obviously there's been delayed diagnosis in screening, not just GI cancers, but breast cancers and lung cancers and every cancer imaginable. So at this point, we are working as, you know, as as fastidiously as we possibly could to process and deal with so many GI related health issues. No, Dr. Strong, both you and Dr. Arahima are physicians, but you're also equally successful in business. You've, you're building companies, your physician leaders. How have you been able to manage that balance because you're both actively seeing patients all the time, and then you have to toggle over to the business side. So you're talking about medical care, and then you're talking about balance sheets. How have you been able to make that transition? That's, that's pretty impressive. It seems pretty hard to do. Yeah, so I've been with Hawaii Pacific Health for about 15 years, and then while with their group, I became the managing partner of our medical group, and I was in the leadership programs for the Hawaii Pacific Health. Also, I went to business school during all this time while I was the chief of medicine right before the pandemic. So and, and, you know, that was when we were developing the software for, for cloud will health. And so I was able to juggle a lot of hats. Now I'm lucky that, you know, I don't have any children, but I, I, I do have a fiance who, you know, lives to her, she let me do what I need to do. But I've always had a mind to, to be creative. So I'm never someone that just sits around doesn't do things. So my, my spare time, I read a lot of books. I'm also in a lot of support groups. I'm in accelerated programs. I'm always reaching out trying to work with the university as well. I've done a lot of taught some classes over there with the project management. I'm going to be participating with the marketing program with one of the department chiefs of marketing over there. So I'm always trying to give back to the community. So I really enjoy doing that, helping people, even through this business, I've been able to, we employ a lot of women, a lot of Hawaiian as well. And so we've been able to push some of our, even some of our employees or contractors through and get them in the medical school and position assistant school. So just putting all that together, I've always tried to help the community. And everything I do has always been focused towards what, what can I do to make this a better place? And so I don't really look at it like work. I look at it like, you know, what can I do to make Hawaii better? How can I give back more to this beautiful place that I came to 15 years ago that changed my life? Dr. Arahim, you're an equally busy person outside of seeing patients every day. How do you do it? Yes, I, it really, you know, kind of in some way. So I trained at a very sort of powerful academic program. I have a PhD. So I actually have a background in research. And so you come out of an institution like this, and the expectation is that you're going to stay, you know, and, and do research and so forth. And, and while I publish prolifically and everything else, I really kind of wish to not live in Boston. And so that's how kind of Hawaii manifested. And so I moved to Hawaiian. I was employed by a hospital, which happens to be also part of HPH. I think within a couple of years, I just realized that there was something entrepreneurial in me that just wasn't met. You know, there was an itch to do something more. And I was very fortunate to meet, you know, one of my best friends and really my brother, Daryl Lee, who was a physician in IA at the time, it still is. And so the two of us really started this venture. So I came out of employment and then started working and we developed the center. And then, you know, just sort of the ideas like Dr. Strong said, I mean, the ideas just kind of kept flowing and the hunger was just unsatiated. And so I mean, clearly, many of us have a little bit of business in them. And, and for doctors, I think in my mind, I know 95% of doctors don't do with Dr. Strong. And I do. However, to me, it's very natural because we're running the business, we're actually taking care of patients, which is the most difficult and most challenging and the riskiest commitment that anyone really has. I mean, where I'm called for our patients 24 seven, we do the procedures refer, we do the marketing, we do the billing, we do all the back office sort of stuff. So, so to have a knack for business, to have an affinity toward business to me, to, in my mind, the most doctors should should really be a natural. I think also just clearly being a part of Covenant and being able to sort of toggle the clinical world, the private practice world, but also the corporate world and exposure to private equity, not just at a local scale, but on a global scale. And then basically, you know, expanding this entrepreneurship into other things, of course, along the way you take classes and courses and executive things. And, and you know, you develop your analytical skills and you, you become, you sharpen and hone your skills even further. So that's really how it, how it happens. Unlike Dr. Strong, I have children, I have two beagles, I have, you know, and, and I'm traveling most, most weeks, like three days a week. And I'm able to still teach at a major medical school here, I'm able to still do, do clinical. So obviously, without a support system and travel me at home and people who care about you and love you, it becomes very difficult. But at times it's very challenging. Sometimes I wake up in the middle of the night, I have no idea where I am. You know, I don't know if I'm in Nashville, I'm in Boston, I'm in Honolulu, I'm in Dubai, it's just, it's just the way this, but it's been a very fun life and I wouldn't, would not