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• Transcript

  James Kotecki (00:00): 

  The boundary pushers, the futurists, the dreamers, the doers, what do they all have in common besides over-caffeination? They seek new possibilities, new innovations that can enhance the human experience, and you'll find them all at CES. So dive into the most powerful tech event in the world, CES 2025. It's January 7th through 10th. It is in Las Vegas, and you should be there. So join us. Register today at ces.tech. 

  (00:41): 

  This is CES Tech Talk. I'm James Kotecki, exploring the trends shaping the world's most powerful tech event, CES 2025 in Las Vegas, January 7th through 10th. 

  (00:54): 

  Today, the future of healthcare could be in a box. Imagine a human-sized, high-tech box, a little room that can take your vitals and virtually connect you to a medical professional, something that exists in the space between traditional and telemedicine. Here to discuss the why and how of hybrid healthcare are my guests. Karthik Ganesh is CEO of OnMed, maker of the OnMed CareStation, which it describes as a clinic-in-a-box. And Hollie Cost is Assistant Vice President of University Outreach and Public Service at Auburn University, which works with OnMed to help underserved communities in rural Alabama. Karthik and Hollie, welcome you both to CES Tech Talk. 

  Hollie Cost (01:35): 

  Thank you. 

  Karthik Ganesh (01:35): 

  Thank you. 

  James Kotecki (01:36): 

  It's great to connect with you both, and want to start right with this concept of hybrid healthcare. I think we understand what traditional medicine is. Through the pandemic, many of us especially started to understand what telemedicine is, but Karthik, what is hybrid healthcare and why does that concept matter? 

  Karthik Ganesh (01:54): 

  It's a great question, and I think you set it up very nicely, James, in your intro. If we think about the world of access to care, if you will, pre-COVID and post-COVID, even the telemedicine has been around for about 18 years, but the American patient, if you ask any of us as consumers of the healthcare system, the way we've conceived of healthcare has always been showing up at a clinic where you have a comprehensive visit with a clinician, right? 

  (02:20): 

  Two fundamental challenges to that, both numbers related. One, extremely expensive, 2 million to set up, over half a million to run every year. That's one part of the challenge. The second part of the challenge is we need about 200,000 docs in this country in the next 10 years. We're producing 18,000 a year. So we've got a numbers challenge. We can't stand up enough clinics and have enough clinicians to satisfy what this country needs. 

  (02:44): 

  At the other end of the spectrum, we go through COVID, we get jazzed about telemedicine, and we think it's going to be the second coming of healthcare. Not quite, right? 47 million Americans don't have access to broadband. That's one challenge. We've been partnering with Hollie and rolling this out in rural communities, and folks who have one, two, and three Mbps of broadband, they really don't have video, yet they're supposed to have broadband. So if you look at the percentage of folks who actually have no viable broadband, you're talking about a much higher number. 

  (03:15): 

  Plus telemedicine visit is really not a clinical visit per se, because you've got no vitals, you've got no scans, you've got no biometrics, and that's where hybrid care comes in. Hybrid care brings the psychological comfort of traditional care. I'm going somewhere, I'm in a clinic, I have all of my vitals, I have all of that in one singular place. It brings that psychological comfort with a life-sized clinician in front of me. Plus it brings the rapid scalability of virtual care. That's what makes it hybrid, it's traditional plus virtual, the best of both, and overcoming the deficiencies of both. 

  James Kotecki (03:50): 

  I'm really interested to dive into some of these psychological aspects as we go through this conversation, but first is this idea of hybrid care something that really makes sense in rural communities or other communities that otherwise just don't have good broadband? In other words, if I can get to a traditional clinic, great. If I've got high-speed internet, great. Is hybrid care really the best option for people who don't have access to one of those two things? Or is someone who theoretically could get a telehealth appointment or theoretically could go to a traditional appointment still going to be better served in some cases by a kind of hybrid approach? 

  Karthik Ganesh (04:25): 

  So I would say two things. One, I would say telehealth is always going to fall short because you've got, again, you've got no scans, no biometrics, no vitals, right? So it really is, and I'm not being flippant about this, it's a video chat with a clinician. 

