 Welcome to our latest edition of Tele Health in Hawaii. My name is Vicar Macharia. I'm the host of the show. I'm also the Chief Executive Officer of Cloudwell Health, an all-virtual, physician-founded telemedicine company that is dedicated to serving the residents of the state of Hawaii. We have a great show for you today. On the show is the Director of Operations for Cloudwell Health, Anella Tecter. How are you, Anella? It's good to see you. Hello, Vicar. Good morning. I'm doing good. How are you? I'm doing good. I'm doing good. To get things started, tell me a little bit about yourself, Anella. You're from Hawaii. You've born and raised there. Walk me through a little bit about yourself, your background, and we'll go from there. Sure. So, yes, I was born and raised here in Hawaii. I actually grew up on the west side. So, my family is from Nanakuli, but right now I reside out in Waimanalo. Just starting out just a little bit about myself, I guess, in the medical field. It started out... I'm in the early stages, I guess, of the pre-med route. That is the hopeful goals for myself. But, yes, as of right now, I am the Director of Operations for Cloudwell Health. What brought you to healthcare? People have many different things they can choose in terms of what they want to do for a profession. What brought you into the healthcare world, Anella? Well, I guess it started at an early age, growing up. You think Tutu is going to live forever, and then you start to realize, like, oh no, what can I do to help my family? So, I think it really started off at a young age, but fortunately for myself, I think, going through school, I was kind of finding that biology and all the science courses that I was taking on my route interested me more than I thought it would have. So, I continued on that route, and then I started scribing. So, I scribed for one of the groups out here at Castle Medical Center, and even more so, I started to fall in love with medicine. I got to learn the background of it, working side by side with the physician, and now I'm kind of just getting more experience from a different aspect, learning, you know, how to communicate more with the community, and doing things more for the patients as well. For folks who may not know, what is a scribe when you mention you are a scribe? What does a scribe do? So, ascribes, we basically shadow the doctor. We follow them, and we help them with their documentation. That way, doctors can focus on their patient care and their bedside, because nowadays, you find doctors are always in front of a computer, but having a scribe allows them that opportunity, so that the scribe does all the documentation, and the doctor can have more to one-to-one FaceTime with the patient. Yeah. Now, you made the move into the world of telehealth, and what brought you into Cloudwell specifically? What was it about the organization that made you want to be a part of it? So, initially, you know, I was brought in since its inception. I was a friend of Dr. Neil Chauhan. He brought me on, and I just thought it was an amazing opportunity, because Hawaii never really had much as far as advancement with technology. You know, medical clinics, they do everything in person, and telehealth was so new, especially we started pre-COVID, so even more so. It was a very new concept, but I came on, and I was really behind their mission statement, making things more accessible to the community of Hawaii. I know getting in touch with the provider can be really difficult out here, too. Yeah. Now, a lot of people ask about, is telemedicine just as good, so to speak, as seeing somebody in person? You know, you've worked in as a scribe, you've been in the hospital, you're now in the virtual world. Is it the same? Can somebody expect the same type of experience on a virtual side? Yeah, definitely. If anything, I think it's better, in my opinion, just because of the convenience of it, to be honest. You know, you're getting care with the doctor, and it is that same face-to-face, one-to-one care that you're expecting to receive from your provider. You know, I know there can be some thoughts or ideas around like, you know, well, what about the physical aspect? How do they properly do the physical exam? But for us, I think we can do almost everything that regular providers can do. We can set you up with a specialist if that's needed, and we do that quite quickly, actually. We can send you out for any diagnostic studies that's needed, so in my opinion, we're doing the same thing that would be done in a regular clinic, and then more because it's just a lot more convenient for the people that are using it. Yeah, so you interact with so many patients every day, and so walk me through it. You know, my stomach is hurting. I live in Honolulu. It's going to take months for me to be seen by a primary care doctor, but I find Cloudwa Health, and I register, it's only a couple clicks. So what happens from there? Can you walk me through it? Yeah, definitely. So like you said, the booking process online, it really is straightforward. And then the next piece really is that hands-on, you know, clinical coordinator comes in and they really take care of our patients. They provide a different kind of patient care or customer service that I feel most patients don't really get, unfortunately, when it comes to health care. We really take our time to make sure patients feel comfortable. They know the next steps. And then we make sure everything is on track and on time when connecting with our providers. Yeah. So there's a connection with the patient. So I would get contacted before the visit by you or one of the team members. Right. We are very good at contacting our patients. So it would be before and then right after too, because even that aspect afterwards. So before the visit happens, we will walk our patients through all the steps, you know, how to connect on video, making sure that that connection is successful, answer any questions that they might have. And then immediately after the visit, we would check patients out and make sure that they know step A to Z. What are the next steps and how are we