The Transformation of Mental Healthcare: From Crisis to Opportunity with James Jordan

Parker Condit: 0:01

Hey everyone, welcome to Exploring Health macro to micro. I'm your host, parker Condit. In this show, I interview health and wellness experts around topics like sleep, exercise, nutrition, mental health, stress management and much more. So by the end of each episode, you'll have concrete, tangible advice that you can start implementing today to start living a healthier life, either for yourself or for your loved ones. And that's the microsite of the show. The macro side of the show is discussing and having conversations around larger systemic issues that contribute to health outcomes. An example that we're actually going to end up talking about today is the adoption of telehealth during the pandemic and, as my guest today correctly points out, that only happened because reimbursement codes were unlocked during the pandemic to allow doctors to get paid for telehealth visits and, in some capacity, telehealth will forever be part of the doctor-patient relationship from now on, and that's a good thing. But it brings up the question what else could we be doing that simply isn't happening because there aren't reimbursement codes, and will we be proactive about it, or will it take another pandemic-like event to facilitate more change? So this is all stuff that we end up discussing on today's show, and my guest today is James Jordan. James is a healthcare and life sciences expert, the president of Stratactic, the national co-chairman of the Bio Bootcamp and a distinguished service professor of healthcare and biotech management at Carnegie Mellon James is a wealth of knowledge and I knew that going into this interview. So I sort of had a loose roadmap for this particular conversation and it turned into much more of a free-form conversation instead of just drilling down into one or two particular topics. So the things we end up going over are the positive and negatives, the positives and negatives that came out of the pandemic how technologies can help improve healthcare access, although there are still plenty of limitations. How AI may be able to help augment the healthcare staffing issue, which is a massive issue right now. The importance of community and we discussed this in a variety of different settings and we also go over the concept of real-time healthcare. Like I said, this felt more like a free-form conversation than strictly an interview. So let me know if you like this slightly different format and maybe I'll do more of it in the future. But without further ado, please enjoy my conversation with James Jordan. James, thanks for joining me. I just want to start with kind of a broad question of kind of getting an understanding of how you would describe the current state of affairs of mental healthcare here in the US.

James Jordan: 2:29

So I think COVID brought forth the topic that has been ignored for decades. There have been some people movie stars and such and presidents that have had mental health issues that have brought it public and taken the stigma off, but the reality is that it really wasn't well-known the impact and there really wasn't well-known the gap between the number of providers and access that people have, and those lines are also very economically and race-driven also in terms of that, and it's very urban and rural.

Parker Condit: 3:05

So I guess the easiest place to start is understanding the financial side of it. So you already mentioned that there's a shortage. Is the shortage in the mental healthcare space? Is that worse than in traditional medicine?

James Jordan: 3:20

I think it's about. For psychiatrists. It's about the same in terms of impact. Doctors were expecting by 2030, to be up to 100,000 in need and we don't have it. And psychologists, it's estimated now to be anywhere from I'm sorry, psychiatrists anywhere from 30 to 50,000. Okay, so it's still very significant.

Parker Condit: 3:43

It's very significant. And then understanding the financial implications of how this is all structured. I think a lot of people who are trying to find therapists and mental healthcare through their insurance are finding that a lot of people are making more money just on a cash pay basis and they can kind of fill up their schedule that way and they can make more on a cash pay basis than they can getting reimbursements. So do you see any hope on the horizon, or how are we going to sort of incentivize more therapists and more mental healthcare providers into the marketplace or any sort of positive light that you can glean on this issue?

James Jordan: 4:23

Well, at this moment, I think this gap and this cash paying aspect of it probably is one of the times where, at least on the therapist and the psychologist side, psychiatrists or medical doctors and go through different training there is an enticement of this gap to have people come into the industry. I think in the case of psychiatrists there's still that motivation. But the cost of the training versus the return is something that people are considering. But I do think that it's becoming more attractive because it is slowly becoming a self-pay situation, whether we like it or not as a society, and that is a very simple return and it's also a scenario where you can be. If you're an entrepreneur and want to have your own practice, you can easily do that versus if you look at physicians, since 2005, 2005,. Only 15% of physicians worked for groups and today it's a much, much higher number. And that's not by their desire. Actually it's economics that forced that. So it's looking very attractive actually from that perspective. In the long run it's just a matter of how do we help more people in the self-pay situation is very selective from an economic perspective for certain groups that can afford to do it, but the rest really can't.

Parker Condit: 5:47

Right. So it seems to just further exacerbate the economic inequalities that may already exist, where if you can afford it, you're going to be able to get it, but if you can't, you're not going to be able to get that access to care.

James Jordan: 6:03

And who's probably in a tougher situation a person that is maybe struggling economically for food, water, shelter every day, or the person that everyone's mental health issue is everyone's mental health issue and it's always important to the individual. So I'm not suggesting that one is worse than the other, because it's all situational, but coping with those tough living situations can be a challenge.

