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INTERVIEW: Elevate the Physical Practice into the Digital Space

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Ryan Carlson
October 6, 2021

In our video health data series, "Leaders in Leveraging Health Data", we chat with J.D. McFarland, Solutions Architect at Mend.

Telehealth lets you reach those who need care no matter where they are.

A telehealth solution that goes beyond teleconferencing can enhance physical practices in the digital space. Telehealth complicates your experience if you don't have the right tools for engaging patients.

In our conversation, it becomes clear that tech-driven efficiency is going to separate companies that succeed from those that barely make it.


Mend with J.D. McFarland: Elevate the Physical Practice into the Digital Space

Ryan: Today, we're here with J.D. McFarland, a solutions architect for Mend. And let's go ahead and just start by talking a little bit about what does Mend do? 

JD: Mend is a patient engagement platform. We're known for telehealth, but we also offer a full suite of patient engagement tools. That means digital forms, digital intake, patient notifications, reminders, post-visit surveys.

We also offer AI no-show prediction tools called Predictive IQ, which can help reduce the risk of no-shows and also alter the behavior of our notification cadence to make sure those clients who are at risk show up. 

Ryan: So who is it that is your primary customer, and by customer we can say it's practices, but more specifically, who is it that is feeling this pain that leans in going Mend. I just heard what you. I want to go to there. 

JD: Practices, oh, all of them hospital systems, health systems. We even have insurance companies that are working with us because everybody found out in the last year that telehealth is not just teleconferencing. So if you're going to have a video session, you need to be able to collect the payment. You need to be able to get all your consent signed, hopefully. And this is where HealthJump comes in and you want to send that data back to the EHR, so you don't have to manually transcribe it. And if you don't have those tools, you've just added one more thing that makes your life more difficult instead of something that makes it easy.

Ryan: That's always, the challenge is asking a practice to log into one more thing. That seems to be the common friction. Yeah. 

JD: Yep. Log into one more thing. Remember a different workflow. This form, now it's going to look different. So I have to worry about how can I train my providers in order to do this new thing.

Ryan: So you're in the hospitals hospital systems. Tell me about specific pain that Mend is just rushing in and addressing, and maybe even the unique challenges that you feel that you're uniquely suited to address. 

JD: There's a bunch, it all boils down to all the things necessary to elevate (ing)  the physical practice into the digital space. (This is an amazing line) At the end of the day, a ton of the things that people do in the office, Are not easily brought up in the digital space. Being able to bring those workflows into the digital spaces where we really excel and like I said, that's collecting information for the patients, but it's also things like pulling information from the EHRs, automating the forms that are sent out to the patients, assigning additional forms based on the answers of those forms. 

Ryan: So it uses that based off of their answers. 

JD: Yeah. So we might send a basic behavioral health assessment, something called a PHQ2, and if it says that, Hey, this patient might be a little depressed. We can subsequently automatically send a full depression screening, and then we can send that information, score it. We can put alerts, trigger alerts in the EHR, and do all sorts of things that go beyond just that teleconferencing experience that wouldn't have to be done in a normal setting by a person. Manually shoveling data around, paper, faxes, emails. And that's a nightmare. 

Ryan: It sounds like you're taking common scenarios, if this, then that, how are you informing those decisions since they're clinical in nature? What informs those next steps in your user journey? 

JD: Short answer. 

Ryan: Anytime you you bring up UX. That is the common answer. 

JD: It depends. So we're completely customizable. That's another thing that we excel at is we're flexible. So unlike a lot of EHR vendors that are in this room today that say, we offer all these solutions, but it's really, we offer our solution...

Ryan: "do you like highly opinionated software? I know you do".

JD: Or maybe I don't. Yeah. So is that it's customizable or is it configurable? Do you have a set of parameters and is it just to adapt to workflows or is it truly, you know, sandbox?

We can highly tweak it to the individual's workflows and where it comes into informing what decisions are being made, what's going to be, what logic do they want us to take? 

So one common area that a lot of our prospects are terrified of is patient self scheduling. About half of our customers come to us and say, we want patient self-scheduling the other half, as soon as we mentioned it say, oh, hell no we don't want that. The reality is patient self scheduling radically reduces no shows, increases patient satisfaction, and it can drive a ton of revenue. Whether you think you want it or not, you really do want it. What you want (for self-scheduling)  is you want all the rules built around it to make it work for your practice.

You don't want a free for all widget on a website that people can pick, "I want to see this doctor at 2:00 AM in the morning". No, you need to be able to build all the business logic and rules around your practice. You want to be able to direct the patient to the right appointment types and patient-friendly language. And that's where we build in all those logical decision trees. And we build it to suit the practice. That's where we really are at our best. 

