 the latest edition of Tell Health in Hawaii. I'm your host, Vikram Acharya. I'm the chief executive officer of Cloudwell Health, an all virtual leading telemedicine provider based here in Hawaii. We have a great, great, exciting show for you today. My guest colleague, Reagan Vaughan. Reagan is the director of wellness and credentialing at Hawaii Medical Assurance Association, also known as HMAA. Reagan, how you doing today? Doing great. Thank you so much for having me. Thanks for being on the show. It's great, great to have you. To get things rolling, tell us a little bit about yourself, where you're from, you're role at HMAA, and we'll go from there. Sure, absolutely. So I'm originally out of San Antonio, Texas. I currently am the director, as you mentioned, director of wellness and credentialing over at HMAA. I really got started with healthcare in college. I was an intern assistant in one of the local emergency rooms, and my interest was really heavy around medical research. So I did that for a couple of years through my undergrad, and then I went into public health right after college, and I got really lucky that I found HMAA right away. You know, I was 22, I moved out to Hawaii. I found this fantastic job that allowed me to do something in my field, really helping grow the wellness department out there, and I've been there ever since. Yeah, that's a really nice story. What brought you to Hawaii, being from Texas? Well, who wouldn't want to go to Hawaii from Texas? It was really just something fun that I wanted to do. I wanted to get out of my normal space. I loved the environment out there. I'd spend a lot of time in my youth, traveling back and forth. I had some connections in downtown already, so I happened to get into town, and it just worked out and was just meant to be. Yeah, yeah. Now, you're the director of two departments, two big departments at HMAA. There's credentialing and then there's wellness. Let's start with the wellness. What's a day in the life, Reagan, when it comes to the director of wellness? So wellness is really my bread and butter. I was actually fortunate enough to come on with HMAA in 2010 and really start developing their wellness program. You know, at that point, we were trying to meet some of the standards with the ACA, make sure that our groups had the resources they needed to start their own corporate wellness programs. So we really started off with things like biometric screenings, vaccination clinics, encouraging things like healthy eating and physical activity. And over the years, over the last 12 years, it's really just become this really great program where now we are also focusing on things like maternity management, colon cancer screenings, and of course, telehealth, which is something we're just super excited to be able to offer to our members. And recently, we've also, in 2019, we maintained our NCQA, Wellness and Health Promotion accreditation. So we're also very proud of that. But in the ins and outs of the day, we're really just looking to help our members identify areas that they need some extra support in in the wellness realm and make sure that they have the resources and tools that they need to make better lifestyle choices and also get access to care when they need it. Yeah, I'm sure, especially, hopefully coming out of the pandemic, there's a significant need around wellness, especially, I'm sure folks, there's the behavioral health side where there's a lot of need there, but also around the physical health as well. A lot of people have gone, possibly several years, without really taking care of themselves, seeing a provider. Are you seeing things like that? Oh, yes, the pandemic definitely impacted everyone. And in Hawaii especially, the lockdowns were a really trying time for a lot of our members, the local residents, being stuck in confined quarters. A lot of people's gyms were shutting down. Their doctors weren't able to do in-person visits. There was also just the general concern about contracting the virus and what exposure means to everyone. And we definitely think that things like virtual telehealth is something that was just really crucial and maintaining care for our members during that time. Yeah. And now there's also the credentialing component, which is an equally important part of what you do. Walk us through, what is credentialing for those that may not know and how important it is when it comes to HMA. So all of our providers are required to be credentialed. Really that's just maintaining records, ensuring that we have all the proper licensure and the criteria is needed to be part of our network. We check everybody out before we get them out into our provider network. And that's something that we do every three years with all of our providers to maintain our URAC accreditation on that site as well. So it's checks and balances on the provider side and I'm really happy to be a part of that site as well. Yeah, yeah, no, definitely. In your day to day, what are some of the challenges that you face with really maintaining that high level of excellence that you and the HMA team deliver on every day? You know, I think one of the biggest things is just making sure that our members and our providers are happy with the service that we provide. And I really couldn't do that without the excellent team that I have. I'm lucky to be surrounded by really great people. My team is fantastic. They're very reliable. You have a really strong attention to detail and quality. And I think that's just a really big factor throughout our company is that everyone within we're a family and ourselves and paying attention to quality, ensuring that we're giving the best service that we can is a really high priority. Absolutely, absolutely. So now HMA also has a very strong, robust telemedicine platform, it's called HIDOC. Walk us through, what is HIDOC? So HIDOC is our telehealth platform which is powered by Cloudwell Health. We're really excited to be partnered with Cloudwell. So we actually started our telemedicine program. We got started thinking about it in 2016. It wasn't something that everybody was jumping into. It wasn't a heavily utilized service at the time, but we launched around 2018 joined with Cloudwell in 2021. And really