 and welcome to the latest edition of Telehealth in Hawaii. My name is Vikram Acharya. I'm the Chief Executive Officer of Cloudwell Health, an all virtual telemedicine provider based in Hawaii. We have an excellent show for you today. I am very excited to introduce to you Dr. Andy Lee. Dr. Andy Lee is the Chief Medical Officer at the Ohana Health Plan here in Hawaii, which is part of the Centine Corporation. He is also a practicing emergency medicine physician. So his insight on how to be a physician executive is going to be very interesting, and we'll delve into those details on today's show. Andy, how are you? Good morning. Aloha. Aloha. Good to see you. Good to see you. Hope you had a nice long weekend. Yep. Nice busy weekend coaching volleyball. Excellent. Excellent. Volleyball is fun. Volleyball is fun. Well, thanks for being on the show today. You know, Andy, you have a very interesting background. You see patients, but you're also the Chief Medical Officer of a very large health plan in Hawaii. To get things started on the show, walk us through your career. How did you get here? How did you decide to go into medicine and then eventually go into the role of being an executive? And we'll go from there. Yeah. Thank you. Good question. To basically start off, I think the basic is follow your passion. How I got to this point was my initial interest in wanting to serve and take care of patients dating back to high school and then going into college. I'm making, threading my way through the challenges of getting into medical school and then being a physician and really volunteering, getting to know what you're getting yourself into because it's a long road. And if you make the wrong choice, it won't be nice. But so you got to make sure you follow your passion and that's what I did through high school, through medical school. And as I look back, that was probably the easy part. Practicing medicine is challenging. Practice emergency medicine for many years now, over close to 20 years and still practicing, like you said. And as I learned more about healthcare, I started to understand that there's more to healthcare and more contributions that physicians could add to health of patients beyond just being in the clinical practice. And that's where I started to have some interest in the administrative roles. And for myself, I really kind of tested myself to see if that's the right role for me to feel like if I can contribute in a meaningful, impactful manner through administration. And I felt like did. So you start volunteering through committees in the hospital for your medical group. You start learning different aspects of healthcare at different angles, where you can contribute, how you can contribute and then you kind of build upon that. As you get yourself out there, you start to be recognized as a person of interest in terms of interested in that type of work outside the clinical practice. And people start noticing you and starting to recruit you. And I sort of guess my sort of leap of faith away from full-time clinical care to exploring the executive administrative pieces of healthcare was just saying what you really feel is right. Don't be shy to express your opinions, really in the best interest of the community and patients. And that's kind of, I guess, my turning point where I was on a board of an organization that spoke my mind, whether good or bad, right or wrong. But I felt that it was in the right place. And that's where you start getting recognized as someone who perhaps is innovative thoughtful, willing to express. And then it starts building up on that and that's when I got recruited to be the medical director of an accountable care organization in a healthcare plan or delivery system in Hawaii, a big healthcare delivery system. Did that for almost six years. And then I felt at that point, I got that organization to a place of an inflection point where they were going to take off to explore new heights. And I felt that my contribution there was full. And I looked to move to my current position as a chief medical officer in a health plan. It's a new place for me. I was never in the health plan side of healthcare. So I've been learning. So I think the real interest of how I got to this point is sort of the eagerness to learn, eagerness to explore, eagerness to contribute and make an impact to the community of where you live. Yeah. You've seen both sides of the spectrum, the clinical side with patients as well as the administrative side. Many physicians have an opportunity when they finish their education to pursue internal medicine or family practice. What drove you to emergency medicine, the ER? Yeah, thank you. For me, emergency medicine was exciting. That's where I volunteered in high school. I saw how much they did and really how much they contribute and have a meaningful impact to the most vulnerable population of your community. So a lot of the people who come into the ER, they're in high needs. They're vulnerable. They don't have access. And I do think emergency medicine was a place where it offered a breath of opportunities in terms of clinical practice. So at your skill levels from surgical, interventional, procedural, to also understanding the primary care sides of basic healthcare maintenance needs, like colonoscopies, blood pressure checks. So I thought it was a catchment area where you could really touch a lot of patients in many different ways. Everything is not the same. You treat a lot of vulnerable patients. I thought the impactfulness of that part of medicine was extremely high and exciting and worthwhile. Yeah, yeah. Now, what's a day in the life of Andy? So you're in a busy emergency room, taking care of patients, fast paced, a lot of patients coming in and out, and then you are serving as a chief medical officer at the same time. Do you split your day between seeing patients in the boardroom, so to speak, or how does that work? Yeah, good question. It's interesting