Ryan: I really like how you're taking some of these common usability challenges and building some automation around it. So how much of it is, build your own, and how much of it is Mend partnering, whether it's client success or a support team to advise on making those updates? 

JD: It's really a white glove experience with Mend, our implementation team and our customer success team is going to be making these changes and customizations for the life of the project.

We joke about, we basically give our customers a ring. We don't want them to ever go anywhere. We want to marry them long-term and that means we're going to be adjusting with them. In many cases, our implementations never stop because they start with phase one, go to phase two. Then they reevaluate phase one because they found out all these other cool things they can do. And we're constantly evolving and building more...

Ryan: you answered my next question, how do you maintain accountability or governance around changes that may be the right change now, but welcome to software. 

JD: It changes.

Ryan: It's always changing. So it sounds like that white-glove experience. Do you have like check-ins or what does that cadence look like to be working with Mend 

JD: it depends on the customer. So sometimes, yeah, it depends in healthcare. Healthcare is extremely different from provider to provider and they need different cadences, we work with some hospitals that really run the show. They have their own change control process, and we're showing up at their meetings. We've got others where they have no processes and we're running everything and we adapt to that. But a typical cadence is we're going to in peak implementation as we're going live, we're going to be talking to them every day. We're going to have standing weekly meetings. That's going to transition to monthly in many cases, but then it might transition back to weekly as we're doing another project. So it, it just, it depends. 

Ryan: Let's talk about the value ladder. There are things that are table stakes. There are things that are differentiators, where not everyone does it. And then there are your premium differentiators. The things that you're doing are truly unique. So knowing that telehealth is a table stakes conversation, what is it that the Mend experience is doing to not just look at differentiators, but do you feel that there's any premium differentiators that sets you apart from...

JD: there's a couple.

First of all, implementations and that customer success experience. But another one, which I haven't mentioned is our support team. We offer full support based here in the United States, primarily in Orlando near our headquarters for both patients and providers. Anybody looking at our app, no matter what feature it's telehealth, whether it's forms, patient self-scheduling, they're always going to have access to our support team through a click. They respond on average in 13 seconds and the average time to resolution is three minutes and we support multiple languages. We want to extend our product to as many people as possible. So that means easing the ability to work with translation services, ultra-low bandwidth requirements.

We actually just released a new release yesterday and we can support video calls on 2G. Which coming from healthcare IT, I used to have a phone system that required more bandwidth just for audio than we require for video. It's crazy, but we want to work for as many people as we can. I can't wait til we're using Starlink and talking to somebody on Mars or the moon.

We wanna, we want to make sure that wherever you're at, you can get the telehealth you need. 

Ryan: That is fantastic. So where do you see the future of Mend going?

JD: Hopefully world domination. 

Ryan: Excellent. 

You're talking about how Mend is uniquely addressing these challenges, where in the conversation are people starting to lean in and going, " what!?". 

JD: So it usually comes down to the customization and the automation being able to make less work for the providers is what they ultimately care about. Provider time is their number one expense. It's their number one frustration point. Maintaining a happy set of providers is very difficult. And right now with telehealth, they now have to compete in some cases for a national pool of talent. It is critical that people make their providers happy in their lives easier, and that comes with automation. And the support has gotten more difficult because now people are working at home and the it infrastructure is not as simple as it used to be.

It was great. Once upon a time when you had this nice, perfectly manicured corporate network with wonderful QoS V LANS for your video, traffic and dedicated video end points, now you've got to deal with connecting to epic via terminal services on someones maybe personal device on their 15 year old Linksys router that they say is connected to gigabit ethernet 

Ryan: and their kids are watching Netflix or doing remote learning at the same time. 

JD: And you may or may not require them to tunnel in through a VPN at the same time. 

Ryan: Yeah. No big deal. 

JD: No big deal.

And yeah, so our team is used to working with that and we're used to working hand in hand with the IT team to do the testing in advance. Test with the providers and make sure those road bumps or bumps in the road are smoothed out as much as possible. 

Ryan: Normally I ask you that the pandemic hit, which growing pains in healthcare, do you feel that you all experienced the most or reacting to the most? But I'm hearing one of them is the increase in number of remote workers. Is there anything else that you found that whether it's demand scale or different types of complexity? 

JD: Demand went way up. Our business increased by 300% during the pandemic. We're fortunate. We architected our infrastructure in advance of COVID to grow and scale. Unlike much larger platforms, we actually didn't crash during COVID and we've continued to grow and scale without any major impacts...

Ryan: Multiple nines? 

JD: Yes, multiple nines and we're very transparent about it. We have a status page, you can go and you can view our uptime and you can view our incidents. 