Parker Condit: 6:29

Yeah, that's exactly what I was kind of getting at. Can you just talk a bit more for people who aren't familiar with social determinants of health, which is kind of what we're talking about? Can you expand on that concept a little bit?

James Jordan: 6:41

Well, you know it's so funny because if you look at Eastern religion and they, you know you talk about the monks and meditation and mind body connection. I mean this has actually been something we've known for thousands of years and the reality, when you think of social determinants of health, it's really just similar. Your circumstances affect your mental capability, your mental capability affects your health. But you know people that are in violent situations. So, for example, we had done a study for pregnancy in women and maybe helping more disadvantaged economic areas by giving them more medical care, but we didn't see from the medical care side as much of a change because they were living in a very mentally stressful situation. These were inner city people that maybe there were gangs around in violence and maybe parents were alcoholics and things like that. And so getting them all the nutrition and all the preventative care that one would get at pregnancy, you would think you would normalize that to. You know someone in a wealthiest circumstance, but it wasn't the case there's. You know these mental health issues impact your entire life. So the social determinants of health is when we're managing a population. All these things about safety and security and food availability all play an impact and historically our healthcare system has been very acute driven. You come in with a cut, we sew you up, you have a heart attack, we take care of the heart attack, but you know it's a society where the most expensive healthcare system in the world but yet we're ranked in quality anywhere from nine to 11 in any given year. And so I think COVID really pushed these social determinants. Public health's been talking about it forever, but I think it really made us understand the impact of these matters.

Parker Condit: 8:30

What do you think are going to be like the long term ramifications of sort of the isolation that occurred during?

James Jordan: 8:35

COVID, that is a great question. We had a lot of friends personally whose kids were going off to college at that point in time. We had that group and then we had the younger group, and so we can watch both of those. But I think from the perspective of childhood development, this data that suggests you know those pre-kindergarten to third, fourth grade periods are very formative for children in terms of getting their social skills and people skills. Oh, there's evidence that the cost of that over the past few years has delayed that significantly. And then you see, with people that have gone off to college, there's a pretty good group of people that came home and had an anxiety and decided you know, I'm going to take my classes back home and be with mom and dad and they're not, as my parents used to say, adulting yet when they really should be, and so they've been back from that. So I don't know the long term implications, because if you don't get help sorting through those issues, they just sort of continue to build upon each other.

Parker Condit: 9:40

Yeah, it's going to be one of those really interesting things to sort of look back on 20 or 30 years from now to see these kind of like you were describing little pockets of time, sort of that pre-school group probably. The transitional period of those maybe go from elementary to middle school or sort of starting college. Probably a very strange transitional period for people during that time, because as an adult, I was adulting at the time and I've tried to continue to do so, but also in a pretty stable position. Yeah, like I certainly felt it for sure, and so I'm curious did you feel any effects of that?

James Jordan: 10:18

So I think for those of us, as you say a quote unquote adulting there was maybe some reflections during that isolation about our lives, what we're doing, what we take joy in, right. So you saw people that were, you know, couples that maybe weren't happy together sorting things out, and other couples separating, people that maybe decided to retire early or change careers, or now people wanting different circumstances, and so I think that part had some favorable aspect to it in terms of that, because we don't slow down our lives to sort of really align what we really want and all the things that we do in a day to day basis. I mean, even now for myself, my wife and I are working from home most of the time. She goes in one day a week and she enjoys that from some aspects of it, but she is totally more productive. And for me, I'm finding that, you know, I do a lot of science stuff, so I'm looking at slides and stained cells and things like that, and it's very easy to look on a zoom like this and be able to see those very nicely. I'm so finding that, you know, it's easier, but I do make sure that I go out at night to. You know, we have certain trade shows or get together professionally in the region. I do make sure I attend those because I also think it's important to get out there. It's easy to isolate yeah.

Parker Condit: 11:44

It was like that when that becomes the norm, you need to really force yourself back into these sort of social normative behaviors and start interacting with people again. But yeah, you did mention that there were some favorable outcomes that came out of COVID. You certainly mentioned that, people sort of reassessing the priorities in their life and I think that was certainly positive.

James Jordan: 12:08

Well, I also think people started playing with tech right. So for me I don't know if I have it in here, but there's a device called by a company called Apollo Neuroscience, and it was a group of people out of the University of Pittsburgh and they had the ability to. They started out working with sound waves and vibration on the body at different parts to work with people that had post-traumatic stress disorder from military, and they found it to be a very successful thing, and so since then they've moved on to other things like rest, relaxation, de-stressing, things like that. I've discovered these technologies and started to use them in my life. So if I need a day of focus, there's a focus component to it. I was an expert witness in some litigation, which is a very nerve-wracking thing, right when you're doing that oh sure. The less nerve-wracking, as it wasn't about me, I was the expert, but still being drilled, I had it vibrating for calm on my arm. So I think those kinds of technologies and helping people sort of get realigned are important. Those aren't quite artificial intelligence, those are just good science. But I think we have some softwares that are starting to come out in the gamification area or teaching people to track their mood so they can realize you're off, because I don't know if you've ever been in a situation where maybe you're a little off and you don't know it, but someone in your life says hey, what's wrong with you? You've been this way for a few days, right? So I think it's some micro shifts that technology can help us with, so we never get to the point where we have these complex issues.

