How Virtual Healthcare is Transforming Patient Care: Michael Dalton, Ovatient CEO

Lisa Belisle: Hello, I am Dr. Lisa Belisle and you are listening to or watching Radio Maine, our video podcast where we explore creativity and the human spirit in its many forms. Today we're exploring creativity and the human spirit with an individual that I've come to really enjoy working with. Some people who are watching Radio Maine might be wondering what is the relevance to actual Maine? Well, I'm going to turn the camera a little bit back to myself, and in doing so, bring it back to Michael Dalton, who is the CEO of Ovatient. For those of you who watch Radio Maine, you know that I spend a lot of time working with artists of the Portland Art Gallery as a means of supporting our family business. But in my real job, my day job, it is actually working as the medical director and a family physician with Ovatient. This has enabled me to continue to live in the wonderful state of Maine because I am offering virtual first care with a company that is creating access to health by doing things virtually. So welcome Michael Dalton, CEO of Ovatient. Thanks for coming on today.

Michael Dalton: Thank you, Lisa.

Lisa Belisle: Michael, I'm interested to know a little bit about your background, how did you get to a place where you said, I believe that virtual first care is going to be important to the future of healthcare, and I want to work with systems like MetroHealth, which is in Cleveland, and MUSC in South Carolina so that I can make this type of virtual care more integrated with the systems that currently exist.

Michael Dalton: When we were looking to create Ovatient as a company, it really started first as a concept, a belief in what we were providing to our patients at that time. I did come from working at MetroHealth in Cleveland, and previous to that it was Summa Health in the Akron area. What we had seen is, oftentimes working with vendors who weren't necessarily connected to a patient, it could be really something that was more transactional in nature. Yes, we were prioritizing convenience. You may be able to see a provider, but did that provider really know you? Did they know your medical history? Were they going to be able to connect with you over a continuous journey within your life? And that's not what everybody needs. Sometimes they just may need an episodic visit to make that connection. But oftentimes, especially as telehealth and virtual care becomes more ubiquitous, there's higher expectations from a patient as well as from a care team. This is really part now of your care that you're getting on a daily basis. One thing too that really stood out for us when I was at Metro was that oftentimes patients were being faced with their own barriers to care, and that could be their work schedules and maybe childcare. Transportation was a huge issue. It still is a huge issue. So what we wanted to do is really find a model of care and create a service that could meet patients where they're at. That could be in their work, it could be at their home, and everybody has a different definition of that. That was something that was really important for me. I also know, growing up, one of the things that I remember vividly was just hearing about my grandparents and the trips that they always had to make from rural Wisconsin to Madison or to Milwaukee to see a specialist. So really where I am excited, and where I think the potential for virtual first care is going, and I know we might have an opportunity to talk about it later, is really bringing that high quality specialty care to a patient's home so that they're not having to travel 3, 5, 10 hours to be seen by a specialist. That will be the exception, not the rule. That's what you would need maybe once a year or once every couple of years to see that specialist.

Lisa Belisle: I know you've previously talked about the erosion of trust between health care and patients. How do you feel like Ovatient is able to contribute to positively rebuilding that trust in the virtual first care model?

Michael Dalton: I think trust is an incredibly important component. I've said before that we are not the United States Treasury. We cannot print more trust. It is really a finite resource, and it's something that we take incredibly seriously in our care model and how we care for our patients, but also how we work with the care teams at our customers, because they may already have a well-established relationship with their patients, and we take that seriously. So if we have the ability to take care of one of their patients, we want to take the best care of them and then hand them back for that care continuity. For virtual first care for a patient, and how we are rebuilding trust for them in the healthcare system, is that we are truly meeting them where they're at. There is not an instance where that patient feels that they may have white coat syndrome, they're having to travel to a health system or into a clinic, and that can be anxiety inducing. So really in the comfort of their own home, maybe with the support of a loved one, they can feel that the only thing that's in between them and that visit is this same video camera that you and I have today. They're really then on equal footing with their provider, with their care team, and it really makes for more of a conversation. It allows them to more easily establish that relationship with their provider, and it really almost provides that true house call that we're able to make for them. It's on their terms that they're able to seek care, to receive care. That's what I'm really excited about. That's what I think a lot of our patients, and why we've had so much adoption of the care model that we're providing today, is because of really removing that barrier to care and creating that opportunity to listen for our patients.