  (04:38): 

  Now, when you look at the traditional model, there are some fundamental deficiencies to that even if you have it available to you. One, you've probably got months before you can get an appointment. Second, you're going to go in there and you're going to wait for your appointment to come through. On the other hand, you can just walk into a CareStation and have the appointment. 

  (04:55): 

  The psychological aspect of us is going to tell us, "Hey, it's more comfortable going in if I can actually see a doctor in a clinic." The convenience factor is going to tell us that if I can get the doctor in a clinic right in front, your clinician right in front of me, and I don't have to wait, and over and above that I don't have to walk into a clinic and walk out with some germs I'd never wanted to bring back home with me. 

  (05:18): 

  Now you walk into this CareStation completely cleaned after every visit with UVC, you've got a hyper-secure, hyper-private, hyper-clean, personalized conversation with the clinician, with the convenience of that conversation, with all of the care, all the scans, and all the vitals that you need, I think as we continue to evolve as a society, hybrid care is going to turn out to be a more viable and a more palatable option in the future. 

  James Kotecki (05:44): 

  I think that the audience like me at this point is salivating for more details about what this box actually looks like, what the experience is actually like, but I want to keep people in suspense for just a minute longer and talk about the situation on the ground for you, Hollie. Before we talk about OnMed, before we talk about bringing in a clinic in a box to a situation, I want to also describe what that situation is that people are coming into. So tell us about the healthcare landscape in rural Alabama where you're serving people and working with OnMed. 

  Hollie Cost (06:13): 

  Thanks so much, James. Alabama ranks 46th in the nation in health system performance. We have this growing health equity divide, we have poor health factors, we have poor health outcome, and it's considered a healthcare desert, particularly with maternal healthcare. We have a shortage of healthcare professionals in all 67 counties, most of which are rural, and we have rural hospital closures every day. So we needed to find a solution, and OnMed has been a vital part of our solution because they're able to fill that gap and be in places where our traditional physicians are not necessarily able to be where we don't have the healthcare that we need. And it's been really nice when we're working with healthcare professionals in the region because they are excited about having another option for the patient and really for their neighbors in these communities. 

  James Kotecki (07:07): 

  So I am curious as we go through this conversation to learn more about what the OnMed kind of clinic-in-a-box situation looks like on the ground in Alabama. But now I want to pivot back to you, Karthik, to first just give us a sense of what the experience is in one of these individual... Is it fair to call them a box, one of these individual boxes? 

  Karthik Ganesh (07:26): 

  It's a CareStation. 

  James Kotecki (07:27): 

  Okay, so people can't see this right now, the two of you can see this. I'm speaking to folks from a phone booth in a WeWork. It's got padded walls. It's relatively soundproof. I imagine the CareStation experience is not too much bigger than this, right? I mean, it's a station meant for a single person to go into, right? 

  Karthik Ganesh (07:45): 

  It is meant for a single person. It is a little bit bigger than your phone booth if that's what you're in. So it's an 8.5 by 11 CareStation, okay? You walk in, the experience is this. You walk into the CareStation, the doors lock, the glass fogs up, the windows fog up. So you've got complete privacy inside of it. It's soundproof inside of it. You walk in. The most logical place that you could stand is in the center of the CareStation, which is exactly where the weighing scale is. So your weight's being taken as you're standing there. You can get your weight checked, you can get your blood pressure checked, you've got a pulse ox, you've got scanning, you've got a bunch of devices that are going on and firing up at the exact same time. Got a 65-inch screen in front of you, you hit start, and a life-sized clinician shows up in front of you. 

  (08:34): 

  Now, the life-sized clinician has almost an air traffic control-like command center at his or her disposal, and she's basically, in this case, she's basically having a conversation with you and she's providing care. So as you go through the conversation, let's say you say, "I've got chest congestion," or, "I've got a sore throat," or, "I've got a bee sting and I've got the swelling on my arm or a rash." She can, essentially using her command center, she can deploy devices. You can have a stethoscope come down from the ceiling, you can have a high def camera come down from the ceiling. If she wants to look inside of your throat, you can hold the high def camera to your mouth, stick out your tongue like you would in a doctor's office, and she can see inside of your throat. You take the stethoscope, you place it against your chest, she will tell you exactly where to place it, and she can hear what's going on in terms of your chest and your congestion in real time. 