because it's interesting for me because I see both sides at the same time. When I see a patient with healthcare needs, I understand the health plan side of how their needs are addressed, where they can be addressed, and how we're especially concerned about the rising healthcare costs in the nation. Hawaii's no different. So in that aspect, I'm really cognizant of delivering appropriate medically necessary healthcare in a responsible manner to our healthcare dollars, but also making sure that the patient gets access and their healthcare needs. So in the day of my life, it's busy. I'm working in the emergency room or helping the health plans. And then my main role at the health plan is really to take what I know the provider's need and making their life easier in their day-to-day care of patients. So the beauty of my ability to keep working in the EMBR, keep being on the provider side, makes my work on the health plan side much more impactful for the providers and also the patients and our members. So it's busy. The beauty of it is I'm still allowed to do community service. I do it through coaching our kids in the islands. I coach volleyball for the club and also for high school here at Kamehameha High Schools. So it's really rewarding to have that balance of giving back to the community and also providing patient care, direct patient care, but at the same time on the health plan side to make sure that our providers are taken care of and also our members on the health plan side. Excellent. Excellent. Would you be willing to share an example of where you took some knowledge on the clinical side and brought it over to your CMO, Chief Medical Officer Roll? Yeah. I think on a high level, what I've been a provider for so many years, I've been on the hospital side, the health system side for many years in Hawaii. And now on the payer side, insurance side for a year now. And what I've really learned from that three-legged stool, I call it, the payer, the provider, the health care system. That's the three-legged stool. We all know a three-legged stool cannot stand with two legs. It's going to fall over, right? So I see the three-legged stool with the patient sitting right on top of it. And what I've learned is that this three-legged stool can jiggle, can rock a little bit, but it can't break. All right. So what I've learned is that each leg of a stool, the payer, the insurance provider, the physician or nurse practitioner or other clinicians, and the facility side, the hospital health care system, needs to be in a symbiotic relationship. And in many ways, they are. They all depend on each other. They all need each other. And they all need to work together. So I've been on each of those stools now. So I know a piece of each leg of the stool or a lot of pieces. And what I've learned is we're all trying to accomplish the same thing. Just need to collaborate, work together to accomplish the same thing. And that same thing is that patient sitting on top of that stool and their health care needs. So I've learned to just understand that we're all in this together. We're not adversaries in any way. We need to work to improve our relationship and collaborating for the patients. Yeah. You're taking a step back from it, Andy. You're an emergency room physician. You're in the height of pandemic. For many of us that had COVID-19, you were the frontline physician. You were one of the very first, if not the first provider that many people in Hawaii saw when they had COVID. What was that experience like for you? And I'm sure it was just very challenging at that time. Good question. I have to give a shout out to all the healthcare heroes who dug in and really sacrificed and some sacrificed their lives during that challenging period. For myself, I had a different challenge. Vic, I didn't actually work in the ER that much during the pandemic because I was actually the chief of staff at one of the healthcare systems in Hawaii at that time. So my role was an avalanche of administrator procedures, adjustments, managing resources, helping with supply chain issues, drug issues, and protective PPE, protective coverings at the time. I didn't actually work in the ER that much, but I was on the other side of the pandemic on the administrative side as the chief of staff. So my work was very heavy in that side and not so much on the ER side. But it was interesting in the ER, what we've seen during that pandemic was how things can change, how things can innovate so quickly. And in terms of being so innovative and everyone coming together, administrators, communities, high schools, kids making masks and shields, and just the love of the community coming together during these trying times was amazing and the amount of stuff that we could accomplish in a short amount of time is spectacular. So I think that human need and drive to help each other is very underestimated. When it's time to really put the pedal to the middle. Absolutely. Big shout out to all our providers that continue to fight the battle against COVID. It's an interesting example you mentioned of going from treating one patient to looking after thousands and thousands of people through the health plan. How do you work with your peers at Ohana to really make sure that the clinical needs are taken into consideration on key decisions that are made? Yeah, I mean, that's a complex question but a simple answer. And really, we look at this from the lens of what's best for the patient. Barn on nothing else trumps anything but what is in the best interest of the patient. So if that is the need of the patient, that's how we're going to execute. In that regard, Andy, what are your thoughts on things like telehealth and the future of it? Yeah, I think telehealth is an extremely powerful tool and the amount of telehealth that we figured out how to innovate during the pandemic. We hope not to lose going forward. The patients that need it are getting used to it and they know how to use