Lisa Belisle: One of the things that you've emphasized is the ability of Ovatient to increase access to care. Of course there is the access to care for specialty services, for example, which I know that a patient is moving toward. But then there are also other access issues that our current patients with Ovatient are dealing with on a regular basis. I'd like to hear you talk more about that, because social determinants of health, it's become kind of a buzz phrase, but you are actively doing something with Ovatient to change that particular social determinant of health, access to care.

Michael Dalton: I've oftentimes thought about access to care as the capacity of having more providers or more ability for scheduling on a template. I don't think access really comes down to just a slot in a schedule. It really comes down to the time of the day that a patient is able to be seen. It's removing those barriers for transportation, that they can be where they're most comfortable, where they have the resources to be seen. That really means access. I think access too is around the ability to pay. Oftentimes in virtual care models and with telehealth, patients have had to either pay cash, use a credit card, they might have to be part of a subscription model to participate and receive high quality virtual care. That's something that we've used as a means to distinguish our care model: if you have insurance, or maybe you're uninsured, we can provide you with cash options to receive care. But the vast majority of our patients, they're able to utilize the insurance that they have today. I've been heartened by this, that the highest number of patients that are using our services today are on Medicaid. And then the next number is actually the employees of our customers, which are health systems. So I think it really is a testament to be able to say, we're creating access for patients who may be on Medicaid and have a number of other social determinants that they're trying to address. But at the same time, our employees at our customers, they have access issues themselves, thinking about being able to get away from the bedside or from the office to see a care team that really is concerned about them. So that's something I now fully appreciate, even what we've been able to do through our care model.

Lisa Belisle: One of the things that comes up often with standalone virtual care organizations and companies is the lack of integration with things like the electronic health record or communication platforms for patients. Talk to me about the decision to work with MetroHealth, MUSC, other places that have Epic and have MyChart, and the importance of integration generally, as far as making sure that virtual first care is a seamless experience.

Michael Dalton: We really were conscientious and intentional about building a care model and a company on top of Epic and to be integrated there, because that's oftentimes in my previous roles where I saw the disconnection, and also the adoption that would come from a provider or care team. The first thing that they would ask is, does it integrate with Epic? They really feel comfortable, they want it to be in one place, they don't want to work within two different screens, models, multiple applications. That's really what we started to see, you started to grow out this huge ecosystem of singular applications. The more that we can do within the EMR, the better that our patients and our providers can connect through that interface that Epic has provided through MyChart and that patient portal. One thing that we've seen too over years is that patients are comfortable with MyChart. They understand its capabilities, some of its limitations as well, but it's a tremendous means by which to communicate with a care team, as well as to be informed about your own medical record and have that information at the ready. So I do think that as we contemplated this, we didn't want patients, and we didn't want our providers, to have to go to a different ecosystem. It really was important for us to maintain and build our care model and our company really on top of Epic. So what we've seen today is really a seamless ability to provide referrals, to manage prescriptions, to better coordinate care across care teams within our customers. I will tell you that it has not been easy to build on Epic. It's not a drawback or anything to do with Epic. It's just that as you think about all the complexity, especially in primary care, and as you know well, really being the quarterback of the team, you need to have all the plays for them in their playbook and at their disposal to provide the best care. So that's how we designed really our model of care, making sure that the primary care team could be truly that quarterback and at the center of care for our patients.

Lisa Belisle: Michael, talk to me about how Ovatient is leveraging data and digital systems to improve care of patients by their local healthcare systems.