it's something we were really grateful to have at the start of the pandemic to have an established program to be able to service our members for the various specialties. So starting out with urgent care, that being something that's really heavily utilized, our members are definitely appreciative of that. Things like pediatrics, but mental health care being a new service with Cloudwell under HIDOC has really just heightened the game for us. It's something that a lot of people in my opinion aren't rushing out to get care for when they need it. And there's different stigmas all around around accessing mental health care. And so I really think that the telehealth aspect of it has really bridged that gap to say, you know what, I know that I need this care and I maybe wouldn't have been excited to go in person right away and start that relationship. But through telehealth, I'm able to go in and talk to a therapist and get the care that I need when I need it. And so that's something that I think has just been super valuable as a part of our telehealth program. It's my favorite thing to promote any time I'm out talking about telehealth is, hey, you know, you can get mental health care on the platform as well. And then just recently rolling out primary care availability as well. It's really also helping to provide access to physicians, especially to members that are gonna be out on the outer islands, maybe there's a physician shortage in those areas or it's just generally hard to get in person with a physician, especially during the pandemic. It's just been a crucial part of our wellness program offerings to be able to, you know, have a backup plan for our members to say, you know, we can get you seen today. Yeah. I'm sure, you know, you have many members who are very hard for them to access primary care, urgent care because of the significant providing shortages in the state, but with HIDOC, they can get it the same day. Absolutely, yeah. And that's definitely invaluable, you know, especially with children having pediatric availability on the platform as well. I've got two kids myself, so I can definitely, you know, stand behind that, that sometimes you wake up in the middle of the night with a fever and all kinds of symptoms. And, you know, it's not necessarily convenient to pull your children out of bed in the middle of the night and take them into an urgent care and ER facilities. So I really think that HIDOC and Intel Health in general is just a really great resource to, you know, get that medical feedback and consult on what you should do next. You know, do I need to go to the ER? A lot of the time, they're simple, you know, explanations for certain things where you can either wait and talk to your primary doctor if you need to, otherwise you can be seen through telehealth and it saves you from spending all that time waiting in the ER, the urgent care waiting room when you really just needed a prescription for antibiotics or something like that. So definitely a great, great option to have. Yeah, no question, no question. When you meet with your members, do they, these days, is it medical needs and behavioral health needs are pretty much about the same? Like what people are looking for? Or is it more on the medical side? Like what type of feedback do you get, you know, when you meet with your members? I think that it's a little more heavy on the medical side, but I think that the mental health side is building, especially because it's not something that members necessarily thought of off the top of their head. You know, when you think about telehealth, you think about, you know, you've got allergies and flu, you've got fever and different kinds of reactions. You need to be seen for a skin infection or something like that, but you don't necessarily think, oh, I can talk to a counselor, I can talk to a therapist through telehealth as well. So I think that that really sparks a lot of interest to hear, oh, I have this option as well. And we've really seen that build the program over the last year or two. Yeah, yeah. So, and it's probably, you know, right now when you meet with members, it's like, you know, it's great that you have mental health, behavioral health services may not have thought about it, but now that you mention it, I'm, you know, both are of importance to us now. Absolutely, absolutely. And the feedback that we've gotten from members who regularly use the mental health aspect of the program is, you know, very positive. They love interacting with their therapist. They go attend regularly. They're not missing sessions. And they're really getting all of the positive aspects of finally receiving that care that maybe that they've been ignoring until now. Absolutely. You know, when you, if you were to look about three to five years down the road, do you foresee more and more utilization of programs like High Dock to advance telehealth? What are your thoughts on that? I definitely think so, especially among the younger generation, you know, I think that people in their early 20s and their 30s, you know, growing up with technology, having access to everything in the palm of your hand and just the general busyness of everyone's schedule, having direct access to a physician without having to wait two weeks, you know, that's something that really speaks to a younger generation as well. So I think that as this is just the norm, you know, as we go over time, it's really gonna pick up because we're also gonna see populations that wouldn't normally get a regular annual checkup with a physician start utilizing it more because it's easier to access that care. You know, they can do it from the comfort of their home. You don't have to take off work to go to the doctor anymore. You can be seen on your lunch break. You can be seen after work. And so I think that accessibility is gonna play a huge role, especially in that younger generation getting used to being seen this way. Yeah. And a lot of people were sort of introduced to telehealth during really the height of the pandemic. It's great that now that they're more familiar with it, you know, we find that once people use it for the first time, there might be some hesitancy in the beginning, but once they use it, they really like it