going to make sure you get it in a timely manner? That's pretty unique. I mean, it's not very common for telemedicine companies to contact you before and after the appointment, especially over the phone. That seems like a very nice feature. Yeah, I agree. I think it really helps too because, you know, telemedicine has now been around because of COVID. But I think having our coordinators contact patients before and after really also adds to that local touch that patients can feel trusted or they trust our company that they are talking to local providers, local staff, and they really understand the elements and the uniqueness of Hawaii. Patients probably feel very comforted that when they speak to you or speak to one of the team members, it's somebody who works and lives in Hawaii. They probably like that a lot. I think so. I mean, I would appreciate it if I know I'm talking to someone who is also from Hawaii. They know the struggles. They get it and because of that, they do everything that they can. They know the ins and out of the network. So I think that they would appreciate it. Now, for people, does Cloudwell Service provide services for all the islands across the entire state? Yeah. So that's been an interesting piece. I think since I've started working with Cloudwell Health, I was actually genuinely surprised to see we get patients from all the islands, a lot of patients from Maui, which I can understand because I have family out in Hana side on Maui and it is so hard driving in and out of Hana Road to just see a provider. So I totally get it. We see patients from Big Island, Kaua'i, like I said, Maui. So we do see patients across all the islands. It's a very interesting concept because people may struggle getting access to a doctor in person, but they do have their smartphone. So that's kind of how the process can get started, at least to see a board certified doctor in Hawaii. Right. Exactly. Yeah. I mean, we have the technology. It's there. Why not use it? Why not get connected with patients through technology? Especially like I said, for those that live in rural areas like Hana Maui, if they need to see a specialist, they don't need to go through the hassle of having to go in and out of Hana Road. They can just connect with the doctor one time. We do all the work on the back end and get them connected with the specialist where they can then make their efforts to make that appointment and get connected with who they need to see. So normally, if I were to go in to see my primary care doctor in person, if I need to see a gastroenterologist because of my stomach ache, I might be given a card. I might be given a phone number, but it sounds like there's a specialist network with Cloudwell that already you do a lot of that already for patients. Yeah. We do have a specialist network already on board, which is really convenient. We really take advantage of that specialist network getting patients seen as soon as possible. And even if they're not in network, in my honest opinion, having to experience a specialist referral as a patient, it can take all up to six months. And what we've been seeing on the platform, we get patients connected within probably at least a month, which is its significant difference. Yeah. Now, this month is National Minority Health Month. And we know that Hawaii is one of the most diverse states in the country. And can you talk to me a little bit about how telehealth overall is breaking barriers and providing timely medical access to minority populations in the state of Hawaii? Yeah. That's definitely a good point to make. Hawaii is definitely a melting pot. That's for sure. We have a diverse group of cultures, just people, ethnic backgrounds. I think when it comes to just the topic of minority groups, I did live out in Nanakuli for my whole life and kind of experiencing how healthcare is. It wasn't great. It definitely wasn't accessible. It was really a struggle having to make appointments. Like you said, it would be sometimes weeks or even months out to get that appointment. And unfortunately, also speaking from experience, most people out here have one to three jobs. So they're having to make a living out here. And I think a part of that struggle or breaking barriers as far as the minority community goes, it's filling in that gap for available resources because it is so easy for someone who is having to have multiple jobs and they put their health on the side. They don't have time, but with telehealth, it really provides a solution where they don't have to spend so much time as far as making an appointment, getting things coordinated, taking time off of work to see a provider. Now they can do it from the comfort of their own home and especially with our hours. They're not typical business hours. So we operate from six in the morning all the way till 1 a.m. So patients can see us before or even after work sometimes on their lunch break because it's not convenient. But I think that's really where telehealth comes in is providing an additional resources that wasn't available at that time. Yeah, I know that especially for there's many people across the state who cannot afford the transportation have to spend a lot of time out of their work day to see a provider, which then affects how much compensation they can get on the job. And that can be very tough when you put all those factors together. But with telehealth, it looks like something could be done within 30 minutes to an hour, which would normally take in potentially half a day or an entire day. Yeah, that is true. Patients, when they see their regular doctor, if they were to see another doctor in person, it does. They have to reserve their entire day for commute for just the appointment. And unfortunately, most of the times when patient is ready to go to their appointment, they're stuck in their waiting room for hours waiting for their time to be scheduled or to be seen. But we solve that. That's another solution that we help with that telehealth just provides a gap for fills that gap. No transportation is needed. You do it from the comfort of your own home. And it doesn't even take that long