Michael Dalton: We're leveraging data from our patient records, as well as from the patients and their electronic health records within their own customers, to really provide one continuous care journey for our patients. So we're able to bring in years of that historical medical record and then incorporate that into our care planning as well as our best practices for the care that we're providing. That's what I'm excited about in this space, that over the next, I'd say 3, 5, 10 years, we are going to be able to really share with our customers and their patients how this virtual first care delivery model is going to improve overall health outcomes. We're still in the early days, I like to call it that we're kind of like in maybe the second or third inning of virtual care and telehealth, and understanding how that really becomes just standard of care. I know there's many health systems who've utilized telehealth, especially in areas where there's high rural populations. But from a virtual first approach, and being able to do that in a comprehensive way, we want to be able to use the data that we're generating to then share that with our customers, with their care teams and their patients, to build a better care model for their own health systems and for the patients that they're treating, so that they understand how virtual care can improve those health outcomes for their patients.

Lisa Belisle: Michael, I know that transparency in healthcare is important to you. How do you feel that the work that Ovatient is doing is increasing that transparency between and among patients and their care team?

Michael Dalton: I think transparency, and being able to share information and have the same access to the medical record or information about your care plan, is incredibly important. It goes back to the original question around how do we rebuild that trust? It really provides that equal footing. It lends to shared decision making, and I think that really is easier to do when we do have that equal footing. It's not somebody sitting across a desk and behind a monitor, or feeling that maybe it's awkwardly placed, that they're to the side or there's an angle as they're connecting with that patient. Just as we're doing here, looking at each other and connecting across the camera in a video, I do think it allows for an easier conversation, a place where maybe that anxiety is reduced and then you're able to just share what your concerns are as a patient, equally for the provider to be able to talk about what is the path that we're going to take, the decisions that we're going to make together. I think that's one of the values and benefits that we can provide through this care model.

Lisa Belisle: One of the things that I know is very important to you is attention to the health of your actual virtual care team and attention to the wellbeing and the building of relationships. How do you approach this in a space that is almost a hundred percent digital?

Michael Dalton: This might sound ironic, but I think because we're in a digital, fully remote environment in which we're working, we have to be even more intentional about being personal and making sure that we have the times for conversation, really making sure that we're approachable, we're available, we're taking inputs from the team. Oftentimes when you're trying to pack everything into a 15 minute huddle or a five minute conversation, we don't have the proverbial water cooler. We have to make that time in order to have those conversations and make sure that voices from our team members are being heard, that they're being respected, that they're being valued, because otherwise it could feel in this remote environment that something could be lost. So making sure that we're picking up the phone. I have a general rule that if you can't say it within two emails or a couple back and forths in a chat, conduct a video call, pick up the phone, just make sure that there's that connection. I think too, just being cognizant of and making sure that we have a place for when there are concerns from our care team that we're there to hear them. If they are talking about feeling some of that isolation, then how do we provide a more connected care team and environment? Somebody could say that's created greater inefficiency because we have these additional times for conversation. I actually think it leads to a more effective team, a more effective care model, that then will create greater efficiencies. But we really have to make sure that, I don't just say patient-centered care, I want to say that we are providing person-centered care, and that is both for our patients and our care team members. Because if our care team is not in a place, if they're feeling isolated or they're feeling not supported, we don't see that as readily or easily, especially being in that remote work environment. So I think also too, Lisa, just making sure that we've all taken kind of an open door approach to our leadership styles and making sure that we're accessible. That's some of the feedback that I have heard from the team, which has been reassuring, is that they have felt supported, they've felt cared for. Just as they are supporting and caring for our patients, we need to do that the same for each other.

Lisa Belisle: Michael, I know that you and I have a shared interest around leadership and theories of leadership, and that we both have academic backgrounds that include degrees in leadership and organizational development. One of the areas that I think you feel strongly about is the importance of servant leadership. How does that manifest for you as a leader and as the CEO of Ovatient?