  (09:24): 

  There are scans that happen that are checking your temperature. If you've got sinusitis and you've got sinus congestion, those are showing up on a heat map essentially for the clinician to say, "Hey, this person's come in. They've got intense congestion here. That in itself could be a driver of what they're coming in for." It is when you think about what we're calling everyday care, a combination of primary care, most of what you would expect from urgent care or post-acute care, the CareStation brings nearly all of your everyday care needs into a very contained comprehensive environment. 

  (10:02): 

  You're done with the conversation, you wrap it up, the clinician can do an e-prescription to whatever pharmacy you prefer. If you need a specialist, they can do the referral to the specialist. You've got a very simple five-star rating in terms of the experience. You're done with it at that point in time, you step out, the clinician remotely now locks the CareStation. UVC light is used, which can actually kill COVID germs as well. So you're basically looking at 99.9% of any virus that's inside of the CareStation at that point being completely eliminated, and then the clinician remotely unlocks the CareStation for the next patient walking in. So you've got an entire clinical experience, the entire experience inside of a clinic in this 8.5 by 11 station that could be deployed anywhere. 

  James Kotecki (10:57): 

  This is sounding like a very futuristic experience. I'm imagining the first time I'm in one of these and I'm seeing a stethoscope kind of descend from the ceiling or as you described it. Does it actually feel like that? Because we talked about the psychological comfort of going into a clinician, do you want people to feel kind of wowed by the technology, or do you want them to not think about that at all? 

  Karthik Ganesh (11:19): 

  We don't want them to think about that. And here's the beauty of it, James. When you think about aesthetics, when you think about the right kind of design, you have to be able to humanize tech. Tech for tech's sake in healthcare has never worked, and psychologically it will not work. If they feel they're in something that is actually futuristic, it is not going to work. So we have mastered the balance between making a person walking in feel comfortable, at the same time, confident about the level of care being provided. 

  (11:52): 

  And Hollie will attest to this. One of the great examples we have is one of our communities in Alabama, we have now seen 48%. And one thing to keep in mind, I mean, when we talk about some of these communities, this is probably the glitziest thing in that community, and they're very comfortable. I mean, that's the beauty of it. They're very comfortable saying, "Hey, the music outside of the CareStation on that screen is too fast for me." 

  (12:17): 

  So that's the level of candor that comes from the folks walking in. We have now seen in that community as an example, we have seen 48% of the community with a 35% return rate back to the CareStation. They not only have psychological comfort that this is going to do what it needs to for me, but they had the confidence to come back because it did right by then the last time around. And these are folks who haven't seen a doctor in sometimes 30, 40 years or maybe ever. 

  James Kotecki (12:46): 

  And Hollie, tell me about how this looks on the ground in terms of the number of these and then physically where these CareStations are located. 

  Hollie Cost (12:54): 

  Sure, I'm happy to. So our first CareStation was located in East Alabama, just very close to Auburn University because we wanted to be able to carefully manage the installation of that and make sure that we were able to easily reach out to the population. This was our really pioneering location and pilot location. So it's in a small county or in a small community called LaFayette in Chambers County. We selected that specifically because they did have a high incidence of some of these conditions that were very alarming to us, particularly during COVID. They had the highest mortality rate in COVID in the state and for a long time, but they also have high rates of obesity, high rates of diabetes, and also hypertension. 

  (13:34): 

  So that was our first location, and they also had a great network of community support, great partnership. But from that, we were actually awarded a grant from the governor's office to install four more of these, and she was particularly interested in these being in West Alabama, and so we now have four additional ones. Actually two just opened yesterday. We just launched those that Hale County is one of the newer locations, Sumter County, one of the newer locations, we have Greene County, and then we also, let's see, have Wilcox County. 

  (14:07): 

  Again, if you look at any of these, these are some of the most impoverished in the state, and we've selected these because they did have some of the lowest health factors and the lowest health outcomes in the state. And we did this with the full support of the community leadership, but also with full support of the community members. As we went around and we had these community health conversations, we identified their priorities. And what we did is we talked to them about OnMed when we went out there, we showed them what the health station could do, what the CareStation can do, and they were very impressed by it. 