to be honest. You can book your appointment within that hour. And you're seeing on time. So that's another thing too that it's unfortunate. It's understandable. But you know, patients, they they reserve that whole day just to see their provider, which shouldn't be the case. Yeah. We've touched on the subject of a lot of the medical care. But we also know mental health is a significant health challenge, timely access to mental health services, specifically with minority populations. Can you explain to me a little bit about how telemedicine can serve that need as well specifically around mental health? I think especially like from a cultural standpoint, sometimes, you know, patients out here are just in the community. It's still not something that it's, I guess, done regularly where patients might feel a certain way, reaching out for help with the therapist still. But I think with telehealth, it now provides a sense of privacy, where they don't have to make the effort to go into an office anymore. They don't need to feel ashamed at all. It's definitely not something to be ashamed about. It's totally fine to reach out for help. And I think with telehealth now, with the privacy and being discreet about needing help and reaching out for an appointment for any mental health concerns, whatever it is you're going through, that is probably a big barrier that has been lifted now with telehealth. Yeah. So there are large pockets of the population that would prefer more of a private setting when discussing their mental health with a therapist. And that's what sounds like that's what telehealth can do. Exactly. Yep. That is exactly right. You know, we and not only that, it goes even further because we can offer as simple as a phone call visit with someone to talk to. It doesn't have to be through video either. Yeah. What is the best part of talking to the patients? What's the best part for you? What brings you the most satisfaction? You know, you're interacting with so many patients a day. Many of them telehealth is new. So you're playing a pivotal role in walking them through what to expect and how it functions. So what's the best part for you when you're interacting with the patient? I mean, it sounds a little cliche. One of two things like happen. So obviously, the first one is I love seeing that I was able to help someone, especially if they're in a situation where normally it would have been so difficult just to get that first appointment with the provider. I think the example that will always stick with me when we first started, one of our first few patients was actually from Big Island. And she just had the she was an elderly patient, but she had such a hard time getting out of her house and getting family to help her coordinate that when she found our services, you know, it was something that was a significant impact for her where she could come back, continue to use our services if she was ever unable to get an appointment with her regular doctor or it was just too difficult at the time to coordinate care with her family. That is one example that will stick with me. I think the other aspect too is because telehealth is still somewhat of a new concept out here. Being able to see the transition from start to finish, because in the beginning patients are they're a little like, I don't know how to use this. I'm not tech savvy. But after the end of their appointment, they're like, wow, that was easy. I don't know why more people don't use this. And then they come back they're, you know, returning patients, they will continue to use our services. So I think that second piece is probably what I enjoy the most is just seeing how much telehealth has changed and that they're so willing to come back. It was so easy for them. You raise an interesting point. It sounds like when people use it in the beginning, there's some hesitation. But once they go through with the process, then they inevitably come back and want to use it again. Yeah, yes, that is exactly what happens. And I think that's where, you know, when the coordinators touch base with them in the very beginning, it creates that trust between patient and provider or clinic. And then after they speak with the doctor through their mobile device or their laptop, then it's just like, wow, that was so easy. I don't know why more people aren't using the service. Yeah, yeah. Now, in terms of how much it costs, you know, there's always a questions of, is a telehealth visit the same cost as an in person visit? What do you explain to patients when they when they ask about that? So most of our patients, they do ask, but most of them, I'd say, do have health insurance. A lot of them are Medicare or Medicaid, so they would have like HMSA Quest and they are, they love to hear that we are servicing members of the state. We have, you know, HM, all the major Hawaii, Hawaii insurance plans, basically. But on the other spectrum of that, especially when COVID, you know, was hitting a lot of families financially, some of them did lose their benefits. So something that I would explain to them is, you know, we do offer affordable rates. It's still going to cost something, but it is a significantly less amount than what you would pay at an urgent care or with an in person provider. So our, we offer two rates. So the first one is $59.99 for a phone call visit. And then the second piece, if they are interested in either like a telephysical or they want that video call, it's $119.99. Telephysical. That's a big word. Yeah. What is a telephysical exactly? You can think of it as like your, I guess, annual maintenance check. So patients, like I said, they have multiple jobs, they put their health on standby and a telephysical just gives that opportunity to touch base with the provider. It's a head to toe wellness check where we thoroughly review any medical histories that patient might have also order any screening diagnostics based off their answers or even their family histories that might be, you know, an underlying diagnosis that they might have not known about. So it just gives an opportunity one-on-one touch base with the provider to a wellness check, get