By JESSICA DAMASSA, WTF HEALTH

“Health tech providers — this is the make-or-break time. If you can’t prove your value in the next, say, eleven weeks, then you should NOT be in the health care game. It’s time to get serious.”

Bruce Greenstein, former CTO at HHS and current Chief Strategy and Innovation Officer at LHC Group, one of the country’s largest home health care providers, stops by to share what he’s learned about the federal government’s response to the COVID-19 pandemic.

Bruce represented the home health industry during last Friday’s (3/13/20) White House meeting, which culminated in a Rose Garden press conference starring the ‘who’s who’ of American health care, retail, and pharma leadership. (Bruce was the guy who elbow bumped Trump.)

Lots of attention on virtual care and telehealth during that presser, and Bruce weighs-in for our health tech and digital health audience about how they can get involved and what big health care companies like his are looking for in digital solutions right now (LHC Group works with 350 hospitals caring for 100K patients.) And how about those HHS Interoperability Rules that have been basically lost in this news cycle? We get Bruce’s feedback on how HHS did, plus his insider info on the HHS “hack.”

Some guidance to help you navigate this chat. Hot Tip: Open up the transcript in YouTube and navigate to these different breaks in the conversation.

• The ‘Trump Bump’ & Gossip from the Rose Garden Press Conference & White House Meetings
• 8:40 mark — Advice for health tech startups (must-watch)
• 15:25 mark — Find out what startups can do that would lead Bruce to “put them in Health IT Hell for the rest of their existence”
• 16.45 mark – HHS “Hack”
• 18.14 mark – HHS Interoperability Rules

Read the interview transcript here:

Jessica:

Hey. It’s Jessica DaMassa with WTF Health. We are here doing a very special report on COVID-19, and joining me right now, I have none other than Trump Bump himself, Mr. Bruce Greenstein, former CTO of HHS and currently the Chief Strategy and Innovation Officer at LHC Group. Bruce, you elbow bumped the Pres. I can’t believe it.

Bruce:

Yeah, I had the opportunity to represent all of us in public health and it was no bigger stage possible. And I’ll tell you the funny story was that, the executives that were on the stage and those principals from across government were all in the cabinet room before. We had a full meeting. They brought us into the room and when the president showed up, the President said that, he said, “I know I want to shake everyone’s hands, but they told me not to shake hands. It’s not the time to shake hands.” So he remembered.

Bruce:

And then when we went out on stage, I think it was the other healthcare executives or him, there’s just such a natural inclination and muscle memory to shake hands, especially in front of the podium, and I got to imagine that some of those executives are seasoned and quite well known, but there’s something about shaking the President’s hand. And so after I saw this go on in front of me, I said, “All right, I’ve got to make a statement for all of us in public health.” And I gave the bump and he said, “That’s good, that’s good,” and we joked around about it back in the Oval Office after the press conference. As a matter of fact, when we walked back in, two of the aides from in the West Wing came up to say, “You’re famous. You’re trending on Twitter. This whole notion of the elbow bump is going viral.” So I thought it was exceptionally funny.

Jessica:

It is. It’s hilarious. I mean, I was watching you live and I was like, Oh, my God. Is that Bruce? Did he just elbow bump the Pres? I mean, I love it. I love it. And you’re telling me, okay, so yeah, this got like major traction, not only among your public health fan base here, but I’m sorry, but who was the celebrity you said that tweeted this out?

Bruce:

So Cardi B has something like 60 million followers on Instagram and my kids told me that it was posted on Instagram and then it had by Friday night, by the time I got back to Louisiana, it had over 9 million views, something to that effect.

Jessica:

Oh my God, you’re just, you’re famous.

Bruce:

And now there’s a name on Android, so with the, called the Trump Bump. Anyhow, any way to help promote ways to social distance. I mean, today really the message is, don’t get close enough to elbow bump, just keep distance altogether. So let’s make sure I’ve got the CDC and White House’s recommendations that were put out late yesterday and I just want to remind everybody, continue to tune into cdc.gov, there’s a COVID-19 part of the website set up. That’s where all the guidance continues to come out in a timely way. And we’re in this for a while. And for everybody out there that’s a part of the healthcare community whether you’re a health tech or you’re a nurse on the front line in a hospital, we are all in this together.

Bruce:

It’s going to be probably 8, 10, 11 weeks until we’re on the other side of the spike. We all need each other healthy to be in the game, to continue to fight this. We can’t relax and then end up with COVID-19 and then be out of the game. We all need to be on the field playing hard, trying to help our country, our communities, our families. It’s one of the most important times in our lives to be in healthcare. This is what we’re all trained to do.