really trade it for anything. Yeah. I give you both a lot of credit. I mean, you're, every day you're going into the hospital, you're on the front lines taking care of very sick people, especially during the COVID pandemic, you were both in there every day. And on behalf of all of us, you give you much respect for that, because you're continuing to do it every day. And I think that's what validates the business of medicine, Vic, because as Dr. Strong said, you know, his motivation, his primary motivation is to do something for the people of Hawaii. That's my motivation as well. So when we, when we know how to run our business successfully and efficiently, we're inviting more access, we're inviting more convenience and more quality to the patients. So, so they don't have to live in Hawaii and think that they live on an island, you know, from like a medical care perspective. My thinking has always been to live locally and think globally. So whatever technology, whatever skill set that people have on the mainland when it comes to clinical medicine, at least in my field and in Dr. Strong's field, we're doing this in Hawaii. So the whole paradigm of telemedicine, which basically disrupted the traditional paradigm of brick and mortar, has been an amazing hit and has allowed people, has allowed me to see people from out of state, has allowed me to see people sometimes overseas. And so really, while the convenience is tremendous, there's almost no decrement in terms of the quality and the, you know, the sacred physician-patient relationship. Yeah. No, that's very true. So Dr. Strong, through Cloudwell Health, in just a couple clicks, I can see a physician who works and lives in the state of Hawaii. Is that, is that how it works? That seems pretty impressive. Yeah. So we built it for Hawaii to service the people of Hawaii. And so people in Hawaii, they want everything local. And so everyone on there is local. They could be on this island. They could be on Maui. They could be on any island, but they're physicians in our community. A lot of them work in the hospitals, such as myself. Some work at, you know, Polly Moment. They could be at Strop. They could be at Queens Castle. But these are all colleagues of mine that I trust. And I would let, I would let them take care of my family members. And one thing that all the doctors in Hawaii, you know, that we say, we treat everyone like family. So, you know, as someone that I'm taking care of, I would treat, take care of them like they're my brother, my sister, my mother, you know, cousin, what have you. So everybody we employ, we want them to feel that way. We want them to have that same ohana that, you know, they would basically treat everyone like a family member. And that goes all the way down through the entire organization that goes down to the coordinator that answered the phone, that help you through your patient journey. We've worked really hard on the patient journey track on the patient experience. We really value the people that we take care of. And we always look for feedback. And so anyone that comes on the platform, we hope they would give us feedback. And those, you know, they can do that through social media on Yelp or Facebook. But we really look at those pieces of information that they share with us. And we really try to take that back and try to perfect things even, even better. So we're always working on the platform trying to evolve things, trying to bring even artificial intelligence into the, you know, into the health, health workplace. Now, you know, we even envision one day being on the metaverse, having no cloud will help on the metaverse where you can go on virtual reality login and see one of us there, you know, almost like in person. So, you know, we look to do these sort of things. We look to create things and look to innovate. And so we're always there. So like you said, three clicks away, and you can be on the phone virtually with us within 15 minutes. Or you can go on and create a calendar and go on there whenever you want. But yeah, we're accessible for the community anytime. That's really impressive. Just a great service to the community. Dr. Arahim, this month is colorectal cancer awareness month. And as you mentioned before, a lot of people have put off going to the doctor, getting tests for very important things because of the havoc from COVID-19. Can you walk us through colorectal cancer, what it is, what steps we can take to try and prevent it with your experience as a gastroenterologist? Sure. So, colon cancer is the third most common cancer in the world. And the colon is the part of the intestine that's called the large intestine. It's also the second most deadly as cancer when you look at the overall scheme of cancer mortality. So it's a very common cancer. Sadly, there's about 150,000 cases diagnosed on an annual basis. And even sadder than that, about a third of people diagnosed are usually like late stage. So they succumb to colon cancer. What is preventable about colon cancer is that 90% of the time, if the cancer is detected early, your survival is almost back to normal. It normalizes someone who's never had cancer. The goal of screening for cancer and prevention is basically to catch it early, but actually to catch even an earlier stage of cancer. So there's something called Apollo, which is a little growth that almost looks like a mold. So when you have a screening procedure, usually the gold standard would be doing a colonoscopy. We're going in to look for these polyps. And what a polyp is, it's a small pre-cancerous lesion where all colon cancers generally evolve from this polyp. So it starts small and it gets large, and at some point it gets large enough to become a cancer. So when one has a colonoscopy, these polyps are found. And