Anurag Gupta – Emergency Care and Specialty Care Telemedicine for Seniors

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Anurag Gupta, MD, MBA, MMSc
Anurag Gupta, MD, MBA, MMSc

Dr. Gupta is the Founder and CEO of Tembo Health, a telemedicine startup seeking to revolutionize healthcare delivery, and is an Assistant Professor of Emergency Medicine at both the Icahn School of Medicine at Mount Sinai and the Zucker School of Medicine. He received his MMSc in clinical informatics from Harvard Medical School, earned his MD and MBA degrees from the University of Michigan and, after training in emergency medicine at Mount Sinai Beth Israel in NYC, completed a postdoctoral NIH/NLM research fellowship at Brigham and Women’s Hospital in Boston. He is board certified in both emergency medicine and clinical informatics, and board eligible in addiction medicine.

A practicing emergency medicine physician, Dr. Gupta brings clinical insight along with business acumen to provide impactful solutions to healthcare systems and organizations. Within his tenure at BWH, he developed multiple clinical decision support algorithms to impact real-time clinical care, resulting in improved utilization of healthcare resources; funded by the NIH, led to numerous publications. During his time at Northwell Health, Dr. Gupta led transformation teams on several initiatives improving efficiency, quality, and cost across 20 hospitals. While at the Boston Consulting Group, Dr. Gupta focused on healthcare strategy across Pharma, MedTech, and Providers, working with C-level executives to help shape long term strategic initiatives (e.g., growth strategy, organizational transformation, M&A, etc.). While at Imagen, a medical device startup building radiology artificial intelligence algorithms, Dr. Gupta served as both Head of Clinical Operations and Head of Strategic Partnerships, driving product development, managing a physician team of 30, collaborating with engineering and AI scientists on research development, and supporting FDA regulatory pathways.

Dr. Gupta’s passion for innovation and curious nature have led to entrepreneurial projects, peer-reviewed publications, and speaking engagements.

Topics:

  • Seniors’ lack of access to healthcare resources
  • Telemedicine services for seniors
  • Specialty care versus emergency care
  • COVID-19 impact on seniors and telemedicine

Hanh Brown: [00:01:12] To welcome and rock up there to Burma living podcast. Thank you so much for joining me. It’s good to have you here today. So could you start by having you share with the audience about yourself, where you’re from and what projects are you working on right now?

Anurag Gupta: [00:01:28] Yeah, great to be here. Thanks for the welcome.
My name is dr. Gupta. I’m an emergency medicine trauma physician by training. Grew up in Michigan and have been in the Northeast New York, Boston for the past decade or so. Over the past decade, I’ve been focusing mostly on the business and technology or informatics side of healthcare. Really trying to address population health needs.

[00:01:48] How do we improve access to healthcare resources for vulnerable populations and so forth. And most recently, for the past three years, I’ve been working on Timbo health at Timbo. We’re still a small team or a startup, but we are making massive impacts for the senior community. We started off as a virtual telemedicine tech enabled service, where we are focused on providing care for seniors in nursing communities.

[00:02:12] And that partnership in terms of partnering with the facilities really allows us to leverage their infrastructure, which then allows our clinicians to provide significantly more complex and high quality longitudinal care for this population.

Hanh Brown:[00:02:27] Oh great. Thank you. So what problems are seniors facing in terms of lack of access to healthcare resources?

Anurag Gupta: : [00:02:38] Through a very personal experience with my own grandfather. About five years ago, I came to realize and understand the depth of the issue. Again, learning through his eyes. What I saw was that prior to being in the nursing community, he, at the age of ADHD, he had multiple diagnoses and picked up a team of healthcare professionals to manage those diagnoses.

[00:02:58] He’s on 22 medications that included his primary care doctor and his cardiologist. Neurologist pulmonologist and so forth. But as he became so frail where it wasn’t safe for him to be at home anymore, he moved into a senior community. What happened was that he lost her feet access to his healthcare team.

[00:03:15] And none of those physicians. Would travel to the nursing community to take care of him. And so, because of that, he lost all the specialists. Even his primary care physician would no longer did not travel to nursing communities. And he had to get a new primary care physician that did come to that particular community.

[00:03:33] And it was a real shock to him, to his wellness, healthcare wellbeing. And he didn’t do so well. And I really felt like telemedicine was most logical solution. To really bring proactive multi-specialty care to my grandfather and other seniors like him. And in that experience, I remember calling dozens of senior communities in Michigan, where I grew up, where my grandfather was based to see if any other facilities have this level of shared because of the complexity that he required for his wellness, and wasn’t able to find it.

[00:04:07] And so that’s where the idea for timber health came from was through that very personal experience.