and they inevitably come back. Yes, that's what we've seen on our end as well is that usually if somebody comes into the service once, they're gonna enjoy it and they're gonna come back and use it again when they need it. Yeah. Now, shifting back to wellness, there's a lot of just higher, higher rates of diabetes, hypertension, high blood pressure, you know, higher rates of chronic conditions, especially in Hawaii. You know, as part of your wellness leadership role, what types of programs are available for members to access when it comes to some of these chronic conditions that could be pre-diabetic or they may have diabetes, what's available to them? Sure, so we work on multiple tiers with chronic conditions and chronic conditions are really something from a wellness perspective, and I think that most wellness programs can attest to this is you really wanna hone in on those risk factors, you know, because preventing comorbidities from things like diabetes, hypertension and high cholesterol, you know, we're gonna, we really wanna prevent those from developing into things like coronary artery disease and digestive heart failure and stage renal disease. You know, we really wanna stop the train there. So what we do is we have different levels. So those that don't really have any risk factors, but they know that their behavior, their lifestyle choices aren't necessarily the healthiest. We have the standard wellness programs that promote physical activity, healthy eating, getting regular checkups with your physician, that kind of baseline wellness care. And then we build up from there. So if you are pre-diabetic, for instance, we've got some digital resources that you can use to kind of step back your risk factors, get some education on, you know, ways that you can just really improve your health even in the slightest ways that are gonna help you prevent from developing things like type two diabetes. We also have partnerships with a bunch of really great vendors, you know, like High Dock and Cloudwell. We also work with several pharmacies who do diabetes education, that sort of work. And then we also have disease management programs for those who are diagnosed with the conditions and they need a little bit of extra help reaching their goals, whether that's medication compliance, regular testing, following up with their physician on a regular schedule and things like that. So we've got nurses that are available to assist with those types of things. But as I mentioned with our telemedicine program, we also are able to refer them to speak directly to a physician and get some consults on things that they should do directly from a medical professional. Yeah, yeah. So the nurses, they're like coordinators for patients. They help coordinate the patient's wellness progress and trajectory. Yes, so every member has a dedicated care plan based on the risk factors they have, the conditions and comorbidities that they have. And then their registered nurse will work with them on at least a monthly, more so, depending on the case basis in order to make sure that they're reaching their goals. Yeah. Now we're often asked this question a lot and I'm sure it's the case with HMA-82. Because we service all the islands, it makes it great, especially for those that might be on specific islands where the provider short is even increasingly acute. And so I'm sure you get that feedback also from the HMA-A side. Look, thank you so much because I don't have a lot of providers on this island but I do have a smartphone and I can access High Dog. Absolutely. And really making sure that we have something for those outer islands members, we don't wanna leave them in a position where they have to travel to Oahu in order to access care. And a lot of members out on those outer islands can attest to the fact that sometimes that is the case. You have to leave and come to Oahu to get care or be seen for certain specialties. And so it's really great for High Dog to be able to say, it doesn't matter where you are. We can definitely help you. And in most cases, it doesn't matter what time it is, we're always there for you so you can access care whenever you need it. So yes, those outer islands, those rural areas, we're really pushing it in those populations to let those members know you have access to this program and it's not gonna take weeks for you to be seen. Yeah, and you raise a good point. It's having care for the outer islands but also because the service is essentially open, essentially almost all the time that they can, whether if you would like primary care at nine o'clock in the evening, you can receive it. Right. Mental health sessions, based off when you're free because many people obviously in the service industry, for example, it's hard for them to be able to take time off. And like you said, go to the doctor or go to your therapist whereas, if that's the time it works for you late at night or early in the morning, then it's available. Absolutely, care on your own schedule and that's really what we all need. A nine to five availability doesn't work for everybody and sometimes things pop up and you need to be seen sooner. You don't have that time to wait. So yes, having that constant, near constant availability is priceless. Yeah, yeah. And now if you were to start to think of other ways in which down the road, high doc, something like high doc can be used, where would you try and try and position it in terms of some new potential ideas? So kind of stemming off of the chronic disease topic, I think that's a population that we'd really like to be able to continue to hone in on and provide additional remote monitoring. It'd be really helpful for not only the patient to understand where they stand with their condition, but also for the physician that's monitoring their condition to get regular live updates, especially if somebody goes into a diabetic crisis. Sometimes it would be really great for members to have a care community who is also aware of what's going on with them and can reach out and say, hey, we noticed that this is going on with you or maybe the member calls in to the physician and they are like, yep, we already see your results right here, full access, full transparency between patient and