  (14:40): 

  And some folks were worried that they may be a little hesitant to use the station, and that's really not been our experience at all in rural Alabama. In fact, I just recently, just right before this call, I got a text from the mayor of Akron, Alabama, which is a tiny little town and with a population, I want to say, around 2 or 300 where we just installed this last station, and this is a quote. He said, "People are so excited to see something of this magnitude come to Akron." So they feel seen, they feel heard. They feel well-treated, and they feel a part of things. 

  James Kotecki (15:18): 

  Congratulations on the success so far then, because I know that community outreach and actually implementing this on the ground is just as important as getting the technology and the system right. How does it work in terms of people's ability to use this? Do they have to get an app beforehand and schedule something? Can they just walk right up to it if nobody's using it and just go in if they have a sore throat, or how does it work? 

  Karthik Ganesh (15:41): 

  They can walk right in. Go ahead, Hollie, please. 

  Hollie Cost (15:44): 

  Okay, thanks, Karthik. Yeah, absolutely, that's the beauty of it, is folks just walk in, they open the door, and there is a start button right there on the screen, and that's all they have to do. And what our people really love about it when they go in is they no longer have to fill out form. The clinician on the screen or the person doing the intake will ask the patient the question, and then they'll go ahead and fill out the forms for the patient as they're talking. So particularly our older patients really appreciate this. So it's just incredibly easy to use. 

  James Kotecki (16:16): 

  CES is an international event, but we're talking about something in the United States, so obviously we have to talk about how people pay for this kind of healthcare. How does that work, Karthik? 

  Karthik Ganesh (16:29): 

  Hollie talked about the governor's office. We have sponsors, and the sponsors come from a variety of different places. So we've obviously got the CareStations, as we just discussed, in large swaths of rural Alabama. We have this inside of a prison system in Texas that has been supported by one of the largest insurers in the country. We have this in a large health system in central Connecticut paid for by the health system because they want to get their footprint and their care message and what they're doing, they want to get that out into the deeper communities that have underserved patients that they can't physically go in and set up clinics themselves, right? 

  (17:07): 

  So we've got insurers who are paying for this, we've got, as Hollie mentioned, we've got state local government paying for this, we've got federal government paying for this in some cases, we have got local communities, and we've got this deployed as an example right now in the community youth center in downtown Miami, and we have one of the largest home builders in the country paying for it as a part of that, we have the University of Miami is looking to do something with us across South Florida because they really want to understand population health and social determinants of care in South Florida. 

  (17:43): 

  So when you think, the beauty of this is, James, underserved is underserved, it's not we immediately gravitate towards a rural health part process. Underserved is rural America, semi-urban America, urban America. I live in Connecticut right outside of the Bronx is probably not that far away from me, right? And you can't find a clinic very comfortably, right? So you could be in the most urban part of the country and still be underserved. And this becomes the perfect solution for any of those scenarios. 

  (18:14): 

  And the key for us that I will keep coming back to is two things. One, especially since you're called out that CES is a global platform, a global symposium. The problems we're looking to solve here are not just American problems. At some point, this CareStation is going to be deployed outside of this country because we're kind of attacking the exact same problems. That's one. 

  (18:34): 

  Second, tech in healthcare has never been a field of dreams. If you build, they will not come. It has been incredibly critical to us and incredibly vital to the way we design these CareStations to humanize the tech and make it very comfortable for a person to walk in and very competent inside from an experiential standpoint, and then give them enough confidence coming out of it that they feel like coming back to it. So all of those components have been very important to us. 

  James Kotecki (19:02): 

  And are they OnMed clinicians on the other end? Are they on your team, or is it a network of people that can kind of tap into it? And how do you train those folks for kind of this new system? 

  Karthik Ganesh (19:14): 

  They're OnMed clinicians whether directly employed or indirectly employed by us. We provide them with the technology. So the technology for us is not just the CareStation, it is also what we call a virtual medical center that we deploy to the clinician wherever they are so that they can provide that care from their location. 

  (19:32): 

  The training is a combination of a number of different things, right? They come to the table incredibly well-equipped with their clinical license. A big advantage we have with this is we're allowing nurse practitioners to practice at the top of their license. They're not in a traditional clinic setting where they've got a couple of minutes with the patient, they're really doing more triage work, quick, quick, quick, and they move on. Here they are in the business of care. This is what they went to school for, right? 