Really. With COVID a number of things emerged. So with more people using the system, we got a lot more feedback on things we can improve. So we've put a ton of improvements into the software. One of the things that we pioneered in the past year was our enhanced virtual waiting room, which if you've used tele-health in the past year, you've probably seen, please wait, your doctor will connect with you shortly.

Ryan: Can I get a PDF of a people magazine from six years ago? 

JD: No, but you can get Ted talks and other educational content available at no charge. And you can even get practice specific materials so they can load their own educational content there on marketing and the patients on average across all platforms and tele-health wait 20 minutes per session. So that's a lot of time that's being wasted, either not engaging the customer. And oh, by the way, when customers aren't engaged, guess what they do, they close the screen and go somewhere else. And so that leads to no-shows. So we've seen a decrease in no-shows through the technology. We've also seen an increase in patient satisfaction.

Those are the kinds of things where we've tried to innovate. 

Ryan: Are those those metrics just tracked through some sort of pop up. I mentioned satisfaction. 

JD: We do satisfaction surveys. We did, we do it both for our internal purposes, but we also will push out satisfaction surveys for the provider.

Ryan: So how did you come up with that idea was it was there some usability study that said, Hey, this looks like blue ocean for us. I've never heard of anyone doing a virtual waiting room where I can actually be entertained or educated other than 

JD: I think enough people just said, Hey, we're tired of looking at the clocking image, and the smart people in our company said, Hey, we got an idea. Let's run with it. Smarter people than me. 

Cause at the time they did it, I was actually a customer of Mend. 

Ryan: Really!?

JD: Yes I was before it was an employee. 

Ryan: What impressed you about Mend the most before you put on the red shirt?

JD: Yeah, so I, my background is in healthcare IT and I had worked with tele-health since 2014. Mend was replacing another piece of software that had completely failed, but it was at our fourth major tele-health generation. As payers opened up new opportunities, because once upon a time you couldn't get paid for it at all.

But with Mend that was their openness to actually do that. Those workflow customizations help us automate. One great story from the company I came from, we actually went live prior to COVID and just coincidentally, we contracted with Mend in advance of it, and we were able to convert 100% to telehealth during COVID with Mend 

Ryan: Shut the front door

JD: and half of our front desk staff walked out, said, we want the enhanced unemployment. So see ya. We're not doing the work anymore. And we were able through automation to not have you have to hire those staff back. 

Ryan: Wow. 

JD: That's how significant it can be. And that was not a planned event on our hand. That's just, that's what happened. And it was a fortunate side effect. That's how powerful these tools can be in a practice.

Ryan: I love the fact that we get to hear from the, the actual customer. How often do they actually have that? Not only me, I have the president, but I'm also a client. Not only am I a solution architect, but I also was a client. 

JD: Yes. 

 I come from the behavioral health world, and that is a very conservative space when it comes to adopting new technology.

And there are very large companies right now who still don't think telehealth is important, but there are others who have adopted to it, taking it on. And guess what? They've grown from being 11 providers to 300 providers in a year. Yep. They're going to be going places, the ones who were saying, yeah, this is just a fad, it'll move on. We'll see where they're at in a few years. 

Ryan: So my wife has a mental health professional who opened up her own practice after being with the whole group right before COVID right before the lockdown and because all of the insurance and you said, yeah, at some point, telehealth was recognized.

COVID made every health plan in the Midwest say you, of course you can. We'll re. And I don't think that's going away. And what it allowed her to do was to meet students who had tele-health parents who had to pick up an extra job, parents who are like, going between different houses because in mental health, the patients you're seeing are in difficult situations many times, right? Yeah. The accessibility that telehealth provides to meet people where they're at is so critical. Right. And so it's transformative to be honest.

JD: Yeah. And in rural areas, if you have say you're going to do family therapy, and you're going to do two or three sessions a week, taking your child out of school, picking them up, taking time off work, you may not really even be able to hold down a job because it might take you two or three hours to get to the point of care.

So it is not as simple as well. It's just, it's an alternative way to see the client. It's hugely transformational for some people. We have a lot of PA patients that we serve on Indian reservations. We're literally as replacing a day long endeavor to go get care. So huge financial impact, especially for people who are most at need.

Ryan: Thank you so much for sharing the Mend story. I think there's still so much to watch. What we're seeing It's all about digital transformation when really it's just go digital, you need to have done it. And I think anyone that's still operating in business today, in healthcare has made the necessary minimum viable enhancements. But man, you cannot kinda mainline some of this efficiency, right? 

JD: It's going to differentiate the companies that are very successful versus the ones who just survive.

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