Telehealth Best Practices: Dr. James Forshee of Priority Health On How To Best Care For Your Patients When They Are Not Physically In Front Of You

I believe the virtual visit concept is a significant step forward in the process of improving clinical care. It provides the opportunity for healthcare to be significantly more patient centric, creating availability when, where, and how people prefer.

One of the consequences of the pandemic is the dramatic growth of Telehealth and Telemedicine. But how can doctors and providers best care for their patients when they are not physically in front of them? What do doctors wish patients knew in order to make sure they are getting the best results even though they are not actually in the office? How can Telehealth approximate and even improve upon the healthcare that traditional doctors’ visits can provide?

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Dr. James Forshee.

Dr. James Forshee is the chief medical officer and senior vice president at Priority Health. In this role, he leads clinical and pharmacy programs, the development and coordination of population health programs and chronic disease management strategies. Dr. Forshee also steers strategic planning to further the company’s mission of improving health, enhancing patient experience and effectively managing cost.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started in your career?

Very early in my career as a physician assistant, I joined a start-up HMO to support the medical directors. This provided the opportunity to become involved in several committees, which I enjoyed, and watched the amazing physician leaders struggle with the business concepts and administrative burdens. It became evident very quickly, as I began to understand my desire to help, that I needed help. The opportunity to get my MBA from the University of Michigan became a reality and I was afforded the opportunity to continue to work full time during this education. Upon completion of the MBA program, I found myself with a 3-piece suit, a Franklin planner, and still a step or two from influence at the Board of Director level.

At that time, my wife and I came to the decision we would start our family, and I would start medical school seven years later with three children and a MD degree and Board Certification in Family Medicine, started my career in administrative medicine!

Can you share the most interesting story that happened to you since you began your career?

Early in my career before PE, VC, (virtual & horizontal acquisitions), and mega mergers all became vogue, I was involved in the sale of a for-profit insurance company. The learnings and intricacies were so fascinating and interesting. This sales process going from end-to-end for the privately-owned for-profit insurance company was like a highly customized MBA course. The preparations, mathematics, operations, negotiations, language & lexicon, medical considerations, emotions, legal reviews, power plays, and new learning as to what is valuable (tangible & intangible), have carried over many times in my career.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

“Do not sell your birth right for a bowl of soup.” This is one of three family rules we established early in our marriage, in our careers, and in child raising. Professionally, there are always many good things; shiny objects, presented each day. Having clear vision as to what is real success, what the journey is about, is critical to making a truly great strategy work. Michael Porter is quoted “the essence of strategy is choosing what not to do”. Making the easy, attractive short-term decision can often disrupt that well thought out strategy. Stay focused, pass by short-term shiny objects, and keep your eyes on the journey and the destination (even if it is my favorite cheddar broccoli soup)!

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

Two individuals come to mind. Personally, my wife always demonstrated a clean focus on “loving others”. It molded and influenced my personal, and to a significant degree, my professional understanding of EQ. I am so grateful for her willingness to stay true to her “mission” in life and the example she provided.

On the academic professional side, one specific mentor always spoke to me about my “aim” in life. He encouraged me to set my sights higher than I could see; to reach higher and reach harder. His ability to dig deep and explain the meaningfulness of the “why” in all of the “aim” discussions continues to make a difference.

Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Telehealth can of course be very different than working with a patient that is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?

I was trained in medical school and residency under the bio/psycho/social model of care. Much of what makes up the patient physician interactions includes non-verbal and subtle observations which a virtual ‘headshot’ is missing. I also believe there is significance of the actual physical examination and touching which can be taken for granted. There are learnings, emotions, and healing associated with the actual physical encounters that are a very vital part of the patient/physician interaction.

On the flip side, can you articulate for our readers a few of the main challenges that arise when a patient is not in the same space as the doctor?

The familiarity of the routine of an office visit should not be undervalued. The simple challenge of technology, cameras, internet, volume control, Bluetooth connectivity, positioning, modesty, loss of context, and certainly the hands-on physical exam, all can diminish the virtual visit experience.

Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your 5 things providers need to know to best care for their patients when they are not physically in front of them? (Please share a story or example for each, if applicable.)