Parker Condit: 13:54

That's a great point. So I actually have an Apollo neuro device. Yeah, that's great. Yeah, no, it's funny. So I've carried it around. I got into it probably during COVID and I definitely enjoyed it while it's using it, but it was one of those things where it just wasn't sticky enough for me. I think it was maybe how long the charge lasted or something like that, but I usually wore it around my ankle and certainly enjoyed it. If you can speak to the benefits of that, or more of the science behind it, I'd be curious. Maybe some of our listeners would be too Sure.

James Jordan: 14:22

So you have your, without getting technical, your nerve system has a fight or flight or a relaxation, and your body, by its nature, will go through these. But because of today, with our high stress environment, we tend to be in the flight or fight. So if you think about, maybe Guitar strings, right, so you've got the, this two E's and the guitar string, there's the fat, slow one, the deep one and there's a really high-pitched one. Well, we tend to operate in the really high-pitched one right, and so the whole idea is, if I can apply sound to that a waves it's not sound, it's waves. What I can do is I can tune it like a tuning fork, and the more you use it, the more habit you would get for balance. And so they had created some algorithms recognizing, you know, the, the, the various uses of let's call them tuning forks, to be able to get back to sort of a balanced Role. And so I've worked for a nonprofit called the Pittsburgh life sciences greenhouse and so we had worked with them. We actually made an early investment in them, and what is what is notable is one of the, the sound waves is relaxation and sleep, and so they just put them on us in this meeting and didn't tell us what they said. And halfway to the meeting I had to say you guys put me on sleep, didn't, because I just starting to get tired, but it's fantastic, it really. It's really quite a technology. But there's other things out there I'm working with with a company called mental health metrics that works with schizophrenia patients and Basically, if a patient gets off their medication and loses their judgment, that the cost can be, you know, 50,000 plus a year to get them back into alignment and if you can, you know, work with them while they still have the medication and their judgment. You can, you can correct things, and so I think you know there's more investment going into this stuff now because we do have this gap. But again, it's hard to get in a program like Schizophrenia, you might get an insurance company to recognize that, but when we talk about sort of these subtler things like anxiety or, you know, some of these traumatic stress disorders that aren't military related, insurance companies really aren't recognizing and funding that yeah, medication adherence.

Parker Condit: 16:39

Apparently, both in this like psychiatric space but also in the traditional medicine space, there's a huge requirement, at least from people I've talked to who care about cost control ACOs, for example, managed care organizations. They're Wild there's, they're screaming for they're like can you any sort of technology to help better manage medication adherence for the like disproportionately high cost that's involved when medications are not appropriately adhered to or taken? One of the other things that I thought came out of COVID that was interesting was the fact that the healthcare system, which traditionally moves very slowly, pivoted and adopted telehealth in like three weeks, like when they needed to. They're like okay, we can do this. So it was nice to see that it's actually possible to get sort of so?

James Jordan: 17:27

so was it that, or was it that the reimbursement codes finally got unlocked?

Parker Condit: 17:31

So I think yep.

James Jordan: 17:32

Yeah, so I, I mean, I think it's, it's not that and I think it's a fine line with telehealth way. Every year I go for my physical is like a nerd session with my doctor. We, we talk about you know different events and different things like that and so he will talk about listen, this sometimes I just need to touch you and hear your heart and all that. But you know, for the most part, telehealth can work for follow-up visits and different, different things like that. There's a wonderful story that shows how, how impactful this can be. I think it was in the post-credits here in Pittsburgh. But University Pittsburgh Medical Center is Is one of the best cancer Hillman Cancer Center is one of the best cancers centers in the region and so obviously people come literally from six, seven hours away to get treated. And it was the story of you know this elderly couple that would have to come into the city for their post follow-up and the reporter followed them and it was this you know, multi hour journey and you know getting getting treated or getting seen and multi-hour journey back and sometimes they would say overnight because they were too exhausted. Right, so there's economics there, they're old, it's exhausted, and so you PMC recognized that and put up these. Wouldn't call it I don't know what they call it it's sort of a telehealth center and but it's. It's manned with one nurse who can take the vitals and do some things and and just you know, be able to video in and it it worked amazingly. But what has stopped that for years is there was a lack of Payment for people, so if you did it you didn't get paid. And it's not to suggest at all that Healthcare providers agree they need to get paid. I mean, most operating margins and hospitals are less than 4%.