Jessica:

Right.

Bruce:

This is time to execute.

Jessica:

All right, so I want to go back to the Rose Garden real quick and I want to see if you’ll give us some gossip. So what was kind of the, I mean here you were, you were with the top leadership of, I mean, basically any company in the U.S. that has anything to do with care at a population level, so I mean, what was the overwhelming sentiment?

Bruce:

Yeah, it’s one of those things that are great about our economy and the United States in general. Here you have guys that fight it out in the retail space every day. You know, there’s been consolidation and really tough competition between CVS and Walgreens and Target and Walmart and in the diagnostic lab space between the two biggest competitors, Quest and Lab Corp and we all came together to put the nations’ biggest challenge first. And there was no sense of, well we won’t do that or we don’t want you to have your name above ours. There was none of that.

Jessica:

Good.

Bruce:

These were just seasoned executives working with some really bright people in the White House and across HHS that are planning with the resources that we have to make more tests available, to make space and clinicians and workflows available, the FDA at the table in real time working with their scientists, getting tests approved and on the market. It’s just, it was, as an American, it was reassuring, it was encouraging, it was heartfelt. It was a, it was a very cool experience, I have to say.

Jessica:

All right, so as an American, yes, as an executive at a healthcare company, I mean, first of all, I want to back up for a second and have you talk a little bit about LHC group. So you are there now. When you left HHS, that’s where you went into. So for those who may not be familiar with LHC group and what you were even doing there in the first place-

Bruce:

Yeah, yeah.

Jessica:

… this is a publicly traded company, but it’s like, unless you do some digging it’s kind of hard to figure out where you guys fit into the ecosystem. So go ahead and introduce it.

Bruce:

Right. Yeah, I’ll tell you about the company and then, that’s the reason why we’re there. So we’re the largest post acute care companies. Most of our work is in home health. We have about 32,000, north of 32,000 employees today. We’re in 36 States.

Jessica:

Okay.

Bruce:

We have more than 100,000 patients on census today. Maybe 101,000, 102,000 people that we’re taking care of spread across the country. And so we do home health, home and community based services. We do hospice care. We have one of the largest ACO management companies in the country. We have a primary care business where nurse practitioners see patients in their home for primary care and then we do assessments for longterm care insurance companies.

Jessica:

Okay.

Bruce:

So a bit of a broad array. The White House in knowing that we’re about to turn on a big offensive for standing up test sites around the country that are going to be primarily focused on people driving and staying in their cars or potentially walk in, or sort of walk through safer dense urban areas where people don’t have cars, human work flow, like basically walking through different stations in distance. And the idea is that people won’t need to go into physician’s offices or hospitals where we’re trying to keep the distance and using the supplies of the masks and gowns, caps, shoe covers and goggles, using those the most efficient way properly.

Bruce:

So when you think about that, we worry about what would a people, what about people in rural areas-

Jessica:

Right.

Bruce:

… in their homes that are home bound. And so, I got a call to ask if we would come to be part of this planning stage. I was there representing the entire home health industry. We’re obviously a very large industry taking care of patients both before they would need to go to a hospital, try to alleviate the need for hospitalization. But by and large, it’s a post hospitalization-

Jessica:

Okay.

Bruce:

… I’ve worked with that are being discharged from the hospital and need help to recover in their own home with skilled clinicians. So, that’s the angle that I was there helping balance out what would we do where people don’t have the accessibility for finding these test sites.

Jessica:

So for those home health care companies that might be watching something like this, I mean, I’ve got a crowd of folks who are in virtual care or those who may have digital health companies that are delivering services primarily through either phone or through telehealth services or even those who are traditional home healthcare companies, what is the message that as somebody who was there representing that part of the industry, I mean, what do you tell us back? Like what do we need to do to prepare here? What should we be focused on?

Bruce:

Yeah, so let me give you the now and the tomorrow message.

Jessica:

Okay.

Bruce:

The first is around testing. Testing is going to be stood up and executed in a number of ways in every community around the country. And what’s encouraging about this situation is, there’s not like three people in the White House planning for the entire country. Instead, communities and their health care communities, emergency management, hospitals, physicians offices are all planning what’s best for their communities right now. At the national level, we’re trying to make the resources, like the tests themselves, the essays, the swabs and the guidance as available widely as possible. And then at the local level, we’ll start out at the state level, Governors spoke to the President yesterday about how to think about this and how to plan for this. The Governors then work with their emergency operation centers that trickle down through their secretaries or commissioners of health and then to local authorities and to hospital executives and to physician leaders.