Hanh Brown: [00:04:13] Yeah, the journey you described, it’s too common. I share somewhat of that journey because once your loved one is in a, the doctors, whether it’s primary. The geriatrician, the neurologist, they don’t necessarily come to you. And it’s very difficult to try to find something that’s near them near all these physicians. But then on top of that, you might be stuck with whichever physician that comes to that community. Who now don’t have your Rutgers don’t know you on a one on one-on-one level.

[00:04:50] So unfortunately it’s too common. And I’m wondering in those situations five years ago, in your opinion, what role should the government play in ensuring access at Telecare? In contrast with the private sector ?

Anurag Gupta: [00:05:07] she’s doing a fairly decent job for us. When we treat residents in the communities, they predominantly have Medicare and Medicare has been leading the forefront in terms of telemedicine adoption, through reimbursement and updating their policies.

[00:05:23] And again, that was a big factor for us to launch Timbo health. When I first had this idea about five years ago, there was still a lot of just lack of clarity in terms of some of the regulatory policies around telemedicine, providing care across state lines, for example, as well as reimbursement for telemedicine.

[00:05:40] And I think so it was unclear five years ago, to me, if this would be a successful business model, but then as Medicare continued to push the envelope in terms of telemedicine, a lot of those barriers were lifted about three, three and a half years ago. Which is why we decided to then launch the venture.

[00:05:56] And over the past 36 months, I can say that every quarter Medicare in particular, CMS is continuing to promulgate telemedicine by increasing the CPT codes that they are allowing for telemedicine, reimbursement, which just creates more access opportunities. So I think that part they’re actually doing a fairly good job and I’m excited to continue to see that trend.

[00:06:16] Just last week or two weeks ago, it was Medicare released. Another, I think was 10 or 11 CPT codes that they are allowing for telemedicine reimbursement.

Hanh Brown: [00:06:24] Yeah, that’s great. Especially in the past nine months, I’m sure we all have seen an exponential growth in debt.

Anurag Gupta:[00:06:31] The pandemic has just unleashed so much energy and interest in making sure that everyone, including our seniors have the access to care that they need just really keep them healthy well, and out of the hospital.

Hanh Brown: [00:06:44] So how do we encourage seniors to seek alternative methods of treatment like telemedicine and how do we overcome the technical literacy problems and make sure that seniors.
Are able to access this new forms of healthcare.

Anurag Gupta: [00:07:02] Great question. Um, I do believe that there are some barriers, right? In terms of having the hardware, the, the network in terms of internet connectivity, software, and then understanding of how to use the technology and so forth. And that is again why temple health we partner with Facilities that way for our nurses, senior, uh, clients, uh, engaging with their telemedicine physician, whether it’s a cardiologist or psychiatrist at temple health is almost as easy as watching TV because we really build the infrastructure with the facility. They have staff onsite 24 seven that can engage the Technology, whether it’s an iPad or it’s telemedicine cart, whatever it is, they’re able to facilitate the visits. And in most of our communities, we have nurses on site, whether it’s daytime hours or 24 seven, where the nurses can actually help even further. Exponentiate the quality and complexity of the visit.

[00:07:56] Because we’ll have a digital stethoscope, digital EKG, vital signs, otoscope dermoscope that the nurse can then actually use during the visit. So the nurse can actually take a digital stethoscope, those seniors, the chest to hear the heart sounds and placed over the back to get the lung sounds. And that way our clinicians are actually here.

[00:08:15] Sounds in real time and get very complex, robust physical exams along with a history, which then again, allows our providers to really wonderful, detailed diagnosis and treatment plan. So through that partnership with senior communities, it’s really wonderful enters, opening the doors to seniors.

Hanh Brown: [00:08:34] So basically the communities have an infrastructure of support to the caregivers and nurses to help the seniors set it up.
Maybe even work with them side by

Anurag Gupta: [00:08:43] side. Yeah.

Hanh Brown: [00:08:46] Awesome. Can you talk about the role of emergency care versus specialty care when it seniors?

Anurag Gupta:[00:08:54] Yeah. So again, with Timbo, we started building our platform with specialty care. So we started with psychiatry since then we’ve added additional specialties, like cardiology, neurology, palliative care, and so forth.

[00:09:06] Of course the boundaries are in terms of what we’re able to do on specialty care side. And I can tell you that even from the beginning three years ago, we had many of our clients that were requesting a urgent care or emergency medicine service. When you have a resident has a fall or has a fever, or has some kind of event sending them to the emergency room for care is it can be a hearing experience sending senior by themselves to the ER, whether they have dementia or other mobility issues and so forth can be a very scary event.