it. It improves access to places and areas of care that we had trouble with access to in the past. I do think some of the regulatory barriers in the past have been chipped away in this area. So I do think in the end, telehealth is an important tool to help patients get the care that they need. I'm sure telehealth is playing a critical role in providing care, especially to folks on the outer islands where it's often much more difficult to receive access to a physician. Yeah, most definitely, especially behavioral health access, our unique situation of having islands in so many areas. We can't have possibly every specialty to service every island on island 24 hours a day. So telehealth is definitely a tool that we need to embrace, really utilize more swiftly, perhaps even push the envelope a little bit further than where we have already come because of our unique situation of the islands. I do worry a little bit about the outer islands, access to care for specialty care, behavioral health care, even acute care. We can't have a thoracic surgeon, neurosurgeon on every island. It's just not possible. So when we have our air ambulance service who's there for the patients in the community, but they're also stretched as well. So it's a challenge and that's why telehealth is a great tool for the patients and other quality outcomes. We've been using a form of not so much telehealth for a while, especially with some stroke care services where we do remote access camera, not initially telehealth, but it's access to our neurologist when the stroke patient comes into the hospital. We turn on the camera, the docs there within minutes for a stroke, which is critical. Time is brain tissue, right? Time is, whereas before we had to wait for the neurologist to drive in, that could take an hour, and that all that wasted time is not good for the brain when you have a stroke. So telehealth is important not just for the outpatient, but even for acute care. So from the ER, you and your team are connecting with neurologists in almost essentially in real time for patients that are coming in with stroke. Most definitely, yeah. I mean, that's the window of opportunity for a stroke patient is the shorter time, the better. Once we have a system at our healthcare hospital here where when a patient comes in with a stroke, we can call a cold stroke, which is all hands on deck. Just like a trauma patient who arrives in a trauma center, you have 20 people crashing on the patient a trauma room. In this case, we have a team mobilized from lab to neurologists to radiologists to blood draw texts, EKG texts, the physician to the nurses. We all jump on the patient and one of the causes to the telehealth neurologist as part of the integral part of the team, a very integral important piece of the team. And we access them through very efficient timing through a telehealth service. That's interesting because you have situations like what you describe with a telehealth neurologist where every second to every minute counts to provide the best outcome. But then there's also other areas such as like primary care, for example, where I'm sure that a lot of your, that in addition to what you mentioned around the behavioral health that a lot of your members, a lot of your patients could probably benefit from as well, correct? Once they see you, it'd be good for them to get access to a primary care doctor and so on. Yeah, most definitely. As we know, primary care access is limited. We have a shortage, an OI for sure, and I'm sure across the nation. Primary care is challenging. Medical school grads, a fair amount of them choose not to go into primary care because they know what they're getting us into. So making, taking care of patients easier for the providers is also extremely important for access. It improves their well-being, improves their ability to connect with the patients. So beyond just telehealth, there's other forms of sort of digital healthcare that includes things like in-basket messaging where you can email your provider questions. It's really, it's really become a lot more innovative than it was just two years back. So a lot of these just help patients get the care that they need, get the care that they answered. And I believe if we do it right, we can sort of solve the problem of the exponential growth of healthcare in our nation. And Hawaii, notwithstanding is the cost of healthcare rises at an exponential rate. And we all talk about GDP growth and health care. I don't know what is it now. Maybe 20% of GDP and it's a big chunk. So we need to sort of flatten that curve of rise of healthcare. And I think these digital platforms and being innovative and embracing them are a key component of brick and mortar ways of doing things in the past. Through the emergency room, as well as your role at O'Hana, is behavioral health becoming a more prevalent topic of discussion? How do we provide as a community the best services we can from a benefit standpoint, from a clinical standpoint? I'm sure that's a growing area, especially through what we've seen in the pandemic. Yeah, most definitely. Thank you for asking that question. In the ER, we see, like I said, the most vulnerable. The patients who are homeless, they don't have a physician. They don't have as much resources, transportation, digital platforms, digital services. And we're starting to see that there's a lot of substance abuse come into the ER. A lot of substance abuse in the community, they do need help. And O'Hana is in a place where we have the community contract for behavioral health. So we actually have a big space in making sure that these patients are cared for. So we take that very seriously. On the ER side, I see it. And the health plan side, I also see it. So it's really, it takes the community to figure this out and we have a role to play in that. Do you have any kind of, not defining moments, but real nice success stories that as a physician and also as an executive moments