physician. I think that would really help with stepping back those risk factors and properly maintaining those conditions. Yeah, those are great long-term steps, that's great vision. So in your spare time, when you have it, you mentioned you have a family, you have young children. Can I tell us a little bit about Reagan's family? Oh gosh, so I have a 11-year-old son. He is in sixth grade, so we're getting exposed to all of that middle school, early teenage tween years, so that's exciting. He's in football right now. He loves basketball and baseball, video games, of course, because what sixth grade boy doesn't love video games. And then I also have an eight-year-old daughter. She's currently in third grade and she's kind of the opposite of the spectrum. She goes to startup business classes. So she's learning how to design her own company and she loves gymnastics and she's just a great personality. And she loves also being part of this type of interaction. She was lucky to be able to be part of one of HMA's news segments on the COVID early in the pandemic. So she's got a good drive for business, which is really funny from an eight-year-old's perspective, but they're great. We spend all of our time together when we're free and really just enjoy each other. Yeah, yeah, no, same on my side. It's like being able to, the kids, when they need medical care, we've accessed telehealth and they really respond to it really well. They're like, wow, I don't have to go in. We don't have to go into the doctor, mommy. Like, daddy, I can do it through the computer and we're like, yeah, it's like a full-on visit. It's really a lot of, and they're fully engaged. I mean, they answer the doctor's questions, they participate. I mean, it really is, like you said, in the years to come, the new mode in which- Oh, absolutely. And they're already used to talking to everybody through FaceTime and video chat. You interact with grandma and grandpa this way. You also get to interact with your doctor this way. So it's great. And yeah, they pick it up really quick. Yeah. Any types of great stories you want to share on the high dock side of grateful members or happy members, people who really tried the service first time and really enjoyed it? You know, keeping in line with the family perspective, some of the best feedback we get is around families. I was up in the middle of the night. My child had a fever. They were throwing up. I didn't know what to do. I didn't want to pull them out of bed. I didn't want to drive 30 minutes into town. I didn't know what the wait was going to be. And they were able to get in within 30 minutes. Late at night, mind you. I believe it was sometime after midnight that they called in and they were able to get a prescription, pick it up the next morning. And, you know, everything worked out great. So I know that the adults are loving the service as well, but I think it's extra beneficial when we know that that's trickling down throughout the family. No, absolutely. Absolutely. To know that it's not just adults who could use it, but children as well. You know, that's a great resource, especially for busy parents. And I suppose that in the middle of the night, it can be very hard, very stressful. You can't leave some children at home when one has to be driven to the hospital. You know, that's hard to do. On the other hand, telehealth was, you know, I know we talked about the pandemic, but it was vital for the pandemic, especially when exposure happened in the workplace. One of the things that we did see is that we would get calls from clients and they would let us know, you know, obviously we assisted with COVID testing early on as well, doing pop-up testing clinics and stuff like that. But when it came to exposure with certain employees, we were able to say, you know, if anyone has questions, concerns, they need a note from a physician in order to go get tested. They were able to call in HIDOC and all of their employees were able to talk to a doctor, evaluate their risk, discuss exposure, identify ways to get tested. So that was a really great resource to have mid-pandemic. Returning to work and that sort of thing as well, we were able to just make sure that the members felt comfortable. They were cleared by a physician to say, okay, well, your exposure was something to take serious. You need to go ahead and, you know, sit out for one to two weeks or, you know, your exposure wasn't direct. You're in the clear. You can return to work without any concerns. So I will say that that was another really big benefit to telehealth, just accessing that medical feedback around COVID. Absolutely. Absolutely. No, that's, these are really excellent points. You know, it's, we're on the heels of a telehealth awareness week. And we've spoken, you know, it's been a great conversation with you about the benefits of telehealth. But I really want to personally thank you not only for being on the show, but the tremendous partnership that, and successful partnership that we've had with Cloudwell Health and HMA working together for the residents of the state. And it's just been an excellent collaboration. You know, you do a tremendous job and it's just great to see so many members who are patients well taken care of. And it's just really been a great partnership and ultimately members and patients have really benefited from it. I want to thank you, I really appreciate it. Absolutely. And you know, that goes both ways. It wouldn't be successful on our end if Cloudwell didn't put such high quality into their service. You know, hands down, you all do a fantastic job of assisting our members. You know, the access to care, the assistance between your call center and your physicians, the follow-ups after the consults, coordinations with the pharmacies. You know, we couldn't be successful without the high quality of work that your team puts out. We appreciate it. We appreciate it. Thank you, Reagan. Absolutely. We appreciate you being on the show. And thank you for everything and Mahalo for your time. It's great to see you. Absolutely. Thank you so much for having me. You're welcome. Have a wonderful day. We'll talk soon. Absolutely. 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 thinktechhawaii.com. Mahalo.