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Q&A: Former VA Secretary Shulkin on digital health refining patient-first care

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Dr. David Shulkin has had a decades-long career in healthcare, from working at the higher echelons of the private healthcare sector to being appointed by President Barack Obama as undersecretary for health at the US Department of Veterans Affairs in 2015. Two years later, Shulkin was confirmed as the ninth secretary of the Department of Veterans Affairs under President Donald Trump.

Shulkin spoke with MobiHealthNews about how the healthcare industry has changed throughout his career and how he’s using lessons from his time in public service to develop his chronic pain management startup Override.

MobiHealthNews: What kind of changes have you seen within the healthcare industry over the course of your career?

Dr. David Shulkin: wow. Well, that’s a big question. Mostly what I’ve seen is a transition from when there was complete professional autonomy, where the provider used to be the one that would control what was happening. That meant the provider would determine the price, the provider would give the advice and expect people to follow it, and the provider really was able to determine the course of treatment.

That changed over approximately two decades, where the power shifted to the payer, to the managed care company, where the managed care company, through scale, got control first of price and then of service, then ultimately began to make policy decisions.

And now we’re entering a phase where, I hope, that it’s transitioning to the patient itself, where the patient has not only the ability through benefit design, but also the ability through transparency and knowledge and the tools, to be able to become a manager of their own care.

MHN: That’s really something we could thank digital health for, right? Allowing consumers to access information that otherwise would be difficult to obtain.

Shulkin: I think that’s right. Digital health means a lot of things to different people. Let’s just start with Google. Google has provided patients with a lot more choice, a lot more information, a lot more ease of access to information. And now if you take digital tools and you put the information into a more usable, personalized format that interacts with the patient and responds to how the patient is responding to a condition, you’re right, I think that does empower the consumer.

MHN: And you’re utilizing digital health in your current work, correct? You started a chronic pain care company with your daughter, called Override.

Shulkin: Yeah, the digital aspect of what we’re trying to do is really a big part of it. What we’re trying to do in this new model of helping patients who suffer from chronic pain is create this balance of a team. And this is true with many chronic illnesses, that, when you get care in a silo, or only one part of the care addresses a person’s needs, you often don’t see the result that you should.

So what we’re doing in this chronic pain model is giving every person a full interdisciplinary team: a physician, a psychologist, a physical therapist, a coach and then the digital tools, because the patient needs to be part of that team. The patient needs to be the one who is determining how fast, how slow, what is needed, more or less, and telling the team how they’re doing and how the team needs to be responding to the patient. And that’s where digital tools can come in.

MHN: How does your application differ from similar applications on the market?

Shulkin: It’s really the content expertise around chronic pain and understanding that chronic pain is not the same as acute pain. Chronic pain is a central nervous system disorder where the brain pathways have actually changed, becoming much more proactive and firing pain signals, so it requires a pain neuroscience approach. And in order to do that, it’s best delivered in a multidisciplinary fashion with a care support team around the patient. And so that model, while it seems sensible, really is very hard to find in this country.

MHN: Is there a connection between the work you did in the US Department of Veterans Affairs to what you’re doing now with your chronic pain offering?

Shulkin: It’s very linked. I was the CEO of a hospital system, and entered the VA because President Obama asked me to come in to help run the VA healthcare system. At the time that happened, that’s exactly when we were pulling millions of veterans off of opioids. And when we pulled them off opioids, [the majority] of them were left with pain, and there wasn’t much to help them. That was really not a good situation. People turned to illicit drugs. They turned to suicide. They got depressed. Severe things happened.

So out of necessity, we developed in the Department of Veteran Affairs has a team-based approach to supporting veterans with chronic pain. And it included teaching the veteran to be an active member of their own team. And now that it’s been studied on millions of thousands of veterans, it’s pretty clear that this works, and it works a lot better than anything I’ve seen in the private sector.

So it was actually the evidence from the VA and the hard work that was done by the people who worked in the VA, the veterans who made this model work, that really allowed us to be able to learn from that to take this to help all sorts of Americans who have previously never had access to a model like that.

MHN: What do you ultimately hope happens with Override?

Shulkin: What we’re really trying to do is to change the standard of care and to allow others to see that there are more effective ways of helping people with chronic pain.

There literally are millions of Americans suffering. And this is part of the reason why we’re seeing so many behavioral health issues, and drug issues, and opioid overdoses, and all sorts of things that are really public health crises. We need to change the way that we are helping patients and treating patients, and allow them to help themselves.

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