Bruce:

So it’s happening all across the world in our country right now. The same thing is happening in Italy and South Korea as we talk to officials in those countries as well. But the planning is distributed, the execution is distributed. What was nice about Friday was that these national assets came together to make, whether it’s their parking lots and real estate available-

Jessica:

Yeah.

Bruce:

… to put up clinics, so that’s happening as we speak. It’s clinical teams from within, whether they have pop up or they have, I should say clinics within the retail pharmacies that will be made available to staff, these drive through testing sites. All that activity is happening. So the question though that you asked is well what should home health or those that are working at home think and that is, you have to be a part of it at each community that you’re in.

Bruce:

So again, I was there representing our industry. So we continue to talk with the national home care association. We talked to our, who are our competitors normally our partners today, so Amedisys and Kindred at Home, Encompass, Enclara Care, AccentCare, all those are stepping up to the plate to ask how can we help patients at home. And so, I’m about to break this out into two areas.

Jessica:

Okay.

Bruce:

So the first is what we’re getting off of, be available to help people get tested at home if they cannot make it to a testing facility period. And you have to figure out, well what does that mean? We have to have contracts with so-and-so, maybe it’s on behalf of a hospital. We have to have the right protective equipment. We have to have the test swabs. So a lot of work that needs to get done to get to the point where you can provide care.

Bruce:

So go and do that planning and get engaged right now. Here’s the next step. We’re already planning for decanting hospitals, which means how basically to get patients out of the hospitals earlier than otherwise planned to create more capacity to take on new patients. And this is when it gets real. This has happened. You might remember in China, the government was sponsoring the building of a brand new hospital because they couldn’t take the surge and Italy and South Korea, extremely worried about capacity issues. We’ve already talked about shortages of beds, respirators, ICU beds. So this is on the national consciousness. It’s also part of the healthcare experts planning. As home care providers and as health tech providers, this is the make or break time. If you can’t prove your value in the next, say 11 weeks, then you should not be in the healthcare game. So it’s time to get serious.

Bruce:

If you take care of patients that have COPD issues and you do remote monitoring, step up and get ready now. If you take patients as they come out of the hospital, get ready to take patients that are likely to be more complex, that have greater challenges and step up your game to provide high quality, safe care at home. That’s what we should be planning on. Who are the partners? Obviously hospitals that want to reduce the number of patients in their bed to get ready to take on more care. Healthcare payers, we’re hearing from the largest health plans to say, Hey, we know that it’s going to get constrained. How can you help us move patients through the system? What are the telehealth assets, both the hardware tools and the solutions and clinical backstops that you need? So right now we’re involved in these conversations as [inaudible 00:14:17] we see whether it’s to get physicians on the phone to write orders, to do med rec, devices to monitor patients at least. What I need is a telephone and somebody with a thermometer.

Bruce:

Doesn’t have to be the most incredibly complex. But I need to be able to manage patient symptoms and care from a distance. If they could have a pulse ox and a blood pressure cuff, I love it. If it’s all connected and I’m getting the data feed even better. But, we’re talking about basic blocking and tackling. Today, we don’t have a surge and a spike that we can’t handle. In five weeks from now, in nine weeks from now, I think it’s going to be a lot different and we need to prepare today to get ready to take on the patients there. If anybody in seven weeks from now says, we’re just not prepared, you should have told us before, well, I don’t need to talk to them. They’re not worth my time. We need to focus on people that are getting prepared today.

Jessica:

Bruce, I’m so fired up now. I can’t even believe it. I’m like so fired up. All right.

Bruce:

Listen, Jessica, you know you’re a major part of this community. You bring people together and you convey very important information.

Jessica:

Thank you.

Bruce:

I’m going to deputize you as part of the solution here. We need to get our industry ready and engaged in working on models. But listen, it’s not about capabilities and sending me a brochure. I need to have pricing, I need to have capacity, I need to have coverage maps, I need to know what inventory looks like.

Jessica:

Yeah.

Bruce:

If one vendor tries to gouge at this time, I will put them in health IT hell for the rest of their existence. It is not the time to take advantage of this situation. It’s time to help people that need help in this nation.

