A little disruption goes a long way…
Some years back now I was introduced to the idea that a person being air evac’d via helicopter from a crash site in the middle of nowhere could have the eyes of an ER Doctor on them in a matter of seconds whilst flying at 10k feet thanks to a slick software developer, a strong telecoms network, and a fancy new piece of kit called an Apple iPad. The Doctor could see the extent of the damage so that they would know how to better prepare in the time it would take for the helicopter to land. This was an amazing undertaking at such an opportunistic time to advance telehealth functions and shrink the cost of care significantly due to recent technology advancements.
I remember when the realization struck me. Sat around the table at lunch in the cafeteria on the north side of Stanford Hospital’s campus. It hit me like an earthquake that this was the turning point. Health Care’s playing field could be levelled in a matter of years. People in the middle of nowhere would have devices that kept records of their every movements and monitored their heart rate, they’d have connectivity to physicians, clinicians, nutritionists, any specialist that they wanted essentially, from the comfort of their own homes. No matter where they were in country. They could be on the side of the road on Route 66 in Missouri, or standing on the shoreline of Lake Tahoe in California, or anywhere in between or east of the Mississippi. Didn’t matter. We could now organize practice in a way that allowed us to reduce costs heavily, on both the patient and the hospital network.
Turns out, I was a bit ahead of my time in my thinking. Also, blissfully unaware of the reality that comes with attempting to expand your practice across state lines, as well as the credentialling process that has to be undertaken with the insurance companies to be eligible to actually treat a patient with their insurance in a State that you don’t reside, and actually get reimbursed for the visit. Not to mention my relative naivety that a remote visit would be reimbursed at the same rate as an in-person visit. Reality started sinking in quite quickly that the admin burden and the red tape that comes along with the bureaucracy surrounding health care law and insurance providers in the US was going to slow this movement down. Effectively it was going to slow it down to a glacial pace for a while, unfortunately.
After I left the Palo Alto area in 2012, I moved down to Canberra, the capitol territory in Australia, where I was about to witness how the Australian health system worked from a patient’s perspective, by accident. No sooner had I arrived, I hit a patch of ice (yes, ice), whilst driving through snow (yes, you read that right, snow) on some narrow mountain roads through Kosciuszko National Park. My little Rav4 began to skid, then dove tail, then finally the rear tires swung around to where the front of the car used to be, the vehicle then went off of the road, hit a ditch and did a complete roll over where I was left sitting right side up in the seat of a vehicle where all 4 tires had popped, the windows shattered and smashed panels galore.
Lucky for me there was a passer-by that rounded the corner just after I flipped. He helped me out of the car and onto the ground where we waited. Another vehicle showed up, called 000, Australia’s 911, and emergency services were dispatched. The man that called asked for my phone number so that emergency services could get in touch. I provided the information readily. The man then asked if I had an iPhone. I did. My phone rang. I was connected to an ER doctor in Cooma that wanted to get a look at me. I was not badly injured, just shaken. He calmed me, warned me not to move for fear of internal injuries, and said I’d be strapped to a board with my neck locked in place for the hour ride from the mountain side into Cooma. I took the ride, had scans, was cleared, and back at my Australian home away from home in a matter of maybe 4 hours. The doc called me via FaceTime the next day to check in and then again 3 days after. Eliminating the need for me to have to make my way to a hospital or clinic, unnecessarily.
It’s now 2020 and I have lived in the UK for the last 6 years. Where I routinely catch my seasonal colds and occasionally come down with something that warrants more serious intervention than the over the counter options. So, I reach into my pocket, unlock my phone, open my Babylon app, schedule a video consultation with a GP (usually within an hour, mind you), and wait for my phone to ring. When it does the physician asks me a variety of questions related to my complaints, looks me over, and makes a determination whether I’m just a bit of a big baby and need to tough it out, or whether or not I need a prescription. If I need a prescription, I select the option of pick up or delivery and usually collect or receive my medicine the same day. This has been standard practice for our family now for over 2 years.
I’ve repeatedly looked back at what care was like back home in the US, and asked, why? Why can’t they seem to adopt this integrated approach to care in the mainstream? Well. That was before February 2020 presented itself.
It took Covid to shake up the US care delivery system enough to force the country to catch on to an accelerated adoption approach for telehealth/medicine/everything. It took a mass pandemic and people being frightened out of their minds for care providers and insurance companies to clock onto the idea that there are better ways of delivering care through remote vehicles, ways that reduce costs and administrative burden for carers, ways that reduce logistic constraints and associated costs for the patient, and ways that can drive high quality outcomes for the patient without ever having to meet physically. A huge portion of diseases, conditions and therapies can be managed, successfully, leveraging the power of a strong network connection, a smart device, and a combination of willing participants on the patient and provider side. This is the future for the US. And it’s already the present in many locations across the globe. It’s time to catch up.
All of these interactions with various health systems throughout my career got me thinking about two things. One, what was the US’s stance on tele access now that the pandemic had arrived? What were the individual states and the insurance companies doing about care, now that the pandemic had struck? When I did a little digging and got some answers to these questions, it allowed me to comfortably explore my second thought. Why is someone not immediately jumping on this opportunity this horrible thing has provided us and building a centralized virtual therapeutic care delivery system for addicted gamblers and gamers.
This may feel like a dramatic and sudden left turn for those of you reading this article without knowing me, or what I’ve been up to the last few years. It involves working with individuals and families suffering from gambling addictions and various tech companies and casino operators to try to provide sustainable options for this group of affected people to recover and heal, understanding that the disease is barely acknowledged outside of the UK. Understanding also, that the care framework, no matter where you are, has a long way to go before it resembles anything close to optimal.
I’ve spent years doing recon across various governments and their management of the problem gambling topic. I’ve interviewed dozens of regulatory personnel, casino operators, care coordinators, industry figureheads, political figureheads, academics, researchers, public interest groups, NGO’s, charities, those in treatment, those in recovery, those who have been in recovery for over 30 years, and every other role that plays a hand in the over-arching value stream that is involved in any way with the management, facilitation, and delivery of care. I can say with a high degree of confidence that there is a lot that is improving but a lot that is failing as well, and that this point in time, right here, right now, is a golden opportunity to leap frog from current state to future state with all of the necessary underpinnings and foundations put in place to create a sustainable approach to how care is delivered in virtual environments in relation to gambling, gaming and mental health conditions that can be associated with each. We can engineer the future of care and we can do it right now.
Kindbridge is an idea come to life founded in the basic principles that care needs to be made available to anyone, anywhere, at any time and that problem gambling and gaming are addictions worth unpacking, understanding, taking seriously at a national level, and worth the investment required both from the human capital and financial capital side to build the necessary eco system for both the patients and the providers to thrive. There is a lot to do, and Kindbridge has formed so that we can tackle the challenge head on and build a world class care delivery system for problem gamblers and gamers in a remote environment. We will go through loads of headaches and heart breaks on this journey, and right around the time we have a breakthrough, we’re going to have to begin re-engineering care delivery again, then again, and again. Every time. Because that is how we achieve the highest quality outcomes and keep up with the ongoing technology advancements. We never stop learning and evolving. That is our promise to you.