Parker Condit: 19:17

Yeah no, and then kind of during COVID, the Most of the elective services, the elective surgeries, were postponed and those are the biggest moneymakers, kind of the get you in three, four or five days, get you out, kind of that quick rotation. So you know they're still dealing with like the the long-term consequences of that and Small independent hospitals are just hammering money right now. But it's a great point that you brought up. If these people can't get paid, it's probably not gonna happen, like most doctors do have very good intentions about like what they want for their patients. But we operate in a system where you know it's not just a simple I can pay for this, it's the reimbursement has to be there from the insurance side.

James Jordan: 19:57

Yeah, the system. You know the concept in just in time Manufacturing card called non-value added, and the thought process is is that Anybody who's not touching the product is non-value added. But so you should be supporting the heck out of them and, you know, do what you can to cut all the other stuff and Make life as efficient for them. And when you think of that, in our healthcare it's it's nurses, it's doctors, it's psychiatrists, psychologists or they're the frontline people, and and yet you know they're the ones that are struggling with this situation, and so I think it behooves all those that are. You know I have a podcast myself called chock-tock gem and is oriented towards the business models of health systems, and that's the United States in general, and so this we could go on for hours about that. But but the the crux of it is is that you know people need to get paid. If I'm the brightest mind in the world, you know the average physician was making so much more 10 or 15 years ago. And you know, as my friend of mine always says, I want my physician to be the smartest, most highly paid person in the room, right, and so they put a lot of time in, but those people can take that energy and that intelligence. They can go Wall Street, then go to other places, have a much less investment and a much higher opportunity. And so you know, almost everyone that you meet that is in this business is in it because they want to help people. That really is their primary motivation. But we're pushing them out, particularly nurses at this point in time. We're just exhausting them and you know we need to find ways to relieve that.

Parker Condit: 21:35

So, when it comes to like mental health care in the US, what is there anything that's disappointed you the most, maybe over the past five or 10 years, from an infrastructure standpoint, a care management standpoint, just something that you've seen where it's like we could be doing a lot better here?

James Jordan: 21:50

It's mostly the access. People do not have access, and if you can't self-pay you're not really gonna get the access or you're gonna get the quality. And then for those public health situations where they are nonprofit clinics you know we have some around here there's just not enough capacity and the people that are working there aren't, you know, paid enough. So we need to figure out a way to maximize the work with the people that we have. And this is where I think you know artificial intelligence and gaming models and some of these other subscription models can be helpful, because what you're trying to do is get someone a program, you're trying to give them feedback and then you're trying to monitor them, and so there are ways with technology that we can do all of that at a much lower cost than it would be to see people one-on-one.

Parker Condit: 22:41

Yeah. So I'm gonna go back to telehealth for a second, because I think what you mentioned is relevant, where you know you were saying like is it appropriate? All the time, and during COVID, like there wasn't really a choice, like people needed answers to questions and we just couldn't do it in person. So it's just, it's what was available and it's still incredibly early from if you expand the timeline. We're very early into the life cycle of telehealth, if you will. So we're still figuring out like the best use cases and the most efficient use of it. But I think it is gonna end up being a mix of which types of providers can offer telehealth and operate telehealth and then which types of providers and practitioners are needed for the in-person visits.

James Jordan: 23:21

Well, even niche. You know I met a woman a few years ago who was practicing out of California that worked with only sexual addiction and, you know, transsexual issues, and she was, you know, one of the few people in the country that could do that. And so someone in I'm making this up, you know Idaho could have access to having a session with her online, like you and I are talking right now, and it can be very, very effective. So it's not only can bring the cost of the treatment down, but, you know, certain people specialize in certain things around the country and you can now not have your geographic location limit the quality of the specialist that you could meet with.

Parker Condit: 24:08

Yeah, that's a great point. So I was also thinking of like that's what I see as like good potential and good opportunity in the future, especially around mental health care. You're talking like technologies, so I think it's like what technologies can help in those early stages and sort of like those lower level thresholds where it's not necessarily I need a therapist, I need a psychologist, I need a psychiatrist. It's like what sort of management can be done at a lower, ongoing level by technology or AI or some sort of augmented technological service like that, or how can people manage themselves.

James Jordan: 24:42

So one of my former students is what the company called TWIL T-W-I-L-L, and they have a section. One of their sections in their community model is women with postpartum depression and just women who've had babies, and they start out sort of in a chatty area but then if they have various issues they can go learn about it. They can find ways to work their way through it and note a little costs and then move up to a pay model if it's something that's more severe, and I think that's important. My wife has a very special story. So our youngest, who's now 25, when she had her child, they had these online chat pages. So we're going back literally 25 years right, and so she met these group of women online and they've remained friends for 25 years. They all know each other's children and they benchmarked each other as their children were growing up, and so one of them had an Asperger's child, but of course, when the child was really little, that wasn't known and these women could benchmark their children against her children and she was able to, you know, maybe get her child some help years and years early. So that's a 25 year old story. That's a very crude, obviously non-technology story, but it shows what you know having community and benchmarks can do to help you make your own decisions.