of, look, I've really bridged the gap. I've been able to serve my community the best I can. Any stories you'd like to share around that? You know, being relatively new to my new position, we've made some changes that I think that are good. I don't, but most of my biggest impact I feel in my career thus far is the relationships that you build with the providers and the communities you work in. You know, my time as an ACO medical director, I felt that a lot of the good things that we did there was really engaging the providers, helping them understand what we're trying to accomplish and helping them understand that, you know, they're a big part of the solution. It's challenging at times for the providers because it's a very different way of thinking. We're trained to do what's best in the best interest and do everything possible for patients because that's kind of our hypocritical to take care of patients. And, you know, rightfully so, there's metrics that we need to measure which adds burden to the day-to-day care providers. So I feel like my biggest happiness in my executive role so far is really to engaging the providers and helping them navigate through the waters of how things are changing now, nowadays. But I think as we work through that together, there would be better days ahead for not just them but also the members and the communities and the patients we serve. The, your role is so important because you can be the bridge. And at many times I would think the translator between what's happening on the front lines with the patients and what executive decisions need to be made at a macro level because sometimes that understanding may not be there but someone like yourself and your role, you're able to bridge that at a level that a lot of people cannot. Yeah, most definitely. And I feel that's why I feel like my role is extremely important and also to continue to practice in the community. I've made an intentional effort to practice in the outer islands in rural health communities. For my 15 to 20 years thus far in the emergency medicine, I've been in sort of a tertiary care center, community health center. Let's see the plethora of patients from all kind of specialty coverages and backups that we have where none of these you have on the outer islands. So I've made an intentional effort in my new role here at Ohana to be out there in the rural health community. So I've been starting to practice on the big island and Ka'u. I'm there this weekend working in Ka'u on the big island, working in Honoka'a on the big island, even working on Kauai in urgent cares. So seeing healthcare delivered in all different aspects in all different communities has been an intentional effort for myself because I wanna know what's out there, what's impacting the patients, the health centers, the communities. And a big part of it is I don't wanna forget that side of medicine. So I wanna stay in there sort of with the pit providers and keeping my feet hands, hands and feet dirty and never forgetting that aspect of why we went into medicine. That's really great. I mean, you're staying in the trenches on the outer islands, especially where there's a lot of need. And then that can help you further how a thing translate those needs to the health plan at a way that a lot of people cannot. Is there a certain kind of significant differences or notable differences you see right off the bat when you're in on working on the outer islands versus Oahu? Well, yeah, access to Oahu is challenging. I've seen access on the neighbor islands much more challenging, access to just primary care. Now, speaking of specialty care, a whole new level of challenge. Even acute care medicine, there's no backups on the neighbor island. I mean, sometimes as simple as an orthopedic backup, you don't have. So it's a big challenge that I've recognized working on the neighbor islands. And yeah, the resources are sparse and not just clinicians, but even just nursing staff and other outpatient resources is also limited. So never mind just the health plan and healthcare of a patient is beyond just maintenance, I mean, health maintenance, care, outpatient or inpatient. There's all different kinds of nursing homes. There's even home-based care is challenging. I've seen on the neighbor islands, and a lot of patients need like long-term care and it's hard. So, Andy, I wanna take a moment to thank you for being on the show. We have a lot of guests on the show, but it's exceedingly rare to have someone of your background who's a practicing physician out in the community, but also at the executive level at the same time, addressing needs on a patient level, but also a macro level. And especially you leading during the time of COVID, working with your peers during the time of COVID, I really wanna thank you for all your contributions and advancing the needs of the members of the state of Hawaii, the residents of the state of Hawaii. It's really, really great to have you on the show and you have a lot to share and I really appreciate it. Yeah, well, thanks, Vic. It's my pleasure to be here to share my story. I think my parting words would be to the people who are watching, thank you for watching and thank you for your interest in the discussions we're having today and beyond just today. I think we should not forget why we're all in this, from Telahel to Think Tech Hawaii and I've seen a lot of your other podcast speakers, all great conversations. So I know the subscribers and the people who are watching care. And I think we should not forget why we're in the business that we're in and it's really for the membership to be healthy and have a good life and to have access to care and that's my parting words. And I appreciate the time to share that with your viewers, Vic. Thank you for your time, Andy. Well said and mahalo, appreciate it. My pleasure, Lo. 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 and LinkedIn and donate to us at thinktechhawaii.com. Mahalo.