Michael Dalton: I do feel very passionately about servant leadership. A former CEO that I worked for really crystallized it for me when he said, if you're not serving a patient, you're serving someone who is. For me at that time, I was, look, I'm never going to be a clinician. I'm not going back to medical school. I'm not going to become a nurse. I'm not going to become a pharmacist. I grew up in a family though. My mom worked for a health system. My dad was the CEO for a mental health clinic, treating clients with severe and persistent mental illness. He was a psychologist in his career. So for me, I had this real desire to care for people, to serve and to take care of others, but I have to do that in a different way. As a leader, it's making sure that there is no task that's too small, really being able to roll up my sleeves. If that means that we need to block a template, if that means that I can make phone calls to patients, I'm happy to. I actually love being able to do that. It gives me the ability to connect with our patients and to do that on behalf of our care teams. I think too, just from that service, is understanding our team members, how do they want to be supported? How can we best support them? That's really important to me, especially not having that physical proximity, not being able to be in the same office with a team member. Again, being very intentional and asking those questions about how can we support you, knowing that I can't be there physically, and just showing some small acts of appreciation or kindness, or having the ability to make that conversation, to pick up the phone. Those are the things that I think are really important for me.

Lisa Belisle: You've also made a priority of in-person time together, whether it's in-person training amongst the clinician team and the administrative team, or whether it's leadership in-person time, or whether it's you going to MUSC, MetroHealth, spending time in-person with people. How do you make the most of in-person connections so as to create benefit for your virtual first environment?

Michael Dalton: I think in this day and age, we have grown more accustomed to being able to connect through a virtual session, a video meeting. For me, I have tried to make the most of being able to travel to see some of my own team members, or when we get together as a team, to make sure that we balance both fun with work and that we are intentional about creating that connection. We're getting ready to do a new onboarding and orientation of new employees. So we have another wave of employees that are coming in, and we had contemplated that we could do a virtual orientation, we could bring another group of team members on. As I looked at it, I said, this is the one time really that this team and these new clinicians that are going to be coming on are going to have the ability to see one another, to work with one another in the same physical space. I thought that was incredibly important, especially because we'll have behavioral health team members, our primary care team members, all coming together and they're working within one care model. To have that time to get to know each other, to break bread with one another, to establish that relationship is critical. We're kind of adding and making an investment really into that relational capital that they're going to need over time, and breaking down maybe some of those barriers if they only knew each other in that virtual setting. So when we do come together, there is some structure. There's some irony too, we've talked about having structured unstructured time, just making sure that we've at least been intentional. We've blocked off that time together and let it go where it may go, and let's talk about what we want to make those personal and human connections. I would be remiss if I didn't say, that's one of the taglines or the areas that we're focusing on, we're saying that we're providing virtual care that's entirely human. That is a really important component for us, especially when we do have that personal time together, or if it's a time where we're in a Teams meeting, just making sure that we can keep things professional but lighthearted. I would just say, Lisa, you do a really nice job of being able to make that personal connection as well. That's one thing I really appreciate about you.

Lisa Belisle: Thank you, Michael. I appreciate your saying that. As I'm thinking about the future of Ovatient and of virtual care, I know that the landscape is a little bit uncertain, but there are a lot of opportunities for us over the next five to 10 years. What are some of the opportunities that you are most, let's say, excited by? Maybe they're not opportunities that are easily worked through, but what interests you, what intrigues you on the virtual care landscape?