I like the way you framed the question, “…. 5 things providers need to know” and would like to add “and should do”.

Would suggest these things as “Top of Mind”:

Be patient…this may be a brand-new experience for patients. And be prepared!

Create a guide or tip sheet to share proactively:

Create a list of questions

Pre-test your equipment

Select a quiet private location

Create a list of medications

Be ready to support from a technology perspective, if not this visit, at the next visit

Your patient’s comfort level may be low at first. Focus on thoroughness to assure them of the validity of this virtual visit

Patients will want to know it is ok to do this virtual visit, and will need to see your comfort level. Be intentional and affirming.

(Remember this is all about the patient!)

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

I believe the virtual visit concept is a significant step forward in the process of improving clinical care. It provides the opportunity for healthcare to be significantly more patient centric, creating availability when, where, and how people prefer.

Let’s zoom in a bit. Many tools have been developed to help facilitate Telehealth. In your personal experiences, which tools have been most effective in helping to replicate the benefits of being together in the same space?

Two things have specifically improved Telehealth. First, camera quality continues to be better and better. Second, the application of Bluetooth technology has augmented the virtual care space. Specifically, stethoscopes, otoscopes, blood pressure cuffs, peak flow meters, and handle nebulizer/inhalers are wellness applications to support their use.

If you could design the perfect Telehealth feature or system to help your patients, what would it be?

Perfect is out of my league. The next significant improvement I would like to see is related to access to a real-time patient controlled medical record system. The patient record from hospital and office medical, to behavioral health, to pharmacy, to social determinants, needs to be part of every healthcare encounter.

Are there things that you wish patients knew in order to make sure they are getting the best results even though they are not actually in the office?

I would refer back to our 5 things physicians need to know and add a little more commentary to creating a clear set of tips and guidelines to be sure the patients’ needs are addressed. Readiness is a great starting place. This starts with testing their equipment, selecting a quiet location, having a list of all current medications, and the 2 or 3 questions specific to the reason for the virtual visit.

The technology is rapidly evolving and new tools like VR, AR, and Mixed Reality are being developed to help bring people together in a shared virtual space. Is there any technology coming down the pipeline that excites you?

Honestly — these types of “tools” do not get me excited. I’m certainly encouraged to see more opportunities for improvement in the scope of virtual care become available. This may include enhancement of current virtual care, and the expansion of possibilities for additional body systems to be appropriately evaluated in a setting other than face-to-face, when patients are willing. Patients fall into a continuum in terms of their willingness to replace face-to-face encounters with their doctors.

Broadening the spectrum of options should increase access to care for some, but at what cost! As I’ve pointed out, cost escalation is a huge concern and none of these technology advances in and of themselves, are being offered to reduce the patients’ expenses. The benefit is very low if due to the pricing, few are able to afford the ‘new tools’ experience. The overall total cost of care indeed can be lowered with virtual medical technology, if we are able to focus the health care delivery systems to accept reduction as a goal!

Is there a part of this future vision that concerns you? Can you explain?

The area which causes me to lose sleep is related to the constant escalation of the cost of healthcare. When I hear 40% of Americans cannot pay cash for a $400 surprise medical bill, and the annual average deductible for an individual is $4,000(+/-), the sustainability of our current health system needs to be questioned. There are 30 new treatments in the pipeline for potential release in 2021–2022 all of which will cost > $300,000. Much more time, intellect and energy need to be focused on affordability and sustainability.

Ok wonderful. We are nearly done. Here is our last “meaty” question. You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.

I’m a huge fan of consumerism. The control of healthcare, healthcare data, and healthcare dollars needs to change. The data is available to delineate quality care and the data is available to delineate the cost of care. When these two data sets are married, simplified, made transparent, and accessible for everyone at an average consumer understandability, we will see a measurable improvement in the patient health care journey.

How can our readers further follow your work online?

You can follow me on LinkedIn: https://www.linkedin.com/in/james-d-forshee-953b7793/. You can also follow updates on Priority Health on LinkedIn: https://www.linkedin.com/company/priority-health/mycompany/.

Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.