the average person has about one in 25 chance of getting colon cancer, 5% chance of having a polyp at any time. So when we see the polyp, we remove it. And the entire procedure takes about half an hour. It's very comfortable. It's very dignified. There's sedation involved. There's not any pain or maybe slight discomfort. But nowadays with our anesthesia, the depth of anesthesia, that is no longer the problem. So this is something that we urge everybody in the world to get colon cancer screening, because that is preventable, almost 100%, just like breast cancer is preventable. There are other cancers in your body that you cannot prevent. Brain cancer, you cannot prevent. Lung cancer, you cannot prevent. Pancreatic cancer, you cannot prevent. And as a result of that, once they're detected, it's already too late because people already have symptoms. So the idea is to find it before it actually becomes symptomatic. And especially in Hawaii, we have a higher prevalence of colon cancer than our counterparts on the mainland. Something that has to do with genetics, something that has to do with some sort of historical influx of different people and races into Hawaii and perhaps exposures to the pollutants and things of that nature. So especially in Hawaii, we should be more vigilant about screening and about preventing colon cancer. Well, that's some interesting statistics. Dr. Strong, if hypothetically I were to see you as my doctor on Cloudwell Health, and I need to see Dr. Arahi, because you're concerned that I may have colon cancer. What would be the steps from a telehealth standpoint to connect me to Dr. Arahi? So I can see. Okay. Yeah. So ideally, you would come through the platform you register as a patient that coordinators would secure the visit. And we would have a dialogue just like we're having right now. I would ask you some questions to see if you're having any symptoms. Obviously, we follow standards in health care. So we would go through a very thorough history taking. We would likely arrange some basic diagnostic lab testing. And if you do meet criteria, we would connect you through to Dr. Arahi's office. Everything's electronically transferred through our system to their system. And so this would be a collaborative effort. We work as a team. We get you over to see Dr. Arahi either virtually or in person. If he's determined that you need a procedure, Dr. Arahi would arrange all that from his end. But it's a very seamless process, very easy to do with the networks that we have with Dr. Arahi and his team. They're always very gracious to take care of our patients. We've sent them patients many times. He's done excellent work for us. We've always gotten great feedback. We think we want to continue that relationship and build on that. It's great that Cloudwell can take the lead in connecting patients to specialists like Dr. Arahi because it cannot be very difficult to access. And the best thing is they are on virtually every island. So it's a network that they've built out on their end that actually complements the networks that we have on our end in our software. That's excellent. Dr. Arahi, are there steps we can take from a lifestyle standpoint to try and reduce the likelihood of something as serious as colon cancer? Absolutely. So what I neglected to mention before was colon cancer becomes common after 45. So now we have reduced screening age from 50 to 45. Now if you're someone who has symptoms already, like you have bleeding or your bowel habits are just altered, there's just something not right, you can get a colonoscopy, for instance, at any age because that's called diagnostic. But from a screening perspective, we start at that age at 45. If you have a family history, we start even sooner than that. So these are all factors. So what you can do, obviously you can't change your genetics. If you have family history, then you basically have to subject yourself to more rigorous screening or surveillance to prevent cancer. But colon cancer is associated with obesity. It's associated with sort of like an excessive carnivore diet, less likely to have it if you're on a Mediterranean diet. So keeping basically a body weight that's closer to normal as possible, consuming basically leafy green vegetables and some data to suggest fiber obviously is very good. Potentially vitamin C is preventable. Potentially people who take aspirin might see sort of a decrease in colon cancer. Less alcohol consumption and then less smoking of course. So these are all kind of the common sense things. But sadly we're seeing a spike in colon cancer and the age is really shifting more to the right, to the younger age groups. So people in their 30s are now at a much higher, millennials are actually a more higher risk for colon cancer than people like over 60 and over. Just sort of the acceleration of the prevalence is really quite interesting. And we attributed mostly to lifestyle and sedentary lifestyle and sort of obesity and so forth. That's some interesting statistics. It sounds like especially now, a lot of people need to get themselves checked by a physician, screened for colorectal cancer and take the appropriate steps to try to achieve a better lifestyle. And on behalf of Think Tech Hawaii, I want to thank Dr. Strong and Dr. Arheem. These are two accomplished physicians committed to the community, committed to the state of Hawaii who have built very successful enterprises. And I thank you both. Thank you for taking the time. Mahalo. I appreciate you. Thank you so much for watching Think Tech Hawaii. If you like what we do, please like us and click the subscribe button on YouTube and the follow button on Vimeo. You can also follow us on Facebook, Instagram, Twitter and LinkedIn and donate to us at think.kawaii.com. Mahalo.