Michael Dalton: I am really intrigued, and this is our overall vision for virtual first care, with truly being able to build out a comprehensive virtual first multi-specialty practice. I know that's a lot of words, but really what we want is for a patient, and I think that will be really an achievement once we do this, for the super majority of their care, they're going to be able to receive that care virtually. So if it's a specialty, behavioral health, primary care, whatever it might be, we're able to take care of that patient and provide them with high quality care in their home. In addition, there's a number of good companies in this space and potential partners for Ovatient that are bringing care and care teams into the home as well. That's where I really am excited over the next five to 10 years, really creating the virtual patient-centered medical home that is in a patient's home, where they're at. When we go back to that question around access, that is the access nirvana for a patient, that they won't be restricted because of their transportation, their own maybe mobility issues, the ability to age in place, to bring a family member from across the country into that care setting. That's almost imperative, especially as we have this growing baby boomer population and generation that we need to care for in the home. As we increasingly grow into Medicare, that's one thing that we're seeing, so many patients who are growing into Medicare that we're able to care for them at home. They'll be more comfortable with virtual care. They'll feel it's very natural. That's where we see this great opportunity, to do that now, and by that time, 10 years from now, it's just natural. I'm also excited about the potential for what Epic and other digital health vendors, but really what Epic is going to be able to continue to do to support virtual first care integrations with other health systems. As we look at interoperability and sharing information both with patients and across care teams and across vendors, I do think that it's going to look markedly different, but in a really improved way, as we're continuing to provide more information to a patient. I think also what I'm excited about in the next five to 10 years, I am very curious about where artificial intelligence is going to be incorporated, not just for a care team, but also for a patient. I think they're going to be much more informed. They're going to be able to take information that maybe sometimes came off as jargon, and they're going to be able to have a much more intelligent, informed conversation with their own care teams. I'm really excited to see how that continues to evolve and how that's going to be incorporated into medical schools and residency programs. These are going to be things that are not off to the side or an extra appendage. This is just going to be standard of care, the model of care, and we need to prepare our next generation of medical students and interns, residents, to be prepared for this.

Lisa Belisle: Michael, Ovatient is a very values driven organization, and it's foundational to the work that we are doing with one another and with our patients. Can you give suggestions for other organizations, that you think could potentially help them become more refocused on values versus where I think we've necessarily gone recently, which is more finances and other operational considerations. How can you take what you've learned as a values driven leader and make suggestions for other leaders who similarly want to reacquaint themselves with this?

Michael Dalton: So we spent a lot of time looking at our mission, vision, values and making sure that they really encapsulated and incorporated what were the values of the team, the behaviors that we wanted to exhibit. But it's been iterative. It's been generative. We started with a foundation for who was on the team at that time, kind of the core founding team. Then we shared this with our first wave of new hires, our clinicians, and really wanted them to understand and incorporate this into how they would work. We wanted feedback. What we gave them was, I would say, a strong straw man, but we needed them to fully incorporate that into their practice and their ways of working. So that was something that we then put together into a social contract. As we sat down with the team, we looked at how do we want to work together, how are we going to hold each other accountable? What were those behaviors? What would be a violation of that behavior? And then what would we do to maybe ameliorate that or address that and provide for that healing? If there was something where we saw in our behaviors that there was a violation of that, we already planned on that, we worked through that. We also then talked through and tied values to what would this look like as we make a transition. Many of our team members had come from working in a health system environment and now they were coming to a startup. We were intentional then to think about what are the values that we need to draw on and incorporate as part of that startup culture, kind of that double helix of our DNA of startup and health system culture. They then were owners in the organization. I don't mean monetarily, it was more that they are the ambassadors, they're the leaders, they're carrying that out, they understand what some of the motivations are, what is our business model, what are we trying to deliver? And we've had some great conversations with them, as well as just their focus should be on providing excellent patient care, high quality patient care, tying those metrics then to meaningful outcomes for their patients. With that, there will be meaningful outcomes for Ovatient and for our customers as health systems. But I really do think that we started with that very core around our values, and having that strong foundation, if we don't have that, we really don't have much on which to build from. I think that's something that's really drawn our team members to Ovatient and kept them here, and something I'm really proud of.

Lisa Belisle: Michael, what leadership qualities do you believe that an individual who is leading in the digital health space, and specifically virtual first care, what leadership qualities do you think that a leader would best be served by having?