Parker Condit: 26:15

Yeah, I think the community aspect is really interesting. It's probably one of those things I undervalued for a long time. I've always described overall health as having like six pillars, if you will like exercise, sleep, nutrition, stress management, daily physical activity and then the last one being community or some sort of connection, if you will. So I've now kind of reprioritized that one much higher on my list. I'm not saying any of them like you need them all, but I'm like much bigger on connection at this point.

James Jordan: 26:46

Well, interesting as you say that and listen. So I started yoga 60, I just finished my 60th class, so relatively new. Yeah, I was talking to someone yesterday and they said if you go to yoga three times a week, you change your body. If you go five times, you change your mind. And so I've been going at least five times since August 1st and so I listened to it. It's got a social aspect to it, right. So this community there they stress breathing and looking at your mind, my body connection, which is I was just going for stretching and then I'm getting some pretty good physical exercise and so I'm getting all three and if I don't go on a particular day, I feel a little off, and so I think we underestimate how you can bring three of those together. And my sister, of course. My sister has a kind of a funny story about exercise. So when she had her child and she, of course, she had four older brothers, so maybe there's a context to this, but she had post-partum depression and she had read that exercise could work and so she would go jogging and she would be running down the street crying and the neighbors are saying you okay, she goes. Yeah, I just have post-partum, I'm gonna work it out and, god bless her, she did right. She just kept running and running and running. And so you know, how do you know that those things would make? I wouldn't have thought yoga would have maybe get this community aspect. After working from home, as we were talking about this mental health, my blood pressure's gone down, my pulse has slowed down for my Apple watch during this time and I don't consider yoga. Like you know, running exercise it's a little different, but it's pulling that together. So I think your six pillars probably have a couple of circles in them that intersect as opposed to being pillars, you know.

Parker Condit: 28:33

Oh, yeah, like it's hard to describe a model, but it's. Yeah, there's tons of overlap and you can't ignore one and pretend it's not gonna affect the other five and things like that. But yeah, I was. So I was a personal trainer before kind of starting this company and I was I'm not always poo-poo-ish on yoga, but I just didn't look at it from the right perspective. I thought of it as like, oh, it's good for stretching and it's kind of like a low level strength activity. Where I was like you can, where I was like, oh, if you want strength, you can better prioritize your time, and I was always like stretching is not that important from like an injury prevention standpoint I still stand on that but from the connection standpoint and some of those positions are just very challenging I'm like, oh, you really have to be in the moment, you have to be there with your breath.

James Jordan: 29:20

Yes, With what you're feeling. That's really interesting. You say that. So when I lift weights and run, I have headphones on, I'm listening to an audio book. That's not the case in yoga and, of course, I'm much older than you, and so for me, being at the desk for so many years and balance and things like that are important. As you get older and that was actually my original motivation I just felt myself sitting down with the dog and getting a little harder to get down or a little tight in the morning and things like that. So it's an interesting connection for sure. I don't know if you know this, because I didn't put this in, but I'm a certified hypnotherapist and I more use it for business reasons. I don't do one-on-one sessions, but a lot of what hypnotherapy is about is you connecting external events to some internal state. That isn't true, and so what a lot of these population health models that can bring information to you, help you find for yourself where things are disconnected. You know how are you feeling this way. You know during a divorce, how are you feeling this way if you fail the test? You know you have a tough situation at home. You know you think you're isolated and you realize no, these are natural feelings, and then you can find ways to correct. So I think a lot of times we first find out that some things wrong with us and we feel abnormal in the first. You know, a lot of times when people have some sort of unknown disease, when it gets diagnosed, they feel better. Nothing has changed, you have the same same health rights, but you feel better. And then when you can label it, you can maybe do something about it. And so I think some of the technologies can help with that and do so in a, you know, cost-effective way.

Parker Condit: 31:13

Yeah, and kind of goes back to community, where you know you can if you can find yourself community of people who are dealing with the same thing or going through the same thing, you realize be like, oh, this is a very normal human experience, Like I'm not abnormal, this is a very normal part of life and I just I may not have the tools to necessarily move forward in the way that I want to yet, but you can certainly acquire them. So I think there's a huge education piece of kind of getting people to understand these are not abnormal states or anything like that, to sort of normalize it a bit more. And that's where I think technology can be really interesting. So I want to pivot it a little bit, to talk a little bit more about AI. Where do you think AI, or what are you most interested in from an AI standpoint over maybe the next five to ten years?