Jessica:

And Bruce, I’ve got to say, I really appreciate this very straightforward advice, especially for this community. Entrepreneurs who I know, I mean, they want to make a difference and sometimes they don’t know how. And I think there’s a lot of fear. And so I think that some of that, I don’t know how this contract is going to… And they don’t want to ruin their bargaining power in the future, but I love the advice that you’ve just given in terms of, it’s like, you know what, there’s a time for flirting and this is not it.

Bruce:

Exactly.

Jessica:

So lay it all out on the table.

Bruce:

Yeah, I mean, I’ll make it, I’ll make it absolutely brass tacks. If somebody is worried about reducing or diminishing their negotiating point in the future, if I don’t have a good solid partner who I could trust right now, I will never negotiate with them in the future period. So it doesn’t matter.

Jessica:

You heard it here. I love it. I want to ask you one last thing for our health check following. Just getting some gossip from you on HHS and what’s going on there currently. So you obviously, beloved former CTO of HHS for us.

Bruce:

Thank you.

Jessica:

I mean, you really did a lot I think to democratize that office and make it, make that, that area of the government a lot more friendly and just a lot more available to the health tech community. So two things on that I wanted to ask you, what do you know about that HHS hack? Anything you can share with us?

Bruce:

Yeah, listen, I’ve been following it along and just this morning the secretary came out to say that there was not a breach-

Jessica:

Okay.

Bruce:

… it instead was an increase in activity. So, I’ve got a cyber division here in my company and they’re hearing a lot of reports including that some hacker sites and organizations have been trying to hack others, which circular firing squad is great for those that are trying to in any way diminish the capability of a response to COVID. Those people are enemies of the state right now. And it should be taken very, very seriously. Follow the news and HHS. Again, as I understand it, the secretary said there was not a breach but an increased activity. You’ll see heightened security on the HHS side, I gather, in a response to this, but let’s make sure we have the whole story before we start to respond to the initial stories around it.

Jessica:

All right. And what about those new interoperability rules?

Bruce:

You know, so in any other time, we would all be giving like high fives and hugs and kisses, right?

Jessica:

Or, elbows.

Bruce:

Like, well yeah, I mean that’s in the new day and now we just have to do a video elbow bump. But in the cabinet room before the press on Friday, I got a chance to catch up with Seema about, Administrator Verma, about the rule, and I just said, “I just want to tell you how happy and proud I am.” “You guys stayed the course, you did the right thing and it’s great.” She said, “Yeah, it sort of got lost in the news didn’t it?”

Jessica:

It totally did.

Bruce:

But they are very excited. I’ve talked to people across HHS, not just in CMS and of course, across our entire community. I was proud to be able to work on some of this in the early days with Don Rucker. He’s done a phenomenal job in leading this effort. CMS was so important in this effort too. All of the government stood their ground and didn’t get pushed over by those that were somehow inconvenienced by seeing this. But now it’s the time to come together and figure out how to really create value. Not by just selling stuff, but really creating value by empowering people to live healthier lives, avoid diseases, and make the most efficient use of their healthcare resources.

Bruce:

And so, I’ll put a plug into a, an organization that I’ve become a trustee for. It’s a not for profit, it’s called The Commons Project and I can send to you the website for it. But basically, an organization that helps safeguard and protect individuals’ information and act as sort of the clearing house and this seal of approval that operations on behalf of another aggregator are done with the highest degree of privacy and security. And right now I know that individuals have this latent distrust of big tech or at least questions about-

Jessica:

Yeah.

Bruce:

… the veracity of security and the, how privacy will be maintained of their data. And it’s a good time that information and trusted sources help individuals before they get hoodwinked into giving all their information away and letting some shady organization resell it and profit off of those individuals. So that’s essentially what I’m thinking.

Jessica:

All right, Bruce. Well thank you so much for the chat here. I am clearly in a shelter, in place situation and very chatty. So I appreciate you letting me dial into you and hear all of the news about what’s going on. I mean, it was exciting to see. I mean, I consider you one of our own, so it’s exciting to see a member of our community, I think of the health tech community up on stage with the President last Friday and to hear about all the great stuff that you’re doing. So thank you so much. Hey, thanks for deputizing me. I too want to send people to health IT hell. Was that that? I mean, that was great. I love it. Bruce, thanks so much. It’s a pleasure to speak with you.

Bruce:

All right. Keep up the great work and I’ll talk to you soon.

Jessica:

All right. Thanks a lot.

Bruce:

All right. Bye.

Jessica:

Bye.