  (19:55): 

  So from a job satisfaction standpoint, it's incredible. And that satisfaction brings the right level of passion and intensity to that conversation with that patient because they're able to make a difference in a person's life, right? So that's very important to us. 

  (20:09): 

  The training and the onboarding for us is a combination of the right person to the tech. The training is a combination of the right level of empathy with behavioral interviewing, as in the right questions asked in the right manner with the right tone of voice that drives the right responses that can then trigger the next set of questions. 

  James Kotecki (20:30): 

  Hollie, I have another question for you, but I have to stay on Karthik for one more second because you're getting right up to an idea that has been rolling around in my head ever since I found out that we were going to be having this conversation, which is the role of AI in standardizing and advancing these kinds of interactions. I don't think most people listening to this podcast will find it too hard to extrapolate to a future where the clinicians on the other end are increasingly guided by AI to keep their tone of voice or their questions appropriate, and/or do we see a future where for a lesser cost or for the purposes of greater scale, you mentioned we don't have enough doctors, is there an AI on the other end of this thing, maybe even just to do the initial intake? What's your philosophy on that, Karthik? 

  Karthik Ganesh (21:16): 

  My philosophy on AI is two things. One, AI has been around for a really long time, and as it feels like as a world we've suddenly woken up the AI and we feel we're not able to choose between sliced bread and AI for some reason right now. So it's confounding to a large extent. AI has been there in healthcare for a while. 

  (21:34): 

  With that being said, I am not a big fan of AI being leveraged in an overt sense. AI can play an incredibly powerful role behind the scenes. I see AI as I think about the CareStation and I think about AI playing out in the CareStation. I would love to see... I mean, we're sitting right now in the midst of a mental health tsunami of proportions that we can't even begin to comprehend. 

  (21:57): 

  What if I was a patient, I walked into the CareStation, Hollie's my clinician, I'm having a conversation with her, and there are sensors that sense that there's a tremor in my voice? Maybe I'm fiddling with my fingers too much. Am I panicked? Do I have anxiety? Is there some other question that Hollie should be asking me as my clinician that helps her better understand my mental state in the conversation? Should she be offering me a different set of services from a social standpoint, because she's going to refer me someplace coming out of this potentially, right? Is there a mental health connotation to the referral that needs to be factored in as well? 

  (22:36): 

  I see AI being incredibly powerful if it is deployed in a more of a subvert manner. In an overt manner, it is going to freak people out because of the interconnected nature of how data works in our ecosystem today, right? Every one of us is very comfortable using our mobile phones. And if we think about most things in life coming down to health and wealth, we're really comfortable using our mobile phones for all things wealth related, whether it's your brokerage, your bank. I don't remember the last time I walked into my bank, right? 

  (23:06): 

  That's not the case with your health. Because what if as a part of that conversation or as a part of an app that I'm using or as a part of that AI component that's on the other end, what if I share something I wasn't...? What if I shared that maybe I'm a smoker? Will that information now go to my life insurance company? Will my life insurance company now jack up my premiums as a result of that? There is a fundamental paranoia that the American consumer and the American patient have had historically about dealing with technology for technology's sake. 

  (23:40): 

  The human component of it is vital to the delivery of care, and that's why I keep coming back to the fact that the core underlying principle in the way we've designed and we deploy these CareStations is humanizing tech. We have to bring the human element. It is tech-enabled, yet human-led, human-delivered because that is vital for healthcare to be successful, or we're going to keep investing in these fields of dreams that, again, if we build, they will not show up. 

  James Kotecki (24:06): 

  Let's talk a little bit more about that human rollout. Returning to you now, Hollie, what are you planning for what's next? What's the total kind of scale or what's the dream here as you roll this out in Alabama? 

  Hollie Cost (24:18): 

  Well, the dream is to make sure that in these communities where we're already located with OnMed that we're serving the community to the greatest capacity. And that's what I do love about working with OnMed because they're a mission-driven company. And so anytime we have concerns or questions or ideas about how we can enhance the services, we go back to OnMed, and we've been able to do that. And so we want to really work very closely in these five different communities to make sure that they are meeting the needs there. 