[00:09:34] And then, you know, now with COVID being in the ER means that you’re being exposed. It’s very likely to COVID as well, which is creates additional stress on everyone because now when the resident comes, if they do come back from the ER or the hospital, or when they come back, I should say, they’re going to be quarantined for 14 days.

[00:09:51] And that creates a lot of stress on the resident in particular, but also on the staff. And so. Really with COVID and our clients really spoke up and said, Hey, you guys are delivering such great specialty care. Why can’t you do emergency care as well? And so we really felt like it was the right thing to do.

[00:10:08] And we had enough clients requesting it that we decided to launch this 24 seven emergency medicine platform. And so again, we have a team of board certified ER, physicians that we use, ER, physicians, because they’re, they’re the experts they can deal with. Trauma falls, COVID behavior issues and so forth, you know, that’s the full range of complexity.

[00:10:27] And then we can also really provide the decision support group, really values shared decision-making with both the residents and their family members. So in part of our protocols for urgent care in particular, our physicians will actually call the family member for every single urgent care visit. And so it’s formed the family, the assessment, the diagnosis, and then have a discussion around, um, to potential, um, options.

[00:10:51] You know, whether we should send the residents to the ER or keep them in the facility, can we facilitate an x-rays needed blood testing or whatever through mobile vendor? So two followup visits that’s really ensure that the resident is doing well, improving and stable. And so overall, what it’s really allowed us to do is between having the emergency platform.

[00:11:11] And then also the specialty care platform is able to provide much more comprehensive, coordinated care. So for example, if we see a resident for some chest pain or shortness of breath, we can do that urgent care visit full evaluation with a stethoscope, EKG, vitals, and so forth and determine the risk benefit of going to the ER.

[00:11:28] We can do follow-up visits through the urgent care platform, but then we can also have the patients see. One of our cardiologists who were telemedicine in that following week to get any more comprehensive dynastic approach and recommendations from specialists.

Hanh Brown: [00:11:43] Some of the equipments that you described, I’m assuming this is portal and it’s a station in the community that they can use room to room for.

[00:11:52] Tele-health. Okay, what does that entail?

Anurag Gupta: [00:11:55] Yeah, sure. So we have, we have a telemedicine carts that we deploy to facilities and it’s on wheels and stainless steel. It can be completely sanitized top to bottom with antimicrobial wipes. And so that way it can be safely taken from patient room to room and the, we train the facility, staff, nurses, and texts, and so forth on how to use the cards, how to engage and so forth.

Hanh Brown: [00:12:18] Okay. So what impact has COVID had on our seniors that hasn’t had general population in your opinion ?

Anurag Gupta: [00:12:27] Seniors are older, right? They’re gonna have more chronic conditions, more medications, they’re more vulnerable to. Two ailments in general. And I think as we’ve seen across the country, when you do have a positive cases in the senior community, it tends to lead towards a mini outbreaks and mortality and so forth.

[00:12:47] Unfortunately, with COVID in particular. The way the virus manifest itself in terms of incubation period, impact severity of symptoms and so forth. It’s been very difficult to keep it under control and everyone’s being impacted. I think seniors in particular and other immune compromised populations that cancer patients and so forth are being impacted.

Hanh Brown: [00:13:13] It’s been a challenge to keep thriving. Because part of keeping them safe is keeping them away from let’s say visitors and so forth. And it’s, it’s an ongoing challenge to balance those tasks. One of the things that is to keep them safe is let’s say what you’re working on is the telemedicine. So I commend you for that.

Anurag Gupta: [00:13:38] Yeah, just on that topic. The other thing I think that people may or may not be talking about as much is the impact on social isolation, depression from behavioral health perspective. Most of these studies, I think very appropriately have gone on lockdown, really limiting access to visitors and so forth.
That has a real emotional toll as well on seniors.

Hanh Brown: [00:14:01] I agree. I agree.

[00:14:05] It’s very important to keep the residents safe. Absolutely. First and foremost is safety, but also have to be very mindful to continue to keep them engaged and thriving integral with family. And I love technology. I always keep going back to technology has been a savior to two families nowadays. So you and I, which allows us to have this conversation, having a mom with a later stage of dementia.

[00:14:33] I’ll tell you, there is no technology that comes near to sitting next to mom and holding her hand and taking a walk with her because there’s some point that they don’t communicate. It’s just the presence of being near them. Now through a screen in your career, how have you combined your business and medical knowledge to help seniors?

[00:14:56] And why is helping the aging population so important to you?

Anurag Gupta: [00:15:03] For me, it has been quite the journey. I started off as a traditional medical student and went through my residency training and so forth throughout my training experience. What I saw was that there’s so much more to medicine and healthcare than just making a diagnosis and providing a treatment plan or it’s prescription or procedure or education.