any screening labs that you might be due for, and then we can follow up on those results. Now, if I live on in Maui and you see me and the doctor sees me and I need to get my labs done, how does that work in terms of you making sure that the labs were done and then ultimately that you get my lab results? How does that work? That seems kind of complicated, doesn't it? You would think it is, but honestly, knowing what happens on the back end, it really isn't. And I like that we can take that headache away from our patients. We really take care of all of it. So doctor will send in the lab orders or we'll call in the orders for our patients. And then from there, you know, patient can just walk into any nearby diagnostic facility, get their labs drawn, we'll book their follow-up appointment, but we will make sure before that follow-up, we contact the facility, we make sure that we get those final results in before they're seen. That's a very strong customer service that you offer. That's really good. I mean, it makes it so much easier for the patient, which is ultimately what this is all about, right? I mean, making it easy to access, but also easy to navigate. Yeah, exactly. Like I said, taking all that headache away from our patients, just letting them do the bare minimum so that they feel confident, they trust our service, we take care of the rest, especially when it comes to specialist referrals. We will book their appointment for them, we'll communicate with the provider, making sure that they have everything they need. That way, when the patient shows up, their appointment is ready to go. There's nothing outstanding or why the patient can't continue. Yeah. Now, if you were to look into the future, and you're in telemedicine every day, and somebody said, do you think telemedicine is here to stay, or do you think it's going to go away? What are your thoughts on it? You interact with patients every day, so you know if this is something that patients are interested in or not. What are your thoughts on that? No, telemedicine is definitely here to stay. It's been way too convenient for patients, and it's also, like I said, it's lifted a lot of those barriers, especially out here in Hawaii, where patients, they have such a hard time accessing healthcare in a timely manner, but healthcare really, it just provides that service for patients that they need, and when they need it. It really also avoids unnecessary visits to an ER or an urgent care in person, so it saves them that aspect of time, but I definitely think telehealth is here to stay, and if anything it will even go further in the future. It's an interesting point. Further in the future you think that we could potentially be looking at models such as like here in the home, or you know, because there's many multi-generational families in the state, and so there is some opportunity I would think to provide these services in the home, which empowers not only the patient but family members as well to be involved in the trajectory of the care of the patient. Yeah, that is definitely true, so you know having my own family here, we all pitch in and we try to take care of Tutu, and I think having something like this where it becomes like in-person home care, that's another barrier that we can definitely lift for our community, you know, having that ability to help families, not only the patient themselves, but alleviating families of that burden where they're having to take care of elderly, they don't have the resources, it's really difficult, but I think that's, that is another concept for telehealth that that we can work on. Yeah, and because right now, especially with people over the age of 65, not only are they more at risk for medical and mental health challenges, but they also just struggle with mobility issues potentially, they may not be able to see a provider, and I imagine this is going to be a very good vehicle for them to receive care, but also empower, like you mentioned, the people in the home too. Yeah, that's another point too, it's, you know, just like having the average person having to designate a whole day just to get themselves seen even more so for our elderly patients, because transportation is an issue, sometimes they have to rent a particular vehicle or, you know, get grandma in and out of the house, in and out of the car, it's really hard and it's hard on those family members, so if we could bring care to them, I think that would be a big solution. And I'm sure when you get on the phone and you contact patients, people are probably pleasantly surprised, like, wow, I'm speaking to Anela. Anela is from Hawaii, she's just like me, I'm not talking to somebody maybe in Boston or Miami, that must be, that must be really nice. It is, it's definitely nice, and like I said, I would appreciate knowing that the service I'm using, it's homegrown, it's local, everything about it is just, you know, a very trusted service. And some of the patients, they really, they're really a joy to talk to and knowing, you know, going back and forth about either the struggles or how we help them, it's really a rewarding overall. It's like you almost develop a very personal relationship with them over time. Yeah, yeah, especially for our returning patients, it's nice to see them back again. And even though it's virtual, it's still a personal relationship and that's what's most important. Absolutely, yes. Anela, you're taking care of patients every day and you are on the front lines providing outstanding care, outstanding customer service, and the organization has progressed significantly, you know, with your involvement. And you're providing great care to all the members and all the residents in the state of Hawaii. And we thank you for that. And thank you for that. And I appreciate everything that you do. And it's great to see from your expert opinion that telehealth is here to stay and that telehealth is just going to thrive in the years to come. Thank you, Vikram. It's been a wonderful experience, you know, working from the company start to finish. And thank you so much for having me on today. Oh, you're most welcome. Mahalo.