James Jordan: 32:01

So I think that the excitement in the privacy, security issues sort of overlap right on these things. So I think, you know, my Dean at Heinz College would always say that technology always moves faster than society can handle it and it has these series of pauses where there's rules and regulations and different things that come up, and we've seen that in, you know, automatic cars and vaccines and certain things over time. So I don't think that this is going to be terribly different. So I think over the next few years we're going to see AI really be good at what I would call the efficiency things of health care scheduling, calls, chatbots, different things like that In the schizophrenic example I gave you. You know being able to tell you that you're drifting and maybe be able to inform your doctor on that. So I think what it's going to do is it's going to help identify and it's going to give people that are either challenged economically or people that are very mild in their situation the ability to to self-manage. The long-term hope is that. You know, we learn how to. You've heard the concept precision medicine. So the concept for your audience, precision medicine, is that my genetics can tell me what's medicine is best for me and in any disease from, you know, point zero to point 25 in any progression of a disease. I'm going to be at different points between there, and when you combine my genetics and you combine the point I'm at, I might get some specialized treatment and I think precision medicine can be applied. The concept can be applied to, you know, we'll call it, maybe for this podcast, precision psychology or psychiatric, but I think that that's where we're going. But I think we're ways off from that. And if you even talk to psychiatrists about the meds that they use, they know they work. They don't necessarily know why they work. So I'm working with a group of professors now. I don't know if they'll get this grant or not, but if you remember, when we were in high school, we had sort of the tails of the distribution, right. So you had a normal distribution, little tails on the side, and the tails on the side were odd stuff, and so I think what this project that I'm working on is intriguing by me is we have neuroscience, immunology and a bunch of scientific disciplines coming together, but when they're doing their research they're interested in the centers of these pieces, because they're interested in their technical question for their specialty. What they've all been ignoring for years is the tails of the data, and so their proposal is to pull all these tails together and see if it gives us a more holistic concept and evidence on what the right things are to do, and so I think that's the long-term future, just like you and I were talking about the community with yoga. It could simply be an Apollo device for vibration my brain is missing a certain chemistry, right and it could put all those things together and have a more holistic and balanced approach, but I think that's 10 to 20 years off.

Parker Condit: 35:14

Sure, yeah, it's also hard to project with how quickly things are moving, but then there's a limitation of existing systems.

James Jordan: 35:21

Yeah, well, what's gonna happen is we're gonna have that evolution of stopping for regulations and guidelines. I mean, the FDA is starting to recognize, okay, what happens when artificial intelligence attaches into the tools that we already have approved, right, so people do their studies and they have these tools and they've proven to the FDA that it works, but now you sort of have something coming in and potentially interfering with that system. We hope that it augments it, but it could also deteriorate it, and so I think that we don't know what that stuff means and we're gonna have to sort it out. Yeah, it's hard.

Parker Condit: 36:00

It's messy. I don't. I don't envy the people who have to figure that out.

James Jordan: 36:03

That's a perfect world, because I think the brain is messy, right. It's not like a broken leg where it's very clear. There's like two things we can do with, three things we can do here. Sure, it's much more complex than that.

Parker Condit: 36:16

Do you think there's gonna be a beneficial shift towards preventative care and prevention?

James Jordan: 36:21

I still don't think our healthcare system I mean we've got some codes for that and stuff but I think in general it's really gonna be. I think the next generation I say next generation, the non baby bloomer generations are more comfortable with online self-care and managing themselves, and so it's going to be interesting to see what that goes, if that trend is statistically significant, that it could move the dial, because I think this is concept of a real-time healthcare system and it's been around for a long time. But it came up again during COVID, where population health and public health is sort of a health self-defense in the government, which is very different from the health system that has acute behavior, and I think we need to bring them together and have insight from both sides of the system. And I don't think we spend money on the population public health aspect of it, which might be the better improvement. When we say we send a rocket to the moon, how many little adjustments it makes to get to its target, and if you waited every hour or so to make those adjustments, it missed the moon by a million miles, and I think that holds true for populations, and so I think an investment in that area can change those micro adjustments are not as expensive to do versus a big moonshot miss, but we just don't have the data to prove that to health care insurers and the government and people in general.

Parker Condit: 37:57

Yeah, I mean I think at least on the insurance side. Feel free to correct me if I'm wrong, but the portability of risk in the US is too easy, where, if you change jobs, you might get a new insurance company. So it's like how much investment you're really going to put into risk that you might not be carrying three years from now. So I think that's always an issue. What do you think patients can do to help drive change in a positive direction, or what can patients do to be their own best advocates, if you will?