[00:15:23] There’s, there’s just so many more factors that go into. Healthcare access to resources, access to healthy nutrition, exercise and so forth. I felt like being a doctor almost wasn’t enough. I felt like I wanted to make such a larger impact. I felt like through informatics through business, I could actually impacted populations much more than I was able to do as a physician treating one patient at a time.

[00:15:49] And so that’s kind of been my path and journey. What’s led me to where I am today. And the senior population in my culture in particular, we’re very close to our elders. My grandfather lived with us, moved in with us when I was in. I think first grade. And so he’s been a huge part of my life. And then seeing him go through this experience and then seeing other families loved ones going through similar experiences was just really frustrating.

[00:16:12] I felt like it was a big enough of a pain point. That was something that I really watched and felt like I had the right tools. Yeah.

Hanh Brown: [00:16:21] I echo that. As far as family values and traditions, even for my mom, it was a very cultural shock to even consider not having my mom with us. It’s a cultural paradigm where the elders, we take care of them in our home.

[00:16:38] And you have to shift that thinking when it becomes, maybe it’s not the safest place anymore, but it takes a whole family. And I realize not everybody’s going to be happy.

Anurag Gupta: [00:16:48] with that decision

Hanh Brown: [00:16:49] But you have to make the decision of what’s best for your loved one. We still have a long ways to go. I believe that there has to be more education on.

[00:17:00] How to care for your loved ones, do older adults, aging population, because now there’s like 10,000 turning 65 classes.

Anurag Gupta: [00:17:08] Per day. Yes.

Hanh Brown: [00:17:10] I think we all need to do a better job amplify, whatever we’re doing, amplify that and bring awareness so that folks are ready to make that decision. So hopefully it’s less painful.

Anurag Gupta: [00:17:21] Yeah, I agree completely. It’s. I remember when we had our first child, our son, it was quite a shock in terms of the amount of responsibility and all the minutia of what you need to do to care for a child. It’s the same for sr. When someone is dependent on you for caregiver perspective, it’s a lot of work and effort.

[00:17:41] And ultimately the reason our family, five minutes grandfather’s senior community was. From a safety perspective, it just wasn’t safe for him to be at home without all the resources that senior community has by education and awareness is really critical and continue to just push the envelope in terms of the level of complexity and quality of healthcare that can get used, whether you’re at home or in a care community.

Anurag Gupta: [00:18:06] Yeah,

Hanh Brown: [00:18:07] Absolutely. I echo everything that you’re saying. Okay. So what do you think. What’s the future of senior health care.

Anurag Gupta: [00:18:17] So senior health care, just at large or in senior communities and healthcare at large, large, again, I think that we’re seeing as the current generation of seniors is entering that stage in their lives.

[00:18:30] We’re seeing much more aptitude for technology and frankly like a more demanding population as well. And I think that they realize that they. Did they deserve certain rights expectations and there they are more savvy with technology. Even my grandma, my grandfather, who’s now 93 on the iPhone and the FaceTime with his grandkids, which is amazing.

[00:18:55] And so I think because of all of those just general things that are happening and then just, I think overall barriers to technology, lower that through. We’ll just continue to be this trend towards use. Technology, whether it’s things like connect you with your doctor retell medicine, or we’re calling an Uber and to take you to the doctor’s office, because you know, now you don’t have to rely on your family member to take a day off from work, to pick you up and drive to the doctor’s office infrastructure available at large, just to make sure that people have that access, which I think has traditionally been one of the, one of the larger issues still and still is.

[00:19:31] We still need to really address that in a meaningful way.

Hanh Brown: [00:19:35] I agree. I think especially the past nine months, it’s proven that technology has been a savior in many ways, keeps us in motion with our work and allow us to meet up like this and continue to form relationships. Although I still want on one better, but this is still a great alternative.

[00:19:53] So I appreciate this opportunity. Do you have anything else that you want to add?

Anurag Gupta: [00:19:58] No. It’s been nice connecting with you and at Tembo where we’re continually iterating and learning what the best part of our data is just making that impact for seniors and the families. As we engage them and improve their wellness and drive health care outcomes.

Hanh Brown: [00:20:13] Thank you. Thank you so much. Thank you so much for joining us this week on boomer living podcast. Make sure to visit our website, boomer, living dot TB, where you can subscribe to the show in iTunes, Google play Stitcher and other platform. This way, you’ll never miss a show. And while you’re added, if you found value in this show, we would really appreciate a rating in iTunes, or simply tell a friend about the show that would help us tremendously be sure to tune in weekly for our next episode.

[00:20:43] And remember growing old is the period and the most positive experience of humans.

Dr. Gupta’s LinkedIn: https://www.linkedin.com/in/anuragmdmba/
Twitter: https://twitter.com/igupta03

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