  (24:44): 

  We do have the most active CareStation in the country in Chambers County right now. So what we're doing right now, I think we found the special sauce. But once we've been able to establish these and we're doing these through our cooperative extension system, which has an office in all 67 counties. Once these are up and running and they continue to go, well, then we are looking at expanding based on the need of the community. 

  (25:06): 

  So that's what we'd ideally like to do, is find these healthcare deserts, identify locations where our OnMed CareStations can be located, and then be able to install those in collaboration with the community and obviously in partnership with OnMed so that we can then address some of these issues. 

  (25:25): 

  So it's not just having the stations there, but what we want to do is we want to really affect these health outcomes. And that's my dream, is my dream is for Alabama not to be 46 and not for us to be happy if we get to be 30th. We need to be much higher than we are, and we want to have a healthier community. So we're building a network of health, and we're building cultures of health, and we're doing that in partnership with OnMed. Really appreciate that. 

  James Kotecki (25:52): 

  And Hollie, is there a specific story that you can tell us, a specific person's experience? Obviously we don't want to violate anyone's privacy, but just to the extent this can be anonymized, is there a story that kind of just stands out from your experience seeing this rolled out? 

  Hollie Cost (26:09): 

  Absolutely. And it's hard to really narrow it down because we have had so many. I mean, we've had parents that have come in and have said that they haven't been getting any health treatment because they'll prioritize their children's healthcare needs, and they couldn't afford to go in because of the co-pays. So that's just in general. 

  (26:27): 

  But more specifically, this has actually happened a couple of times in Chambers County. We've had an individual who was in a crisis situation with respect to their blood pressure, and they've gone into the station, whereas they may not have been able to go anywhere else because the nearest hospital is 25 miles away from the location where we have OnMed. They've gone into the station, their blood pressure was so high that they had to call 911. Someone came in, and they were having a stroke event in there, and so they were able to transport them immediately. Whereas the patient then admitted had that CareStation not been there, they would've just gone on to work. They would've driven somewhere that would've been 25 to 30 miles away. 

  (27:03): 

  So that was really a life-saving situation. And we have multiple examples. We're actually keeping a file on testimonials because there are so many of those that we've gotten from patients who have acknowledged just how convenient this is for them and how much it really is impacting their lives. 

  James Kotecki (27:20): 

  Wow. Well, Karthik, we understand OnMed is going to be at CES 2025. What are you planning, and what can people expect? 

  Karthik Ganesh (27:28): 

  We're going to be at the Venetian in the digital health section of it. We expect to be in the middle of all of the foot traffic, we expect to have a lot of media show up, we expect to find a lot of partnerships. It is solving a big problem like healthcare access needs to be a team sport. We're not going to solve it all by ourselves. We are going to need the Hollies of the world who are just very active champions and just inspirational champions in their communities doing what they need to to bring the OnMed like solutions to their communities, and we're hoping to find such partners as a part of it. We're very excited about CES. This is incredibly powerful consumer tech from a healthcare standpoint, and we're excited to showcase it at CES. 

  James Kotecki (28:20): 

  And to be clear, we're going to see the CareStation on the show floor, I assume. Can people go in and get a taste of what that's like? 

  Karthik Ganesh (28:27): 

  Yeah, absolutely. 

  James Kotecki (28:28): 

  Okay. Well, looking forward to checking that out. Karthik Ganesh of OnMed and Hollie Cost of Auburn University, thank you both for joining us today on CES Tech Talk. 

  Karthik Ganesh (28:38): 

  Thank you. 

  Hollie Cost (28:38): 

  Thank you. 

  James Kotecki (28:40): 

  And that's our show for now, but there's always more tech to talk about. So if you're on YouTube, please subscribe and leave a comment. If you're listening on Spotify, Apple Podcasts, iHeartMedia, or wherever you get your podcasts, hit that follow button and let's give those algorithms what they want. You can get even more CES and prepare for Vegas at ces.tech. That's CES dot T-E-C-H. Our show is produced by Nicole Vidovich and Paige Morris, recorded by Andrew Linn, and edited by Third Spoon. I'm James Kotecki talking tech on CES Tech Talk.