James Jordan: 38:24

So I think we kind of see that clashing of that right now post-COVID. So, if you remember, if you go to the doctor during COVID, they told you to wait in the parking lot. They made a nice easy sign-in process for you and you got called in, you went right into the room and the doctor came in within a few minutes and we weren't all queued up like we had historically been queued up, and I think some places have gone back to the old way. Hey, I don't care if you're sitting in the lobby for 45 minutes and for the first time you can see people complaining and you can see people actually changing providers, and so I think people need to stick up for themselves. But I also think that people need to take responsibility for their own health and educating themselves in their own health. So one of the things that's great about chat, gpd and Claude and Bard and all those things that are out there. Of course, it's all how you ask the question, because they want to make sure they're not behaving as a doctor, but you can find stuff out. I was talking to someone that had a PFO in their heart, which is a small hole in what treatment can be done, and their first response from their doctor is you're too early to treat. Well, they went online and they read everything on it and they recognized that the code to get treated is a stroke. This person's in their 20s, they're like unacceptable. So I think that pushing back and taking responsibility and being assertive is important. Now, the challenge to that is we all generally are held somewhat hostage to our health plans. So that's the challenge.

Parker Condit: 40:10

Yeah, and I think there's probably again like an adjustment period where there's so much information available now and everyone can have a platform and a voice. So there's trust issues, there's misinformation issues, there's malinformation issues, and I'm sure doctors are getting inundated with I read this, I heard this, somebody so and so said where, in addition to them having to do their jobs in an extraordinarily short period of time, they're also having to filter out. Is this coming from a reliable source? Do I need to take them seriously Without being dismissive to the needs and the requests of their patients? So I think that will normalize.

James Jordan: 40:54

So my neighborhoods. We have four daughters and they're all older now. So you forget what it was like to raise a family. And so our neighborhoods turning over and we have a lot of young families in our neighborhood and I just watch at the consumption of time that it takes. And so it's really hard to have a full-time job, have a full-time family and take time for yourself. And there's lots of evidence that in electronic health record maintenance and things like that, that mothers will just make sure those records are perfect but they won't take the time to correct their own. Father's working three jobs and not having time to work out. I can. One of my neighbors works his tail off and I've seen he's been here for three or four years now and I can see him putting on weight. It's just not having that time. So we can say take care of yourself. But again, it's more complex than that when they say take care of themselves. Right now it's their five-year-old and their three-year-old they're taking care of. So it's hard to take care of yourself. But I think we tend to take care of ourselves a little bit more when we know we're drifting. And that's where some of these tools like I've noticed lately people wearing the blood glucose monitors who don't have diabetes. Just tracking, track. Yeah, really, you are, yeah, so I think that's interesting, right. What motivated you to do that?

Parker Condit: 42:27

So it's more so for our company. We're integrating with Dexcom and Freestyle Libre. So one of our other employees we got a Dexcom or, sorry, Freestyle, so they're testing that it's making sure our integration works correctly. So I'm just doing it to make sure our software is working the way it should be.

James Jordan: 42:45

But even before this. I don't have one of those, but I have the good old fashioned stick your finger one in my closet and I just do it once a month and I keep it on a little spreadsheet, yeah.

Parker Condit: 42:58

Yeah, it's just some of the things you can do to start being more informed about your own health and, I think, also having larger volumes of data on yourself. It reduces the probability of outliers, like if you go to your doctor once a year, it's I get concerned that we're making a lot of big life decisions just on one data set, one snapshot in time. I think there is going to be more continuous data. It's going to be important for the future.

James Jordan: 43:28

I agree, I agree. I think every time I go they're like, well, your blood pressure is high. It's like, well, that's the white coat disease. And I'll pull out my app where I measure myself at least once a week, and I'm like, ok, it's been 125, over 74 for the past year. And he's like, ok, well, but even for them, right, I mean, you're saying that that visit, they don't have any other data otherwise to know, right, so in my case I can produce it. And then he had asked me on my next visit to bring my cough so he could calibrate it, right, and it was just to him to calibrate it to him and it worked, it was calibrated. So he's like, ok, I'm fine. But again I go back to thinking of more middle class blue crawler people that are working a couple jobs to keep things going and the only thing they might have is some technology that tells them they're drifting, because they actually don't have time in their lives to reflect on it.

Parker Condit: 44:34

Yeah, that's totally reasonable. It's nice to be in a position where you can have a blood pressure monitor and you're not stage one hypertensive and you're just doing it because you're being proactive, or same thing with blood glucose. It's a privilege to be in that position.

James Jordan: 44:48

Yeah, and so when we talk about population health, the top 1% who have money are going to be able to pay for things to be able to get what they want. It's the rest of the country which makes up our. I mean, the whole idea behind public health is that a healthy person produces gross domestic product in the coldest economic perspective. So these things that we do as a country, that just does not make sense. We'd rather spend all this money over here as opposed to making someone productive or having health care that covers their injuries and their issues. And I'm struck by. I was at my nonprofit in the south side of Pittsburgh and it was a beautiful sunny day and someone's letter came to our address and I noticed it was a couple houses down. So I decided to go down and knock on the door of this old brownstone and a woman came in oxygen and she's got her walker and she invited me in for tea. She was a lovely slave. She was so insistent that I felt I was rude otherwise. So I went in and I had some tea with her and she told me she was only 60 years old and, honest to God, she looked like she was 80 and she's struggling with oxygen. And she tells me a story how her son went off to college to be an engineer and he had now moved back home to take care of her and he wasn't there right now because he was off at Burger King. And so not to suggest anyone working with Burger King is a bad job because it's not but this person had the potential to be an engineer and now he was giving that up and what that meant was the mother's disease affected that son and his next generation and maybe his potential and the generations after, and I don't think we think about that as we think about applying healthcare in this country.