Michael Dalton: I do think they need to be patient. I think they need to have really great listening skills. I think they need to have, even having taken feedback, being able to hear what the team says, it still means that it's within them as a leader to make the decision, to have that courage and to stand behind it. As well though, if they have made a mistake, to own it, to be accountable and to share that. I've had to do that. I've made mistakes. Hard to believe, Lisa, I know, but I've made mistakes. When I do, I share with the team, I'm transparent and I own it and I tell them, here's the mistake that I've made. Here's what we're going to do to move forward. I think that's really been appreciated by the team. There's also been times where I've taken feedback from them, and even in receiving that feedback, I maybe disagreed, and I shared with them and I was transparent, I was open. I gave them more insight into the decision making so they could understand the why. I think that's really important, especially in this setting for team members, for employees, for patients, to understand the why. I just think sometimes as leaders, we tell them the what and the how. I think that is not enough. That's where it really has come through in my servant leadership, making sure that I do understand how can I help you, and then coming alongside them to do that. So I think that's my advice that I would provide.

Lisa Belisle: In finishing up our conversation, knowing that this truly is your baby, this is your company. You care for it like a very proud parent. And also you're up with it in the middle of the night. It never goes to sleep. It's always demanding food. It gives you some joy but also can cause some heartburn, as with all babies and all parents. But this baby is growing, and this baby is going to, we are with one health system, we're evolving into another health system, and we're going to evolve into multi-specialty care. So as this baby becomes a toddler and then a teenager and then a fully grown adult, how is that going to change your approach as a parent?

Michael Dalton: I have wondered that, because I know that maybe my leadership style is going to need to change, but maybe it's my approach that's going to need to change, but not my leadership style. That's because you hear sometimes about how companies grow and then they change. That goes back to the focus around our values. I don't think our values should change. I think we spent so much time, and I really believe in the values that we have, and I want those to be just foundational to who we are. As time goes along, that's where you've seen me be more intentional about how we start meetings and making sure that we're talking about where have we seen our values in action, and how are we recognizing that in some of our team members. But as the Ovatient baby grows and outgrows its onesie, I've shared with you and other team members that we're all leaders. I envision though, and this is why it's so important to do this from day one, leading with our values and who we are as an organization and living those values out and providing feedback and continuing to create a culture of learning and improvement, that I really look forward to one of our providers being the next medical director, you being able to grow into a new role, seeing people and celebrating them for their growth and their success at Ovatient, and that they continue to embody and be an ambassador of the values and the care that we're providing. So I think that that's the one thing as a proud parent, as your child grows, you need to be able to be maybe a little bit less hands-on, still available, still accessible, still that rock on which others in the organization or the family are able to rely upon, but you are able to maybe take a little bit of a step back and then make sure that you're also still serving kind of in that role as a shepherd, and looking even out further to be able to expect and anticipate where we need to go, where some of those pitfalls might be, just to be available to provide that sage wisdom. This is going to happen over years, Lisa, but I just think over time it's just making sure that you really bring along and being a good steward, making sure that you've got that intentional time upfront with team members. As I look at it too, I would never want to not be part of an orientation for new team members, not have that personal time to get to know somebody. I know that we'll continue to grow, but I want to know everybody on that first name basis. I've seen that, and I really love that, even in organizations where I came from where they might have eight to 10,000 people, still seeing CEOs, still seeing executive leadership that made it very intentional to still know about a team member, a loved one, what was going on in their lives. That's where I think it's about being accessible, being available, being open, and then also being able to use your position as a CEO or as a leader to help one of your team members, one of their family members, being in a position to help. I just think that all goes back to that servant leadership, and that's who you are. It doesn't change.

Lisa Belisle: Michael, I appreciate you making it possible for me to continue to offer excellent, high quality patient and person centered care from my home in Maine through your work, our work with Ovatient based in Cleveland. I also appreciate your taking the time to talk with me today on Radio Maine, our video podcast where we celebrate creativity and the human spirit. Today I've been speaking with Ovatient CEO Michael Dalton, who happens to be my colleague at Ovatient, and I'm very appreciative of the work you're doing, and I appreciate the time that you've taken today to explore this more with me. Thank you, Michael.

Michael Dalton: Thank you for your partnership and thank you for your belief in what we're doing at Ovatient. And thank you for this time.