Parker Condit: 46:38

Yeah, no, I think we do tend to be pretty short-sighted with our healthcare decisions in this country. So that does lead me to what's gonna be one of my last questions. I do wanna be respectful of your time, but given what you just said, do you think we're gonna move towards a single payer system?

James Jordan: 46:55

No too many lobbyists and lawyers and accountants and it's hard to say whether that's a good thing or a bad thing. I will say I interviewed someone from my podcast who had done drug development all over the country, all over the world, so in Europe and all that. And you know we think of a one-payer system but a lot of those countries have a second payer. So if you go to France you can have private insurance and you can have private plus, right, yeah, so the private plus is intriguing because it sort of separates that issue of our society should have a minimum health level and then if you can afford more, you know you should be able, through capitalism, to have more. But I think that what we're, the big benefit that I saw in interviewing him was there was one billing system and we have. I was talking to a doctor the other day. He's got 34 different unique ways of billing for his patients in New Jersey and that's complicated and it's expensive and it's a waste of time and so if we could, maybe we won't get to a one-payer system, but if we could get to one level of paperwork that would reduce administrative investment so much and put it back to the patient and the doctors, the nurses, the psychiatrists, the psychologists.

Parker Condit: 48:19

Yeah, it's nice that we can circle back to this concept you brought up earlier, which was the non-value added. I had a note written down. I'm not sure of the exact number, but I saw something on LinkedIn a while ago I think it was something to the effect of 68 cents of every healthcare dollar is not going towards healthcare providers.

James Jordan: 48:37

I know it's above 60. Okay, so I think you're probably correct in that Right.

Parker Condit: 48:41

So that's just an astronomical, astronomically high number, and I get that. Healthcare is complicated. I think we've made it as complicated as possible, but that's not a challenge to anyone in the US healthcare system.

James Jordan: 48:52

To prove you're wrong, Well, I found it amusing when they were talking about the recently the unions had negotiated with the car people and they were saying you know it's going to be $900 more per car. And I thought to myself okay, so what are you doing to reduce the people that aren't working on car dollars to make up for that? Because, again, the talent of the people working on cars? Obviously there's designers and things in the background, but you know how many dollars in your car are those other people?

Parker Condit: 49:21

Yeah, that's a great point. Do you have anything like anything that we've talked about today? Do you have any additional resources you'd want to point people towards, to sort of learn more?

James Jordan: 49:30

I know we cut this is sort of a meander in conversation, but tends to be how they go there, so I think you know, just to timestamp our conversation, when you put it out, two days ago President Biden signed an executive order on artificial intelligence and getting a group of people to figure how this, how we can have the benefits without the downsides, and so I think at this point we don't have a lot of information on this, that it's very nascent, and you know, you and I don't know what's going on behind chat, gpt and all that.

Parker Condit: 50:06

We just know sort of it works right. It's a clever box. We also know it's full of bias.

James Jordan: 50:10

We know there's all sorts of issues associated with it, so I think we're really at a very beginning timeframe of understanding this. Yeah, so I don't think there's one place you can go at this point in time.

Parker Condit: 50:22

Yeah, I think just continue to have these conversations will be very beneficial. Is there anything you want to add for sort of closing thoughts to wrap this up?

James Jordan: 50:31

No, I would just add that the people that are interested in understanding the business of healthcare. I have an academic website called healthcare data dot center, so instead of dot com it's dot center CENTER, and I have information up there on physicians, pharmaceutical industry, medical devices, gamification, all these things. So any one of your members of your audience are interested in those specific topics. You can probably find something there. Great.

Parker Condit: 50:56

Yeah, I've spent quite a bit of time looking through a lot of you put out a lot of information, which is great, and I also have your press kit. So we're going to link to all your social websites and also all of your work websites as well. So we'll make sure people can find you if they are so inclined to do so. Very good, thank you so much, james. This has been a really fun conversation. I appreciate you coming on. All right, take care. Well, to those of you still here, that's all for today's show. I want to thank you so much for listening. I really hope you enjoyed today's conversation. If you want to learn more about today's guests, please visit our website exploringhealthpodcastcom. There you can find show notes for today's episode, links to the guests and our full episode archives. If you enjoyed today's show and you want to hear more, make sure to subscribe on your favorite podcast platform. I really appreciate each and every one of you listening. Until next time.